At the State level, authority and responsibility for emergency management typically reside within an Emergency Management Agency (EMA), although variations exist. Before 9/11 and the anthrax attacks in 2001, it was common for States to consider public health and medical emergencies to be distinct from other emergencies, thus requiring separate processes for response that were not all centrally supported by the EMA and public safety agencies. However, this approach has begun to change, as current State and Federal initiatives (including HHS bioterrorism preparedness programs) call for the development of management processes to improve coordination among State agencies, and between the State and intrastate jurisdictions.
Another issue post-9/11 has been the growth of State level homeland security agencies and how they integrate with existing emergency management and public health programs. While homeland security programs generally focus on terrorism, emergency management traditionally has taken an all-hazards approach. It is important for public health and medical emergency planners to understand how these programs are structured within their jurisdiction, and where authority lies for emergency or disaster response.
The role of States in MSCC will vary based on their individual laws and regulations. In general, however, State authorities may assume several key responsibilities during emergency preparedness and response. The following paragraphs describe four such responsibilities.
- Assist jurisdictional incident management (Tier 3) when local response resources become severely challenged. The bulk of this operations support is commonly provided through the State level MACC at the State EOC. Assistance may include:
- Providing assets or funding for the purchase or use of additional resources
- Assisting with the coordination of intrastate mutual aid
- Facilitating interaction, information flow, and strategic planning between affected intrastate jurisdictions.
States can also assist the medical sector by providing regulatory relief during incident response (Exhibit 5-1). Relevant State laws or regulations that may need to be revised or temporarily suspended in a public health or medical emergency should be identified during preparedness planning, and processes for their revision or temporary suspension should be formally described. Some examples include:
- Professional licensure, permit, or fee requirements for:
- State medical, nursing, or other healthcare providers
- Out-of-State medical, nursing, or other healthcare providers
- Pharmacists or pharmacy services
- Medical examiners
- Statutes governing the number of licensed or staffed beds allowed in healthcare organizations (HCOs)
- Statutes governing access to and disclosure of protected medical information
- Regulations stipulating provider-to-patient ratios and other standards of care parameters
- Regulations surrounding processing the remains of the deceased (e.g., in the event of overwhelming mass fatalities).
Exhibit 5-1. Emergency Medical Regulatory Relief
In the aftermath of Hurricane Katrina, the Governor of Louisiana declared a state of public health emergency and issued an Executive Order temporarily suspending State licensure laws, rules, and regulations for out-of-State medical professionals and personnel offering medical services in Louisiana, provided that these out-of-State medical personnel possessed current State medical licenses in good standing in their respective State(s) of licensure. In addition, the Executive Order designated out-of-State medical professionals and personnel as agents of the State of Louisiana for tort liability purposes.
- Provide primary incident command in response to certain emergencies or disasters. State Government (led by the Governor or his/her designee) provides management oversight of the unified command (UC) and directs response activities according to a State Emergency Operations Plan (EOP).[1] Scenarios that might necessitate State-based incident command include:
- Diffuse or widespread incidents involving multiple jurisdictions (but incorporating recognition of authority at the local level)
- Incidents requiring response assets that are primarily State resources (e.g., public health epidemiology expertise)
- Public health incidents and other types of emergencies designated by State laws or regulations.
- Coordinate among multiple States to promote a consistent response strategy across State boundaries. The State may also work with States not affected by a hazard to facilitate receipt and distribution of tactical mutual aid to affected communities. Interstate coordination is addressed in more detail in Tier 5.
- Provide the requisite interface with Federal authorities so local jurisdictions can request and receive Federal support (see Tier 6). The Governor or his/her designee declares a formal public health or general emergency and adheres to established procedures to request, receive, and distribute Federal assistance to affected jurisdictions. These procedures should be defined during preparedness planning.
- This chapter does not examine specific components of the State EOP, since these will vary significantly from State to State. The focus instead is on the various roles States may have in catastrophic events.
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