The effects of funding change and reorganization on patterns of emergency response in a local health agency.

Indicators for Stress Adaptation Analytics (ISAAC) is a protocol to measure the emergency response behavior of organizations within local public health systems. We used ISAAC measurements to analyze how funding and structural changes may have affected the emergency response capacity of a local health agency. We developed ISAAC profiles for an agency's consecutive fiscal years 2013 and 2014, during which funding cuts and organizational restructuring had occurred. ISAAC uses descriptive and categorical response data to obtain a function stress score and a weighted contribution score to the agency's total response. In the absence of an emergency, we simulated one by assuming that each function was stressed at an equal rate for each of the two years and then we compared the differences between the two years. The simulations revealed that seemingly minor personnel or budget changes in health departments can mask considerable variation in change at the internal function level.