This chapter has presented several key concepts of ICS on which the MSCC Management System is based. A difficulty with applying traditional ICS in major medical and public health incidents is that it is designed primarily for management participation by public safety personnel. It is difficult within ICS to identify defined mechanisms for incorporating private sector assets into incident management, even if they are essential in providing leadership-level expertise for the incident. This problem was apparent in New York City after 9/11, where it was challenging to efficiently incorporate engineering deconstruction expertise (largely a private sector asset) into incident management.[21] This issue is particularly problematic for medical input into incident management because specialty medical expertise in the United States resides primarily in the private sector.
The World Trade Center experience in the aftermath of 9/11 and the response to Hurricane Katrina demonstrated many factors that can exacerbate the public-private divide:
- Private assets may have conflict-of-interest issues when participating in public management.
- Public agency officials may be reluctant to accept high-level management advice because they may not be comfortable with the source's objectivity or expertise. This is more likely if in-depth familiarity was not established during preparedness planning.
- Private-sector assets do not have the liability immunity for public management that is enjoyed by public officials when acting within their established capacity. This may create a reluctance to engage in public decision-making without reliable assurance that they will not incur unacceptable legal risk.
Response systems for public health and medical incidents must identify and implement methods to bridge the public-private divide. Depending on the type of incident, qualified medical experts may provide strategic advice through a formal position in UC or as senior advisors to the UC. Alternatively, they may serve as technical specialists when their input is provided at a tactical level. Regardless of the approach, qualified medical experts must know when and how to interface with incident management (as they are rarely in charge of major response), and understand other implications of mass casualty and/or mass effect events. These experts should be selected from the medical community for their ability to accurately and fairly represent the collective interests of the private sector by providing the following:
- Advice as it relates to medical operations
- Evaluation of management options for addressing medical issues
- Peer review of public messages for medical accuracy and clarity
- Peer review of messages to the professional medical community to promote accuracy of the message and acceptance by participating medical responders
- Other assistance or expertise, as indicated.
- This observation was made by Dr. Joseph Barbera, who was present at the World Trade Center site in the days and weeks following the attacks.
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