The widespread outbreak of an infectious disease poses tremendous challenges for all disciplines in the emergency-services community. Pandemic emergencies are generally regarded as a significant public-health problem, but it is important that all stakeholders recognize that such pandemics present the law-enforcement community with major challenges as well.
Fortunately, pandemic outbreaks have been rare in the United States. However, strains of influenza virus entering the United States produced tens of thousands of deaths in 1957 and 1968, and what is known as “The Great Pandemic of 1918” was responsible for 30–50 million deaths throughout the world. Societal conditions in the 21st century, however, are considerably different from what they were during previous outbreaks. Today: (1) contagious diseases can rapidly traverse the globe; (2) The American people have been conditioned to expect a highly effective health-care system not only to mitigate but even to prevent outbreaks – another way of saying that governmental intervention is expected to deal swiftly and effectively with pandemic emergencies; (3) A particularly virulent strain of disease outbreak resulting in high mortality would probably induce shock and fear throughout the country; and (4) The speed of modern communications will help provide rapid notification to the American people of pandemic developments – and, in all likelihood, lead to some sensationalized reporting as well.
The nation’s emergency planners, at all levels of government, know that major pandemic emergencies will have a particularly adverse effect on all disciplines of the U.S. first-responder community. Some planning estimates forecast as much as a 40 percent reduction in the staffing of first-responder agencies following a major outbreak of a contagious disease. Law-enforcement agencies will nonetheless be expected to maintain civil order, with depleted resources, while facing a probably frightened and potentially hostile population.
Shifting Roles for Law EnforcementDuring the height of a pandemic emergency, law enforcement (L-E) agencies will be called upon to carry out additional responsibilities. Depending on the severity of the pandemic, L-E officials may have to allocate scarce resources to several key functional responsibilities, each of which involves a significant crowd-control challenge. To begin with, local medical services may require law-enforcement protection of pharmaceutical stockpiles. Law-enforcement units also may be required to cope with protests, demonstrations, and even some riots. During severe and concentrated pandemic outbreaks, L-E units may be responsible for establishing and securing quarantine and isolation areas. Lastly, law-enforcement personnel may be required to augment the staffs of correctional facilities working to secure those facilities and/or suppress major disruptions.
Each of these functional responsibilities requires advance planning and preparation. Local L-E personnel and agencies probably will be required to bear most of the burden for a certain period of time. Moreover, the very nature of severe pandemic situations will test even the best multi-jurisdictional integration plans and agreements. For these and other reasons, all plans and preparations must take into account the almost certain depletion of functional staffing as a universal characteristic of pandemic situations.
Protection of Pharmaceutical StockpilesAs a severe pandemic progresses through various phases of infecting the local population, some communities may become aggressively dissatisfied with the pharmaceutical distribution procedures and protocols that have been established. Community reaction is likely – in some instances, at least – to threaten the important storage and distribution centers for drugs and vaccines. To help cope with severe pandemic situations, the U.S. Department of Health and Human Services (HHS) has established agreements with law-enforcement agencies to protect the national stockpile sites of these essential medicines. Local L-E officials should develop similar plans to protect local stockpile sites from theft and/or the disruption of distribution operations.
An integrated, multi-layered approach for the protection of pharmaceutical stockpiles is essential. For that reason alone, L-E agencies, local medical services, and local emergency-management officials should develop integrated plans for the extensive public notification of pharmaceutical distribution-center operations, protocols for the physical security of distribution centers and storage sites, the procedures needed to maintain information security on pharmaceutical stockpile storage sites, and public notification of the effectiveness of pharmacological and treatment intervention. Incorporation of these elements in local strategies for integrated planning will help ensure an optimum balance of mitigating public fear and uncertainty while also maintaining the physical security of stockpile sites and distribution centers.
Managing Demonstrations and Civil UnrestPandemic emergencies may last for several months during which cycles of improvement may be immediately followed by elevated infection rates. Over the course of the pandemic period, the public may become dissatisfied with real or perceived public-health management. In worst-case situations, health-care and/or government facilities may be targeted for demonstrations. Protest activities are likely to start as orderly expression of public dissatisfaction; however, these same demonstrations may be exploited by persons with malicious intentions. Terrorists in particular may use the concentration of people for a peaceful protest as the stage for an attack. From the strategic perspective of a terrorist group, attacks carried out during already dangerous emergency situations enhance the psychological impact of the attack.
The World Health Organization (WHO) identifies six phases of a global pandemic. Phase 1 indicates a steady state in which no pandemic infections in humans have been identified. Phase 2 is declared when there is a marked increase in infections among animal species of a viral strain that has the potential for infecting humans. Phase 3 is characterized by an identified sub-strain of viral infection in humans, but with no detected human-to-human transmission. When small clusters (fewer than 25 people) of sub-strain-infected people are identified with infections lasting less than two weeks, and resulting from limited human-to-human transmission in a localized area, the WHO declares a Phase 4 pandemic. Phase 5 infections are characterized by larger clusters (generally 25–50 people) with infections lasting two to four weeks (but remaining generally localized). In Phase 6, the virus is highly transmittable between humans and there has been a marked increase in infections and sustained transmission beyond local areas.
Demonstrations and protests may become violent on their own accord, of course. When a pandemic emergency progresses over a long period of time and elevated infection rates seem to be the norm, such demonstrations and protests can be expected to become more intense and aggressive. Law-enforcement agencies are nonetheless expected – with fewer personnel, it should be remembered – to deal with such situations with appropriate crowd-control countermeasures. In any event, pandemic civil-disturbance planning should incorporate measures to de-escalate tensions, especially during the protest planning phases, if any. One way to do this is to leverage multi-jurisdictional agreements to augment the number of personnel available.
Securing Quarantine and Isolation AreasThe implementation of quarantine and isolation restrictions encompasses a broad spectrum of medical, legal, and political issues, often with great intensity. Medical and public-health officials may establish quarantine sites in local hospitals and medical centers. Providing security for small and relatively localized quarantine sites may not require significant law-enforcement staffing. However, during severe pandemic outbreaks travel may be limited and isolation areas may have to be established to help reduce the spread of infection. For those and other reasons, the legal authorities needed to order quarantines and/or establish isolation areas must be clearly defined, in advance, from the local level up through the state level.
In addition, individual law-enforcement professionals must be absolutely clear on the rules and regulations governing the use of force authorized to enforce quarantine and isolation-zone containment; the latter task may require significant additional law-enforcement resources. Under severe conditions, quarantine and isolation-zone containment also may involve crowd-control operations, and the very establishment of isolation zones may result in civil disobedience from both sides of the fence.
The comprehensive integration and participation of all stakeholders is essential both for law-enforcement planning and in the preparations for possible quarantine and isolation containment. Among the most important of these stakeholders are the local district attorney’s office and the state attorney general’s office, as well as local elected decision makers. However, public-health and emergency-management officials, community medical leaders, and law-enforcement personnel, working in concert, should be capable of developing, and carrying out, effective integrated multi-disciplinary plans and preparations.
Correctional-Facility Crowd-Control ConsiderationsCommunicable diseases frequently spread through correctional facilities more rapidly than through the general population. As might be expected, pandemic-generated fear and uncertainty are particularly prevalent in correctional facilities. The prisoner population itself usually includes a large number of persons already suffering from compromised health conditions. The more virulent strains of an infectious disease are therefore likely to produce a proportionately higher mortality rate in a correctional facility. Largely for that reason, prisoner populations may react violently to the correctional staff during a pandemic, and local L-E personnel may be needed to help control the facility and to support the correctional staff in suppressing prisoner rebellions.
Coordinated planning – involving correctional staffs, law enforcement, and the medical community – is vital in preparing to address these types of situations. Custodial crowd control requires considerable coordination under normal conditions. In a pandemic situation, disruptive prisoners may be both asymptomatic and infected, significantly increasing the risk of transmission to other prisoners as well as to correctional and law-enforcement officials. The plans developed to deal with such situations should therefore consider the secure movement of selected prisoners, if practical, to ensure their isolation from others. Some prisons and jails already hold prisoners from other jurisdictions. Local interagency agreements for prisoner housing and safekeeping need to be reviewed and, where necessary, amended to provide for the movement of any prisoner determined to be an obstacle to overall safety and security during a pandemic.
Planning and Preparation of Paramount ImportanceLaw-enforcement officers and command staff are generally very well versed in the tactics, techniques, and procedures for managing crowd control. The pandemic emergency creates significant difficulties in coping with crowd-control situations. Well integrated planning is essential to ensure that all agencies having a role in the management of pandemic events are coordinated in supporting the L-E crowd-control mission. The procedures required for a multi-jurisdictional, interdisciplinary coordinated response must be developed and practiced through various exercise methodologies.
Recognizing and preparing for additional assignments also must take into account the fact that the characteristic realities of pandemics may greatly complicate overall law-enforcement operations. For that reason, emergency service professionals must periodically review and practice their intra- and inter-agency response protocols.
To summarize: Pandemic emergencies have unexpectedly struck the United States, and other nations throughout the world, many times in the past. The very nature of viral mutation and evolution suggests that the next major pandemic threatening the United States will be unexpected – and, probably, shocking to modern society. Realistic preparedness is essential to mitigating the impact of, and accelerating recovery from, pandemics at the local level.
Joseph Steger is the pseudonym of a senior law-enforcement commander whose undergraduate background in a pre-medical program led to initial certification as an EMT in 1981. He retained that level of certification for eight years and across three states while serving as a federal law-enforcement officer. Over the years, Steger has worked closely with CONTOMS-trained tactical medics and physicians in numerous situations.