But the various funding streams used by these programs are slowly being cut — specifically the Public Health Emergency Preparedness (PHEP) and Cities Readiness Initiative grants released by the federal government to support state and local health departments. As they decrease, health departments are coping as best they can. But according to the National Association of County and City Health Officials, some 55 percent of the nation’s local health departments reduced or eliminated at least one program between July 2010 and June 2011, and 20 percent of these programs focused on emergency preparedness. Also because of the budget cuts, 53 percent of all health departments experienced some sort of negative job impact (e.g., employee furloughs or reduced staff working hours) that cuts into their overall state of readiness.
So what happens next? The aforementioned funding allows for dedicated personnel, equipment, National Incident Management System (NIMS) and Incident Command System (ICS) classes, various training and even participation in exercises. As that funding decreases, who will take over the various initiatives implemented by these programs if and when they go away? Does the emergency management discipline have enough knowledge to seamlessly pick up the critical public health preparedness pieces?
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Understanding Public Health Preparedness The list of public health's accomplishments includes: -- development of all-hazards preparedness plans; -- implementing NIMS; -- administering workforce training in emergency response; -- creating public education campaigns; -- implementing new or improved communication systems; -- completion of various public health emergency exercises; -- collaboration with nonprofit and faith-based organizations on emergency response planning; -- enhancement of disease surveillance systems; -- hiring new staff to work on preparedness planning; -- implementation or improvement of syndromic surveillance systems; -- development of a medical surge capacity plan; -- improved the physical security of their facilities; -- implementing a Medical Reserve Corps volunteer program; -- enhanced local public health laboratories; -- implementing a Community Emergency Response Team program; and -- stockpiling various vaccines or antivirals |
The responsibilities of public health entities in an emergency aren’t limited to those situations detailed above — they also must respond during weather-based emergencies like hurricanes and snowstorms. The duties involved in these incidents can include health system readiness, mass care responsibilities and assistance with shelters/sheltering. Additional areas of emergency preparedness and response typically include epidemiological investigations, foodborne emergency preparedness and response to various environmental hazards.
On a daily basis, the responsibilities of PHEP units or programs include:
- training health department personnel how to respond to emergencies they will typically have to confront;
- training in the ICS and NIMS to assure coordinated response (both within the health department and with other, more traditional emergency response partners);
- outreach and collaboration with external partners such as public safety, private sector, nongovernmental organizations and community organizations;
- constant modernization and revision of various emergency plans (e.g., emergency operations plan, medical countermeasures dispensing, non-pharmaceutical interventions, pandemic influenza, anthrax preparedness, etc.);
- planning for drills and exercises that test emergency plans; and
- implementing the corrective actions learned from the exercises.
Critical Efforts
Mass dispensing is another area where public health has taken a forward role.
Sometimes referred to as the brass ring of public health preparedness efforts, this specifically is the mass distribution of vaccines and/or antibiotics that each state and local health department has developed plans to dispense to its population. This can be accomplished either with traditional points of dispensing
or through another mechanism. Although originally developed to distribute prophylaxis in the form of antibiotics to affected populations following a biological agent attack, these plans and responses, as seen during the H1N1 pandemic, can also be applicable to vaccination efforts.
Mass fatality management is another important issue to handle. Although not traditionally seen as a public health issue, oftentimes it is the public health entities that see mass fatality incidents for what they are and get everyone to the table to plan and eventually respond. The recently released FEMA National Preparedness Report noted that from 2007 to 2009, the percentage of states that had established fatality management plans increased from 64 to 96 percent. But it’s important to note that assessment of these fatality management plans indicated that some are not yet adequate or actionable.
Clearly federal, state and local public health emergency planning, preparedness and response efforts have become much more robust since the events of Sept. 11, 2001. Sadly this state of readiness will simply not be able to withstand funding cuts. So, what happens next? Does our state of health-care system readiness go away? Does the discipline of emergency management have the resources to take it over, continue and possibly even expand efforts and programs? Having the potential to be impacted by funding cuts of their own, is it realistic to think that emergency management entities can take on these responsibilities?
Unfortunately we are left with more questions than answers.
Raphael M. Barishansky is the chief of public health emergency preparedness and response for the Prince George’s County (Md.) Department of Health. Prior to this position, he served as executive director of the Hudson Valley Regional EMS Council based in Newburgh, N.Y.
