COVID_National_Health_Security_Preparedness_Index: NHSPI_measure_metadata: 129 rows where sorted by verbose_data

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Link	rowid	obsid	index	item_code	domain_code	domain_name	domain_description	subdomain_code	subdomain_name	subdomain_description	subdomain_long_desc	measure_name	measure_description	measure_rationale	data_source	verbose_data_source ▼	data_dates	limitations
77	77	159.0	Index	4.2.9	4.0	HD	Healthcare Delivery	11.0	HPS	Hospital and Physician Services	Hospital and physician services refers to care for a patient who is formally admitted (or “hospitalized”) to an institution for treatment and/or care and stays for a minimum of one night in the hospital or other institution.	M168	Percent of the state’s population living within 100 miles of a burn center, including out-of-state centers	Treatment of burns requires specialized resources and a highly trained multidisciplinary medical staff. This measure focuses on the capacity to provide a specialized medical infrastructure and medical staff capable of providing specialty burn care to trauma patients during a mass casualty incident.	ABA	American Burn Association (ABA) data on Burn Care Facilities analyzed by PMO personnel.	2014 & 2018	The measure does not evaluate the specialized resources needed for surge capacity when an emergency results in a large number of burn patients.
94	94	206.0	Index	4.5.3	4.0	HD	Healthcare Delivery	14.0	HC	Home Care	Home care is clinical and nonclinical care that allows a person with special needs to stay in their home. It may also be assumed to include the management of patient care needs for those patients not sick enough to require hospitalization or long-term care, or for whom hospitalization is not deemed to be of benefit. Other examples of home care include, but are not limited to: skilled nursing visits, respiratory care services, provision of durable medical equipment, hospice, and pharmacist services.	M293	Number of home health and personal care aides per 1,000 population in the state aged 65 or older	Home health and personal care aides provide important supportive care to those unable to live independently at home. These care providers are important to maintain the health and wellbeing of the clients under their care. During a health emergency, these providers may be crucial to implementing the emergency care plan for the home-based client.	ACS PUMS	American Community Survey (ACS), 1-year Public Use Microsample (PUMS) data analyzed by PMO personnel (3-year average)	2012—2017	The measure does not evaluate availability of home health aide services during a health emergency, or whether providers have emergency care plans for their clients.
63	63	124.2	Index	3.2.5	3.0	IIM	Incident & Information Management	8.0	INFM	Information Management	The ability to develop systems and procedures that facilitate the communication of timely, accurate, and accessible information, alerts, warnings, and notifications to the public using a whole-community approach. This sub-domain includes using risk communication methods to support the use of clear, consistent, accessible, and culturally and linguistically appropriate methods to effectively relay information regarding any threat or hazard, the actions taken, and the assistance available.	M228	Percent of households in the state with broadband in the home	The measure is focused on the availability of residential infrastructure that provides fixed internet connections. The measure assesses the households per state that maintain residential fixed connections.	U.S. Census Bureau	American Community Survey (ACS), 1-year estimate (GCT2801).	2012—2017	The measure focuses only on fixed broadband connections, and does not include an indication of the broadband system's ability to remain operational in a emergency or disaster.
129	129	259.91	Index	6.4.4	6.0	EOH	Environmental & Occupational Health	20.0	WR	Workforce Resiliency	Actions taken to protect workers and emergency responders from health hazards while on the job	M705	Percent of employed population (16 and older) in the state who work from home	During emergencies community resiliency, health security, and preparedness is enhanced if individuals can shelter in place. Having the ability to work from home provides individuals with the option to shelter in place.	U.S. Census, American Community Survey, various years.	American Community Survey (ACS), 1-year estimate (Table B08128)	2012—2017	The measure data does not include all individuals who can work at home on a "part-time" basis.
40	40	58.0	Index	2.2.9	2.0	CPE	Community Planning & Engagement Coordination	4.0	ARP	Children & Other At-Risk Populations	Actions to protect individuals specifically recognized as at-risk in the Pandemic and All-Hazards Preparedness Act (i.e., children, senior citizens, and pregnant women), and those who may need additional response assistance including those who have disabilities, live in institutionalized settings, are from diverse cultures, have limited English proficiency (or are non-English-speaking), are transportation disadvantaged, have chronic medical disorders, and have pharmacological dependency; all of whom require additional needs before, during, and after an incident in the functional areas of communication, medical care, maintaining independence, supervision, and transportation.	M170	Percent of state children (0-18 years) who reside within 50 miles of a pediatric trauma center, including out-of-state centers	Treatment of traumatic injury among children requires timely access to specialized skills and resources. The measure indicates medical infrastructure and, by inference, trained staff capable of providing specialized care to pediatric trauma patients.	AHA	American Hospital Association (AHA), AHA Annual Survey of Hospitals data and U.S. Census population data analyzed by PMO personnel.	2012—2017	The measure does not indicate the capacity of the trauma center, such as the number of available pediatric trauma beds or inpatient treatment beds for the care of pediatric patients.
74	74	155.0	Index	4.2.5	4.0	HD	Healthcare Delivery	11.0	HPS	Hospital and Physician Services	Hospital and physician services refers to care for a patient who is formally admitted (or “hospitalized”) to an institution for treatment and/or care and stays for a minimum of one night in the hospital or other institution.	M152	Percent of the state’s population who live within 50 miles of a trauma center, including out-of-state centers	The measure indicates access to advanced trauma care at a Level I or II designation. In general, trauma centers are regional resources essential to assist in the management and rehabilitation of patients with injuries from various types of emergencies and disasters. A Level I Trauma Center is capable of providing the most complex care for severe injuries. A Level II Trauma Center can initiate definitive care for all injuries, but may need to transport complex cases to Level I facilities to complete treatment.	Estimated by PMO Staff	American Hospital Association (AHA), AHA Annual Survey of Hospitals data and U.S. Census population data analyzed by PMO personnel.	2012—2017	The measure does not evaluate the quality or comprehensiveness of care provided by the trauma centers.
78	78	163.0	Index	4.2.13	4.0	HD	Healthcare Delivery	11.0	HPS	Hospital and Physician Services	Hospital and physician services refers to care for a patient who is formally admitted (or “hospitalized”) to an institution for treatment and/or care and stays for a minimum of one night in the hospital or other institution.	M296	Percent of hospitals in the state providing a specialty geriatric services program (includes general as well as specialized geriatric services, such as psychiatric geriatric services/Alzheimer care)	Hospital-based geriatric care is an important inpatient service as the nation's population continues to age. Hospitals that provide geriatric care are better able to provide care and services to inpatient geriatric populations.	AHA	American Hospital Association (AHA), Annual Survey of Hospitals	2012—2017	The measure does not consider hospital geriatric services provided through contractual arrangements, the program's capacity to provide services during an emergency, or whether high quality care is provided to geriatric patients without having a designated specialty program.
79	79	164.0	Index	4.2.14	4.0	HD	Healthcare Delivery	11.0	HPS	Hospital and Physician Services	Hospital and physician services refers to care for a patient who is formally admitted (or “hospitalized”) to an institution for treatment and/or care and stays for a minimum of one night in the hospital or other institution.	M297	Percent of hospitals in the state providing palliative care programs (includes both palliative care program and/or palliative care inpatient unit, but excludes pain management program, patient-controlled analgesia, and hospice program)	Effective provision of palliative care is an important consideration in providing care during a disaster or health security event. Hospitals that have established palliative care programs as part of their hospital facilities services are more likely to be able to provide these services during an emergency and are more likely to have these services integrated with the hospital emergency plan.	AHA	American Hospital Association (AHA), Annual Survey of Hospitals	2012—2017	The measure does not evaluate the quality of services provided, or the program's capacity to provide services during an emergency.
80	80	165.0	Index	4.2.15	4.0	HD	Healthcare Delivery	11.0	HPS	Hospital and Physician Services	Hospital and physician services refers to care for a patient who is formally admitted (or “hospitalized”) to an institution for treatment and/or care and stays for a minimum of one night in the hospital or other institution.	M298	Number of hospital airborne infection isolation room (AIIR) beds per 100,000 population in the state, including hospitals with AIIR rooms within 50 miles from neighboring states	Airborne infection isolation rooms (AIIRs) are important to the treatment and care of patients that have diseases that are spread through airborne transmission. The measure provides information on hospital resources that can be used for emergency preparedness activities, including planning and response.	AHA	American Hospital Association (AHA), Annual Survey of Hospitals	2012—2017	The measure does not consider mutual aid plans that may be in place to supplement the number of available AIIR beds in the event of an emergency.
89	89	190.0	Index	4.4.4	4.0	HD	Healthcare Delivery	13.0	MBH	Mental & Behavioral Healthcare	Mental and behavioral healthcare is the provision and facilitation of access to medical and mental/behavioral health services including: medical treatment, substance abuse treatment, stress management, and medication with the intent to restore and improve the resilience and sustainability of health, mental and behavioral health, and social services networks. It includes access to information regarding available mass care services for at-risk individuals and the entire affected population.	M316	Percent of hospitals in the state providing psychiatric emergency services	This measure indicates psychiatric services that are owned or provided by a hospital or by a hospital's health system (i.e., don't require a contractual agreement). In times of disaster, psychiatric emergencies may occur and their prompt and efficacious treatment is important to a comprehensive behavioral health response. These emergency services may be treated in a number of settings, including hospitals. All hospitals are engaged in some level of disaster planning. If a hospital self-identifies as providing emergency psychiatric services, it is more likely that these services are coordinated/integrated with other disaster preparedness and response behavioral health efforts.	AHA	American Hospital Association (AHA), Annual Survey of Hospitals	2012—2017	The measure source data does not have a standard definition of emergency psychiatric services, and survey respondents may have different interpretations for positive responses. All hospital emergency medical services include emergency psychiatric services, but fewer hospitals have more complete, specialty-staffed, comprehensive psychiatric emergency services. Negative responses may indicate the absence of any emergency psychiatric services, or the absence of a separate, identifiable, comprehensive service. The measure does not evaluate the extent of service integration with other disaster preparedness and response efforts by the hospital or emergency psychiatric service, or the disaster-related services provided such as mobile crisis response capacity and telephone-based crisis services.
97	97	221.0	Index	5.1.11	5.0	CM	Countermeasure Management	15.0	MMMDD	Medical Materiel Management, Distribution, & Dispensing	The ability to acquire, maintain (e.g., cold chain storage or other storage protocol), transport, distribute, and track medical materiel (e.g., pharmaceuticals, gloves, masks, and ventilators) before and during an incident and recover and account for unused medical materiel after an incident. This capability includes managing the research, development, and procurement of medical countermeasures in addition to the management and distribution of medical countermeasures.	M270	Percent of hospitals in the state participating in a group purchasing arrangement	Hospitals that participate in group purchasing can improve their effectiveness by attaining leverage with suppliers. This allows resources to concentrate on operational and clinical issues with a vision of improved patient outcomes.	AHA	American Hospital Association (AHA), Annual Survey of Hospitals	2012—2017	Although group purchasing arrangements may be in place, many other economic and non-economic factors affect shortages of drugs and medical supplies and create gaps in the supply chain.
55	55	111.0	Foundational	3.1.11	3.0	IIM	Incident & Information Management	7.0	INCM	Incident Management	The ability to establish and maintain a unified and coordinated operational structure with processes that appropriately integrate all critical stakeholders and support the execution of core capabilities and incident objectives. This sub-domain includes the capability to direct and support an event or incident with public health or medical implications by establishing a standardized, scalable management system consistent with the National Incident Management System and coordinating activities above the field level by sharing information, developing strategy and tactics, and managing resources to assist with coordination of operations in the field.	M150	State uses a system for tracking hospital bed availability during emergencies	The ability for a state to track and update hospital bed availability continuously using a consistent, nationally-accepted platform is important for management of surge capacity during a mass casualty event.	ASPR HPP	Assistant Secretary for Preparedness and Response (ASPR) Hospital Preparedness Program	2012-2018	The measure data is collected by existing state and local reporting systems using secure data entry to measure bed counts during emergencies, and does not replace states' need to evaluate state and local bed count system development and implementation.
42	42	71.0	Foundational	2.3.1	2.0	CPE	Community Planning & Engagement Coordination	5.0	MVDE	Management of Volunteers during Emergencies	The ability to coordinate the identification, recruitment, registration, credential verification, training, and engagement of healthcare, medical, and support staff volunteers to support the jurisdiction’s response to incidents of health significance	M36	State participates in Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP) Program and has a state volunteer registry	The measure indicates participation in a standard national system to verify emergency volunteers and credentials through preregistration before an emergency occurs.	ASPR ESAR-VHP	Assistant Secretary for Preparedness and Response (ASPR), The Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP)	2014	The measure does not evaluate the quality or comprehensiveness of the volunteer registry, indicate whether it has been used during exercises or responses, or reflect state capacity for volunteer surge during emergencies.
51	51	101.0	Foundational	3.1.1	3.0	IIM	Incident & Information Management	7.0	INCM	Incident Management	The ability to establish and maintain a unified and coordinated operational structure with processes that appropriately integrate all critical stakeholders and support the execution of core capabilities and incident objectives. This sub-domain includes the capability to direct and support an event or incident with public health or medical implications by establishing a standardized, scalable management system consistent with the National Incident Management System and coordinating activities above the field level by sharing information, developing strategy and tactics, and managing resources to assist with coordination of operations in the field.	M10	State public health laboratory uses a rapid method (e.g., Health Alert Network (HAN), blast e-mail or fax) to send messages to their sentinel clinical laboratories and other partners	The measure focuses on a state public health laboratory's ability to effectively transmit information rapidly and electronically to partners and to coordinate response activities.	APHL AHLPS	Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey	2013—2016	The measure does not evaluate the frequency that the alert network is used or tested for routine or emergency messages, or whether it reaches all sentinel clinical laboratories and other partners in the state.
15	15	18.0	Index	1.2.2	1.0	HSS	Health Security Surveillance	2.0	BMLT	Biological Monitoring & Laboratory Testing	The ability of agencies to conduct rapid and accurate laboratory tests to identify biological, chemical, and radiological agents to address actual or potential exposure to all hazards, focusing on testing human and animal clinical specimens. Support functions include discovery through: active and passive surveillance (both pre- and post-event), characterization, confirmatory testing data, reporting investigative support, ongoing situational awareness. Laboratory quality systems are maintained through external quality assurance and proficiency testing.	M1314	State public health chemical OR radiological terrorism/threat laboratory is accredited or certified by the College of American Pathologists (CAP) or Clinical Laboratory Improvement Amendments (CLIA)	A laboratory must have federal certification to conduct testing for chemical agents. The measure focuses on certification or accreditation of a chemical laboratory. Also, a relevant certification framework exists for radiological terrorism laboratory certification. The measure also indicates whether a state's radiological terrorism laboratory has earned such certification.	APHL AHLPS	Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey	2013—2018	Certification may be based on simulated samples, since actual chemical samples are lacking. Selected responses from the 2018 survey have been corrected for Colorado and therefore no longer correspond to the originally published survey results
17	17	22.0	Index	1.2.7	1.0	HSS	Health Security Surveillance	2.0	BMLT	Biological Monitoring & Laboratory Testing	The ability of agencies to conduct rapid and accurate laboratory tests to identify biological, chemical, and radiological agents to address actual or potential exposure to all hazards, focusing on testing human and animal clinical specimens. Support functions include discovery through: active and passive surveillance (both pre- and post-event), characterization, confirmatory testing data, reporting investigative support, ongoing situational awareness. Laboratory quality systems are maintained through external quality assurance and proficiency testing.	M8	State public health laboratory has a plan for a 6-8 week surge in testing capacity to respond to an outbreak or other public health event, with enough staffing capacity to work five 12-hour days for six to eight weeks in response to an infectious disease outbreak, such as novel influenza A (H1N1)	The measure focuses on the state public health laboratory workforce readiness and surge capacity.	APHL AHLPS	Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey	2013—2018	The measure does not evaluate the quality or comprehensiveness of the plan, or the frequency of the plan being used or tested.
18	18	23.0	Index	1.2.8	1.0	HSS	Health Security Surveillance	2.0	BMLT	Biological Monitoring & Laboratory Testing	The ability of agencies to conduct rapid and accurate laboratory tests to identify biological, chemical, and radiological agents to address actual or potential exposure to all hazards, focusing on testing human and animal clinical specimens. Support functions include discovery through: active and passive surveillance (both pre- and post-event), characterization, confirmatory testing data, reporting investigative support, ongoing situational awareness. Laboratory quality systems are maintained through external quality assurance and proficiency testing.	M9	State public health laboratory has a continuity of operations plan consistent with National Incident Management System (NIMS) guidelines	The measure focuses on laboratory preparedness to sustain operations and provide alternative methods for operations during a public health emergency that directly impacts the laboratory staff or facility.	APHL AHLPS	Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey	2013—2018	The measure does not evaluate the quality or comprehensiveness of the plan, or the frequency of the plan being used or tested.
19	19	24.0	Index	1.2.9	1.0	HSS	Health Security Surveillance	2.0	BMLT	Biological Monitoring & Laboratory Testing	The ability of agencies to conduct rapid and accurate laboratory tests to identify biological, chemical, and radiological agents to address actual or potential exposure to all hazards, focusing on testing human and animal clinical specimens. Support functions include discovery through: active and passive surveillance (both pre- and post-event), characterization, confirmatory testing data, reporting investigative support, ongoing situational awareness. Laboratory quality systems are maintained through external quality assurance and proficiency testing.	M11	State public health laboratory has a plan to receive specimens from sentinel clinical laboratories during nonbusiness hours	The measure focuses on a public health laboratory's ability to receive samples at all times of the day from healthcare laboratories. It demonstrates that the public health laboratory is capable of receiving critical specimens during nonbusiness hours.	APHL AHLPS	Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey	2013—2018	The measure does not evaluate the quality or comprehensiveness of the plan, or the frequency of the plan being used or tested.
20	20	25.0	Index	1.2.10	1.0	HSS	Health Security Surveillance	2.0	BMLT	Biological Monitoring & Laboratory Testing	The ability of agencies to conduct rapid and accurate laboratory tests to identify biological, chemical, and radiological agents to address actual or potential exposure to all hazards, focusing on testing human and animal clinical specimens. Support functions include discovery through: active and passive surveillance (both pre- and post-event), characterization, confirmatory testing data, reporting investigative support, ongoing situational awareness. Laboratory quality systems are maintained through external quality assurance and proficiency testing.	M12	State public health laboratory has the capacity in place to assure the timely transportation (pick-up and delivery) of samples 24/7/365 days to the appropriate public health Laboratory Response Network (LRN) reference laboratory	Rapid transport of specimens and isolates to a public health laboratory is important to decrease the time to recognize and identify a potential public health emergency. The measure focuses on a laboratory's ability to assure transport of samples at all times of the day.	APHL AHLPS	Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey	2013—2018	The measure does not evaluate the timeliness of the sample transport, or the whether the transport is available for all sentinel laboratories in the state.
27	27	36.0	Index	1.2.21	1.0	HSS	Health Security Surveillance	2.0	BMLT	Biological Monitoring & Laboratory Testing	The ability of agencies to conduct rapid and accurate laboratory tests to identify biological, chemical, and radiological agents to address actual or potential exposure to all hazards, focusing on testing human and animal clinical specimens. Support functions include discovery through: active and passive surveillance (both pre- and post-event), characterization, confirmatory testing data, reporting investigative support, ongoing situational awareness. Laboratory quality systems are maintained through external quality assurance and proficiency testing.	M286	Number of chemical threat and multi-hazards preparedness exercises or drills the state public health laboratory conducts or participates in annually	Drills and exercises are important to the development and improvement of emergency preparedness and response plans and procedures. Frequent testing of plans and updated plans are important to continuous quality improvement.	APHL AHLPS	Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey	2013—2018	Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.
6	6	8.0	Index	1.1.6	1.0	HSS	Health Security Surveillance	1.0	PHSEI	Health Surveillance & Epidemiological Investigation	The creation, maintenance, support, and strengthening of passive and active surveillance to: identify, discover, locate, and monitor threats, disease agents, incidents, and outbreaks provide relevant information to stakeholders monitoring/investigating adverse events related to medical countermeasures. The sub-domain includes the ability to successfully expand these systems and processes in response to incidents of health significance.	M217	State public health laboratory has implemented the laboratory information management system (LIMS) to exchange laboratory information and results electronically with hospitals, clinical labs, state epidemiology units, and federal agencies	Laboratory Information Management Systems (LIMS) are important contributors to timely and accurate sending and receiving of critical laboratory testing information.	APHL CLSS	Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)	2012, 2014, & 2016	Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents. Selected responses from the all years of survey have been corrected for Wyoming and 2016 fresponse for Oklahoma has been corrected and therefore no longer correspond to the originally published survey results.
7	7	9.0	Index	1.1.7	1.0	HSS	Health Security Surveillance	1.0	PHSEI	Health Surveillance & Epidemiological Investigation	The creation, maintenance, support, and strengthening of passive and active surveillance to: identify, discover, locate, and monitor threats, disease agents, incidents, and outbreaks provide relevant information to stakeholders monitoring/investigating adverse events related to medical countermeasures. The sub-domain includes the ability to successfully expand these systems and processes in response to incidents of health significance.	M220	State has legal requirement for nongovernmental laboratories (e.g. clinical, hospital-based) in the state to send clinical isolates or specimens associated with reportable foodborne diseases to the state public health laboratory	States and the federal government have disease reporting regulations that require notification of foodborne and other infectious diseases. Reporting requirements provide population-based data on infectious diseases.	APHL CLSS	Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)	2012, 2014, & 2016	Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents. Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.
8	8	10.0	Foundational	1.1.8	1.0	HSS	Health Security Surveillance	1.0	PHSEI	Health Surveillance & Epidemiological Investigation	The creation, maintenance, support, and strengthening of passive and active surveillance to: identify, discover, locate, and monitor threats, disease agents, incidents, and outbreaks provide relevant information to stakeholders monitoring/investigating adverse events related to medical countermeasures. The sub-domain includes the ability to successfully expand these systems and processes in response to incidents of health significance.	M256	State public health laboratory participates in either of the following federal surveillance programs: Foodborne Diseases Active Surveillance Network (FoodNet) or National Molecular Subtyping Network for Foodborne Disease Surveillance (PulseNet)	The measure indicates participation in national information sharing systems and electronic web-based public health surveillance systems. Participation assures that laboratory and surveillance data are comparable across states and enables national measurements of disease burden and progression.	APHL CLSS	Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)	2012 & 2014	The measure does not evaluate the quality or comprehensiveness of participation in the surveillance networks.
13	13	15.0	Foundational	1.1.13	1.0	HSS	Health Security Surveillance	1.0	PHSEI	Health Surveillance & Epidemiological Investigation	The creation, maintenance, support, and strengthening of passive and active surveillance to: identify, discover, locate, and monitor threats, disease agents, incidents, and outbreaks provide relevant information to stakeholders monitoring/investigating adverse events related to medical countermeasures. The sub-domain includes the ability to successfully expand these systems and processes in response to incidents of health significance.	M801	State public health laboratory participates in the Centers for Disease Control and Prevention (CDC) Influenza surveillance program, and/or the World Health Organization (WHO) Influenza Surveillance Network	The measure indicates state participation in national information sharing systems and electronic web-based public health surveillance systems for influenza. Participation assures that key laboratory and surveillance data will be comparable across states and enables national and global measurements of disease burden and progression..	APHL CLSS	Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)	2012 & 2014	The measure does not evaluate the quality or comprehensiveness of participation in the surveillance networks.
16	16	21.0	Index	1.2.6	1.0	HSS	Health Security Surveillance	2.0	BMLT	Biological Monitoring & Laboratory Testing	The ability of agencies to conduct rapid and accurate laboratory tests to identify biological, chemical, and radiological agents to address actual or potential exposure to all hazards, focusing on testing human and animal clinical specimens. Support functions include discovery through: active and passive surveillance (both pre- and post-event), characterization, confirmatory testing data, reporting investigative support, ongoing situational awareness. Laboratory quality systems are maintained through external quality assurance and proficiency testing.	M208	State public health laboratory has a permit for the importation and transportation of materials, organisms, and vectors controlled by USDA/APHIS (U.S. Department of Agriculture/ Animal and Plant Health Inspection Service)	The laboratory must have a federal U.S. Department of Agriculture/Animal and Plant Inspection Service (USDA/APHIS) permit for the importation and transportation of controlled materials. The measure focuses on possession of the permit.	APHL CLSS	Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)	2012, 2014, & 2016	Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.
21	21	26.0	Index	1.2.11	1.0	HSS	Health Security Surveillance	2.0	BMLT	Biological Monitoring & Laboratory Testing	The ability of agencies to conduct rapid and accurate laboratory tests to identify biological, chemical, and radiological agents to address actual or potential exposure to all hazards, focusing on testing human and animal clinical specimens. Support functions include discovery through: active and passive surveillance (both pre- and post-event), characterization, confirmatory testing data, reporting investigative support, ongoing situational awareness. Laboratory quality systems are maintained through external quality assurance and proficiency testing.	M211	Percent of 10 tests for infectious diseases that the state public health laboratory provides or assures, including the study of the characteristics of a disease or organism in blood tests for arbovirus, hepatitis C, Legionella, measles, mumps, Neisseria meningitides serotyping, Plasmodium identification, Salmonella serotyping, Shigella serotyping, and Varicella	The measure focuses on the public health laboratory's (PHL's) ability to provide a range of diagnostic and surveillance testing.	APHL CLSS	Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)	2012, 2014, & 2016	The state public health laboratory testing “provide or assure” standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Inclusion of this measure ensures that the Index is consistent with national expert opinion and federal recommendations concerning comprehensive public health laboratory testing capabilities. However, the measure does not assess the quality of the testing, the timeliness of results reporting to enable responses to public health threats, nor whether sufficient capacity exists to test the volume of samples required during a health security event. Selected responses from the 2016 survey have been corrected for Louisana and therefore no longer correspond to the originally published survey results.
22	22	27.0	Index	1.2.12	1.0	HSS	Health Security Surveillance	2.0	BMLT	Biological Monitoring & Laboratory Testing	The ability of agencies to conduct rapid and accurate laboratory tests to identify biological, chemical, and radiological agents to address actual or potential exposure to all hazards, focusing on testing human and animal clinical specimens. Support functions include discovery through: active and passive surveillance (both pre- and post-event), characterization, confirmatory testing data, reporting investigative support, ongoing situational awareness. Laboratory quality systems are maintained through external quality assurance and proficiency testing.	M216	Percent of 15 tests for infectious diseases that the state public health laboratory provides or assures including: antimicrobial susceptibility testing confirmation for vancomycin resistant Staphylococcus aureus, Anaplasmosis (Anaplasma phagocytophilum), Babesiosis (Babesia sp.), botulinum toxin—mouse toxicity assay, Dengue Fever, Hantavirus serology, identification of unusual bacterial isolates, identification of fungal isolates, identification of parasites, Klebsiella pneumoniae Carbapenemase (blaKPC) by PCR, Legionella by culture or PCR, malaria by PCR, norovirus by PCR, Powassan virus, rabies	The measure focuses on the public health laboratory's (PHL's) ability to provide a range of diagnostic and surveillance testing.	APHL CLSS	Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)	2012, 2014, & 2016	The state public health laboratory testing “provide or assure” standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Inclusion of this measure ensures that the Index is consistent with national expert opinion and federal recommendations concerning comprehensive public health laboratory testing capabilities. However, the measure does not assess the quality of the testing, the timeliness of results reporting to enable responses to public health threats, nor whether sufficient capacity exists to test the volume of samples required during a health security event. Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.
54	54	110.0	Foundational	3.1.10	3.0	IIM	Incident & Information Management	7.0	INCM	Incident Management	The ability to establish and maintain a unified and coordinated operational structure with processes that appropriately integrate all critical stakeholders and support the execution of core capabilities and incident objectives. This sub-domain includes the capability to direct and support an event or incident with public health or medical implications by establishing a standardized, scalable management system consistent with the National Incident Management System and coordinating activities above the field level by sharing information, developing strategy and tactics, and managing resources to assist with coordination of operations in the field.	M229	State public health laboratory has a 24/7/365 contact system in place to use in case of an emergency	The measure focuses on the ability of a state to maintain a 24/7/365 contact system to receive notification of a public health emergency and activation of an incident management system that requires laboratory support.	APHL CLSS	Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)	2012 & 2014	The measure does not evaluate the quality or comprehensiveness of the system, or the frequency of the plan being used or tested.
103	103	237.0	Index	6.1.2	6.0	EOH	Environmental & Occupational Health	17.0	FWS	Food & Water Security	The sufficient availability, access, use, and protection of safe and clean food and water resources to support human well-being and health.	M275_DW	State public health laboratory provides or assures testing for drinking water	Having the capability at a state public health laboratory to test different types of water samples is important to the characterization of various water-based environments that may be contaminated or otherwise affected by a health security event. Being able to rapidly characterize the level of contamination is important for preventing exposure and being able to allow re-entry/use during the recovery phase of an event.	APHL CLSS	Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)	2012, 2014, & 2016	The state public health laboratory testing “provide or assure” standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Inclusion of this measure ensures that the Index is consistent with national expert opinion and federal recommendations concerning comprehensive public health laboratory testing capabilities. However, the measure does not assess the quality of the testing, the timeliness of results reporting to enable responses to public health threats, nor whether sufficient capacity exists to test the volume of samples required during a health security event.
104	104	238.0	Index	6.1.3	6.0	EOH	Environmental & Occupational Health	17.0	FWS	Food & Water Security	The sufficient availability, access, use, and protection of safe and clean food and water resources to support human well-being and health.	M275_PWW	State public health laboratory provides or assures testing for private well water	Having the capability at a state public health laboratory to test different types of water samples is important to the characterization of various water-based environments that may be contaminated or otherwise affected by a health security event. Being able to rapidly characterize the level of contamination is important for preventing exposure and being able to allow re-entry/use during the recovery phase of an event.	APHL CLSS	Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)	2012, 2014, & 2016	The state public health laboratory testing “provide or assure” standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).
105	105	239.0	Index	6.1.4	6.0	EOH	Environmental & Occupational Health	17.0	FWS	Food & Water Security	The sufficient availability, access, use, and protection of safe and clean food and water resources to support human well-being and health.	M275_REC	State public health laboratory provides or assures testing for recreational water	Having the capability at a state public health laboratory to test different types of water samples is important to the characterization of various water-based environments that may be contaminated or otherwise affected by a health security event. Being able to rapidly characterize the level of contamination is important for preventing exposure and being able to allow re-entry/use during the recovery phase of an event.	APHL CLSS	Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)	2012, 2014, & 2016	The state public health laboratory testing “provide or assure” standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).
106	106	240.0	Index	6.1.5	6.0	EOH	Environmental & Occupational Health	17.0	FWS	Food & Water Security	The sufficient availability, access, use, and protection of safe and clean food and water resources to support human well-being and health.	M275_SUR	State public health laboratory provides or assures testing for surface water	Having the capability at a state public health laboratory to test different types of water samples is important to the characterization of various water-based environments that may be contaminated or otherwise affected by a health security event. Being able to rapidly characterize the level of contamination is important for preventing exposure and being able to allow re-entry/use during the recovery phase of an event.	APHL CLSS	Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)	2012, 2014, & 2016	The state public health laboratory testing “provide or assure” standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.
107	107	242.0	Index	6.1.7	6.0	EOH	Environmental & Occupational Health	17.0	FWS	Food & Water Security	The sufficient availability, access, use, and protection of safe and clean food and water resources to support human well-being and health.	M275_WST	State public health laboratory provides or assures testing for waste water	Having the capability at a state public health laboratory to test different types of water samples is important to the characterization of various water-based environments that may be contaminated or otherwise affected by a health security event. Being able to rapidly characterize the level of contamination is important for preventing exposure and being able to allow re-entry/use during the recovery phase of an event.	APHL CLSS	Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)	2012, 2014, & 2016	The state public health laboratory testing “provide or assure” standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.
108	108	243.0	Index	6.1.8	6.0	EOH	Environmental & Occupational Health	17.0	FWS	Food & Water Security	The sufficient availability, access, use, and protection of safe and clean food and water resources to support human well-being and health.	M276	Percent of 16 tests for different organisms or toxins that the state public health laboratory provides or assures to assist with foodborne disease outbreak investigations, including Bacillus cereus, Brucella sp., Campylobacter sp., Clostridium botulinum, Clostridium perfringens, Cryptosporidium sp., Cyclospora cayetanensis, Listeria monocytogenes, norovirus, Salmonella, Shigella, Staphylococcus aureus, STEC non-O157, STEC O157, Vibrio sp., Yersinia enterocolitica.	Being able to test for the most important agents that cause foodborne disease is an important capability of a state public health laboratory. Rapid identification of these agents in food and water samples can enhance the investigation of foodborne disease outbreaks and is important in identifying the source of the contamination.	APHL CLSS	Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)	2012, 2014, & 2016	The state public health laboratory testing “provide or assure” standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).
112	112	249.0	Index	6.2.1	6.0	EOH	Environmental & Occupational Health	18.0	EM	Environmental Monitoring	The systematic collection and continuous or frequent standardized measurement and observation of: environmental specimens (air, water, land/soil, and plants) analyzing the presence of an indicator, exposure, or response (warning and control), including monitoring the environment for vectors of disease to give information about the environment to assess past and current status and predict future trends	M202	State public health laboratory provides or assures testing for air samples	The measure focuses on the capability of a state public health laboratory to perform testing from air samples.	APHL CLSS	Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)	2012, 2014, & 2016	The state public health laboratory testing “provide or assure” standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.
113	113	250.0	Index	6.2.2	6.0	EOH	Environmental & Occupational Health	18.0	EM	Environmental Monitoring	The systematic collection and continuous or frequent standardized measurement and observation of: environmental specimens (air, water, land/soil, and plants) analyzing the presence of an indicator, exposure, or response (warning and control), including monitoring the environment for vectors of disease to give information about the environment to assess past and current status and predict future trends	M257_AIHA	State public health laboratory is certified or accredited by the American Industrial Hygiene Association (AIHA)	State public health laboratories that provide environmental health testing are required to meet certain industry standards to ensure safe and accurate testing of specimens and/or samples. Certification or accreditation provides assurance that a laboratory is meeting these standards to conduct laboratory tests properly.	APHL CLSS	Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)	2012, 2014, & 2016	Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.
114	114	251.0	Index	6.2.3	6.0	EOH	Environmental & Occupational Health	18.0	EM	Environmental Monitoring	The systematic collection and continuous or frequent standardized measurement and observation of: environmental specimens (air, water, land/soil, and plants) analyzing the presence of an indicator, exposure, or response (warning and control), including monitoring the environment for vectors of disease to give information about the environment to assess past and current status and predict future trends	M257_EPA	State public health laboratory is certified or accredited by the Environmental Protection Agency (EPA)	State public health laboratories that provide environmental health testing are required to meet certain industry standards to ensure safe and accurate testing of specimens and/or samples. Certification or accreditation provides assurance that a laboratory is meeting these standards to conduct laboratory tests properly.	APHL CLSS	Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)	2012, 2014, & 2016	Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.
115	115	252.0	Index	6.2.4	6.0	EOH	Environmental & Occupational Health	18.0	EM	Environmental Monitoring	The systematic collection and continuous or frequent standardized measurement and observation of: environmental specimens (air, water, land/soil, and plants) analyzing the presence of an indicator, exposure, or response (warning and control), including monitoring the environment for vectors of disease to give information about the environment to assess past and current status and predict future trends	M257_NELAC	State public health laboratory is certified or accredited by the National Environmental Laboratory Accreditation Conference (NELAC)	State public health laboratories that provide environmental health testing are required to meet certain industry standards to ensure safe and accurate testing of specimens and/or samples. Certification or accreditation provides assurance that a laboratory is meeting these standards to conduct laboratory tests properly.	APHL CLSS	Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)	2012, 2014, & 2016	Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.
116	116	254.0	Foundational	6.2.6	6.0	EOH	Environmental & Occupational Health	18.0	EM	Environmental Monitoring	The systematic collection and continuous or frequent standardized measurement and observation of: environmental specimens (air, water, land/soil, and plants) analyzing the presence of an indicator, exposure, or response (warning and control), including monitoring the environment for vectors of disease to give information about the environment to assess past and current status and predict future trends	M196	State public health laboratory provides or assures testing for environmental samples in the event of suspected chemical terrorism	A state needs to be capable of determining, by appropriate scientific methods, agents involved in a suspected act of chemical terrorism. It is also necessary to be able to determine the prevalence of such agents in air, food, and water resources by testing environmental samples. This is both a measurement indicative of the incident and a measure of mitigation and recovery effectiveness.	APHL CLSS	Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)	2012 & 2014	The state public health laboratory testing “provide or assure” standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).
117	117	255.0	Index	6.2.7	6.0	EOH	Environmental & Occupational Health	18.0	EM	Environmental Monitoring	The systematic collection and continuous or frequent standardized measurement and observation of: environmental specimens (air, water, land/soil, and plants) analyzing the presence of an indicator, exposure, or response (warning and control), including monitoring the environment for vectors of disease to give information about the environment to assess past and current status and predict future trends	M272	Percent of 12 tests for different contaminants in environmental samples that the state public health laboratory provides or assures, including asbestos, explosives, gross alpha and gross beta, inorganic compounds (e.g., nitrates), metals, microbial, lead, persistent organic pollutants, pesticides (including organophosphates), pharmaceuticals, radon, or volatile organic compounds	The ability of a state's public health laboratory to test for a broad spectrum of potential environmental contaminants known to cause human health effects is important. Environmental monitoring for these contaminants during a health emergency will allow responders to identify areas that should be restricted and help establish protective actions to minimize public and first responder exposure.	APHL CLSS	Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)	2012, 2014, & 2016	The state public health laboratory testing “provide or assure” standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).
118	118	256.0	Index	6.2.8	6.0	EOH	Environmental & Occupational Health	18.0	EM	Environmental Monitoring	The systematic collection and continuous or frequent standardized measurement and observation of: environmental specimens (air, water, land/soil, and plants) analyzing the presence of an indicator, exposure, or response (warning and control), including monitoring the environment for vectors of disease to give information about the environment to assess past and current status and predict future trends	M273	State public health laboratory provides or assures testing for hazardous waste	Disasters and other events can cause the release of substances that are the by-product or waste of industrial processes into the environment. These substances are often toxic and hazardous to human health. It is important that the state laboratory has the capability to test for hazardous substances (or can assure that this capability exists). This capability is significant in characterizing the area contaminated by the release and is also essential to the clean-up and site remediation/restoration.	APHL CLSS	Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)	2012, 2014, & 2016	The state public health laboratory testing “provide or assure” standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.
30	30	38.1	Index	1.2.24	1.0	HSS	Health Security Surveillance	2.0	BMLT	Biological Monitoring & Laboratory Testing	The ability of agencies to conduct rapid and accurate laboratory tests to identify biological, chemical, and radiological agents to address actual or potential exposure to all hazards, focusing on testing human and animal clinical specimens. Support functions include discovery through: active and passive surveillance (both pre- and post-event), characterization, confirmatory testing data, reporting investigative support, ongoing situational awareness. Laboratory quality systems are maintained through external quality assurance and proficiency testing.	M911	State public health laboratory provides or assures testing for soil	Soil testing is an essential component of environmental monitoring.	APHL CLSS	Association of Public Health Laboratories (APHL). Comprehensive Laboratory Services Survey (CLSS). 2012 & 2014. Additional details about this measure are available from the source. Data have been compiled by APHL biennially since 2004. The CLSS covers the 50 states, the District of Columbia, and Puerto Rico. State-level data are not available to the public but can be accessed by public health laboratory directors, among others. Data were obtained directly from the source.	2012, 2014, & 2016	The state public health laboratory testing “provide or assure” standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Inclusion of this measure ensures that the Index is consistent with national expert opinion and federal recommendations concerning comprehensive public health laboratory testing capabilities. However, the measure does not assess the quality of the testing, the timeliness of results reporting to enable responses to public health threats, nor whether sufficient capacity exists to test the volume of samples required during a health security event. Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.
5	5	7.0	Index	1.1.5	1.0	HSS	Health Security Surveillance	1.0	PHSEI	Health Surveillance & Epidemiological Investigation	The creation, maintenance, support, and strengthening of passive and active surveillance to: identify, discover, locate, and monitor threats, disease agents, incidents, and outbreaks provide relevant information to stakeholders monitoring/investigating adverse events related to medical countermeasures. The sub-domain includes the ability to successfully expand these systems and processes in response to incidents of health significance.	M22	State health department has an electronic syndromic surveillance system that can report and exchange information	The measure indicates state health department-access to syndromic surveillance data. Syndromic surveillance enables continuous monitoring for indicators of population level changes in health status that can in turn provide early warning of hazardous events.	ASTHO Profile V. III	Association of State and Territorial Health Officials (ASTHO), ASTHO Profile of State Public Health: Volume Three	2012 & 2016	Data are self-reported by state public health agencypersonnel and may reflect differences in awareness, perspective and interpretation among respondents. Nevada did not complete the survey used as the original data source but they subsequently provided information for this measure.
67	67	145.0	Index	4.1.7	4.0	HD	Healthcare Delivery	10.0	PC	Prehospital Care	Prehospital care is generally provided by emergency medical services (EMS) and, includes 911 and dispatch, emergency medical response, field assessment and care, and transport (usually by ambulance or helicopter) to a hospital and between healthcare facilities.	M140	Number of emergency medical technicians (EMTs) and paramedics per 100,000 population in the state	Parametics and EMTs provide the workforce necessary to respond rapidly to individuals who experience acute health events, deliver initial care in the field, and provide transport to appropriate healthcare facilities for continued treatment. The size of this workforce is one indicator of a state’s surge capacity for large-scale emergencies and mass-casualty events. .	BLS OES	Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES)	2012—2017	The measure may not distinguish licensed EMTs and paramedics from those that are licensed, practicing, and affiliated. BLS and other national data sources have been shown to undercount certain types of health professionals, and may differ considerably from the estimates available from state licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, they should not cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error.
96	96	220.0	Index	5.1.10	5.0	CM	Countermeasure Management	15.0	MMMDD	Medical Materiel Management, Distribution, & Dispensing	The ability to acquire, maintain (e.g., cold chain storage or other storage protocol), transport, distribute, and track medical materiel (e.g., pharmaceuticals, gloves, masks, and ventilators) before and during an incident and recover and account for unused medical materiel after an incident. This capability includes managing the research, development, and procurement of medical countermeasures in addition to the management and distribution of medical countermeasures.	M161	Number of Pharmacists per 100,000 population in the state	Pharmacists are highly educated, trained, and licensed healthcare professionals who dispense prescription medications to patients and offer advice on their safe use in a range of settings, including retail drugs stores, healthcare facilities, and academic research and training centers. They play a key and increasingly larger role in disaster-related countermeasure management and the dispensing of medicine. The measure focuses on state's workforce capacity of pharmacists.	BLS OES	Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES)	2012—2017	The measure does not consider mutual aid plans that may be in place for healthcare facilities to supplement the number of available pharmacists in the event of an emergency. Also, BLS and other national data sources on health provider supply have been shown to undercount certain types of providers, and may differ considerably from the estimates available from state licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, they should not cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error.
2	2	4.0	Index	1.1.2	1.0	HSS	Health Security Surveillance	1.0	PHSEI	Health Surveillance & Epidemiological Investigation	The creation, maintenance, support, and strengthening of passive and active surveillance to: identify, discover, locate, and monitor threats, disease agents, incidents, and outbreaks provide relevant information to stakeholders monitoring/investigating adverse events related to medical countermeasures. The sub-domain includes the ability to successfully expand these systems and processes in response to incidents of health significance.	M18	Number of epidemiologists per 100,000 population in the state, by quintile (1=Lowest Quintile, 5=Highest Quintile)	The measure indicates the state-wide personnel capacity of epidemiologists. An accessible epidemiology workforce is critical to assuring an organization can maintain on-going surveillance operations to detect emerging disease and to surge, or ramp up, during and after any significant event involving exposure to a hazard.	BLS OES & ASTHO	Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES) and ASTHO Profile of State and Territorial Public Health--2012 and 2016 Epidemiologists by Jurisdiction	2012—2017	The measure may overestimate the number of epidemiologists who are available to prepare for and respond to emergencies, because it counts all personnel regardless of the occupational settings in which they practice and the job responsibilities they perform. BLS and other national data sources on health provider supply have been shown to undercount certain types of professionals, and may differ considerably from the estimates available from state licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, this is unlikely to cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error.
120	120	257.1	Index	6.2.10	6.0	EOH	Environmental & Occupational Health	18.0	EM	Environmental Monitoring	The systematic collection and continuous or frequent standardized measurement and observation of: environmental specimens (air, water, land/soil, and plants) analyzing the presence of an indicator, exposure, or response (warning and control), including monitoring the environment for vectors of disease to give information about the environment to assess past and current status and predict future trends	M904	Number of environmental scientists and specialists (including health) per 100,000 population in the state	States with a larger supply of environmental health specialists may have a superior ability to prevent, detect and contain health hazards related to air, water, food, housing, soil, climate, and other environmental conditions.	BLS OES	Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES), OES 19-2041	2012—2017	The measure does not evaluate the level of training of the environmental and health scientists. The measure does not consider mutual aid plans that may be in place for agencies to supplement the number of available environmental and health scientists in the event of an emergency. Also, BLS and other national data sources on health provider supply have been shown to undercount certain types of health professionals, and may differ considerably from the estimates available from state medical licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, they should not cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error.
95	95	211.0	Foundational	5.1.1	5.0	CM	Countermeasure Management	15.0	MMMDD	Medical Materiel Management, Distribution, & Dispensing	The ability to acquire, maintain (e.g., cold chain storage or other storage protocol), transport, distribute, and track medical materiel (e.g., pharmaceuticals, gloves, masks, and ventilators) before and during an incident and recover and account for unused medical materiel after an incident. This capability includes managing the research, development, and procurement of medical countermeasures in addition to the management and distribution of medical countermeasures.	M60	State has developed a written countermeasure management plan including Strategic National Stockpile (SNS) elements	State has developed a written countermeasure management plan including Strategic National Stockpile (SNS) elements	The measure indicates whether a written plan exists to facilitate the receipt, distribution, and dispensing of protective supplies from the Strategic National Stockpile (SNS) quickly and efficiently.	CDC PHEP	2012—2018	The measure does not evaluate whether the state has the resources and ability to implement the plan in a timely and effective manner.
59	59	131.0	Foundational	3.3.5	3.0	IIM	Incident & Information Management	7.0	INCM	Incident Management	The ability to establish and maintain a unified and coordinated operational structure with processes that appropriately integrate all critical stakeholders and support the execution of core capabilities and incident objectives. This sub-domain includes the capability to direct and support an event or incident with public health or medical implications by establishing a standardized, scalable management system consistent with the National Incident Management System and coordinating activities above the field level by sharing information, developing strategy and tactics, and managing resources to assist with coordination of operations in the field.	M341	State law includes a general provision regulating the release of personally identifiable information (PII) held by the health department	States with laws authorizing the release of PII without patient consent for purposes of responding to communicable diseases are able to more quickly implement effective response strategies to slow and stop the spread of disease. These laws include such information as to whom personally identifiable information may be released and the specific rationale or purpose for which such may be done.	PHLP	CDC Public Health Law Program resources. https://www.cdc.gov/phlp/	2013	The measure does not evaluate the state's legal scope of authority, infrastructure to investigate violations, or other strategies to respond to inappropriate release of personal information.
87	87	172.1	Index	4.3.15	4.0	HD	Healthcare Delivery	12.0	LTC	Long-Term Care	Long-term care refers to a continuum of medical and social services designed to support the needs of people living permanently or for an extended period in a residential setting with chronic health problems that affect their ability to perform everyday activities. This includes skilled nursing facilities, rehabilitation services, etc.	M303B	Number of licensed skilled nursing facilities with deficiencies in compliance with CMS Emergency Preparedness requirements, per 100 facilities in the state (1=Highest Quintile and 5=Lowest Quintile)	Nursing home residents are at increased risk for morbidity and mortality during emergencies. CMS requires facilities to maintain effective evacuation plans, emergency communication plans, and other protocols that can protect patients in emergency situations.	CMS	CMS Nursing Facility Inspection Reports	2014—2018	Nursing facility inspectors may vary in their ability to detect meaningful deficiencies in emergency plans.
126	126	259.5	Index	6.3.6	6.0	EOH	Environmental & Occupational Health	19.0	PEI	Physical Environment and Infrastructure	Actions taken to reduce health hazards in the physical environment, including elements of the natural and built environment.	M334	State has a climate change adaptation plan	Climate change is already increasing global temperatures, leading to rising sea levels and more frequent and intense extreme weather events. These changes could affect coastlines, water supplies, human health, ecosystems, and more. Each community will be affected differently, so formal planning and concrete actions are needed to address these changes at both the state and local level. States and municipalities are recognizing the importance of preemptive action to address their vulnerabilities to climate change impacts. Many states have begun to address adaptation concerns either within broader climate action plans or through separate efforts.	C2ES	Center for Climate and Energy Solutions (C2ES), State and Local Climate Adaptation	2014—2018	The measure does not evaluate the quality or comprehensiveness of the plan, or the degree to which the plan is implemented.
56	56	115.1	Index	3.2.5	3.0	IIM	Incident & Information Management	7.0	INCM	Incident Management	The ability to establish and maintain a unified and coordinated operational structure with processes that appropriately integrate all critical stakeholders and support the execution of core capabilities and incident objectives. This sub-domain includes the capability to direct and support an event or incident with public health or medical implications by establishing a standardized, scalable management system consistent with the National Incident Management System and coordinating activities above the field level by sharing information, developing strategy and tactics, and managing resources to assist with coordination of operations in the field.	M701	Average number of minutes for state health department staff with incident management lead roles to report for immediate emergency response duty (reverse coded)	This performance indicator demonstrates the ability to immediately assemble public health staff with incident management lead roles to ensure a timely response to an incident. Specifically, this indicator captures an agency’s ability to assemble key decision-makers who are responsible for leading and managing a response.	CDC OPHPR	Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness	2011—2016	Data are self-reported by health department representatives and may reflect differences in awareness, perspective and interpretation among respondents.
100	100	226.0	Index	5.2.3	5.0	CM	Countermeasure Management	16.0	CUE	Countermeasure Utilization & Effectiveness	The level to which the community has achieved preparedness for vaccination and immunization and the level to which the community completes a course of countermeasure usage or follows through in the use of an intervention. This also covers the resultant outcome from the appropriate use of the intervention.	M33	Percent of seniors age 65 and older in the state receiving a pneumococcal vaccination	The measure focuses on adults aged 65+ who have ever had a pneumonia vaccination. The measure should be viewed alongside other measures in the Countermeasures Utilization Effectiveness sub-domain as an indicator of pre-event capacity of the state's immunization system.	CDC BRFSS	Centers for Disease Control and Prevention (CDC), Behavioral Risk Factor Surveillance System Survey Questionnaire (BRFSS). Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Survey data analyzed by PMO personnel.	2012—2017	The measure evaluates the recommended vaccine for preventable disease in seniors, and may not reflect the vaccination rate for a severe emerging disease.
1	1	3.0	Foundational	1.1.1	1.0	HSS	Health Security Surveillance	1.0	PHSEI	Health Surveillance & Epidemiological Investigation	The creation, maintenance, support, and strengthening of passive and active surveillance to: identify, discover, locate, and monitor threats, disease agents, incidents, and outbreaks provide relevant information to stakeholders monitoring/investigating adverse events related to medical countermeasures. The sub-domain includes the ability to successfully expand these systems and processes in response to incidents of health significance.	M17	State health department participates in the Behavioral Risk Factor Surveillance System (BRFSS)	The measure indicates participation in the nation's largest surveillance system that tracks health conditions and risk behaviors. The Behavioral Risk Factor Surveillance System (BRFSS) is used to collect prevalence data from U.S. adult residents regarding risk behavior and preventive health practices that can affect health status. Participation can provide population-level data that can be useful in vulnerability assessments and developing messaging and intervention strategies.	CDC BRFSS	Centers for Disease Control and Prevention (CDC), Behavioral Risk Factor Surveillance System Survey Questionnaire (BRFSS). Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Survey data analyzed by authors.	2012—2015	The state's extensiveness of participation in the BRFSS based on sampling and instrumentation is not measured, and varies widely across states.
4	4	6.0	Foundational	1.1.4	1.0	HSS	Health Security Surveillance	1.0	PHSEI	Health Surveillance & Epidemiological Investigation	The creation, maintenance, support, and strengthening of passive and active surveillance to: identify, discover, locate, and monitor threats, disease agents, incidents, and outbreaks provide relevant information to stakeholders monitoring/investigating adverse events related to medical countermeasures. The sub-domain includes the ability to successfully expand these systems and processes in response to incidents of health significance.	M20	State health department participates in the National Electronic Disease Surveillance System (NEDSS)	The measure indicates participation in the national, electronic public health surveillance system. Participation assures that key surveillance data are comparable across states and enables national measurements of disease burden and progression.	CDC NEDSS	Centers for Disease Control and Prevention (CDC), Division of Health Informatics and Surveillance (DHIS), National Electronic Disease Surveillance System (NEDSS)	2013—2015	The measure does not evaluate the quality or comprehensiveness of state participation in the system.
60	60	132.0	Foundational	3.3.6	3.0	IIM	Incident & Information Management	7.0	INCM	Incident Management	The ability to establish and maintain a unified and coordinated operational structure with processes that appropriately integrate all critical stakeholders and support the execution of core capabilities and incident objectives. This sub-domain includes the capability to direct and support an event or incident with public health or medical implications by establishing a standardized, scalable management system consistent with the National Incident Management System and coordinating activities above the field level by sharing information, developing strategy and tactics, and managing resources to assist with coordination of operations in the field.	M342	State law requires healthcare facilities to report communicable diseases to a health department	Prompt reporting of communicable diseases to the state or local health department is crucial to the control and prevention of disease outbreaks. State and local public health system disease surveillance and control activities are the backbone of the nation's ability to control the spread of communicable diseases.	NEDSS	Centers for Disease Control and Prevention (CDC), Division of Health Informatics and Surveillance (DHIS), National Electronic Disease Surveillance System (NEDSS)	2013	The measure does not evaluate the effectiveness of state monitoring and enforcement of reporting requirements, the timeliness or completeness of reporting, or the ability of the health departments to receive and use the reported information.
31	31	38.2	Index	1.2.25	1.0	HSS	Health Security Surveillance	2.0	BMLT	Biological Monitoring & Laboratory Testing	The ability of agencies to conduct rapid and accurate laboratory tests to identify biological, chemical, and radiological agents to address actual or potential exposure to all hazards, focusing on testing human and animal clinical specimens. Support functions include discovery through: active and passive surveillance (both pre- and post-event), characterization, confirmatory testing data, reporting investigative support, ongoing situational awareness. Laboratory quality systems are maintained through external quality assurance and proficiency testing.	M902	State has a high-capability laboratory to detect chemical threats (Level 1 or 2 LRN-C laboratory)	Level 2 laboratories are staffed with chemists who are trained to detect exposure to a broad array of chemical agents. Level 1 laboratories provide surge-capacity testing for federal CDC laboratories and are able to detect exposure to an expanded number of chemical agents beyond the Level 1 testing capabilities. State participation in LRN-C may enable faster detection of chemical exposures that are of public health concern.	CDC NCEH/DLS/ERB	Centers for Disease Control and Prevention (CDC), National Center for Environmental Health (NCEH), Division of Laboratory Sciences (DLS), Emergency Response Branch (ERB)	2016 & 2017	The measure does not evaluate the quality or comprehensiveness of the laboratory capabilities.
98	98	224.0	Index	5.2.1	5.0	CM	Countermeasure Management	16.0	CUE	Countermeasure Utilization & Effectiveness	The level to which the community has achieved preparedness for vaccination and immunization and the level to which the community completes a course of countermeasure usage or follows through in the use of an intervention. This also covers the resultant outcome from the appropriate use of the intervention.	M24	Percent of children ages 19-35 months in the state receiving recommended routine childhood vaccinations, including four or more doses of diphtheria, tetanus, and pertussis vaccine, three or more doses of poliovirus vaccine, one or more doses of any measles-containing vaccine, and three or more doses of Hepatitis B vaccine	The measure is used by the Centers for Disease Control and Prevention (CDC) and states to monitor health status and is an important measure of achievement of immunization program objectives. The measure is a pre-event indicator of the capacity of the state's public and private immunization infrastructure needed to respond to an emerging vaccine-controllable disease.	CDC NIS	Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHC), National Immunization Survey (NIS)	2012—2017	The measure evaluates routine vaccines for preventable disease in pre-school age children, and may not reflect the vaccination rate for a severe emerging disease.
101	101	227.0	Index	5.2.4	5.0	CM	Countermeasure Management	16.0	CUE	Countermeasure Utilization & Effectiveness	The level to which the community has achieved preparedness for vaccination and immunization and the level to which the community completes a course of countermeasure usage or follows through in the use of an intervention. This also covers the resultant outcome from the appropriate use of the intervention.	M34	Percent of children aged 6 months to 4 years old in the state receiving a seasonal flu vaccination	The measure is used by Centers for Disease Control and Prevention (CDC) and states to monitor health status and is an important measure of the achievement of the state's immunization objectives. The measure serves as a pre-event indicator of the capacity of the immunization infrastructure in the state needed to respond to an emerging vaccine-controllable disease.	CDC NIS	Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHC), National Immunization Survey (NIS)	2012—2018	Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on healthcare facilities may be marginal in the event of a major disaster.
58	58	128.0	Foundational	3.3.2	3.0	IIM	Incident & Information Management	7.0	INCM	Incident Management	The ability to establish and maintain a unified and coordinated operational structure with processes that appropriately integrate all critical stakeholders and support the execution of core capabilities and incident objectives. This sub-domain includes the capability to direct and support an event or incident with public health or medical implications by establishing a standardized, scalable management system consistent with the National Incident Management System and coordinating activities above the field level by sharing information, developing strategy and tactics, and managing resources to assist with coordination of operations in the field.	M338	State requires healthcare facilities to report healthcare-associated infections to the Centers for Disease Control and Prevention's (CDC's) National Health Safety Network (NHSN) or other systems	Healthcare-associated infections are a major, yet preventable, threat to patient safety. The National Health Safety Network (NHSN) is the CDC's system to collect surveillance data on these infections and to provide prevention strategies to healthcare facilities and providers.	CDC HAI	Centers for Disease Control and Prevention (CDC), National Healthcare Safety Network (NHSN), Healthcare—Associated Infections (HAI) Progress Report	2012 & 2013	The measure does not evaluate the healthcare facility compliance with reporting requirements.
10	10	12.0	Foundational	1.1.10	1.0	HSS	Health Security Surveillance	1.0	PHSEI	Health Surveillance & Epidemiological Investigation	The creation, maintenance, support, and strengthening of passive and active surveillance to: identify, discover, locate, and monitor threats, disease agents, incidents, and outbreaks provide relevant information to stakeholders monitoring/investigating adverse events related to medical countermeasures. The sub-domain includes the ability to successfully expand these systems and processes in response to incidents of health significance.	M289	State health department participates in a broad prevention collaborative addressing healthcare-associated infections (HAIs)	Healthcare-associated infections (HAIs) are diseases acquired by patients while receiving medical treatment in a healthcare facility. HAIs are significant sources of preventable disease burden, and place communities at elevated risk of large-scale outbreaks and epidemics. State prevention collaboratives consist of multiple hospitals within a state that support implementation of evidence-based prevention strategies through peer learning, performance measurement, and feedback reporting to clinicians and staff. State health department participation in these collaboratives is an indicator of the strength of HAI prevention strategies.	CDC PSR	Centers for Disease Control and Prevention (CDC), National Healthcare Safety Network (NHSN), Prevention Status Reports	2013	The measure does not evaluate the quality, comprehensiveness, or effectiveness of HAI prevention collaboratives.
99	99	225.0	Index	5.2.2	5.0	CM	Countermeasure Management	16.0	CUE	Countermeasure Utilization & Effectiveness	The level to which the community has achieved preparedness for vaccination and immunization and the level to which the community completes a course of countermeasure usage or follows through in the use of an intervention. This also covers the resultant outcome from the appropriate use of the intervention.	M32	Percent of seniors age 65 and older in the state receiving a seasonal flu vaccination	The measure focuses on adults aged 65+ who have had an influenza vaccination within the past year. This measure is used by the Centers for Disease Control and Prevention (CDC) and states to monitor health status and is an important measure of achievement of immunization program objectives. The measure is a pre-event indicator of the capacity of the state's public and private immunization infrastructure needed to respond to an emerging vaccine controllable disease.	CDC FluVaxView	Centers for Disease Control and Prevention (CDC), National Immunization Survey (NIS) and the Behavioral Risk Surveillance System (BRFSS), FluVaxView State, Regional, and National Vaccination Report	2013—2018	Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on healthcare facilities may be marginal in the event of a major disaster.
102	102	228.0	Index	5.2.5	5.0	CM	Countermeasure Management	16.0	CUE	Countermeasure Utilization & Effectiveness	The level to which the community has achieved preparedness for vaccination and immunization and the level to which the community completes a course of countermeasure usage or follows through in the use of an intervention. This also covers the resultant outcome from the appropriate use of the intervention.	M35	Percent of adults aged 18 years and older in the state receiving a seasonal flu vaccination	The measure focuses on influenza vaccination coverage for adults aged 18 to 64 years. This measure is used by the Centers for Disease Control and Prevention (CDC) and states to monitor health status and is an important measure of achievement of immunization program objectives. The measure is a pre-event indicator of the capacity of the state's public and private immunization infrastructure needed to respond to an emerging vaccine-controllable disease.	CDC FluVaxView	Centers for Disease Control and Prevention (CDC), National Immunization Survey (NIS) and the Behavioral Risk Surveillance System (BRFSS), FluVaxView State, Regional, and National Vaccination Report	2013—2018	Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on healthcare facilities may be marginal in the event of a major disaster.
9	9	11.0	Index	1.1.9	1.0	HSS	Health Security Surveillance	1.0	PHSEI	Health Surveillance & Epidemiological Investigation	The creation, maintenance, support, and strengthening of passive and active surveillance to: identify, discover, locate, and monitor threats, disease agents, incidents, and outbreaks provide relevant information to stakeholders monitoring/investigating adverse events related to medical countermeasures. The sub-domain includes the ability to successfully expand these systems and processes in response to incidents of health significance.	M23	Percent of foodborne illness outbreaks reported to CDC by state and local public health departments for which a causative infectious agent is confirmed	The measure indicates a state's ability to confirm the pathogens that cause foodborne disease outbreaks. This capability allows states to identify and intervene rapidly to prevent further spread of outbreaks in the community.	CDC NORS	Centers for Disease Control and Prevention (CDC), National Outbreak Reporting System (NORS)	2012—2017	The measure does not evaluate the quality or comprehensiveness of the state's reporting of foodborne illness outbreaks.
88	88	172.2	Index	4.3.16	4.0	HD	Healthcare Delivery	12.0	LTC	Long-Term Care	Long-term care refers to a continuum of medical and social services designed to support the needs of people living permanently or for an extended period in a residential setting with chronic health problems that affect their ability to perform everyday activities. This includes skilled nursing facilities, rehabilitation services, etc.	M23NH	Number of disease outbreaks in nursing homes or assisted living facilities per 1,000 certified nursing home residents in a state (reverse coded)	Nursing home residents are at increased risk of foodborne illnesses and face higher risks of serious complications and death.	CDC NORS	Centers for Disease Control and Prevention (CDC), National Outbreak Reporting System (NORS)	2012—2017	States vary in their ability to detect and report outbreaks in long-term care settings.
111	111	247.2	Index	6.1.14	6.0	EOH	Environmental & Occupational Health	17.0	FWS	Food & Water Security	The sufficient availability, access, use, and protection of safe and clean food and water resources to support human well-being and health.	M23PC	Number of foodborne illness outbreaks reported to CDC by state and local public health departments for which a causative infectious agent is confirmed (per 1 million population)(reverse coded)	The measure focuses on a state's ability to confirm the etiologic agent causing a foodborne disease outbreak. States actively investigating and resolving food and water outbreaks are able to identify and intervene more quickly to prevent a further spread of outbreaks in the community.	CDC NORS	Centers for Disease Control and Prevention (CDC), National Outbreak Reporting System (NORS)	2012—2017	The measure does not evaluate the quality or comprehensiveness of the state's reporting of foodborne illness outbreaks.
121	121	257.2	Index	6.2.11	6.0	EOH	Environmental & Occupational Health	18.0	EM	Environmental Monitoring	The systematic collection and continuous or frequent standardized measurement and observation of: environmental specimens (air, water, land/soil, and plants) analyzing the presence of an indicator, exposure, or response (warning and control), including monitoring the environment for vectors of disease to give information about the environment to assess past and current status and predict future trends	M23A	Number of disease outbreaks in a state due to animal contact per 1 million population (reverse coded)	The measure focuses on a state's ability to confirm the etiologic agent causing a foodborne disease outbreak. States actively investigating and resolving food and water outbreaks are able to identify and intervene more quickly to prevent a further spread of outbreaks in the community.	CDC NORS	Centers for Disease Control and Prevention (CDC), National Outbreak Reporting System (NORS)	2012—2017	The measure does not evaluate the quality or comprehensiveness of the state's reporting of illness outbreaks.
14	14	17.0	Foundational	1.2.1	1.0	HSS	Health Security Surveillance	2.0	BMLT	Biological Monitoring & Laboratory Testing	The ability of agencies to conduct rapid and accurate laboratory tests to identify biological, chemical, and radiological agents to address actual or potential exposure to all hazards, focusing on testing human and animal clinical specimens. Support functions include discovery through: active and passive surveillance (both pre- and post-event), characterization, confirmatory testing data, reporting investigative support, ongoing situational awareness. Laboratory quality systems are maintained through external quality assurance and proficiency testing.	M1	Public Health Emergency Preparedness (PHEP) Cooperative Agreement-funded Laboratory Response Network chemical (LRN-C) laboratories collect, package, and ship samples properly during an LRN-C exercise	The measure focuses on laboratory knowledge, skills, and abilities to follow federal packaging and shipping regulations and the Centers for Disease Control and Prevention's (CDC) Laboratory Response Network (LRN) protocols.	CDC Snapshot	Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness	2011—2013	The measure is based on an exercise that includes only simulated samples, excluding real-life scenarios such as mislabeled specimens or specimens arriving at the laboratory at different times.
23	23	30.0	Index	1.2.15	1.0	HSS	Health Security Surveillance	2.0	BMLT	Biological Monitoring & Laboratory Testing	The ability of agencies to conduct rapid and accurate laboratory tests to identify biological, chemical, and radiological agents to address actual or potential exposure to all hazards, focusing on testing human and animal clinical specimens. Support functions include discovery through: active and passive surveillance (both pre- and post-event), characterization, confirmatory testing data, reporting investigative support, ongoing situational awareness. Laboratory quality systems are maintained through external quality assurance and proficiency testing.	M2	Percent of Laboratory Response Network biological (LRN-B) proficiency tests successfully passed by Public Health Emergency Preparedness (PHEP) Cooperative Agreement-funded laboratories	Recognition of a health emergency requires accurate and timely laboratory testing of a variety of samples in order to detect potential diseases or exposures. The measure focuses on the ability of lab to detect and identify biological threat agents in an exercise or test scenario.	CDC Snapshot	Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness	2011—2016	Laboratories may not undergo proficiency testing for all assay capabilities. Selected responses from the 2013, 2014, 2015, and 2016 survey have been corrected for Louisana and therefore no longer correspond to the originally published survey results.
24	24	31.0	Index	1.2.16	1.0	HSS	Health Security Surveillance	2.0	BMLT	Biological Monitoring & Laboratory Testing	The ability of agencies to conduct rapid and accurate laboratory tests to identify biological, chemical, and radiological agents to address actual or potential exposure to all hazards, focusing on testing human and animal clinical specimens. Support functions include discovery through: active and passive surveillance (both pre- and post-event), characterization, confirmatory testing data, reporting investigative support, ongoing situational awareness. Laboratory quality systems are maintained through external quality assurance and proficiency testing.	M3	Percent of pulsed field gel electrophoresis (PFGE) subtyping data results for E. coli submitted to the CDC PulseNet national database within four working days of receiving samples from clinical laboratories	Bacterial subtyping data can be important in outbreak detection. The measure focuses on the timeliness of the public health laboratory to perform subtyping tests and report results nationally.	CDC Snapshot	Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness	2011—2016	The measure does not encompass time elapsed for specimen transport and identification, and is limited to foodborne agents that have PFGE subtyping.
25	25	32.0	Index	1.2.17	1.0	HSS	Health Security Surveillance	2.0	BMLT	Biological Monitoring & Laboratory Testing	The ability of agencies to conduct rapid and accurate laboratory tests to identify biological, chemical, and radiological agents to address actual or potential exposure to all hazards, focusing on testing human and animal clinical specimens. Support functions include discovery through: active and passive surveillance (both pre- and post-event), characterization, confirmatory testing data, reporting investigative support, ongoing situational awareness. Laboratory quality systems are maintained through external quality assurance and proficiency testing.	M5	Percent of chemical agents correctly identified and quantified from unknown samples during unannounced proficiency testing during the state’s Laboratory Response Network (LRN) Emergency Response Pop Proficiency Test (PopPT) Exercise	The measure focuses on a public health laboratory's ability to perform, without notice, tests on patient specimens for chemical agents and report the results.	CDC Snapshot	Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness	2013—2016	The measure does not consider the public health laboratory's ability to process a large number of samples.
26	26	34.0	Index	1.2.19	1.0	HSS	Health Security Surveillance	2.0	BMLT	Biological Monitoring & Laboratory Testing	The ability of agencies to conduct rapid and accurate laboratory tests to identify biological, chemical, and radiological agents to address actual or potential exposure to all hazards, focusing on testing human and animal clinical specimens. Support functions include discovery through: active and passive surveillance (both pre- and post-event), characterization, confirmatory testing data, reporting investigative support, ongoing situational awareness. Laboratory quality systems are maintained through external quality assurance and proficiency testing.	M7	Number of additional chemical agent detection methods—beyond the core methods—demonstrated by Laboratory Response Network chemical (LRN-C) Level 1 or 2 laboratories in the state	Recognition of a health emergency requires accurate and timely laboratory testing of a variety of samples in order to detect potential diseases or exposures. The measure focuses on the ability of a laboratory to detect and identify chemical threat agents during an exercise or test.	CDC Snapshot	Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness	2011—2016	The measure does not consider all methods that the laboratory is capable of testing.
28	28	37.0	Index	1.2.22	1.0	HSS	Health Security Surveillance	2.0	BMLT	Biological Monitoring & Laboratory Testing	The ability of agencies to conduct rapid and accurate laboratory tests to identify biological, chemical, and radiological agents to address actual or potential exposure to all hazards, focusing on testing human and animal clinical specimens. Support functions include discovery through: active and passive surveillance (both pre- and post-event), characterization, confirmatory testing data, reporting investigative support, ongoing situational awareness. Laboratory quality systems are maintained through external quality assurance and proficiency testing.	M287	Percent of pulsed field gel electrophoresis (PFGE) sub-typing data results for Listeria monocytogenes submitted by state and local public health laboratories to the CDC PulseNet national database within four working days of receiving samples from clinical laboratories	Rapid identification of Listeria moncytogenes at the state's PFGE laboratory and rapid submission of the results to the Pulsenet national database is important to be able to identify multistate or national outbreaks of diseases. Once outbreaks are identified and the source is investigated, recalls and advisories can be issued to protect the public from additional exposure.	CDC Snapshot	Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness	2011—2016	The measure does not consider the volume of samples processed or quality of PFGE results, nor encompass time elapsed for specimen transport and identification.
29	29	38.0	Index	1.2.23	1.0	HSS	Health Security Surveillance	2.0	BMLT	Biological Monitoring & Laboratory Testing	The ability of agencies to conduct rapid and accurate laboratory tests to identify biological, chemical, and radiological agents to address actual or potential exposure to all hazards, focusing on testing human and animal clinical specimens. Support functions include discovery through: active and passive surveillance (both pre- and post-event), characterization, confirmatory testing data, reporting investigative support, ongoing situational awareness. Laboratory quality systems are maintained through external quality assurance and proficiency testing.	M288	Number of core chemical agent detection methods demonstrated by Level 1 or 2 LRN-C laboratories in the state	The Centers for Disease Control and Prevention (CDC) identified nine core methods for detecting and measuring chemical agents, and conducted testing to determine LRN-C laboratories' proficiency in these methods. The core methods are significant as they use technical fundamentals that provide the foundation of chemical analysis capabilities.	CDC Snapshot	Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness	2011—2016	The measure does not consider compliance with the standards set by the Clinical Laboratory Improvement Amendments (CLIA) and the College of American Pathologists (CAP) accreditation program, and whether proficiency is achieved annually for the methods reported. Selected responses from the original data source have been corrected for Colorado and Louisana and therefore no longer correspond to the originally published results.
62	62	120.0	Foundational	3.2.1	3.0	IIM	Incident & Information Management	8.0	INFM	Information Management & Communications	The ability to develop systems and procedures that facilitate the communication of timely, accurate, and accessible information, alerts, warnings, and notifications to the public using a whole-community approach. This sub-domain includes using risk communication methods to support the use of clear, consistent, accessible, and culturally and linguistically appropriate methods to effectively relay information regarding any threat or hazard, the actions taken, and the assistance available.	M64	State has a public information and communication plan developed for a mass prophylaxis campaign	The measure reflects the capacity for timely public health risk communication during an emergency that requires dispensing of medical countermeasures.	CDC PHEP	Centers for Disease Control and Prevention (CDC), Public Health Emergency Preparedness and Response Cooperative Agreement Program.	2012-2018	The measure focuses on pre-event planning during a mass dispensing scenario, and does not include planning for broader emergency scenarios, capacity for response-driven public information and risk communication strategies, or capabilities in implementing the plan.
3	3	5.0	Foundational	1.1.3	1.0	HSS	Health Security Surveillance	1.0	PHSEI	Health Surveillance & Epidemiological Investigation	The creation, maintenance, support, and strengthening of passive and active surveillance to: identify, discover, locate, and monitor threats, disease agents, incidents, and outbreaks provide relevant information to stakeholders monitoring/investigating adverse events related to medical countermeasures. The sub-domain includes the ability to successfully expand these systems and processes in response to incidents of health significance.	M19	State health department participates in the Epidemic Information Exchange (Epi-X) System	The measure indicates participation in the Centers for Disease Control and Prevention (CDC)-sponsored national information sharing system. Participation in this system provides access to national level alerts and raises situational awareness beyond state borders.	CDC Epi-X	Centers for Disease Control and Prevention (CDC), The Epidemic Information Exchange (Epi-X) Program	2013	The measure does not evaluate the quality or comprehensiveness of state participation in the system.
92	92	204.0	Index	4.5.1	4.0	HD	Healthcare Delivery	14.0	HC	Home Care	Home care is clinical and nonclinical care that allows a person with special needs to stay in their home. It may also be assumed to include the management of patient care needs for those patients not sick enough to require hospitalization or long-term care, or for whom hospitalization is not deemed to be of benefit. Other examples of home care include, but are not limited to: skilled nursing visits, respiratory care services, provision of durable medical equipment, hospice, and pharmacist services.	M291	Percent of home health episodes of care in the state where the home health team determined whether their patient received a flu shot for the current flu season	Providing influenza vaccinations to vulnerable populations that are provided care through a home health agency is an indicator of the capability and quality of care provided by the agency.	CMS HH	Centers for Medicare & Medicaid Services (CMS), Home Health Care-State by State Data	2013—2018	Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on healthcare facilities may be marginal in the event of a major disaster.
93	93	205.0	Index	4.5.2	4.0	HD	Healthcare Delivery	14.0	HC	Home Care	Home care is clinical and nonclinical care that allows a person with special needs to stay in their home. It may also be assumed to include the management of patient care needs for those patients not sick enough to require hospitalization or long-term care, or for whom hospitalization is not deemed to be of benefit. Other examples of home care include, but are not limited to: skilled nursing visits, respiratory care services, provision of durable medical equipment, hospice, and pharmacist services.	M292	Percent of home health episodes of care in the state where the home health team began their patients' care in a timely manner	The measure is an indicator of the capacity and effectiveness of the state's home care system to begin home care in a timely manner. Delays in providing home care can affect patient health and safety. The measure also indirectly looks at the hospital patient discharge system and its collaboration with home care providers.	CMS HH	Centers for Medicare & Medicaid Services (CMS), Home Health Care-State by State Data	2013—2018	The measure does not evaluate the quality of the services provided including length of service delays.
83	83	178.0	Index	4.3.7	4.0	HD	Healthcare Delivery	12.0	LTC	Long-Term Care	Long-term care refers to a continuum of medical and social services designed to support the needs of people living permanently or for an extended period in a residential setting with chronic health problems that affect their ability to perform everyday activities. This includes skilled nursing facilities, rehabilitation services, etc.	M308	Average number of nurse (RN) staffing hours per resident per day in nursing homes in the state	Registered nurses (RNs) are important providers of skilled nursing care to residents. This measure is a reflection of core capacity for a clinical asset.	CMS NH	Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages	2014—2018	The measure source data are collected during a specific two-week period and do not take into account variations related to season, region, resident acuity, skill mix of other care providers, and other factors. The measure does not evaluate staff availability for a disaster or whether staff received disaster response training.
84	84	179.0	Index	4.3.8	4.0	HD	Healthcare Delivery	12.0	LTC	Long-Term Care	Long-term care refers to a continuum of medical and social services designed to support the needs of people living permanently or for an extended period in a residential setting with chronic health problems that affect their ability to perform everyday activities. This includes skilled nursing facilities, rehabilitation services, etc.	M309	Average number of nursing assistant (CNA) staffing hours per resident per day in nursing homes in the state	Certified nursing assistants (CNAs) provide important, non-nursing level care to residents and clients under their care. The average number of CNA staffing hours per resident per day is a reflection of core capacity and a measure of safety in terms of patient care.	CMS NH	Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages	2014—2018	The measure source data are collected during a specific two-week period and do not take into account variations related to season, region, resident acuity, skill mix of other care providers, and other factors. The measure does not evaluate staff availability for a disaster or whether staff received disaster response training.
85	85	180.0	Index	4.3.9	4.0	HD	Healthcare Delivery	12.0	LTC	Long-Term Care	Long-term care refers to a continuum of medical and social services designed to support the needs of people living permanently or for an extended period in a residential setting with chronic health problems that affect their ability to perform everyday activities. This includes skilled nursing facilities, rehabilitation services, etc.	M307	Percent of long-stay nursing home residents in the state that are assessed and appropriately given the seasonal influenza vaccine	This is a measure of the strength of the state's public health programs and general level of competency of long-stay resident facility managers as reflected in their effectiveness in risk avoidance through a seasonal vaccination program. It is also a measure of the population percentage who would have additional protection against seasonal flu, somewhat reducing the overall pressure on the healthcare system by mitigating the effect of seasonal flu during disaster response.	CMS NH	Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages	2013—2018	Vaccine effectiveness varies each year as a function of the accuracy in predicting the influenza strains covered by each year's vaccine. As a result, expected influenza protection and reduced demand on healthcare facilities may be marginal in the event of a major disaster.
86	86	181.0	Index	4.3.10	4.0	HD	Healthcare Delivery	12.0	LTC	Long-Term Care	Long-term care refers to a continuum of medical and social services designed to support the needs of people living permanently or for an extended period in a residential setting with chronic health problems that affect their ability to perform everyday activities. This includes skilled nursing facilities, rehabilitation services, etc.	M310	Average number of licensed practical nurse (LPN) staffing hours per resident per day in nursing homes in the state	Licensed practical nurses (LPNs) are important members of the resident care team, and provide skilled nursing care. This measure is a reflection of core capacity for a clinical asset.	CMS NH	Centers for Medicare & Medicaid Services (CMS), Nursing Home State Averages	2014—2018	The measure source data are collected during a specific two-week period and do not take into account variations related to season, region, resident acuity, skill mix of other care providers, and other factors. The measure does not evaluate staff availability for a disaster or whether staff received disaster response training.
72	72	151.0	Index	4.2.1	4.0	HD	Healthcare Delivery	11.0	HPS	Hospital and Physician Services	Hospital and physician services refers to care for a patient who is formally admitted (or “hospitalized”) to an institution for treatment and/or care and stays for a minimum of one night in the hospital or other institution.	M147	Median time in minutes from hospital emergency department (ED) arrival to ED departure for patients admitted to hospitals in the state (identifier ED-1)(reverse coded)	Measuring the time that patients spend admitted in the emergency department before being admitted to the hospital as an inpatient is important when managing medical surge (i.e., ramp up) and ensuring expeditious access to treatment during a public health emergency.	CMS TEC	Centers for Medicare & Medicaid Services (CMS), Timely and Effective Care—State	2013—2018	The measure does not evaluate the severity of the patients' conditions, or the nature of their treatment between emergency department arrival and discharge.
73	73	152.0	Index	4.2.2	4.0	HD	Healthcare Delivery	11.0	HPS	Hospital and Physician Services	Hospital and physician services refers to care for a patient who is formally admitted (or “hospitalized”) to an institution for treatment and/or care and stays for a minimum of one night in the hospital or other institution.	M148	Median time in minutes from hospital admission decision to emergency department (ED) departure for patients admitted to hospitals in the state (identifier ED-2)(reverse coded)	Measuring the time that patients spend in the emergency department after the physician decides to admit a patient and before the patient is admitted into the facility as an inpatient is critical to understanding the challenges that may be experienced in terms of medical surge (i.e., ramp up). Understanding the patient movement flow and barriers can assist in surge planning for public health emergencies to increase patients' access to treatment and supportive care.	CMS TEC	Centers for Medicare & Medicaid Services (CMS), Timely and Effective Care—State	2013—2018	The measure does not evaluate the hospital's capacity to move patients from the emergency department to inpatient care during a mass casualty or other event.
127	127	259.8	Index	6.4.2	6.0	EOH	Environmental & Occupational Health	20.0	WR	Workforce Resiliency	Actions taken to protect workers and emergency responders from health hazards while on the job	M530	Percent of employed population in the state with some type of paid time off (PTO) benefit	During emergencies community resiliency, health security, and preparedness is enhanced if individuals can shelter in place. Paid time off, or PTO, provides the financial flexibility to take time off from work and shelter in place.	IPUMS--CPS, Miriam King, Steven Ruggles, J. Trent Alexander, Sarah Flood, Katie Genadek, Matthew B. Schroeder, Brandon Trampe, and Rebecca Vick. Integrated Public Use Microdata Series, Current Population Survey: Version 3.0. [Machine-readable database]. Minneapolis: University of Minnesota, 2010.	Current Population Survey (CPS), Annual Social and Economic Supplement (ASEC) data analyzed by PMO personnel.	2013—2018	The measure data is estimated based on a survey of a sample of the general population.
49	49	94.0	Index	2.4.3	2.0	CPE	Community Planning & Engagement Coordination	5.5	SCC	Social Capital & Cohesion	The community social capital that helps society function effectively, including social networks between individuals, neighbors, organizations, and governments, and the degree of connection and sense of “belongingness” among residents.	M188	Percent of adults in the state who volunteer in their communities	Community residents who volunteer, like those who vote, is an indicator of community cohesiveness. Rate of volunteerism is considered a representation of community involvement and engagement, which can strengthen pre-event planning as well as post-event response and recovery activities.	CPS Volunteer Supplement	Current Population Survey (CPS), Volunteer Supplement data analyzed by PMO personnel.	2012—2015, 2017	Data do not reflect the frequency, regularity or sustainability of volunteering, and respondents may be inclined to over-report their volunteerism.
50	50	95.0	Index	2.4.4	2.0	CPE	Community Planning & Engagement Coordination	5.5	SCC	Social Capital & Cohesion	The community social capital that helps society function effectively, including social networks between individuals, neighbors, organizations, and governments, and the degree of connection and sense of “belongingness” among residents.	M189	Number of annual volunteer hours per state resident, 15 years and older	Community residents who volunteer, like those who vote, have long been associated with more cohesive communities. This measure is another way of indirectly capturing the community-level benefits derived from those who "give back" or volunteer their time.	CPS Volunteer Supplement	Current Population Survey (CPS), Volunteer Supplement data analyzed by PMO personnel.	2012—2015, 2017	Respondents may be inclined to over-report the number of hours they volunteer. Also, certain communities that have strong social cohesion may have a low reported rate, such as settings where both parents work full-time and may not have time to volunteer.
128	128	259.9	Index	6.4.3	6.0	EOH	Environmental & Occupational Health	20.0	WR	Workforce Resiliency	Actions taken to protect workers and emergency responders from health hazards while on the job	M531	Percent of employed population in the state engaging in some work from home by telecommuting	During emergencies community resiliency, health security, and preparedness is enhanced if individuals can shelter in place. Having the ability to "telecommute" provides individuals with the option to work at home and shelter in place.	U.S. Census, Current Population Survey Work Schedules Supplement, various years.	Current Population Survey (CPS), Work Schedules Supplement data analyzed by PMO personnel.	2011—2013, 2015, 2017	The measure data is estimated based on a survey of a sample of the general population.
34	34	48.1	Index	2.1.9	2.0	CPE	Community Planning & Engagement Coordination	3.0	CSCC	Cross-Sector / Community Collaboration	The coordination necessary to engage community-based organizations and social networks through collaboration among agencies primarily responsible for providing direct health-related services; partners include public health, healthcare, business, education, and emergency management in addition to federal and nonfederal entities necessary to facilitate an effective and efficient return to routine delivery of services.	M9031	Percent of hospitals in the state that participate in health care preparedness coalitions supported through the federal Hospital Preparedness Program of the Office of the Assistant Secretary for Preparedness and Response	Broad participation in Health Care Coalitions may enhance communication, resource-sharing, and coordinated planning and response activities across sectors in the event of an emergency.	HHS ASPR	Division of National Healthcare Preparedness Programs in the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services	2013—2017	The measure does not evaluate the quality or comprehensiveness of participation in the health care preparedness coalitions.
35	35	48.2	Index	2.1.10	2.0	CPE	Community Planning & Engagement Coordination	3.0	CSCC	Cross-Sector / Community Collaboration	The coordination necessary to engage community-based organizations and social networks through collaboration among agencies primarily responsible for providing direct health-related services; partners include public health, healthcare, business, education, and emergency management in addition to federal and nonfederal entities necessary to facilitate an effective and efficient return to routine delivery of services.	M9032	Percent of emergency medical service agencies in the state that participate in health care preparedness coalitions supported through the federal Hospital Preparedness Program of the Office of the Assistant Secretary for Preparedness and Response	Broad participation in Health Care Coalitions may enhance communication, resource-sharing, and coordinated planning and response activities across sectors in the event of an emergency.	HHS ASPR	Division of National Healthcare Preparedness Programs in the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services	2013—2017	The measure does not evaluate the quality or comprehensiveness of participation in the health care preparedness coalitions.
36	36	48.3	Index	2.1.11	2.0	CPE	Community Planning & Engagement Coordination	3.0	CSCC	Cross-Sector / Community Collaboration	The coordination necessary to engage community-based organizations and social networks through collaboration among agencies primarily responsible for providing direct health-related services; partners include public health, healthcare, business, education, and emergency management in addition to federal and nonfederal entities necessary to facilitate an effective and efficient return to routine delivery of services.	M9033	Percent of emergency management agencies in the state that participate in health care preparedness coalitions supported through the federal Hospital Preparedness Program of the Office of the Assistant Secretary for Preparedness and Response	Broad participation in Health Care Coalitions may enhance communication, resource-sharing, and coordinated planning and response activities across sectors in the event of an emergency.	HHS ASPR	Division of National Healthcare Preparedness Programs in the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services	2013—2017	The measure does not evaluate the quality or comprehensiveness of participation in the health care preparedness coalitions.
37	37	48.4	Index	2.1.12	2.0	CPE	Community Planning & Engagement Coordination	3.0	CSCC	Cross-Sector / Community Collaboration	The coordination necessary to engage community-based organizations and social networks through collaboration among agencies primarily responsible for providing direct health-related services; partners include public health, healthcare, business, education, and emergency management in addition to federal and nonfederal entities necessary to facilitate an effective and efficient return to routine delivery of services.	M9034	Percent of local health departments in the state that participate in health care preparedness coalitions supported through the federal Hospital Preparedness Program of the Office of the Assistant Secretary for Preparedness and Response	Broad participation in Health Care Coalitions may enhance communication, resource-sharing, and coordinated planning and response activities across sectors in the event of an emergency.	HHS ASPR	Division of National Healthcare Preparedness Programs in the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services	2013—2017	The measure does not evaluate the quality or comprehensiveness of participation in the health care preparedness coalitions.
52	52	104.0	Index	3.1.4	3.0	IIM	Incident & Information Management	7.0	INCM	Incident Management	The ability to establish and maintain a unified and coordinated operational structure with processes that appropriately integrate all critical stakeholders and support the execution of core capabilities and incident objectives. This sub-domain includes the capability to direct and support an event or incident with public health or medical implications by establishing a standardized, scalable management system consistent with the National Incident Management System and coordinating activities above the field level by sharing information, developing strategy and tactics, and managing resources to assist with coordination of operations in the field.	M84	State all hazards emergency management program is accredited by the Emergency Management Accreditation Program (EMAP)	The measure focuses on the accreditation of a state according to a set of 64 standards for emergency management programs that covers program management, administration and finance, laws and authorities, hazard identification, risk assessment and consequence analysis, hazard mitigation, prevention, operational planning, incident management, resource management and logistics, mutual aid, communications and warning, operations and procedures, facilities, training, exercises, and crisis communications. Each area is important for managing an incident and assuring multi-agency coordination.	EMAP	Emergency Management Accreditation Program (EMAP), Who Is Accredited?	2014—2018	The measure does not consider state emergency management programs with conditional accreditation, and some states may choose not to pursue accreditation for various state and local reasons.
109	109	244.0	Index	6.1.9	6.0	EOH	Environmental & Occupational Health	17.0	FWS	Food & Water Security	The sufficient availability, access, use, and protection of safe and clean food and water resources to support human well-being and health.	M195	Percentage of community water systems in a state that meet all applicable health-based standards	Safe and sanitary drinking water is vital to a community's health and wellbeing. Community (public) water supplies and systems that have difficulty providing water that meets the health-based standards are more likely to be systems that are not adequately maintained or operated.	EPA SDWIS	Environmental Protection Agency (EPA), Safe Drinking Water Information System Federal (SDWIS/FED) Drinking Water Data	2012—2017	The measure does not evaluate drinking water supplies that are non-public (private), or provide information on community water supplies that were adversely affected by emergencies or disasters.
110	110	247.1	Index	6.1.13	6.0	EOH	Environmental & Occupational Health	17.0	FWS	Food & Water Security	The sufficient availability, access, use, and protection of safe and clean food and water resources to support human well-being and health.	M925	Percentage of community water systems in a state that meet all applicable non-health-based standards	Safe and sanitary drinking water is vital to a community's health and wellbeing. Community (public) water supplies and systems that have difficulty providing water that meets the non-health-based standards are more likely to be systems that are not adequately maintained or operated.	EPA SDWIS	Environmental Protection Agency (EPA), Safe Drinking Water Information System Federal (SDWIS/FED) Drinking Water Data	2012—2017	The measure does not cover drinking water supplies that are non-public (private) and does not directly provide information on community water supplies that were adversely affected by emergencies or disasters.
124	124	259.2	Index	6.3.3	6.0	EOH	Environmental & Occupational Health	19.0	PEI	Physical Environment and Infrastructure	Actions taken to reduce health hazards in the physical environment, including elements of the natural and built environment.	M928	Housing Mitigation for Flood Hazards, population living in a community participating in the FEMA Community Rating System (communities with a CRS of 1 through 9) as a percent of all communities participating in the National Flood Insurance Program	States can reduce health, safety and financial risks posed by flooding by encouraging communities to participate in the community rating system.	FEMA	FEMA National Flood Insurance Program (NFIP) Community Rating System (CRS)	2017—2018	Participation in the National Flood Insurance Program (NFIP) is voluntary. It is possible that some communities located in flood zones are not part of the NFIP.
43	43	72.0	Index	2.3.2	2.0	CPE	Community Planning & Engagement Coordination	5.0	MVDE	Management of Volunteers during Emergencies	The ability to coordinate the identification, recruitment, registration, credential verification, training, and engagement of healthcare, medical, and support staff volunteers to support the jurisdiction’s response to incidents of health significance	M266	Percent of the state’s population who live in a county with a Community Emergency Response Teams (CERT)	Citizen Corps is a U.S. Department of Homeland Security initiative coordinated through the Federal Emergency Management Administration (FEMA) to engage, educate, and train volunteers to strengthen personal and community preparedness and response. Launched in 2002, Citizen Corps comprises a network of more than 1,200 county, tribal, state, and territorial councils and 2,400 registered Community Emergency Response Teams (CERT), which have completed specialized training. Citizen Corps has partner programs, which include Fire Corps (through FEMA and the National Volunteer Fire Council) and Volunteers in Police Service (through the International Association of Chiefs of Police).	FEMA & CC CERT	Federal Emergency Management Agency (FEMA), Citizen Corps Community Emergency Response Teams (CERT), and U.S. Census data analyzed by PMO personnel.	2012—2014, 2016	The measure does not evaluate the quality or comprehensiveness of the CERT, including leadership strength, local and governmental agency support, or participation by multiple sectors.
44	44	73.0	Index	2.3.3	2.0	CPE	Community Planning & Engagement Coordination	5.0	MVDE	Management of Volunteers during Emergencies	The ability to coordinate the identification, recruitment, registration, credential verification, training, and engagement of healthcare, medical, and support staff volunteers to support the jurisdiction’s response to incidents of health significance	M346	Number of total Medical Reserve Corps members per 100,000 population in the state	The Medical Reserve Corps (MRC) is a national system of local, community-based teams of volunteers—medical and public health professionals and others without health backgrounds—who are identified, credentialed, trained, and prepared in advance of an emergency. MRC-registered volunteers are vital to providing care to people with serious injuries or illnesses associated with mass casualty events and disease outbreaks.	MRC	Medical Reserve Corps (MRC), MRC Units Database and Census Bureau data analyzed by PMO personnel.	2012—2014, 2016—2018	The measure does not evaluate the quality of the MRC management and current status of licensed/credentialed/trained members, or include other formal and informal systems of registering, credentialing, and managing health and medical volunteers such as ESAR-VHP (Emergency System for the Advance Registration of Volunteer Health Professionals).
45	45	74.0	Index	2.3.4	2.0	CPE	Community Planning & Engagement Coordination	5.0	MVDE	Management of Volunteers during Emergencies	The ability to coordinate the identification, recruitment, registration, credential verification, training, and engagement of healthcare, medical, and support staff volunteers to support the jurisdiction’s response to incidents of health significance	M176	Number of Medical Reserve Corps (MRC) members who are physicians per 100,000 population in the state	The Medical Reserve Corps (MRC) is a national system of local, community-based teams of volunteers—medical and public health professionals and others without health backgrounds—who are identified, credentialed, trained, and prepared in advance of an emergency. MRC-registered physicians are vital to providing care to people with serious injuries or illness associated with mass casualty events and disease outbreaks.	MRC	Medical Reserve Corps (MRC), MRC Units Database and Census Bureau data analyzed by PMO personnel.	2015—2018	The measure does not evaluate the quality of the MRC management and current status of physician members who are licensed, credentialed, and received emergency response training.
46	46	78.0	Index	2.3.8	2.0	CPE	Community Planning & Engagement Coordination	5.0	MVDE	Management of Volunteers during Emergencies	The ability to coordinate the identification, recruitment, registration, credential verification, training, and engagement of healthcare, medical, and support staff volunteers to support the jurisdiction’s response to incidents of health significance	M179	Number of Medical Reserve Corps (MRC) members who are nurses or advanced practice nurses per 100,000 population in the state	The Medical Reserve Corps (MRC) is a national system of local, community-based teams of volunteers—medical and public health professionals and others without health backgrounds—who are identified, credentialed, trained, and prepared in advance of an emergency. MRC-registered nurses are vital to providing emergency care for ill or injured people during a disaster or disease outbreak.	MRC	Medical Reserve Corps (MRC), MRC Units Database and Census Bureau data analyzed by PMO personnel.	2015—2018	The measure does not evaluate the quality of the MRC management and current status of nurses or advanced practice nurses who are licensed, credentialed, and received emergency response training.

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