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IIIIIIIII Alternative li I I Regional Public <br /> Washington State—went from 39 local health National Capital Region (NCR - D.C.) —effort to <br /> jurisdictions (LHJ) to 5 regional departments with organize for future preparedness <br /> goal of reducing antecedents of chronic disease • Historic inconsistency/variation in what constitutes <br /> ■ Community Transformation Grant (CTG) the NCR <br /> supported training and technical assistance to • Coordination groups established/rebooted (Health <br /> advance policy and system changes Operations Council, Bioterrorism Emergency <br /> ■ Establishing timely communication channels Preparedness Subcommittee) improved regular <br /> builds trust communication <br /> ■ Pre-existing LHJ governance ad inadequate • Essence Regional Surveillance Systems established <br /> time to understand local needs and build trust new regional data system <br /> slowed decision-making • Some progress, but continued tension and lack of <br /> clarity on who's in charge <br /> Massachusetts —went from 35148 regional Japan —Two-staged transformation from 460 <br /> • NACCHO funding helped establish the hokenjo during Covid-19 <br /> Advanced Practice Center for Emergency ■ Initially inflexible triage protocols and narrowly <br /> Preparedness—) Mutual Aid Agreements and held controls overwhelmed hospitals and honkejo <br /> multidisciplinary exercises staff <br /> • Regions are responsible for emergency ■ Later risk stratification, sharing gateway functions <br /> notification (Local Emergency Notification relieved bottlenecks and equalized hospital <br /> Systems [LENS]), alerts and mobilization capacity <br /> • Regional 4B Emergency Operations Plan (REOP) ■ Persistent need for investment in data and public <br /> health infrastructure <br /> ............................................ <br /> ............................................ <br />