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Eight years after the anthrax attacks of October 2001, the United States lacks a set of clear and defensible measurement tools for assessing the nation's public health emergency preparedness. Countermeasure delivery — the ability to dispense life-saving medications and other medical supplies to large populations, often on very short time lines — is one area in which considerable progress has been made. Even in this area, measurement tools have focused on assessing the existence of personnel, plans, and equipment, not on whether the health system can put these resources into practice in emergency conditions.

The United States Department of Health and Human Services (HHS) asked RAND to assist the Centers for Disease Control and Prevention, Division of the Strategic National Stockpile (CDC/DSNS) in developing tools for assessing the readiness of state and local health departments to carry out countermeasure-delivery operations. This report describes those tools and provides an approach for measuring development for public health emergency preparedness that can be applied more broadly. The operations manuals that are discussed provide guidance on assessing a jurisdiction's countermeasure-delivery capabilities. Users can download and print spreadsheet-based data-reporting tools that will facilitate calculation of required metrics and collection of key data. The manuals and the data-reporting tools are available on the CDC web site at:

The report also describes how the assessments were developed and tested. The assessments are based on a series of small-scale drills, each focusing on a specific building-block capability (e.g., call-down of staff, setup of Point of Dispensing, and generating a pick list) and on specific metrics to be collected in each drill. The building blocks were identified using a generalized model of Public Health Preparedness and Response and detailed analysis of the processes involved in countermeasure delivery. These tools were field-tested by several state and local health departments. The report concludes by providing concrete next steps for refining and implementing the assessments, and discussing lessons learned from this assessment development process that might apply to other efforts to develop assessments of public health preparedness.

This report will be of interest to state and local health departments responsible for planning and exercising countermeasure delivery, as well as to other agencies charged with supporting countermeasure-delivery operations and to those interested in broader exercise and measurement issues.

Table of Contents

  • Chapter One


  • Chapter Two

    Determining What to Assess

  • Chapter Three

    Overview of Operations Manuals

  • Chapter Four

    Field Testing: Methods and Results

  • Chapter Five

    Implications and Next Steps

  • Appendix A

    Analysis Used to Select SNS Elements Around Which to Build Assessments

  • Appendix B

    Questions for Eliciting Feedback on Field Tests of SNS Capability Assessments

This work was sponsored by the U.S. Department of Health and Human Services Office of the Assistant Secretary for Preparedness and Response. The research was conducted in RAND Health, a division of the RAND Corporation.

This report is part of the RAND Corporation Technical report series. RAND technical reports may include research findings on a specific topic that is limited in scope or intended for a narrow audience; present discussions of the methodology employed in research; provide literature reviews, survey instruments, modeling exercises, guidelines for practitioners and research professionals, and supporting documentation; or deliver preliminary findings. All RAND reports undergo rigorous peer review to ensure that they meet high standards for research quality and objectivity.

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