Two primary funding efforts by the federal government have been instituted since 9/11 that have significantly shifted the focus of planning and preparedness in healthcare facilities to ensure improved response to bioterrorism or other disease-based mass-casualty events. These programs are described below.
The Department of Health and Human Services (DHHS) Health Resources and Services Administration (HRSA) began in early 2002 to provide monies for public health departments to develop programs to upgrade the preparedness of the nation’s hospitals and for collaborating entities to respond to bioterrorism and deal with nonterrorist epidemics of rare diseases. The program focuses on identifying and implementing bioterrorism preparedness plans and protocols for hospitals and other participating healthcare entities (HRSA 2003). Grant awards were designed for the development and implementation of regional plans to improve the capacity of hospitals and their emergency departments, outpatient centers, EMS systems, and other collaborating healthcare entities to respond to incidents requiring mass immunization, treatment, isolation, and quarantine in the aftermath of bioterrorism or other outbreaks of infectious disease.
The Centers for Disease Control and Prevention (CDC) Bioterrorism Cooperative Agreement is a grant program designed to upgrade state and local public health jurisdictions’ preparedness for and response to bioterrorism, other outbreaks of infectious disease, and other public health threats and emergencies (CDC 2003). DHHS requires each state that receives funds to develop a statewide plan identifying how it will respond to a bioterrorism event and other outbreaks of infectious disease and also how it will strengthen core public health capacities in all relevant areas. The program initially identified the following six focus areas for improvement:
1. Planning and readiness
2. Surveillance and epidemiology
3. Biological-laboratory capacity
4. Communications and information technology
5. Health information dissemination
6. Education and training
Stafford Act. The 1993 Robert T.Stafford Disaster Relief and Emergency Assistance Act, as amended (Public Law 93–288), provides federal assistance to states to manage the consequences of domestic disasters by expediting the rendering of aid, assistance, and emergency services and the reconstruction and rehabilitation of devastated areas.
Weapons of Mass Destruction (WMD) Act of 1996. Title XIV of the Defense Against Weapons of Mass Destruction (Public Law 104–201), which became known as the WMD Act of 1996, provided funding for equipment and training for local first responders for the effective management of incidents involving WMD. The Department of Defense was charged with initiating the Domestic Preparedness Program in the nation’s 120 largest cities for training first responders, including healthcare facility personnel.
Bioterrorism Act. The Public Health Security and Bioterrorism Preparedness and Response Act of 2002, commonly called the Bioterrorism Act (Public Law 107–108), was designed to improve the ability of the United States to prevent, prepare for, and respond to bioterrorism and other public health emergencies. This law established the Office of Public Health Preparedness under the Department of Health and Human Services.
Homeland Security Act of 2002. The Department of Homeland Security (DHS) was created under the Homeland Security Act (Public Law 107–296). Many of the functions of different federal agencies were consolidated under a single department. The bill
§transferred the National Pharmaceutical Stockpile, later renamed the Strategic National Stockpile, to DHS, requiring DHS to consult with the Centers for Disease Control and Prevention (CDC) on administration of the program;
§transferred the Office of Emergency Response, which oversees the National Disaster Medical System, from the Department of Health and Human Services to DHS; and
§required CDC to establish the Bioterrorism Preparedness and Response Division.
Homeland Security Presidential Directives (HSPDs). Presidential directives designed to promulgate presidential decisions on homeland security matters are designated Homeland Security Presidential Directives.
§HSPD-5: Management of Domestic Incidents
§HSPD-6: Integration and Use of Screening Information
§HSPD-7: Critical Infrastructure Identification, Prioritization, and Protection
§HSPD-8: National Preparedness
CDC funding, through the state public health departments to the local community, is projected to continue for a number of years to ensure continuity of programs in public health. The regional or local coordinator is responsible for working with healthcare organizations to improve preparedness and response capability in each of the focus areas
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