Bio-Preparedness: From the Top Down

All political jurisdictions must be prepared for a biological event, whether a manmade threat such as an anthrax attack or a natural threat such as pandemic influenza. Because some jurisdictions throughout the United States conduct exercises on these and other threats on a regular basis, other jurisdictions – at all levels of government – can learn valuable lessons from the documented experiences of others. By collecting and sharing these and other lessons, and implementing the recommendations derived from those lessons, the nation as a whole can be much better prepared to cope with biological threats in general. (Many such lessons – from biological and other threats – can be found on Lessons Learned Information Sharing (LLIS.gov).)

During the fall of 2007, the State of Washington sponsored an annual bioterrorism exercise to test the state’s readiness to cope with biological threats in that state. The exercise involved a simulated biological attack that resulted in an outbreak of Salmonella typhi caused by tainted communion wafers. However, despite their personal awareness of the outbreak, several local health officers were not sure whether it constituted a “significant” public health event that would have required them to declare a public health emergency.

Some local health officers did decide, in fact, not to declare such an emergency, which meant that they also did not: (a) request a county-level declaration of emergency; and/or (b) request that the county emergency operations center be activated. During the after-action review of the exercise, region officials recommended adding specific “triggers” into public-health preparedness plans that would remove any ambiguity about what is and what is not a significant public health threat.

The same type of regional planning has proved valuable in other parts of the country as well. In both 2006 and 2007, for example, the Louisiana Department of Public Health sponsored regional tabletop exercises, throughout the state, to test various aspects of both local and statewide preparedness for biological threats. During the Region III exercise – an area that includes the parishes between New Orleans and Baton Rouge that were hit especially hard by Hurricane Katrina – public health professionals noted a sharp increase in the number of mental health patients, including pediatric cases. The demand for psychological services in the area far exceeded the supply at that time.

Because of that finding, the region’s representatives worried that any additional stress caused by a pandemic or other biological threat might completely overwhelm the system. The after-action report therefore recommended that the region work with other jurisdictions in the area, as well as the state, to accommodate a possible future surge in mental health cases by resource sharing and/or by mutual-aid agreements.

Direct Involvement & Hands-On Participation Another Louisiana region faced a different problem in its efforts to cope with biological preparedness – namely, getting elected officials more directly involved in the preparedness efforts. Prior to the Region VI tabletop exercise, the regional Office of Public Health sent invitations for participation to a number of elected officials. However, none of them attended the exercise, which meant that they had no input or insight into the issues, recommendations, and corrective actions proposed by those (at lower levels of government) who did participate in the exercise. Because so many citizens turn almost automatically to elected officials for guidance during emergencies, it is essential to have those same officials directly involved during the preparedness and exercises stages of bio-preparedness planning.

The after-action review therefore recommended developing, and conducting, workshops specifically designed for elected officials not only to bring them all together in one space at the same time but also, and of greater importance, to make them more fully aware of their own important roles during emergencies of all types. The after-action review also strongly recommends encouraging these same officials to participate directly and personally in the workshops and exercises scheduled, instead of sending staff members.

Being prepared for biological threats involves cooperation at and from all levels of government as well as clear guidance for each individual involved. By learning from these exercises, and by implementing positive changes in plans and procedures from the local level up, the nation as a whole can be much better prepared for whatever threats it might face in an increasingly uncertain future.

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Jennifer Smither

Jennifer Smither is the outreach and operations manager for Lessons Learned Information Sharing (LLIS.gov), the Department of Homeland Security/Federal Emergency Management Agency’s national online network of lessons learned, best practices, and innovativeeas for the U.S. homeland security and emergency management communities. She received her bachelor’s degree in English from Florida State University.

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