Public health emergency (United States)

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In the United States, a public health emergency declaration releases resources meant to handle an actual or potential public health crisis. Recent examples include incidents of flooding, severe weather,[1] and the 2009 H1N1 influenza outbreak. Homeland Security Secretary Janet Napolitano described it as a "declaration of emergency preparedness."[2]

The National Disaster Medical System Federal Partners Memorandum of Agreement defines a public health emergency as "an emergency need for health care [medical] services to respond to a disaster, significant outbreak of an infectious disease, bioterrorist attack or other significant or catastrophic event. For purposes of NDMS activation, a public health emergency may include but is not limited to, public health emergencies declared by the Secretary of HHS [Health and Human Services] under 42 U.S.C. 247d, or a declaration of a major disaster or emergency under the Robert T. Stafford Disaster Relief and Emergency Assistance Act (Stafford Act), 42 U.S.C. 5121-5206)."[3][4]

The declaration of public health emergency in the March 2009 flood of the Red River in North Dakota was made under section 319 of the Public Health Service Act. Under section 1135 of the Social Security Act, this declaration permits the state government to request waivers of certain Medicare, Medicaid and CHIP requirements from the Centers for Medicare and Medicaid Services (CMS) Regional Office. Examples include allowing Medicare health plan beneficiaries to go out of network, allowing critical access hospitals to take more than the statutorily mandated limit of 25 patients, and not counting the expected longer lengths of stay for evacuated patients against the 96-hour average.[1]

FEMA - 7797 - Photograph by Jocelyn Augustino taken on 03-12-2003 in District of Columbia

In the swine flu outbreak, the declaration allowed the distribution of a federal stockpile of 12 million doses of Tamiflu to places where states could quickly get their share if they decide they need it, with priority going to the five states with known cases.[2] Because Obama's choice for Secretary of HHS, Kathleen Sebelius, had not yet been confirmed, the public announcement of the emergency was made by President Obama and Homeland Security Secretary Napolitano.[5] However, the formal determination of a public health emergency was made by Charles Johnson, acting HHS secretary, under section 319 of the Public Health Service Act, 42 U.S.C. § 247d.[6]

A military health emergency is defined by the NDMS as "an emergency need for hospital services to support the armed forces for casualty care arising from a major military operation, disaster, significant outbreak of an infectious disease, bioterrorist attack, or other significant or catastrophic event."[3][4]


A Catastrophe has been defined by Dr. Rick Bissell as: "an event that directly or indirectly affects and entire country, requires national and possibly international response, and threatens the welfare of a substantial number of people for an extended period of time.”[7] Bissell makes the distinction between "catastrophes" and "disasters" in that, for catastrophes: “their complexity and their various impacts are so significant that the ordinary emergency planning, preparedness, and response tools are no longer sufficient, or may even be counterproductive.”[7] Therefore, the failure of all levels of the disaster wheel (preparation, mitigation, response, recovery) can neither be planned for nor be fixed once it has occurred. Not all situations can be accounted for simply because of the combination of the common uncertainty and probability principles. It would be extremely lengthy due to the immense amount of detail needed to cover all aspects of any possible catastrophe would not only be daunting to read, even more so to develop realistically. The best way to begin to plan for a catastrophe would be by following the continuum of magnitude, starting at the local level and moving up all the way into international mutual aid. Because catastrophes have such a massive impact and demand resources, international aid should not be out of the question. The catastrophe plan should not be made rigid because of the large amount of grey area as to what exactly will be affected by the event.

Prep Cycle

Public health officials could set up parameters to help prevent this event from occurring in the first place because they are able to send inspectors in a timely fashion to uphold the health codes. An outbreak of bubonic plague in this era may be a sign of biological attack. However, should such an outbreak occur again, the public health official would have to notify the Emergency Management at the first sign. Steps toward containment and recovery must be swift due to the nature of such an outbreak. Furthermore, there would need to be several tests taken and careful watch over possible target populations in order to quickly spot other new outbreaks. The origin of the outbreak must be determined quickly to prevent possible global spread. The emergency manager has access to the resources needed to contain and eliminate the outbreak, and combined with the education of the public health official on how to go about doing so would result in a better chance of containment. Also, the emergency manager would work on recovery steps for the affected population and infrastructure while the public health official addresses how to prevent an outbreak from occurring again. By using the preparedness cycle, planning transitions into organization, training and equipment, which in turn transitions to exercising those actions, followed by evaluating the effectiveness and improving upon the plan for next time.[[Sylves, Richard T. and William L. Waugh, Jr. (1996). Disaster Management in the U.S. and Canada: The Politics, Policymaking, Administration and Analysis of Emergency Management, 2nd edition. Springfield, IL: Charles C. Thomas, Publisher, LTD (ISBN 0-398-06609-4).]] Autonomy in terms of emergency management is a very important facet of the big picture. We want to be autonomous for most emergencies and disasters simply because locally, we know the populations, special needs populations, topography and key affected points much better and are able to respond faster and more effectively than outside organizations. However we as emergency managers do not want to be completely autonomous to all situations because in the case that we may actually need external help, we need to already have those paths carved out before hand to make logistics easier. Swift and effective response is key to optimal disaster recovery. As emergency managers we must be able to operate completely alone until mutual aid arrives. If our responses fail or if communications to other organizations fail, our efforts are wasted and the situation then becomes a possible catastrophe. We must be prepared for these events and so, education, training and communication are the three most important aspects. The Stafford Disaster Relief and Emergency Assistance Act and Posse Comitatus Act are just a couple of examples of steps taken to preserve local and state’s right to autonomy from the federal and international governments.

Steps for response[edit]

Assess the upcoming event and the possible key affected areas. Figure the resources needed to do target hardening steps to help prevent total destruction and help with quick recovery. An old adage states that “an ounce of prevention is worth a pound of cure”. Pre-planning stages and paving effective communication lanes to obtain external aid is very important to the saving of lives. Using these pre-made venues saves precious time during an event. A big obstacle to this is to make the happy medium between a very specific detailed emergency plan and a flexible one to which many disaster events may apply. Up-to-date education and training are other key elements to making for a swift and effective response and recovery. Retaining infrastructure is a huge challenge to an emergency manager because intact infrastructure makes for easier use of communication and multiple routes for much needed resourced to enter the affected area. Without this communication to the external organizations, they will not know how to bring about the needed resources (by land, air, sea?). The use of a command center away from the affected area such as a Louisiana emergency management center in Texas will help prevent this issue and many others by not “putting all of your eggs in one basket”. If this chain of communication were to break down, the situation very well can turn from simple regional emergency to a catastrophe or even a mass extinction event.[8]

See also[edit]

A number of state and local agencies, laws, and office holders have been omitted here.


  • Sylves, Richard T. and William L. Waugh, Jr. (1996). Disaster Management in the U.S. and Canada: The Politics, Policymaking, Administration and Analysis of Emergency Management, 2nd edition. Springfield, IL: Charles C. Thomas, Publisher, LTD (ISBN 0-398-06609-4).
  • Anderson, James (2011). Public Policymaking, 7th edition. Boston, MA: Wadsworth, Cengage Learning (ISBN 0-618-97472-5).