2. Introduction
Almost any emergency or disaster event has the potential to adversely affect the health of the public, and in fact, public health is now defined as an emergency response agency.1 As such, it is one of the many agencies that respond to an event that disrupts the community. When there is a disruptive event, the role of public health may be one of quiet surveillance to assure that the event does not pose or become a threat to public’s health, or it may be to implement specific measures to prevent or control a specific threat to the public’s health. For example, after major flooding, the most visible activities will be taken by rescue teams, police, traffic agencies or public utilities, while public health agencies heighten surveillance for water-borne diseases caused by the contamination of drinking water. Other public health actions could include providing public information about preventive measures to be taken, such as issuance of a boil-water advisory.
There are many emergencies in which the public health agency plays a central role in defining the scope of risk, such as the deliberate release of an infectious agent (such as anthrax) into the community, or the natural occurrence of a virulent, highly infectious disease, such as SARS. In this case, the public health agency would serve as one of the key leaders in the community response, working closely with other agencies, to design protective actions, instruct health professionals about preventive or treatment interventions or even using legal authority to restrict movement by exposed or infected persons.
At regional and national levels, jurisdictions in the United States have adopted a system for achieving unified inter-agency management during emergency response operations. This system is referred to as the National Incident Management System (NIMS). The purpose of NIMS is to assure that there is a comprehensive national framework that will support efficient incident management for all domestic incidents, regardless of size, nature or complexity. The framework of NIMS provides for a seamless inter-agency (and in some cases inter-state or state-federal) interface and standardization of emergency response organizational structures, emergency plan training, emergency response equipment, inter-agency communication equipment and other technology. The Incident Command System (ICS) is one part of NIMS.
ICS is a management system that is used to achieve optimal command and control within an organization as well as seamless inter-agency coordination during any type of emergency event. It uses a clearly defined chain of command, a common nomenclature for key management positions, defined management sections and specifically described emergency response functional roles. Under the ICS, only those management sections and emergency response functional role positions that are needed to respond to the emergency are activated, and during any event different sections and/or roles may be opened or closed as needed. This ability to scale up or scale down agency activities during the response is referred to as “expandability” and “contractibility” of the emergency response operation. Thus ICS has been deemed to be efficient, as only those resources in the plan that are needed are used at any given time. Under ICS, common titles are used for key management roles across all jurisdictions in order to enhance inter-agency communication.
ICS was originally developed in California as a way to improve multi-agency fire-fighting efforts, and has been adopted and adapted by the Federal Emergency Management Agency (FEMA), state and local offices of emergency management, police and fire departments, utility works and others as the model for achieving efficient, coordinated emergency response. ICS has been adopted by the United States government as the management model to be used for any sort of response that includes federal assets. Therefore, for public health to be an effective player in any sort of inter-agency response, it must be able to function under the ICS so that it can easily integrate itself within any multi-agency response operation. Knowledge and use of the ICS by public health will allow it to be a more effective player at the emergency response table. Those who lead public health agencies must have a thorough understanding of this system so that the agency they lead can function in synchronization with other agencies on the local, state and national levels. In this document we have mapped the ICS to the usual emergency response procedures that are used by public health during any sort of event that can affect the health of the public. We are referring to this mapping as Public Health ICS, or PHICS (“pikes”). PHICS is not different from or an alternative to ICS, but rather, illustrates how public health can use the incident command system as a framework for agency emergency response plans.
1 For example, see: Department of Homeland Security. National Response Plan, Electronic PDF file] December 2004: http://www.dhs.gov/dhspublic/interapp/editorial/editorial_0566.xml. Accessed March 9, 2005. See also the Public Health Security and Bioterrorism Preparedness and Response Act of 2002. http://thomas.loc.gov/cgi-bin/query/D?c107:5:./temp/~c107lUZQAf:: Accessed March 2, 2005.