Public Health:
What It Is and How It Works,
Fourth Edition
• Chapter-by-Chapter Power Point Slides
• Links to Internet-based resources
Chapter 8
Public Health Emergency
Preparedness and Response
Chapter 8 Will Help You To:
• differentiate among different types of public health emergencies and
disasters, their definitions and the terminology related to them
• identify the main characteristics of the principal natural disasters and
their effects
• explain the concepts of vulnerability, risk, disaster prevention, and
the links to longer term effects
• describe why emergencies and disasters are a problem for which
the public health system must be an integral participant across a
range of disaster activities
• describe the role and responsibilities of public health professionals
in emergency preparedness and response
• identify how and where to locate the agency emergency response
plan (or the pertinent portions of the plan)
• describe how the chain of command and communication strategies
function in emergency response
Chapter 8 Will Also Help You To:
• define terrorism and bioterrorism
• identify Category A, B, and C biological agents, and their unique
characteristics and relevance to bioterrorism events and threats
• describe the relative role of first responders and public health in
response to bioterrorism
• describe, in general terms, recent federal public health service
initiatives for bioterrorism preparedness
• describe the proper response to an announced anthrax threat in the
form of a letter
• identifying the basic laboratory technologies that are being used at
present and that will be used in the future to diagnose bioterrorist
threats
• describing the basic differences in the public health response to a
contagious versus a point-source aerosol release of a bioterrorism
agent
Public Health Roles in Emergency
Preparedness and Response
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Surveillance
Epidemiologic Investigation and Analysis
Laboratory Investigation and Analysis
Intervention
Risk Communication
Preparedness Planning
Community-Wide Response
Bioterrorism Expertise
Workforce Preparedness
Information Loop of Public Health Surveillance
Public
Reports
Summaries,
Interpretations,
Recommendations
Health Care
Providers
Health
Agencies
Analysis
Americans’ Views of Health Problems Post 9/11
“Issue is 1 of 2 or 3 most
important health problems” (%)
“Issue is 1 of 2 or 3 most
urgent health problems” (%)
Bioterrorism/Anthrax/Smallpox
Cancer
22%
50%
Healthcare costs/Insurance
Heart Disease
19%
24%
Cancer
HIV/AIDS
19%
23%
Other
Diabetes
17%
11%
AIDS
7%
Obesity
Heart Disease
7%
6%
Smoking
7%
1% Alcohol/Drug abuse
Health problems from terrorist attacks
1% Smoking
6%
0
10
20
30
40
50
0
10
20
30
40
Note: Sums up to more than 100% because each
respondent was asked to give up to three different
answers.
HSPH/RWJF/ICR poll, November/December 2001
Gallup poll, November 8–11, 2001
50
Anthrax Attack 2001: Mail Flow Network…
Pataki’s Office
(NY)
Bellmawr Distribution plant (NJ)
W. Trenton PO (NJ)
CBS (NY)
Times Sq.
PO (NY)
Princeton PO (NJ)
Radio City PO (NY)
ABC (NY)
Ansonia PO (NY)
New York
Post (NY)
Kuser Road Business
Morgan Central
Postal Facility (NY)
Other
Post Offices
48 local Post
Offices including:
Distribution plants including:
(Bulk Mail Ctr, Dominic V Daniels,
Hackensack, Central NJ,
Performance, Monmouth, Newark
Main, Patterson, West Jersey)
Local Businesses
including:
Boulevard PO (NY)
Rockefeller Ctr PO (NY)
NBC (NY)
Lenox Hill PO (NY)
NYC001-47 Home
ENT Hospital (NY)
Carteret Hub & Spoke
Facility (HSF) (NJ)
All DC City Mail for Zips
20000-20099
Hamilton Processing
Facility (NJ)
Southwest PO Station
Truck to Atlanta, GA
Friendship PO Station
?
West Palm PO Main
Branch (FL)
Brentwood
Mail Facility (DC)
56 USPS
Facilities
including:
Dulles PO Branch
Pentagon PO Branch
Lantana PO (FL)
Stamp Fulfillment
Kansas City, MO
Green Acres PO (FL)
Walter Reed Complex
177 Federal Agencies
including:
Blue Lake PO (FL)
Lake Worth PO (FL)
Landover (Justice)
Supreme Court
P-St. Mail Sorting (DC)
BATF
Boca Main Substation (FL)
AMI Building (FL)
Dirksen Bldg
Hart Bldg
Ford Bldg
Longworth Bldg
DC VAMC
State Department
SA-32 (VA)
State Department
SA-3 (DC)
= Confirmed anthrax case associated with site
= Suspect anthrax case associated with site
= Environmental samples positive
November 7, 2001
US Embassy in
Vilnius, Lithuania
US Embassy
in Lima, Peru
US Embassy in
Yekaterinburg,
Russia
Anacostia mail room
National Preparedness and
Response Coordination
• National Incident Management System
• Federal Assets
– Department of Homeland Security
– National Disaster Medical System
– Metropolitan Medical Response Systems
– Strategic National Stockpile
– State and Local Public Health Funding
State and Local Coordination
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•
•
•
State Agencies and Asses
Incident Command Systems
Local Agencies and Assets
Drills and Exercises
State and Local Preparedness
Project Grants
• Bioterrorism Preparedness Funding for States
and Cities
– Preparedness Planning, Epidemiology and
Surveillance, Lab Capacity, Health Alert Information
Systems, Risk Communication, Workforce
Preparedness
– “Full Use” strategy addresses both specialized
response needs as well as basic capacity
– Increases federal investment in public health
infrastructure by ~20% (funds about 6,000-7,000 new
positions in state and local public health agencies)
Reported change in selected LHD functions over past 3 years as a result of
efforts to improve emergency preparedness (NACCHO, 2006, n=393)
Maternal & child health
Regulation, inspection & licensing
Other health sercices
Population-based prim ary prevention
Treatm ent for com m unicable diseases
Other environm ental health activities
Screening for diseases & conditions
Access to laboratory services
Surge capacity
Im m unization
Relationships w ith other agencies
Legal basis for PH actions
Epidem iology
Public health surveillance
Inform ation system s
Workforce training
Com m unication system s
Preparedness planning
Stronger
No Change
Weaker
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Percent of LHDs that Conducted Selected Emergency
Preparedness Activities in the Past Year. (NACCHO, 2006)
None of the below activities
Participated in an actual public health emergency
Reviewed relevant legal authorities
Assessed emergency preparedness competencies of staff
Procvided emergency preparedness training to staff
Developed or updated a written emergency plan
Particiapted in drills or exercises
2%
37%
65%
71%
87%
90%
92%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Drills and Exercises: TOPOFF-2
Discussion
• Review the Bioterrorism and Emergency
Readiness Competencies for All Public Health
Workers with a special emphasis on the 9 Core
Emergency Preparedness Competencies for All
Pubic Health Workers and complete the online
course Basic Emergency Preparedness for
Public Health Workers. Based on your own
experiences, which of the core emergency
preparedness competencies need the most
attention/improvement in the public health
workforce today.
Discussion
• Review the UCLA web resource cataloging
Epidemiologic Information on Bioterrorism.
Briefly describe the bioterrorism risk
associated with the two infectious agents
that you believe to be the most likely to be
used in a bioterrorism event affecting your
community. Be sure to explain why.
Discussion
• You are a member of a Blue Ribbon Panel of
Experts evaluating a recent incident that
occurred in your city. Review the case study, A
Haze over Hickernoodle City: Biodefense
Readiness in a Community with a focus on
evidence that indicates the local disaster plan
needs to be revised and which improvements
are most needed. Develop a brief memo to the
Mayor of Hickernoodle City outlining your
findings and recommendations.
Internet Resources
• Centers for Disease Control and Prevention, including the CDC
Public Health Preparedness and Emergency Response web site
• Federal Emergency Management Agency
• Food and Drug Administration
• Association of State and Territorial Health Officials
• National Association of County and City Health Officials
• Public Health Foundation
• American Public Health Association
• State Health Departments (such as the Illinois Department of Public
Health or others that you may find at the ASTHO web site)
• Local Health Departments (such as the Chicago Department of
Public Health or others you may find through some of the various
national web sites or those of state health departments)
Additional Resources
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American Anthrax Outbreak of 2001. UCLA Department of Epidemiology
Basic Emergency Preparedness for PH Workers. Online course for public health
workers in basic emergency preparedness and response concepts.
Bioterrorisk. Online simulation developed by the Illinois Public Health Preparedness
Center; 2003
Bioterrorism Preparedness and Response Course Resources (variety of resource
materials used in online training courses for public health workers)
CDC Public Health Preparedness and Emergency Response web site. Centers for
Disease Control and Prevention (includes links to specific chemical and bioterrorism
agents).
Chicago Department of Public Health Bioterrorism Web Site
Epidemiologic Information on Bioterrorism. UCLA Department of Epidemiology
Illinois Department of Public Health Bioterrorism Web Site
Public Health Emergency Response Guide for State, Local, and Tribal Public Health
Directors. Centers for Disease Control and Prevention.
Public Health Incident Command System: A Guide for the Management of
Emergencies or Other Unusual Incidents within Public Health Agencies (PDF
documents). Center for Public Health Preparedness, University at Albany School of
Public Health
Terrorism and Other Pubic Health Emergencies: A Reference Guide for the Media
(PDF documents). US Department of Health and Human Services; 2005.