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Kristin Murphy, Deseret News
A participant clears debris during Salt Lake County's combined emergency training exercise during the Great Utah ShakeOut at the Welby Pit in South Jordan on Thursday, April 18, 2019. The exercise was held with the Utah Department of Transportation, Salt Lake County Emergency Services, the Utah Division of Emergency Management, the Army Reserves and others.

SALT LAKE CITY — Outbreaks, disaster and violence are realistic fears facing America. But the country is preparing for them too slowly, with only incremental improvements, according to a new report funded by the Robert Wood Johnson Foundation. A dozen states, however, including Utah, are beating national averages.

For the sixth consecutive year, the United States has shown "modest improvement" in its preparations to face hazards, according to Glen Mays, University of Kentucky professor of health policy and leader of the team that looked at state and national preparedness for the report, released Tuesday. It's a good news/bad news story that finds "uneven progress across the country, leaving some communities vulnerable," while others do quite well.

Terrorism, emerging infectious diseases and extreme weather are among the dangers included in the National Health Security Preparedness Index. The 2019 index rates the United States' preparedness at 6.7 on a scale of 10 — "a 3.1 percent improvement over the last year and an 11.7 percent improvement since the index began in 2013," the report says.

Still, it would take at least 10 years at the current rate of improvement to be ready to face all the potential challenges and achieve at least a 9 on the 10-point scale, said the report.

That's simply too long, Mays told the Deseret News. "We know we are facing a growing constellation of health threats because of a variety of things: climate change, infectious disease, risk of terrorism and community violence. All of those are uncertain events that can adversely affect the health status of lots of people."

If the nation performed like the best states, with scores that range from 7.2 to 7.4 of 10, it would take fewer than six years to be mostly prepared to meet risks, he said.

" We know we are facing a growing constellation of health threats because of a variety of things: climate change, infectious disease, risk of terrorism and community violence. All of those are uncertain events that can adversely affect the health status of lots of people. "
Glen Mays, University of Kentucky professor of health policy

Utah was one of 12 states that did better than the national average, scoring 7.2 of 10. Massachusetts topped the list at 7.4. "Conversely, 17 states had health security levels that fell significantly below the national average," the report found.

"Utah shows perhaps the most improvement in the health care delivery domain of any over this period," said Mays, who noted "steady and significant improvements in health care delivery," progressive health care systems and "aggressive use" of health information technologies like telemedicine.

The National Health Security Preparedness Index was created by the Centers for Disease Control and Prevention in 2013. University of Kentucky analysts rate preparedness using 129 measures, including the condition of a state's bridges, whether public schools have hazard plans and supplies, the number of health care providers that would be available in a crisis, electronic medical records and surveillance, air quality and water quality testing, vaccination rates and how well nursing homes are staffed, among others.

Kristin Murphy, Deseret News
Siaosi Tupouata, a Salt Lake County district worker, checks for a pulse on a mannequin during debris management training during the Great Utah ShakeOut at the Welby Pit in South Jordan, Utah, on Thursday, April 18, 2019.

"States and communities have a responsibility to be prepared to respond to health emergencies and to recover quickly from them," Dr. Nany Messonnier, acting director of the CDC's Center for Preparedness and Response, said in a written statement. "Having a comprehensive index helps states see where cross-sector investments and cooperation are paying off and where more effort is needed."

Strengths and weaknesses

The nation overall scored highest for "incident and information management," at 8.7. That includes being able to send people, money, supplies and information where needed in an emergency. The country also scored well on "health security surveillance," which includes being able to monitor health threats and check the spread of health hazards, at 8.3 out of 10.

The lowest rating was for health care delivery, a mere 4.9 out of 10. In many communities, a crisis would overwhelm available health care resources. That's a factor that drags down scores for much of the country.

Utah bested national numbers in all but one category, "countermeasure management," which looks at how well the state can store and then distribute needed supplies in crisis. Utah received 5.3, compared to the nation's 6.5.

" Once you get outside the Wasatch Front, we have very sparse, frontier and remote communities that often do not have depth in either space or staff. "
Kevin McCulley, preparedness program manager for the Utah Department of Health

Kevin McCulley, preparedness program manager for the Utah Department of Health, said the report underestimates Utah in that category. "We do have a very well developed medical countermeasures initiative" with concrete distribution plans and ability to execute on those plans within communities, he said.

The CDC supports a nationwide Public Health Emergency Preparedness Program, with funds flowing to local health departments, tribal nations and other preparedness agencies. In Utah, those include the health department's preparedness bureau, the epidemiology bureau and the state lab, McCulley said.

Federal funding and support also reach states in other efforts, including the Healthcare Preparedness Program. And partnerships unite private-sector health care systems, long-term care, hospitals, home health and emergency medical services, among others. The state can deploy people, equipment and supplies and bring public and private entities together in strong coalitions to respond to emergency events, he said.

But like all states, Utah faces challenges. One of Utah's biggest is largely geographic, McCulley said. "Once you get outside the Wasatch Front, we have very sparse, frontier and remote communities that often do not have depth in either space or staff."

Heather Tuttle

Particularly challenging in an earthquake would be the number of hospital beds available to the injured, depending on where it occurred. About three-fourths of the hospital beds in Utah are "within a stone's throw" of the earthquake fault line — and Huntsman Cancer Center, the University of Utah Hospital and Primary Children's Hospital all sit on it. Utah could be short 8,000 beds in the event of a catastrophic earthquake, he said.

"It would be a heavy lift to engage and move those folks to nonimpacted areas," said McCulley. "So we continue to chip away at that gap ... and every day is one more day we have a chance to figure that out."

Similarly, most of the health care infrastructure in the state is concentrated between Ogden and Provo. So if a quake hit the area, people might be moved out to more rural areas, but providing services there could be difficult, McCulley said. Utah has already placed equipment and other assets that might be needed for easy deployment and worked to achieve "operational readiness."

Doing your part

Joe Dougherty, Utah Department of Public Safety spokesman, said Utah's better prepared than even its relatively high rating would suggest. But family and individual preparations are crucial. He encourages people to educate themselves and each other, plan to avoid spreading disease and develop skills to be resilient in a natural disaster.

"We fortunately live in a state of people who want to be self-sufficient," he said. "People have to make decisions on whether they will help or need help in an extreme event. We like to help them lean toward helping others."

Utah has many education efforts and opportunities to get involved, including community emergency response team training on how to respond appropriately in a major emergency. That's vital knowledge, because in a disaster of any kind, those nearby are going to have the first impact and the first response is unlikely to come from a firefighter or other professional, he said.

Experts say repeatedly that those who recover best are folks with a strong sense of community, who know their neighbors and look out for or check up on people who might be vulnerable in an event.

" Now we have a system in place that could accommodate whatever's next, and we don't know what that next is. "
Kevin McCulley, preparedness program manager for the Utah Department of Health

If practice makes perfect, Utah plans to be in decent shape. Dougherty said government agencies and community groups practice a lot for how to handle crisis and encourage families to practice, too. Local responders practice how they'd deploy in different scenarios. Law enforcement and Utah Transit Authority practice annually what to do in case of a bomb on a train. Thousands of Utahns take part in the Great Shakeout practice for the earthquake thought to loom somewhere in the state's future. Designated managers in state agencies practice what to do and how to direct others.

When the Ebola virus appeared in the United States in 2015, Utah didn't see any cases. But officials took the opportunity to figure out how to handle it, building a biocontainment system for future danger.

"Now we have a system in place that could accommodate whatever's next, and we don't know what that next is," McCulley said. "We use the smaller events as an opprotunity to conduct exercises to really put ourselves in that scenario of what it might be like during a very bad day."

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That includes working with those who experienced catastrophic events, from a hospital CEO in Las Vegas who shared how they handled the mass shooting at a concert to lessons from the west Texas town where a fertilizer plant exploded.

"We believe collectively as a nation this is not proprietary information," said McCulley. "We use the opportunity to learn from others who have been through it."

Those who want to get started on emergency planning should check out the resources provided online by the Federal Emergency Management Agency and also the BeReadyUtah site, he said.