title: Using social network analysis to understand Missouri's system of public health emergency planners.
abstract: OBJECTIVE
  Effective response to large-scale public health threats requires well-coordinated efforts among individuals and agencies. While guidance is available to help states put emergency planning programs into place, little has been done to evaluate the human infrastructure that facilitates successful implementation of these programs. This study examined the human infrastructure of the Missouri public health emergency planning system in 2006.
  
  
  METHODS
  The Center for Emergency Response and Terrorism (CERT) at the Missouri Department of Health and Senior Services has responsibility for planning, guiding, and funding statewide emergency response activities. Thirty-two public health emergency planners working primarily in county health departments contract with CERT to support statewide preparedness. We surveyed the planners to determine whom they communicate with, work with, seek expertise from, and exchange guidance with regarding emergency preparedness in Missouri.
  
  
  RESULTS
  Most planners communicated regularly with planners in their region but seldom with planners outside their region. Planners also reported working with an average of 12 local entities (e.g., emergency management, hospitals/ clinics). Planners identified the following leaders in Missouri's public health emergency preparedness system: local public health emergency planners, state epidemiologists, the state vaccine and grant coordinator, regional public health emergency planners, State Emergency Management Agency area coordinators, the state Strategic National Stockpile coordinator, and Federal Bureau of Investigation Weapons of Mass Destruction coordinators. Generally, planners listed few federal-level or private-sector individuals in their emergency preparedness networks.
  
  
  CONCLUSIONS
  While Missouri public health emergency planners maintain large and varied emergency preparedness networks, there are opportunities for strengthening existing ties and seeking additional connections.
authors.affiliation: Saint Louis University School of Public Health, St. Louis, MO, USA. jenine.harris@dhss.mo.gov
authors.forename: Jenine K
authors.initials: JK
authors.lastname: Harris
authors.forename: Bruce
authors.initials: B
authors.lastname: Clements
mesh_terms: D003142:Communication; D004189:Disaster Planning / Q000458:organization & administration*; D006077:Government Agencies / Q000458:organization & administration; D006801:Humans; D007373:Interinstitutional Relations; D008923:Missouri; D011635:Public Health Administration; D023481:Terrorism