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Fixing Emergency Management’s Relationship With Public Health

The pandemic revealed that all is not well.

One of the things that the COVID-19 pandemic revealed is that many communities should take another look at their emergency management and public health relationships. Yes, perhaps in some areas of the nation everyone got along hunky-dory, but that was not the case everywhere.

See my September International Association of Emergency Managers (IAEM) Disaster Zone column:

Emergency Management’s Relationship with Public Health

If there is one thing that the COVID 19 pandemic exposed, it was the working relationship between emergency management and public health. In many cases, it was the lack of a working relationship, especially when it comes to the dance that has to happen when the major disaster is a public health one and not a hurricane, tornado, flood, or wildfire.

The reality is that public health is usually a supporting agency in most disasters. Environmental health especially is thrust to the forefront and where the more typical interface with emergency management occurs in the disaster response and recovery. Limited numbers of public health personnel are engaged in these natural disasters and the center of activity is at the jurisdiction’s Emergency Operations Center (EOC).

The pandemic changed all that for a number of reasons. If you follow the normal Incident Command System (ICS) process of having the agency with the most skin in the game be the Incident Commander (IC) then public health should have been in almost total control, being advised and supported by other responding agencies. I expect that somewhere that did happen. In my limited experience of having worked on three pandemic After Action Reports (AAR) for local jurisdictions, and my conversations with many more emergency managers and public health representatives—that was not the norm.

Here are some very broad-brush statements that may ring true for you, or they may not, based on your own personal experience.

One emergency manager told me just today that public health is not used to “responding” and don’t consider themselves responders. The reason they work in public health is not to “respond” to events, but to contribute on the other day-to-day work of public health. I certainly observed multiple settings where public health had to be cajoled into sending a representative to the EOC to provide a liaison between emergency management and public health. In one case, a public health liaison stated the reason they were there was to quelch innumerable requests for information coming from the EOC which were often duplicative and coming from different branches or divisions within the EOC.

Another point of contention that existed was over the release of COVID case information. Emergency managers might describe the process as similar to “pulling teeth” in trying to extract information that they considered valuable to having situational awareness on the progress of the disease in their community. On the other side of the table you had public health thinking that their mission was to protect the personal information of individuals and perhaps businesses or portions of the community that had outbreaks of the disease. Hospitals were also part of this information “tug of war” with each side trying to get the other to cave to their demands or perspectives.

Then there were the Personal Protective Equipment (PPE) challenges that emerged early in the pandemic. While this should have been a federal Health and Human Services (HHS) mission, they were quickly overwhelmed when the National Strategic Stockpile (NSS) proved inadequate to the response that was needed. The Federal Emergency Management Agency (FEMA) was thrust into a leadership role, and they scooped up state and local emergency management organizations to be the logisticians to respond on the distribution side of the equation.

Once again, this became a point of contention between public health and emergency management early in the pandemic. Which organization was going to manage the requests and distribution of PPE? In general, this appears to have fallen eventually to be a major role for emergency management. Some public health agencies were happy to wash their hands of the entire process (likely they used sanitizer) and let emergency management bear the workload.

The above are not all the bones of contention that people found. However, they are illustrative of the work that needs to be done now to reconstruct what that relationship should be between public health and emergency management. This will not just happen organically. It is up to leaders on both sides of the equation to reach out to their counterparts and go have a cup of coffee and talk about their mutual experiences and how the rough spots can be smoothed over.

If a constructive dialog can be established then each leader needs to bring their organization along towards a reconciliation and building a new relationship that respects the other’s role and seeks to find better ways of planning, training and eventually responding to a disease outbreak. You never know, it may just be a recurrence of another, even more virulent version of COVID that forces us back to an “all hands-on deck” response.

Eric Holdeman is a contributing writer for Emergency Management magazine and is the former director of the King County, Wash., Office of Emergency Management.