Table 3. Shared knowledge and lessons learned from Washington County CASPER exercise by category
Category Shared Knowledge/Lessons Learned
Rural areas Prioritize rural areas over urban areas for ground-truthing if time is limited. Allow more time (3-4 times as long) to ground- truth rural versus urban areas.
Rural blocks often include homes without public roads and a mix of houses and barns. Use ground-truthing insights to produce detailed maps of these areas.
Plan for use of an appropriate vehicle in challenging terrain which may involve using a personal vehicle if the local government entity does not have fleet vehicles with four wheel drive.
Plan for teams in rural areas to have no cell phone signals, and thus no access to the command center, by providing a thorough safety overview during the training and maps with sufficient detail on finding and replacing homes.
Consider that teams with rural blocks may need more time to complete surveys and this may affect check in times and exercise time depending on the number of rural blocks.
Send geographically competent volunteers to rural areas (volunteers who have been in the area or live in rural areas).
Remember many people keep their cattle without fences in rural areas. If the cattle have calves, they can become territorial.
Discuss cultural considerations and how to approach rural residents safely and respectfully during your training. Roleplay proper etiquette for volunteers to mimic in your local rural settings.
Cultural competency Recruit volunteers who are bilingual and bicultural.
Pre-plan for bilingual teams – send them to clusters with the highest percentage of households that speak their language of proficiency.
Train volunteers to identify themselves as from public health, not government.
If a volunteer wishes to survey their home area, which was selected as a cluster, support that effort.
Don’t send teams of two males as this can be viewed as threatening to some community members.
Send a notification letter to pre-selected households in English and the second most common language.
Offer all households preparedness materials in English and the second most common language.
Test questionnaire translation with native speakers for cultural competence and phrasing issues.
Test language services in advance of event, especially if CASPER will be held on the weekend and service is usually used during weekdays only.
Epidemiology-led Engage your epidemiologists in leading your CASPER exercise.
A previous CASPER event in Washington County, led by non- epidemiologists, resulted in volunteers misunderstanding the critical nature of sampling methodology and invalidated the
results of the exercise.
When possible, recruit local and state epidemiologists and epidemiology interns from local schools of public health to aid in planning and coordinating the event.
Utilize the understanding of local systems and culture your epidemiologists provide when planning a CASPER.
Safety Involve your local law enforcement extensively in CASPER planning. Ask about blocks with known safety issues and safety considerations for volunteers. Have your local law enforcement inform on-duty personnel about the days and times of the event. If possible, have local law enforcement give part of the Just-In-Time-Training (JITT).
Law enforcement informed us many dwellings now have video and sound devices that can detect and display your presence and voice before you are at the door, so it’s critical to be professional from the moment your volunteers exit the vehicles.
The week prior to the event, send a letter to all randomly- selected household informing them that teams of volunteers will be in their neighborhood asking about emergency preparedness. Do not include the date and time of exercise.
For gated or multi-dwelling units, make in-person contact with the community manager to inform them of the survey. Have a follow-up call with the managers to answer any questions or concerns.
Review your local laws with your law enforcement with regard to trespassing.
Consider homes marked with a “no trespassing” sign as inaccessible.
Approach residence with “no solicitation” signs but have volunteers acknowledge the sign, identify themselves and ask permission to explain the questionnaire.
Wear bright safety vests with reflective coatings at all times.
Look for indications of pets you may not be able to see before you enter a gated area outside of a house, such as a food bowl or water bowl sitting in the yard.
If a person appears to be considerably compromised from drugs/alcohol upon answering the door, thank them for answering the door and politely leave.
Sampling approach Use the most recent tax assessment data to identify residential addresses for all census blocks.
Oversample clusters – increase the number of census blocks in the first stage and number of households in second stage.
Ground-truth all addresses within two months of the CASPER to identify and plan for known challenges (e.g., gated
communities, abandoned/missing residence, no trespassing signs, apartment buildings, unrestrained animals, etc.).
Replacement strategy Go to a household once and replace a household that didn’t answer or refused the survey by moving one house directly to the right up to three times.
Volunteer recruitment Start recruiting volunteers several months prior to the event and stay in regular contact with volunteers to confirm
participation.
Leverage existing partnerships to increase recruitment of volunteers.
Over-recruit volunteers – anticipate that 30% of confirmed volunteers may withdraw prior to the event or fail to appear the day of the event.
Training Provide a 3-4 hour JITT training the morning of the field exercise followed by lunch.
Incorporate multiple adult learning styles into the training (including: roleplaying, skits, skills practice).
Directly discuss and roleplay what to do with anti-government sentiments particularly for rural areas.
Emphasize the details of the replacement strategy and allow volunteers time to practice different replacement scenarios (e.g., apartment units with multiple floors) providing guidance and positive feedback.
Materials Create binders for all teams that are reviewed as part of the JITT training and include at least the following: detailed routes and maps prepared with vetted addresses, interviewing tips, logistic and safety information, educational materials and detailed replacement information.
Included prominent “Public Health” shield stickers on the back of the clipboards so when residents look through their doors’ peepholes, they see the public health shield.
Organizational structure Use Incident Command Structure during the event.
Have several in-house interpreters for common language(s) in your area, even if you are using a language service, to ensure access to timely interpretation.
Assign at least two team member to answer volunteer calls during the event related to replacement strategy, mapping and technical issues.
Check surveys for completeness when teams return and ask about any missing information – recall will be much better right after the interviews versus days or weeks later.
Survey volunteers directly after the event or hold a hot wash to gain insight into how the exercise went.
Cost Consider staff time as a part of your cost when planning for a CASPER exercise.
CASPERs don’t have a high material cost but are expensive in staff time. We estimated our CASPER cost at $27 000.
