The Intersection of Public Health and EMS During Disaster Response

Local health departments provide more than just vaccines and pamphlets

It’s been a typical Monday evening shift for you on All-City EMS, a municipal EMS agency handling BLS and ALS for a large urban area. You’re about to turn your patient care reports in to your supervisor when you see a bulletin on the wall from the local health department about a series of flu vaccination clinics coming up. You roll your eyes and say, “Is that all those public health folks are good for? Flu vaccinations?”

Chances are you don’t really know or understand the function and structure of your local health department. Many of us work for EMS agencies that literally have nothing to do with the overarching health department that serves the same municipality, county or region.

Health departments come in all shapes and sizes, serving both large and small communities and areas. Traditionally, these entities organize themselves around functional operational divisions or units. These divisions usually include, but are not limited to, such specialized fields as maternal and child health, epidemiology/disease control, administration, environmental health, community health and behavioral health. But these same public health entities have been planning and preparing for, and responding to, various emergencies for many years, including environmental emergencies, foodborne and sanitation issues, and water supply safety.

Since the 2001 anthrax attacks, considerable funding has been provided to local, state and federal public health agencies and organizations to orient them toward the more comprehensive state of preparedness needed to cope with the dangerous realities of today’s world. These realities include the possibility of public health entities needing to plan for and respond to the full spectrum of WMD threats (specifically the CBRNE threats) as well as other threats, such as pandemic influenza. As EMS providers, and a part of the larger healthcare structure, it’s in our best interests to understand the capabilities of our local and state health departments; any lack of knowledge has the potential to work against us in cases of large-scale emergencies or when we’re faced with an emerging threat.

I had the opportunity to examine the recently released National Association of County and City Health Officials (NACCHO) 2010 National Profile of Local Health Departments (LHDs) and was pleasantly surprised to find an entire chapter of this text devoted to emergency preparedness (chapter 6).

NACCHO represents all governmental local health departments, including counties, cities, districts, townships and tribal public health agencies. Today, active membership in NACCHO continues to grow, with about 1,300 local health departments represented. The aforementioned chapter contained information on things like the number of health departments employing dedicated emergency preparedness staff; the types of events health departments typically consider emergencies requiring an emergency response; as well as other information (funding streams specific to emergency preparedness, etc.).


Some of the facts included in the report shouldn’t come as a surprise—for example, 61% of LHDs responded to the 2009–10 H1N1 influenza outbreak—while others certainly are surprising, such as the fact that, on average, LHDs use 30% of their staff to respond to natural disasters; this is a large percentage and has the potential to impact other functions of the health department, lowering the priority of some public health services during emergencies.

Traditionally, the emergency response staff has a solid background in public health through both education and experience, and a working knowledge of ICS and NIMS principles. Additional reported emergency response activities for the LHDs during this time period included infectious disease (26%), natural disaster (23%), foodborne outbreak (21%), chemical spills or releases (9%), and exposure to a potential biological agent (5%).

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