All Response Is Local — Most of the Time
We’ve all heard or said it: “All response is local.” But during the 2009-2010 H1N1 pandemic, priorities, strategies and tactics were strongly influenced, and in some cases, mandated by national and state organizations. Even before most communities had cases, they were already mobilizing based on direction and resource allocations from state health departments and the Centers for Disease Control and Prevention. None of this is new in emergency response. Leaning forward is a natural part of an emergency manager’s job. And modifying tactics based on resource availability is one of the Incident Command System’s (ICS) strengths. What’s important is that we recognize how strongly the national and state priorities defined the response and assume that we’ll have the same pressure in future incidents.
I believe that in future public health emergencies, strategies and priorities will again be pushed down to local jurisdictions. In most large-scale events, such as bioterrorism and outbreaks, decisions regarding appropriate therapies, treatment regimens and patient information won’t be developed at the local level. We must be prepared to incorporate this reality into our ICS. At a practical level, this means ensuring that our systems are flexible to incorporate outside direction and that our self-esteem is strong enough to handle it.
Not Everyone Wants Our Help
Many in public health expected that an influenza pandemic would cause an overwhelming demand for vaccine. Although there was a lot of interest when the vaccine was first available, that surge passed quickly. In the end, our influenza vaccination rates were slightly better than we’ve seen in past years. And we have millions of unused doses of vaccine.The lesson here is: Like most other emergencies, there will be people who don’t want our help. There are always a few people who’ll refuse to evacuate in a natural disaster, and in a disease outbreak, there will always be people who won’t want the medications we offer.
This realization must be incorporated into our planning processes. We shouldn’t assume that we’ll need to provide treatment to the whole population. We should research what percentage of our population will accept the treatments we offer and build our response to match that demand.
It's Good To Have Friends
Actually we learned this before the H1N1 pandemic, but it’s worth repeating: Having active, robust relationships with local people and organizations is invaluable. In an emergency, there’s no substitute for picking up the phone and talking with a school nurse or clinic director you already know.
Public Health Can Do Incident Command Well
Before the H1N1 pandemic, many weren’t convinced that public health departments could successfully manage a large-scale public health emergency. Emergency response is a new role for public health, and we didn’t have much experience with ICS (not because we didn’t believe in it, but because we didn’t have many opportunities to practice it). But once H1N1 hit, those doubts were dashed. Public health agencies recognized that they had to respond and that the response had to be big. By any measure, our response was successful.
Kevin Bersell is an emergency preparedness specialist with Public Health Region 2 of the New Mexico Department of Health. His opinions are solely his and do not represent the views of the New Mexico Department of Health.
