Understanding Public Health Mutual Aid

Wikipedia defines mutual aid as “an agreement among emergency responders to lend assistance across jurisdictional boundaries.” It then amplifies that definition with the following particulars:  “This may occur due to an emergency response that exceeds local resources, such as a disaster or a multiple-alarm fire. Mutual aid may be ad hoc, requested only when such an emergency occurs. It may also be a formal standing agreement for cooperative emergency management on a continuing basis, such as ensuring that resources are dispatched from the nearest fire station, regardless of which side of the jurisdictional boundary the incident is on.” 

Another definition of mutual aid is offered by the Massachusetts Department of Public Health, which briefly describes mutual aid as “an inter-municipal agreement that allows communities to support each other, if their resources are stretched beyond normal capacity.”

Traditionally, when one thinks of mutual aid, the first mental images are usually of law-enforcement agencies assisting one another during large-scale incidents or events, fire departments working in tandem during major urban or rural conflagrations, or EMS (emergency medical services) teams assisting each other at horrendous traffic accidents or other major incidents likely to generate a large number of patients.

In real life, of course, health departments across the United States effectively protect communities from infectious diseases, environmental hazards, and other grim realities of modern life each and every day through a variety of preventive, preparedness, and even response measures.   However, an event that threatens public health could quickly overwhelm the public health resources of a particular municipality, county, state, or region, even if that event does not constitute a declared emergency.  For example, an infectious-disease outbreak in any political jurisdiction may require immediate action to prevent the development of a major epidemic threatening many neighboring jurisdictions.  Additional public-health expertise and personnel – drawn from several jurisdictions – can be critical to addressing and controlling such an event.

A Richly Detailed Document – In Writing 

Mutual aid in the field of public health can consist of aid to another public-health agency in the form of personnel, equipment, facilities, services, supplies, and/or other resources and probably would include, but not be limited to, inspections, the establishment of vaccination clinics and/or emergency dispensing sites, or even administrative assistance.

One of the operational as well as legal cornerstones of effective cooperation is the establishment of a mutual-aid agreement between various local, county, state, or regional health departments.  A binding and effective public-health mutual-aid agreement should therefore, as a minimum: (a) consider the possible scope of work; (b) address such important and related issues as employment and liability; and (c) provide a formal structure both for requesting assistance from other communities and for providing assistance to those same communities.  The agreement should optimally be modeled on already existing mutual-aid arrangements – particularly in the fields of public safety and firefighting services – that have been used successfully for many years. In that context, the public-health mutual-aid agreement will and should be a logical extension of public-health planning and preparedness programs and activities.

A template approach to this integral agreement could be developed incorporating the following:

  • Section 1: Scope of the agreement;
  • Section 2: Authority – i.e., spelling out the legal authority under which the Health Department functions;
  • Section 3: Definitions – This section will define the relevant terms usually set forth in the mutual-aid agreement and would include, as a minimum, the terms mutual aid, public health agency/health department, sending agency, and receiving agency;
  • Section 4: Requests for Assistance – This section sets forth, in specific detail, the processes used both for receiving and for providing mutual aid;
  • Section 5: Limitations – This section makes clear that the provision of mutual aid is and must always be voluntary; and
  • Section 6: Liability – This section ensures that each party shall be liable for the acts and/or omissions of its own employees.

The various agencies involved in a mutual-aid agreement may want to include other sections to cover such related matters as reimbursement, overall implementation realities, workers’ compensation claims, and the possible future severability of the agreement.

Of course, the role that health departments play in planning, preparedness, and response to emergencies is always evolving.  As a logical next step in this progression, non-traditional first responders need to understand the importance of formalized mutual-aid agreements.  Understanding the capabilities of contiguous jurisdictions and hammering out the details of the formal agreements binding neighboring jurisdictions are, of course, best done prior to an actual incident or event – in which the specific details in the agreement will certainly be put to the test. 

Raphael Barishansky

Raphael M. Barishansky, DrPH(c), is a consultant providing his unique perspective and multi-faceted public health and emergency medical services (EMS) expertise to various organizations. His most recent position was as the Deputy Secretary for Health Preparedness and Community Protection at the Pennsylvania Department of Health, a role he recently left after several years. He is also currently a doctoral candidate at the Fairbanks School of Public Health at Indiana University.

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