Using NHSS 'To Minimize the Risks'

The recently released (January 2010) National Health Security Strategy (NHSS) is the first comprehensive policy document focusing specifically on the nation’s goals of protecting people’s health in times of emergency. The U.S. Department of Health and Human Services (HHS) states that the purpose of the NHSS is “to guide the nation’s efforts to minimize the risks associated with a wide range of potential large-scale incidents that put the health and well-being of the … [American] people at risk.”

The strategy not only sets priorities for both government and non-government activities during the next four years, but also includes an interim implementation guide listing actions expected to be taken within the next nine months.

In moving the strategy forward, the guide lists 10 objectives to achieve what it terms health security. Each of those objectives is significant in itself, and the entire strategy should be reviewed by career professionals as well as senior decision makers. However, for planning and operational purposes, public health agencies and organizations should pay particular attention to the following four objectives as they continue to transform their traditionally social-service organizations into response agencies and entities:

(1) Objective: Ensuring situational awareness so that responders are aware of changes in emergency situations. A situational-awareness capability is of particular importance to public health agencies to ensure they are fully aware of what is in place now, prior to any potentially harmful incident or event, so that when an incident does occur they have the ability to respond appropriately. The process of achieving such awareness can be defined in four steps: (a) Being able to understand the current situational environment, as well as present and/or imminent dangers; (b) Understanding the potential hazards inherent in the present environment but perhaps not yet apparent; (c) Acting to protect victims from incidents, events, or potential hazards described in either of the first two steps; and (d) Communicating relevant information about such hazards to appropriate decision-making authorities and/or to the general public.

(2) Objective: Developing and maintaining the workforce needed for national health security. Achievement of this objective is and will be critical for public health entities both now and for the foreseeable future. Moreover, there are both emergency and non-emergency facets involved. Among the more important emergency facets is the fact that public health entities will have to ensure that there is a health-security ready workforce in place that includes all levels of providers, supervisors, managers, and other executives. In the non-emergency area, the strategy should include a full understanding of the fact that the public-health workforce – including public health, health care, homeland security, and emergency medical services providers (a workforce that clearly is at the center of national health security) – has been shrinking in recent years and may become even smaller in the foreseeable future. This objective has become even more critical because of the current economic problems facing not only the federal government but also most state and city governments as well.

(3) Objective: Fostering integrated healthcare delivery systems that can respond to disasters of any size or complexity. The NHSS plan specifically refers to communities being protected by coordinated health care systems. Such coordination implicitly includes the situation of an agency actively coordinated with its mutual-aid partners and both county and regional resources as well as area hospitals and other ESF (Emergency Support Function) partners such as emergency medical services (EMS) agencies and medical examiners. Agencies also must be aware of what “outside” resources are likely to be available at the time of a large-scale incident, and what gaps exist in regard to emergency preparedness and response – as well as what is being done to address those gaps. Here it should be recognized that these findings, if fully documented, may translate into an increase in the quantity, and quality, of the exercises (tabletop, functional, and full-scale) scheduled as well as leadership actions on the state and federal levels that not only can reduce “territorialism” but also, and at the same time, enhance rewards for cooperative behavior.

(4) Objective: Ensuring timely and effective communications. This is perhaps the most critical as well as most frequently criticized area of readiness (or the lack thereof), and many large-scale incidents are either “won” or “lost” because of effective communications (again, or the lack thereof). If nothing else, public health agencies at all levels of government should use a communications system that shares a common radio frequency, and – not matter what system is used – must have at least a few built-in redundancies. Those redundancies probably should include, but not necessarily be limited to, radio caches, 800 mghz radios, satellite phones, and amateur radio operators. In the last-named category there could and probably should be both ARES (Amateur Radio Emergency Service) and RACES (Radio Amateur Civil Emergency Service) units, both of which should be included in planning efforts and exercises.

As has been proved time and time again – most recently with the H1N1 pandemic and the Haitian earthquake, interaction with other healthcare partners might well spell the difference between failure and success in the handling of any major incident. In short, the NHSS probably should be considered as the federal government’s first (but by no means last) move in a continuing process to ensure that all healthcare agencies, at every level of government, are on the same page in terms of coping with large-scale public health emergencies. Those public health entities which are expected to be at the tip of the spear in a health emergency should take notice – and whatever action is needed – based on recognition of that fact. 

Raphael Barishansky

Raphael M. Barishansky, DrPH, is a public health and emergency medical services (EMS) leader with more than 30 years of experience in a variety of systems and agencies in positions of increasing responsibility. Currently, he is a consultant providing his unique perspective and multi-faceted public health and EMS expertise to various organizations. His most recent position prior to this 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. Mr. Barishansky recently completed a Doctorate in Public Health (DrPH) at the Fairbanks School of Public Health at Indiana University. He holds a Bachelor of Arts degree from Touro College, a Master of Public Health degree from New York Medical College, and a Master of Science in Homeland Security Studies from Long Island University. His publications have appeared in various trade and academic journals, and he is a frequent presenter at various state, national, and international conferences.

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