The National Health Security Strategy

The recent past has seen the first-ever declared World Health Organization phase 6 pandemic and a resulting potential for overcrowded EDs, panicked citizens and an overall nationwide fear about vaccine shortages. By mid January, according to the WHO, more than 200 countries worldwide had confirmed cases of pandemic influenza H1N1 2009, and at least 14,142 people had died from it. In the U.S., the Centers for Disease Control and Prevention estimated that between 39 million and 80 million cases occurred between April and December 12, 2009, with as many as 362,000 hospitalizations and up to 16,460 deaths. (The disagreement in death toll reflects the difficulty of identifying and specifically attributing H1N1 deaths, particularly in nations with poor healthcare infrastructure.) Most U.S. EMS agencies and some public health agencies lacked continuity-of-operations plans to deal with the contingency of providers getting sick and not being able to work.

Back in April 2009, the then-acting Secretary of Health and Human Services determined that a public health emergency existed nationwide involving H1N1 influenza that had a significant potential to affect national security. This initial declaration allowed the authorization of emergency use of certain antiviral medications, as well as personal protection equipment. It also led to the release of a percentage of allotted portions of the Strategic National Stockpile to various states.

Then, on October 24th, this declaration of a public health emergency was followed with a presidential declaration of a "national emergency." This proclamation was a proactive measure taken in response to the growing number of infected. It meant that Health and Human Services Secretary Kathleen Sebelius had new authority to bypass federal rules when advising state, regional and local health authorities regarding the opening of alternative care sites, such as off-site hospital centers at schools or community centers, if hospitals in their jurisdictions sought such permission.

Some hospitals opened drive-through and drive-up tent clinics to screen, treat and/or vaccinate for H1N1. The rationale behind this was to keep infectious people out of regular emergency rooms and away from other sick patients. The federal proclamation also meant that hospitals could modify patient rules--for example, requiring patients to give less information during a hectic time--to quicken access to treatment.

Most recently, these interesting times have led Sebelius to release the National Health Security Strategy (NHSS). This document is the first-ever comprehensive United States strategy for protecting the public health during a large emergency, such as the H1N1 influenza pandemic. Its two major goals are to build community resilience and strengthen and sustain the health and emergency response systems. The strategy sets priorities for government and nongovernmental activities during the next four years, with its interim implementation guide listing actions to be taken in the next nine months. There are 10 objectives laid out in the plan, but EMS providers should pay close attention to the following three:

Ensuring situational awareness so responders are aware of changes in emergency situations: A situational awareness capability is something EMS agencies need to assure is in place now, prior to any event, so that when an incident occurs, they have the ability to respond appropriately.

Fostering integrated healthcare delivery systems that can respond to disasters of any size: The plan specifically mentions communities being protected by coordinated EMS systems. Is your agency coordinated with its mutual-aid partners, county and regional resources, as well as area hospitals and other ESF #8 partners? Do you know what resources are available at the time of a large-scale incident? What gaps exist, and what can you do to address them?

Ensuring timely and effective communications: Most large-scale incidents are "won" or "lost" based on the element of effective communication. Does your EMS agency utilize a system that shares a common radio frequency? Do you have built-in redundancies for the system--this can include radio caches, satellite phones and amateur radio operators (ARES, RACES, etc.)--and have you written them into your planning efforts and exercises?

As proven time and time again, but most recently with the H1N1 pandemic, interaction with our other healthcare partners could spell the difference between failure and success in handling any major incident. The NHSS is the federal government's first move in a process to ensure we are all on the same page when it comes to large-scale public health emergencies. EMS agencies should take notice--and action--based upon it.

Raphael M. Barishansky, MPH, is program chief of public health emergency preparedness for the Prince George's County (MD) Health Department and a member of EMS Magazine's editorial advisory board. Contact him at rbarishansky@gmail.com.