The public health community is charged with organizing the preparedness and response of the health and medical services in the United States. After years of decay, public health is evolving in its leadership role for domestic disaster organizational response. For healthcare executives to engage in domestic preparedness, it is essential to develop solid relationships with local and regional public health officials, local and area emergency management agencies (EMAs), and local responder organizations.
Before establishing the Department of Homeland Security (DHS), the approach to disaster management for terrorist events was divided into two discrete functions: crisis management and consequence management. Crisis management is a security/law enforcement function focused on identifying the perpetrators of an event, collecting and protecting evidence and the chain of custody, and ensuring justice for those involved. At the federal level, crisis management currently falls under the jurisdiction of the Federal Bureau of Investigation. Consequence management refers to addressing the consequences of a disaster and is currently under the jurisdiction of the Federal Emergency Management Agency (FEMA). Under DHS, federal guidelines will merge the elements of crisis and consequence management into a unified command structure.
Planning and readiness assessment establishes strategic leadership, direction, assessment, and coordination of activities (including the Strategic National Stockpile response) to ensure statewide readiness; interagency collaboration; and local and regional preparedness (both intrastate and interstate) for bioterrorism, other outbreaks of infectious disease, and other public health threats and emergencies.
Surveillance and epidemiology capacity focuses on enabling state and local health departments to enhance, design, and/or develop systems for rapid detection of unusual outbreaks of illness that may be the result of bioterrorism, other outbreaks of infectious disease, and other public health threats and emergencies.
Laboratory capacity—biologic agents develops the capability and capacity at all state and major city/county public health laboratories to conduct rapid and accurate diagnostic and reference testing for select biologic agents likely to be used in a terrorist attack.
Health Alert Network (HAN) enables state and local public health agencies to link public health and private partners around the clock through Internet capability. The program provides for rapid dissemination of public health advisories and ensures secure electronic data exchange.
Communication of health risks and dissemination of health information ensures timely information dissemination to citizens during a bioterrorist attack, other outbreak of infectious disease, or other public health threat or emergency.
Education and training assesses the training needs of key public health professionals, infectious-disease specialists, emergency department personnel, and other healthcare providers related to preparedness for and response to bioterrorism, other outbreaks of infectious disease, and other public health threats and emergencies.
Source: Centers for Disease Control and Prevention (CDC). 2003. “Continuation Guidance for Cooperative Agreement on Public Health Preparedness and Response for Bioterrorism—Budget Year Four.” [Online article; retrieved 8/03.] http://www.bt.cdc.gov/planning/continuationguidance/pdf/guidance_intro.pdf.
The Department of Homeland Security, with embedded elements of DHHS, provides a federal structure and system for coordination and oversight of resources that are essential for assisting areas affected by disaster. FEMA’s ten geographical regions work closely with state and local EMAs, ensuring consistency of services to all areas and citizens.
At the state level, EMAs assume a multitude of different organizational structures. The emergency management community consists of professional emergency managers, emergency operations center personnel, 911 telecommunicators, and first responders—that is, fire departments, emergency medical services, medical transport, and law enforcement. When activated for disasters, the EMA expands to coordinate all primary agencies with designated roles in response to a declared disaster. These may vary in number and are dependent on the size and extent of the disaster. However, once a governor has declared a state of emergency, the EMA becomes the coordinating hub for activation of the local and/or state emergency operations plan. Mirroring the Federal Response Plan, representatives from each of the emergency support functions coordinate services from the EMA.
Emergency management uses an “all hazards” framework based on the premise that most incidents will draw on similar resources and will apply a similar structure in managing the response to an incident, as opposed to identifying a different structural response for different types of emergencies. In developing an all-hazards plan, unique aspects of incidents are addressed in annexes to existing plans rather than in a separate plan produced for each event.
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