THE UTILIZATION OF HEALTHCARE
COALITIONS AND RESILIENCY FORUMS:
THE NATIONAL HEALTH SECURITY
STRATEGY
John J. Walsh, Jr.
Co-Director, Program in Disaster Research and Training
Vanderbilt University
School of Medicine
Nashville, TN USA
Allan Graeme Swan
MESH Coalition
Indianapolis, IN USA
Significant Events and Major
Legislation: The US Perspective
Significant Events and Major Legislation: The
US Perspective
Healthcare is an unremunerated power in the United
States constitution, and is, therefore, reserved to the
States. For much of the US’s history Federal government
assistance was often non-existent.
• Natural disaster relief and response was left to local
government, churches and civic groups. Individuals were
considered the primary delivers of management and relief
activities.
Significant Events and Major Legislation: The US Perspective
 Between 1803 and 1947, 128 specific pieces of disaster
relief legislation were passed.
 A loan system was established for the rebuilding of
public facilities damaged by disasters.
 In 1934 Congress authorized the establishment of the
Reconstruction Finance Corporation.
 The Disaster Loan Corporation was established in 1937.
 The Texas City fertilizer explosion in 1947 led to
establishment of many of today’s liability criteria for
government disaster responsibility.
Significant Events and Major Legislation: The US Perspective
 In 1979 the Federal Emergency Management Agency
(FEMA) was created by executive order.
 The Stafford Act was established in 1988 which is an
amended version of the Disaster Relief Act of 1974. this
established authority for disaster declaration
protocols. Further amendments included:
 The Homeland Security Act of 2002
 Post Katrina Emergency Management Reform Act (PKEMRA)
2006
 The Sandy Recovery Improvement Act of 2013 (SRIA)
Significant Events and Major Legislation: The US Perspective
 A series of biologic attacks within the US (anthrax)
and the continued threat of pandemics led to
Congress passing a number of public health
preparedness legislation.
Biological Weapons Anti-Terrorism Act of 1989
Public Health Security and Bioterrorism Preparedness
Response Act (2002)
Biodefense and Pandemic Vaccine and Drug Development
Act of 2005
Pandemic and All Hazards Preparedness Act (2006, 2013).
This established position of the Assistant Secretary for
Preparedness and Response (ASPR) and codified the concept
of the healthcare coalition.
Significant Events and Major
Legislation: The UK Perspective
Significant Events and Major Legislation: The UK Perspective
 The United Kingdom has adopted a decentralized
approach to emergency management. This approach
since approximately 1998 has been defined by the
term ‘resilience’.
 Civil Contingencies Secretariat (2001) defined
resilience as “the ability at every level to detect,
prevent and if necessary handle disruptive challenges.”
 Resilience has not always been a concept associated
with decentralized emergency management in the U.K.
Significant Events and Major Legislation: The UK Perspective
 An evolution came as national crises exposed
deficiencies in the emergency management approach
of the UK Government
 This encouraged policy changes with a greater focus on
preparedness and recovery rather than response.
 The impetus and focus of UK emergency powers
legislation was on civil unrest and strikes.
 The focus continues to have a large influence on the
United Kingdom’s emergency management
development as does domestic terrorism.
Significant Events and Major Legislation: The UK Perspective
 The enactment of the Prevention of Terrorism Act
(PTA) of 1974, was a response to the bombing
campaign moving from Northern Ireland to other parts
of the United Kingdom.
 The PTA was substantially revised due to civil rights
issues in much the same way the U.S. Patriot Act was to
be a generation later as the original terrorist threat
receded.
Significant Events and Major Legislation: The UK Perspective
 In the early 2000’s the UK adopted the concept of
resiliency, with a clear focus on preparedness and
recovery.
 The fuel crisis and the flooding of 2000 led to the
creation of the Civil Contingencies Secretariat (CCS).
 The CCS reports directly to the Prime Minister’s Office
and replaced the Home Office (closest US equivalent is
the Department of Homeland Security) as controller of
emergency planning and response.
Significant Events and Major Legislation: The UK Perspective
 The CCS’s responsibilities encompassed the
coordination of risk identification through the use of
the National Risk Assessment (NRA) and the National
Risk Register (NRR).
 This responsibility extends to contingency planning
and developing a resilient national infrastructure and
private sector.
Significant Events and Major Legislation: The UK Perspective
 Response to the 2000 floods and the foot and mouth
outbreak (2001) was determined to be deficient.
 In 2004, the Civil Contingencies Act (CCA) was enacted,
which was a major overhaul of the current emergency
management system.
Coalition Utilization and Resiliency:
US Approach
Coalition Utilization and Resiliency: US Approach
 The Office of the Assistant Secretary for Preparedness
and Response (ASPR) administers the Hospital
Preparedness Program, which establishes the
framework for developing and implementing a
coalition-based approach for healthcare system
preparation, response and resiliency.
 The framework aligns 15 Public Health Preparedness
Capabilities and the eight (8) aligned Healthcare
Preparedness Capabilities.
Coalition Utilization and Resiliency: US Approach
 Throughout US disaster history the military has played
a role in response and recovery.
 The 1906 San Francisco earthquake and subsequent fire
illustrates the military’s vital response and support
function, building tents, feeding survivors, and fighting
fires.
 The Civil Defense Act was amended in 1976 to allow
state and local governments to spend funds on
activities other than preparing for nuclear attacks.
 This funding expansion began the shift in emergency
management leadership being responsible for state and
local preparedness.
Coalition Utilization and Resiliency: US Approach
 Since 9/11 the use of military assets and resources for
disaster coordination, preparedness and response has
grown significantly.
 Interaction between civilian and military planning and
collaboration is increasing.
 However, merging and overlapping of civilian/military
functionality is a concept faced with both political and
legal challenges.
Coalition Utilization and Resiliency:
UK Approach
Coalition Utilization and Resiliency: UK Approach
 Through the framework of resiliency the Civil
Contingencies Act (CCA) encompassed a multidisciplinary and multi-hazard planning approach to
emergency management.
 This incorporates eight underlying principles:








Preparedness
Continuity
Subsidiarity
Direction
Integration
Communication
Co-operation
Anticipation
Coalition Utilization and Resiliency: UK Approach
 The CCA has two major parts:
Part 1
 A framework for local level civil protection that
introduced leaders of multi-agency partnerships for each
police area, known as Local Resiliency Forums (LRF’s).
 The National Health Service is considered a Category 1
responder and required to participate in the LRF.
 Each LRF is charged with promoting resilience through
coordinating the identification, assessment and planning
procedures necessary to mitigate risk and ensure
continuity following a disaster.
Coalition Utilization and Resiliency: UK Approach
Part 2
 An update of national emergency powers (updating
to the previous Emergency Powers Acts of 1920 and
1964, these powers are considered a “last resort and
shall be applied only in exceptional circumstances.”
Coalition Utilization and Resiliency: UK Approach
 In 2011 the CCA established a Resilience and Emergencies
Department (RED) to facilitate communication between
LRF’s.
 In the last 11 years the CCA has been fully reviewed twice.
The Pitt Review was a comprehensive evaluation of the
emergency management response to the 2007 English
flooding (13 deaths and left 55,000 properties flooded).
 Among the 92 recommendations were that each Local Resiliency
Forum should review and share their lessons learned in order to
inform them for future planning.
Coalition Utilization and Resiliency: UK Approach
 The UK model of emergency management assumes a
primary role for government.
 Increasingly local government and local resilience
forums are given primacy, but private sector
contributions are assumed to be small.
The US Healthcare Coalition and
Emergency Management Models
The US Healthcare Coalition and Emergency Management Models
 The US currently maintains an all-hazard approach to
planning and response operations consisting of a
unified command structure with multi-agency
coordination. This system is utilized for all natural,
man-made, technological and public health
emergencies.
 The coalition model has a shorter history with a focus
on developing a non-governmental structure.
Governance models consist of 501(c)3 private
foundations or public charities, 509(a)3 supporting
organizations, 501(c)6 business league/trade
organizations, or private embed within an existing
organization framework have each been proposed.
The US Healthcare Coalition and Emergency Management Models
 Statewide utilization of coalitions within existing
individual state health department systems is also a
model that is becoming more frequently implemented.
 Healthcare coalitions and emergency management
agencies work closely in all phases of the disaster
paradigm within the US disaster system.
The US Healthcare Coalition and Emergency Management Models
 Statewide utilization of coalitions within existing
individual state health department systems is also a
model that is becoming more frequently implemented.
 Healthcare coalitions and emergency management
agencies work closely in all phases of the disaster
paradigm within the US disaster system.
The UK Healthcare Resiliency
Forums and Emergency
Management Models
The UK Healthcare Resiliency Forums and Emergency Management
Models
 It was not until 2013 that healthcare specific resiliency
forum activities were proposed by the Civil
Contingencies Act (CCA).
 In April of 2013, the newly enacted Health and Social
Care Act took effect.
 The Act made significant changes to the emergency
management model associated with healthcare
organizations by establishing Health Emergency
Preparedness, Resilience, and Response (EPRR) in
order to ensure a safe and consistent emergency
management system in the health sector.
Conclusion
Conclusion
 Perhaps it is self-evident the development of major
emergency legislation is reactive as well as locally national
specific, because the societal shocks that demand legislative
change seem are so profound at the time. Hurricane Katrina,
7/7, 9/11 all fall into this category.
 The legislation then sets in motion responses that refer
back to those events, but not always forward to future
challenges.
 We suggest that developing taxonomies of the underlying
assumptions, particularly through international
comparison, could improve new response organizations. A
wider study including more countries and sectors other
than healthcare is warranted.