Public Health Emergency - Leading a Nation Prepared
The following example demonstrates how the concepts presented in this chapter may be applied during an actual incident response. The various phases of response (as described in Chapter 1) highlight when critical actions should occur; however, the example extends only as far as incident response operations, as this is the focus of the MSCC Management System.
Background and Incident Description
Incident recognition begins when the clinical suspicion is first reported to DoH and public health experts recognize the implications. Although it has not been confirmed, the suspicion of SARS is enough to warrant immediate actions by DoH, and a rapid health investigation commences. Epidemiological questioning quickly indicates that the patient (index case) had exposure to many customers at the meat shop after becoming demonstrably ill.
Notification/activation occurs when the DoH public health officer requests a management meeting with representatives from emergency management, fire/EMS, law enforcement, and public works. After a brief discussion, they agree to partially activate Jurisdiction Alpha's EOP for public health response (formal declaration of emergency is not required to activate portions of the EOP). The following actions also occur:
Mobilization of jurisdictional resources occurs as the designated agencies activate their individual EOPs, and ramp up their staffing accordingly. Similarly, Jurisdiction Alpha's EOC is activated and staffed.
Incident operations are led by a UC that was designated in the initial management meeting. The UC is composed of selected individuals from jurisdictional (Tier 3) public health, fire/EMS, and law enforcement. The jurisdiction's public health authority is recognized as the "lead" UC agency. The UC coordinates closely with the jurisdiction's emergency manager, who manages the EOC (a MACC for the UC).
Management representatives from each agency in the UC conduct a teleconference to discuss what is known about the incident and to determine a course of action. It is decided that an ICP will be established at the DoH Operations Center, but UC members agree to transfer the ICP to the jurisdiction's EOC if management needs exceed the resources available at the DoH Operations Center. This backup is planned because multiple reports are coming in about patients with febrile illnesses reporting to HCOs. Many of these patients have recently visited the butcher shop in question.
Members of the UC quickly establish themselves at the ICP and coordinate the integration of their respective disciplines. Each agency maintains authority over its own assets, yet all contribute to the composition of the ICS Sections (Operations, Logistics, Plannings, Admin/Finance). For example, a senior DoH staff member directs the Operations Section, while personnel from other agencies manage specific branches (see Figure 4-2) under Operations.
Expedited SARS serology tests from the index patient strongly indicate the patient died from SARS. Confirmatory testing is being conducted at the CDC. The rapid epidemiological investigation, aided by public service announcements asking anyone in contact with the meat shop to report to a DoH clinic for evaluation, has identified an extensive list of potential contacts. The contacts are given written instructions on the disease, its signs and symptoms, and precautionary measures. They are provided digital thermometers and arrangements are made to contact them daily for a health check.
Based on available information, the UC develops the first formal jurisdictional IAP for the next opertional period (designated as the upcoming 24-hour period starting at 7:00 a.m.). The jurisdictional IAP includes:
The jurisdictional IAP is shared with Tier 2 coalition members and State emergency management officials (Tier 4). The State, in turn, provides pertinent information to adjoining jurisdictions, bordering States, and to Federal public health personnel assisting in the State response. The operational period established by the State is adjusted so that State meetings occur one hour after the jurisdiction's (Tier 3) meetings. This phase-shift of Tier 4's operational period allows for coordination of operational briefings.
With the UC having defined its incident objectives and strategies through the jurisdictional IAP, other activities are identified for emergency management operations support to address through the EOC. These EOC responsibilities include:
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