The
Post 911 World
A Rural Jurisdiction
Develops Cooperative Relationships with Local Health Departments
By Stephanie Nelson, Health Officer, Gallatin City-County
Health Department
Gallatin City-County Health Department’s experience in
emergency preparedness planning is probably like that of many small, rural
jurisdictions with limited resources.
Located in southwest Montana, Gallatin has a population of 71,000 and is
considered one the larger counties in the state. As in most states, public health is under-funded and not well
understood. But the public health
emergency preparedness funding has provided an unprecedented opportunity to
change that. In partnership with the Montana
Department of Public Health and Human Services and Gallatin County Emergency
Management, Gallatin City-County Health Department has made great progress in
ensuring that many critical elements needed to respond to public health
emergencies are now in place.
Multiple
Challenges
Due to events beyond our control, local public health
agencies across the nation must make emergency preparedness planning a high
priority. Over the past two years, local health departments have been charged
with writing and exercising emergency plans for bioterrorism, pandemic
influenza, and the Strategic National Stockpile, while creating smallpox
response teams and bracing for West Nile virus and the possibility of severe
acute respiratory syndrome (SARS).
These activities have been in addition to the day-to-day mandated
business of protecting public health.
Local public health agencies large and small, urban and
rural, have struggled not only with the workload, but also with the sense of
urgency. Archaic public health laws and
marginal public health surveillance systems posed additional challenges. In a state like Montana, with a
decentralized public health system, issues surrounding jurisdictional lines
have complicated the development of a regional response to address limited
resources and surge capacity.
Nonetheless, progress has been made, in part because of the lessons
learned from fire and law enforcement about the Unified Command model and
mutual aid agreements.
Public
Health/Safety Partnership
Since
September 11, 2001, there has been a renewed commitment to ensure the
government’s ability to protect the public health and safety. The response to
the attack on the World Trade Center, followed by the anthrax-contaminated
letters, involved multiple systems such as fire, law, public works, and public
health. Those events reinforced the need for a multidisciplinary approach in
emergency preparedness planning and response.
Across the nation, public health and safety have been striving to
improve their working relationships through joint emergency planning,
exercises, and training.
The
mandated core responsibilities of public health are very similar to those of
safety, i.e., to identify, contain, and mitigate threats that pose a risk to
the community. In this regard, public
health is a critical contributor to the emergency management system. Over the past two years, a number of
activities have brought public health and law enforcement to the same
table. Tabletop drills and exercises on
mass immunization clinics, the Strategic National Stockpile, and implementation
of isolation and quarantine have demonstrated the important role of law
enforcement in a public health emergency and the value public health would
bring to the Unified Command. The
investigations of “suspicious” substances and packages have provided public
health and law enforcement an opportunity to jointly create procedures that
ensure forensic and epidemiological (public health) investigations are
coordinated. All of these activities
have provided public health and safety officials an opportunity to learn each
other’s language and ways of conducting business.
Bioterrorism
and emerging communicable diseases such as SARS, West Nile virus, and “bird”
(avian) flu, have placed public health in the forefront of the emergency
response. Now, the larger emergency
response system better understands the local health department’s mandated
responsibility to monitor, track, and respond to situations that may put the
public’s health at risk. As a result,
law enforcement is supporting improvements to the public health surveillance
system. For example, law enforcement is sharing 911 data, making the health
surveillance system more responsive to new and emerging threats. Developing systems to track 911 data, as
well as emergency room/hospital admissions and pharmaceutical purchases, could
be useful in identifying unusual illness patterns or early signs of a
communicable disease outbreak in our community. In this new age of terrorism and global public health, such
information could trigger not only a public health investigation but a criminal
investigation as well.
In
Gallatin County, the alliance of agencies that make up the public health/health
care system has embraced the Unified Command model. This alliance, Unified
Health Command (UHC), comprises Gallatin County Emergency Management, Montana
State University Student Health, Bozeman Deaconess Hospital (Infection Control,
Emergency Services: Emergency Room and Ambulance), Gallatin Community Clinic
(Community Health Center) and Gallatin City-County Health Department. The UHC
convenes regularly to discuss relevant public health issues and to ensure
coordinated planning, training, and exercises. A recent and welcome addition to
this alliance has been a representative from law enforcement. This
multiple-system approach has been most successful in Gallatin County.
The new relationships between agencies, such as law
enforcement and public health, are the ones that really matter; they will
ensure an appropriate and timely local emergency response. Local leadership is driving this
collaborative planning and training process.
Although we have accomplished much since September 11th,
there is still a tremendous amount of work to be done. The UHC is committed to working closely with
the larger emergency management system in order to ensure a coordinated, timely
and effective local response. Only by
working with this larger system can we all meet our common goal, to protect and
promote public health, welfare and safety.
For
more information, contact Stephanie Nelson at (406)
582-3120, e-mail snelson@co.gallatin.mt.us.