Since Congressional passage of the Public Health Security and Bioterrorism Preparedness and Response Act of 2002, the nation’s public-health community has made tremendous improvements in its emergency-response capabilities. The terrorist attacks of 11 September 2001, the anthrax attacks shortly thereafter, hurricanes Isabel and Katrina, and the early warnings of a possible influenza pandemic were instrumental in underscoring the need for the presence of public-health representatives at the proverbial “planning table.”
In the Commonwealth of Virginia, the need for public-health officials to collaborate with non-health partners in preparedness efforts is recognized and understood as key to the success of the initiatives developed. Plans for the distribution of emergency medical supplies and pharmaceuticals through the Strategic National Stockpile (SNS) program, for example, are in place and routinely practiced. The federal government’s NIMS (National Incident Management System) and ICS (Incident Command System) principles are embraced as effective tools for the management of infectious-disease outbreaks and for a broad and varied spectrum of such other health-related events as the evacuation of medically fragile patients, drinking water infrastructure failures, the spread of foodborne diseases and weather catastrophes such as floods and hurricanes.
Interoperability and collaboration are key components in the Commonwealth’s planning decisions. As an example, Virginia, like many other states and territories, participates in the federal government’s Chempack Program.
This program is administered through the CDC (Centers for Disease Control and Prevention) and public-health agencies, but involves both public and private sector stakeholders. A guiding principle of Chempack is that caches of nerve-agent antidotes must be forward-deployed for immediate use in the event of a nerve agent attack. In view of the expediency required for effective antidote administration, adherence to this principle demands that clear and concise protocols be developed across agency as well as jurisdictional lines.
Pre-positioning Medical Assets and Special Needs Planning
In addition to these examples of partnerships in action, the Virginia Department of Health (VDH) has developed an assortment of strategies to engage the department’s SNS partners and community stakeholders on the pre-positioning of local pharmaceutical caches that may be needed to give citizens protection from exposure to a biologic agent. Among the many related issues discussed and in most cases resolved were the development of policies on first-responder/first-receiver and head-of-household dispensing, the alternative modalities needed to expedite community mass prophylaxis efforts, the preparedness efforts needed to cope with a pandemic influenza, sheltering and evacuation plans for the technologically dependent and/or special medical needs populations, and communications interoperability – all of which require, in the implementation stage, not only close collaboration but also a mutual understanding of the response roles of other agencies and organizations involved in the collective response.
VDH’s close working relationship with the Virginia Fusion Center also demonstrates the department’s strong support for inter-agency cooperation and information sharing. The Fusion Center, with which VDH communicates routinely (often daily), is essential to Virginia's homeland-security efforts and serves as the primary resource for the exchange of critical information between and among local, state, and national homeland security, law-enforcement, and intelligence agencies.
Today, a collaborative environment exists in which a broad spectrum of organizations and agencies – including but not limited to local and state emergency management, firefighting, law enforcement, and EMS (emergency medical services) agencies as well as the National Guard and numerous non-profit, faith-based, and volunteer organizations – all participate in varying degrees. Just as important to the collective effort are such private-sector businesses as pharmacies, transportation companies, manufacturers, hospitals, community health providers, and many others.
The Varied Voices of Other Stakeholders
Virginia also enjoys the strong support of various health initiatives and inter-agency collaborations promoted by and/or through the Governor’s Office, the Office of Commonwealth Preparedness, and the Commonwealth’s Secretary of Health and Human Resources. A late January meeting among federal representatives – from the Department of Health and Human Services (HHS), the Federal Emergency Management Agency (FEMA), the Department of Defense (DOD), state and local agencies (in the public health, emergency management, and transportation fields, primarily), private health providers (hospitals and nursing homes) and such professional organizations as the Virginia Hospital and Healthcare Association and the Virginia Health Care Association – further demonstrated the important value of the partnerships, and professional relationships, already being developed.
The January meeting – which was convened to work on mutually acceptable pre-hurricane “landfall” decision-and-deployment timelines for the Hampton Roads area – was particularly important because it fully engaged policy planners and decision-makers in open-ended discussions of differing and sometimes competing local, state, and federal planning assumptions.
Those discussions also revealed that, on a number of important matters, the concepts of operations followed by the various agencies represented were not always in alignment. Nonetheless, attendees came to a closer appreciation not only of one another’s roles but also of the reasoning behind existing (and sometimes differing) policies on trigger points and implementation strategies. Future meetings are planned over the coming months to resolve various inconsistencies that have been identified.
Through these and other closely related efforts, VDH has emerged, and is participating, as a strategic partner in planning and multi-agency coordination for all-hazards events at the federal, state, regional, and local levels.