Perceived Attitudes and Staff Roles of Disaster Management at CBOCs

Recently, the U.S. Department of Homeland Security redefined disasters into 4 types: natural hazards, societal hazards, technologic hazards, and terrorism. The incidence of manmade and natural disasters is on the rise in intensity and frequency globally. Recent events such as tornadoes and hurricanes in the southeastern U.S., tsunamis in Japan, earthquakes in Haiti, wild fires, heat waves, and terrorist attacks like that of September 11, 2001, underscore the urgency of developing and maintaining solid local public health disaster response plans to minimize mortality and morbidity.

The 2010 BP oil spill in the Gulf of Mexico, the largest in history, hurricane Katrina, and the lingering impact of hurricane Sandy on the East Coast further raise concerns about our communities’ ability to handle disasters, especially in the early hours after events, when federally coordinated help is being organized and not yet fully available locally or from other nations.¹ The recent fertilizer plant explosion in West Texas, the 2013 Boston marathon bombing, and the Newtown, Connecticut, massacre remind us of the unpredictable nature of both manmade and natural disasters.

Coordinated Response

Regardless of its origin, residents expect a coordinated local response during an emergency, and it is important that government agencies meet this expectation. Fulfilling these expectations, however, takes many partners, and it is important to have a clear idea of who is involved in emergency preparedness (EP) and the response of each partner’s role.

Role of Government

Federal, state, and local governments have a critical role in emergency management (EM). When state government, local government, or an individual entity is overwhelmed with a disaster, the role of the Federal Emergency Management Agency is to provide assistance and resources to cope with the emergency.² Private industry and traditional disaster relief agencies, such as the American Red Cross and the Adventist Development and Relief Agency, are also involved in response efforts. Recent examples have shown that these partnerships are often overwhelmed with the needs of large regions experiencing limited resources. Therefore, hospitals and local public health departments frequently must carry much of the immediate burden of stabilizing communities and coordinating response with government agencies and local partners.³

Role of Public Health and the CDC

Federal agencies and local public health departments have been given critical roles in planning and responding to disasters. In particular, the PHS focuses on population care and shapes how public health entities should respond to mass casualty events and pandemics, including local response coordination. The CDC is primarily responsible for assisting state and local governments with disaster response and recovery after a large-scale public health emergency.³ The CDC works closely with local public health departments in decision making; tracking the source, spread, and severity of health threats; assessing impacts; educating the public on how to safeguard their health; and implementing measures to protect the public. During a large-scale health emergency, the CDC also maintains and provides resources through the maintenance and distribution of the nation’s Strategic National Stockpile of medications and supplies that may be needed during events such as the recent 2009 H1N1 influenza outbreak or other public health emergencies.³

Role of Local Businesses and Professional Institutions

Nationally, businesses and professional institutions are coming together and organizing in such a way that places them as part of the solution. More specifically, the National Voluntary Organizations Active in Disaster and Community Organizations Active in Disaster have grown exponentially since September 11, 2001.⁴ These efforts include but are not limited to development of EP plans and the subsequent sharing of those plans, sharing of key assets critical to response activities, development of a community key asset database, and training/exercise participation.

Role of Hospitals

The Hospital Preparedness Program was developed to prepare the nation’s health care system to respond appropriately to mass casualty incidents, whether due to bioterrorism, natural disaster, or other public health emergencies. Health care systems must be able to develop a disaster medical capability that is rapid, flexible, sustainable, integrated, coordinated, and capable of providing appropriate care in the most ethical manner with the resources and capabilities it has at its disposal.³ Although involved as first responders, traditionally, medical care systems, hospitals, physicians, and pharmacists are faced with the dual task of individual patient care and are thus more limited as partners in an overall local response system.

Also vital to this discussion is the reality that hospital emergency departments (EDs) already routinely operate at or above capacity, limiting their ability to prepare for mass casualties due to a public health disaster. Hospitals continue to divert more than half a million ambulances per year due to ED overcrowding.³ How they could step up in a true emergency situation is questionable at best.