OBJECTIVE: The efficacy is measured for a public health intervention related to community-based planning for population protection measures (PPMs; ie, shelter-in-place and evacuation). DESIGN: This is a mixed (qualitative and quantitative) prospective study of intervention efficacy, measured in terms of usability related to effectiveness, efficiency, satisfaction, and degree of community engagement. SETTING: Two municipalities in the Commonwealth of Puerto Rico are included. PARTICIPANTS: Community members consisting of individuals; traditional leaders; federal, territorial, and municipal emergency managers; municipal mayors; National Guard; territorial departments of education, health, housing, public works, and transportation; health care; police; Emergency Medical Services; faith-based organizations; nongovernmental organizations (NGOs); and the private sector. INTERVENTION: The intervention included four community convenings: one for risk communication; two for plan-writing; and one tabletop exercise (TTX). This study analyzed data collected from the project work plan; participant rosters; participant surveys; workshop outputs; and focus group interviews. MAIN OUTCOME MEASURES: Efficacy was measured in terms of ISO 9241-11, an international standard for usability that includes effectiveness, efficiency, user satisfaction, and "freedom from risk" among users. Degree of engagement was considered an indicator of "freedom from risk," measurable through workshop attendance. RESULTS: Two separate communities drafted and exercised ~60-page-long population protection plans, each within 14.5 hours. Plan-writing workshops completed 100% of plan objectives and activities. Efficiency rates were nearly the same in both communities. Interviews and surveys indicated high degrees of community satisfaction. Engagement was consistent among community members and variable among governmental officials. CONCLUSIONS: Frontline communities have successfully demonstrated the ability to understand the environmental health hazards in their own community; rapidly write consensus-based plans for PPMs; participate in an objective-based TTX; and perform these activities in a bi-lingual setting. This intervention appears to be efficacious for public use in the rapid development of community-based PPMs.

In addition to catastrophic immediate impacts, communities in the United States remain vulnerable to the long-term effects of severe tropical cyclones and hurricanes caused by storm surge, flooding, and high winds.1 In September 2017, Hurricanes Irma and Maria struck Puerto Rico causing catastrophic damage to the entire commonwealth. Many buildings were damaged or destroyed, including primary care clinics, hospitals, and public health and social services facilities. Essential life-sustaining services such as power, water, and communication were temporarily inoperable, and employment, agriculture, education, and tourism were disrupted.2 In this editorial, we suggest that the Essential Public Health Services (EPHS) framework can be used as a strategic starting point for planning public health system recovery following disasters.

Few regions of the world are at higher risk for environmental disasters than the Pacific Island countries and territories. During 2004 and 2005, the top public health leadership from 19 of 22 Pacific Island countries and territories convened 2 health summits with the goal of developing the world's first comprehensive regional strategy for sustainable disaster risk management as applied to public health emergencies. These summits followed on the objectives of the 1994 Barbados Plan of Action for the Sustainable Development of Small Island Developing States and those of the subsequent Yokohama Strategy and Plan of Action for a Safer World. The outputs of the 2004 and 2005 Pacific Health Summits for Sustainable Disaster Risk Management provide a detailed description of challenges and accomplishments of the Pacific Island health ministries, establish a Pacific plan of action based upon the principles of disaster risk management, and provide a locally derived, evidence-based approach for many climate change adaptation measures related to extreme weather events in the Pacific region. The declaration and outputs from these summits are offered here as a guide for developmental and humanitarian assistance in the region (and for other small-island developing states) and as a means for reducing the risk of adverse health effects resulting from climate change.