The Intersection of Public Health and EMS During Disaster Response

Most of these reported responses have the potential to call on EMS and public health to interact, even if not on an emergency scene. Although not specifically mentioned in the NACCHO report, these responses also call for established plans that have been researched and written based on realistic capabilities as well as exercised in advance.

Another interesting element brought out in this chapter is the actual number of staffers dedicated to emergency preparedness employed by LHDs. LHDs serving jurisdictions with a population numbering between 100,000 and 499,999 had an average of two dedicated staffers for emergency preparedness while those LHDs serving an area with 500,000 or more people had a median of four dedicated employees. This translates to resources for EMS agencies to call upon in regard to information on naturally occurring events, (e.g., pandemics), man-made incidents (chemical or biological attacks) or even an additional perspective on large-scale event readiness.

An additional area where your LHD can add to the EMS arsenal is in regard to stockpiling of both personal protective equipment (including gloves and N-95 masks) and antiviral medication—both of which are resources providers may have to utilize during a pandemic situation or other public health emergency when EMS will be on the front line of patient care.

Clearly, this means interaction between public health authorities and EMS personnel prior to an emergency situation, which can include joint training, drills and exercises. EMS agencies and personnel need to realize that good working relationships with their health department partners (this can be local, county or regional) make sense in regard to disaster/emergency preparedness. A good example of this would be a tabletop exercise for public health officials and EMS agencies to test sharing resources.

One of the elements of the report that stood out was the amount of funding LHDs receive to support their emergency preparedness efforts, with the vast majority receiving funds through various federal initiatives, including the Public Health Emergency Preparedness (PHEP) cooperative agreement, Cities Readiness Initiative (CRI) or Hospital Preparedness Program (HPP) grants. A much smaller amount received funding through state or local governments.

Just to give the readership some idea of the total figure we are speaking of, in fiscal year 2011 the federal government funded state and local preparedness and response capabilities to the tune of nearly $664.3 million. No matter the funding stream, some of this money goes toward various training, drills and exercises to ensure the healthcare system is ready—and EMS is an element of the healthcare system. Clearly, that means EMS should be participating in these trainings, drills and exercises.

One of the issues mentioned in the chapter on emergency preparedness is utilizing volunteers in emergency response. Nearly all LHDs (93%) reported engaging volunteers for preparedness activities. This includes Medical Reserve Corps (MRC), Community Emergency Response Teams (CERT) or even Red Cross volunteers. This becomes an area of concern for EMS agencies, as many utilize volunteers as primary first responders; some of these responders may have other duties volunteering for the local and/or state health department in the capacities mentioned above.

Another interesting statistic is in chapter 7 of the report—LHD Activities—which reported that 4% of the LHDs surveyed provide EMS to their communities. This section gave no additional breakdown regarding the level of service provided (ALS or BLS) as well as any other services associated with EMS (medical control, dispatch, etc.). What’s interesting to note is two of the larger, more well-established EMS systems in the U.S.—Boston EMS and Denver Paramedics—are both departments of their local public health agency.

Collaboration

“More so today than at any other time, communities are relying on strong partnerships to ensure the health and safety of the country. No one entity—whether it’s public or private—can do it alone,” says Jack Herrmann, senior advisor and chief of public health preparedness at NACCHO. Herrmann adds, “Many local health departments have long been working from a position of having to do more with less, but unfortunately, the time has come where less means less. Critical public health services will not be available due to recurrent budget cuts and the elimination of key workforce positions. The only way we can beat this is for everyone to come together, pitch in and help.”