Planning ahead for a public health emergency is a daunting task. From the H1N1 flu to West Nile virus, or even a possible biohazard, each state is mandated to have a plan in place.

Every state must inform its citizens when the public’s health is at risk. In Georgia, the Department of Public Health has that task. And that’s where things get really daunting.

Handling hundreds, if not thousands, of callers simultaneously in an emergency is no easy assignment even for a state health department. One of the specialized agencies that does vital work in this field is the Georgia Poison Center.

“I call it the SUPHER response plan,” says Dr. Robert Geller, medical director of the Poison Center, about the state’s response to public health crises.

The SU in the acronym represents “surge,” while the PH refers to “public health.” And finally, Geller explains, “the ER is all about emergencies.”

Georgia Poison Center has operated the 24-hour poison emergency information service for more than 40 years. It receives more than 100,000 calls per year, providing assistance and expertise in the medical diagnosis and management of human and animal poisonings.

The new SUPHER system will respond to four basic concerns that callers are likely be asking about.

People want to know where the danger is, what it is, what to do if they are already suffering the effects of it, and what to do if they’ve probably been exposed but don’t feel any effects. That’s how Geller explained what is needed for handling immediate telephone surges in the event of a disease outbreak or even a disaster in Georgia.

“Let’s just say it’s a new, novel strategy for providing access to disease information for the public,” Geller said. “People will have general concerns, and the SUPHER network can handle up to 480 calls simultaneously and with [clinically] credible information.”

“We’re hoping 80 percent of the people calling about a pandemic may be helped with automation and continuous updates,” said Geller, describing the system recently to a large group of hospital and public health personnel.

It has been tested with Clayton County’s Board of Health.  SUPHER would only be used in a serious emergency — something requiring that critical information be disseminated to the general public quickly and efficiently.

The Georgia Poison Center leads  the development and deployment of SUPHER on a statewide basis.  All the while, the Georgia Poison Center will retain its identity as a helpline for the public.

SUPHER’s purpose is to help mitigate a telephone surge.

An automated response system would handle as many callers as possible, providing uniform answers to the most likely questions.

“Ours is a mutual aid model,” Geller stated. The system supports public health district offices statewide by answering their phone lines after normal working hours. Callers receive accurate information from an accredited source with answers to common questions that have been prepared ahead of time. This provides the public with consistent information, helping to deter the spread of rumors.

According to the CDC, what people basically want to know during an emergency is how to protect themselves. It’s vitally important that the information the public receives is easy to understand, that different official sources don’t give conflicting information, and that the information is available as rapidly as possible.

Emergency and risk management experts suggest that what they don’t want in an emergency is public officials “shooting from the hip” with their responses.

“Managing such calls in an emergency situation is no easy task when people have different reactions, are in various locations, speak many languages and have a variety of needs,” said Eric Jens, risk communicator for the Department of Public Health. “Geller and his staff have taken all this and more into consideration with their ongoing development of SUPHER.”

Using local assets when possible

SUPHER is not an ordinary call center. Calls may be answered by up to 100 agents, and the number on duty can expand or contract as call volume fluctuates. While SUPHER is based in Atlanta, personnel can be added to the network from any location that has Internet access.

Normally, a call in Georgia via SUPHER is automatically routed to the caller’s county health department. There, a county health department agent may answer the phone, or if staffing is limited, the caller gets a pre-recorded message specific to the county.

If the county health department is occupied with other callers, or if it’s after normal office hours, calls will be directed to the first available agent on the SUPHER network. The agent gets a message indicating the caller’s location and can answer appropriately.

When SUPHER was being designed, planners estimated an average call length of six minutes, which would allow the system to process 4,800 calls per hour, most being handled by an integrated voice response unit.

Knowing that call centers are at the heart of communication in a disaster, the Georgia Department of Public Health looked to GPC for its years of call-line expertise. Trained medical personnel (usually nurses and pharmacists) answer phones and save lives 24 hours a day, seven days a week in many centers.

Currently, the CDC is looking at America’s poison centers for their capabilities during a potential flu pandemic. The CDC’s Nurse Triage Line Project is investigating a collaborative effort with the Association of State and Territorial Health Officials and the National Association of County and City Health Officials.

This project could improve patient access to antiviral medications during an influenza pandemic. In turn, the burden on health care resources would be lowered, while the needs of the uninsured and underinsured would be met when (and if) antiviral drugs might be required.

The beauty of the system in Georgia is that “simultaneous updates can be made to SUPHER, based on the magnitude of the event,” explained Geller.

It might be a disease outbreak in Macon, a chemical leak near Atlanta or even a hurricane hitting Savannah. Whatever the problem, the SUPHER response system can help.

Judi Kanne, a registered nurse and freelance writer, combines her nursing and journalism backgrounds to write about public health. She lives in Atlanta.