Question One: Quarantine and Isolation
In the early stages of the emergence of infectious diseases, isolation and quarantine are in most cases the only and last resort used to control effectively and manage the conditions (Al-Ateeg, 2004). These methods are usually handy when there is a limited knowledge of a newly identified or an occurrence of a previously contagious disease that poses a serious public threat. While these methods are used to respond to emerging and re-emerging public health threats and protecting the public by preventing the exposure of the population who have or may not have contracted a contagious disease, there are significant differences between them (Al-Ateeg, 2004). Isolation occurs when people who are medically known to have contacted a dangerous infectious disease are separated and treated from the healthy population to prevent the disease from spreading (Diffen, 2016).
Quarantine on the hand refers to the process in which persons who have been exposed to a communicable disease but are not yet medically proven ill, are separated from the others and closely monitored for the disease. Unlike isolation, quarantine also applies to animals, buildings, and even cargo that poses health concerns to the healthy populace (Diffen, 2016). Another difference between the two lies in the process used in addressing the disease. For instance, while the patients in isolation receive medical care for the disease separately from the rest with precautions set to protect the health providers from contacting the disease, people in quarantine receive care designed to prevent them from contacting the disease. Individuals in isolation are treated in special medical facilities while those under quarantine receive care in specialized care facilities or emergency centers. Moreover, isolation period lasts for the time the disease is clinically considered infectious whereas quarantine period lasts for the incubation period of the disease microbe (Diffen, 2016).
Question Two: Challenges in accommodating residents with functional needs at a shelter
Individuals with functional needs are those people who have needs that extend beyond those required by the general population. These people cannot, for instance, make own provisions to have their needs met. Examples of individuals with functional needs include those who have mobility, hearing, visual, speech, or chronic impairments, suffer from chronic medical conditions that require regular care such as diabetes or Foley catheter maintenance as well as those who are elderly (Hazlett, 2009). Because of these challenges, people with functional needs presents a number of difficulties to the Public Health and Emergency Management officials at their shelters. First, there is the problem of ensuring proper housing design and considerations that play a crucial role in emergency response and preparedness. Housing concerns also include such factors as personnel staffing and equipment fitting. Because most shelters are in buildings not adequately equipped as medical care facilities addressing emergency medical concerns for these people can be rather challenging (National Council on Disability (U.S.), 2009). Some of these establishments may also lack no sources of emergency power generation while a good number of them are poorly equipped with only a limited source of power.
Second, there is the challenge of addressing disaster-related vulnerabilities for these groups of persons and building their capacities to face disaster-related challenges because of a lack of evidence-based knowledge about how best to organize their readiness, response, and recovery efforts (National Council on Disability (U.S.), 2009).
Question Three: Mass fatalities as it relates to public health
During a public health pandemic, health practitioners in conjunction with the relevant authorities need to be prepared to control and manage additional fatalities arising from the outbreak during the post and inter-pandemic period (LaDue, 2010). In the context of public health, a Mass Fatality (MF) incident is any health situation where there is the occurrence of more deaths from an incident than the capacity of the available medical practitioners to handle (Gershon et al., 2014; Mass Fatality Planning Committee, 2011). While there is no minimum number of death requirements for an incident to be an MF case because of such factors as community variation in size and resource capabilities, the outstripping of the available response facilities such as hospitals and mortuary is an indication of an MF incident (Mass Fatality Planning Committee, 2011). One lesson learned during the readings about MF as it relates to public health is that no matter the size of the MF incident, it is the local Medical Examiner or Coroner (ME/C) who have the legal mandate to conduct the identification of the victims (Gershon et al., 2014). ME/C is also responsible for ascertaining the cause and manner of the deaths among other medical/legal activities like the notifications of the next of kin.
Moreover, under the direction of the Public Health and Medical Services, the local-level response to MF event would primarily involve the coordination of the available resources and response teams among its Public Health regions and arrange for state and federal support (Mass Fatality Planning Committee, 2011). Several events may cause an MF incident. Notable causative factors include natural hazards (such as floods and hurricanes, wildfire, earthquakes, and tornadoes), man-made hazards (such as infrastructural collapse, motor and airline accidents, and terrorist attacks) as well as disease outbreaks (Gershon et al., 2014). For example disease pandemics such as influenza has the potential to not only spread rapidly among the population but also to last for a considerable time long enough to cause fatalities in such high numbers to overwhelm the existing ME/C infrastructures support (Mass Fatality Planning Committee, 2011). In such a widespread scenario, there is the need for a collaborative response from ME/C from all levels – Federal, State, District, and Local – to coordinate the MF response. So far, the occurrence of both natural and human-related calamities such as Hurricane Katrina (2005) – 1,464 deaths and the 2001 9/11 terrorist attacks (approximately 3,000 deaths) have demonstrated that MF management platform is vulnerable to overwhelming events. (Mass Fatality Planning Committee, 2011) There is, therefore, the need to strengthen the MF management, planning, and response to be prepared for such events and even worst-case scenarios (LaDue, 2010).
Question Four: The Emergency Support Function 8 response to the Boston Marathon bombing
The primary objective of the Public Health Support Function 8 (ESF 8) is to provide the mechanism for Federal resource assistance, capabilities, and capacities to supplement the local, state, territorial, and insular areas in all-hazards emergency or disaster event (Public Health Emergency [PHE], 2012). The ESF 8 coordinates the state’s resources in response to such catastrophes, emergencies, or incidences that may lead to public health, human, behavioral, and medical service emergency, including those MFs that have cross-border implications (Federal Emergency Management Agency (FEMA), 2013). To accomplish this goal, ESF 8 oversees all the emergency management functions of MF preparedness, mitigation, response, and recovery with all the relevant government agencies and NGOs that carry out public health or medical services. Just like in the 2013 Boston Marathon Bombing, the ESF 8 resources are used in situations where the local (county and regional) agencies are overwhelmed by an MF incident and the State Emergency Response Team (SERT) requests additional assistance (FEMA, 2013). In the case of the Boston Marathon bombing, the ESF 8 provided the means for a public health and medical response, treatment of victims, as well as the translocation of survivors and the vulnerable populations of the incident. The Boston ESF 8 also provided assistance in the evacuation of people out of the disaster area, emergency behavioral health crisis advising and special needs sheltering and care.
One of the significant planning components for the 2013 Boston Marathon was the pre-planning and enhancement of the public health and medical system supporting the race under the leadership of the Boston Athletic Association (BAA) (Massachusetts Emergency Management Agency (MEMA), 2014). Despite staffing the Multi-Agency Coordination Center (MACC) at the MEMA headquarters and activating the various state and local coordination and operations centers, two bombs turned the Boston Marathon into a bloodbath. The first of the two bombs detonated at 671 Boylston Street at 2:49 p.m. and the second bomb thirteen seconds later 180 yards up the course at 755 Boylston Street (MEMA, 2014). According to MEMA (2014), homemade improvised devices (IEDs) caused the explosions. The IEDs were concealed in backpacks and placed on the ground level in viewing areas seconds before they detonated. The explosions killed three people and injured 264 spectators many of whom suffered several critical injuries. Furthermore, 16 of the survivors suffered traumatic amputations (MEMA, 2014).
Question Five: CDC’s value in the National Response Framework
The US National Response Plan (NRP) superseded by the National Response Framework (NRF) is a nationwide emergency response plan to natural calamities (such as earthquakes and hurricanes) as well as human-related disasters (such as terrorist attacks and accidents). Since the 2000s, particularly the 9/11 the United States has spent a considerable amount of federal budget to fund and sustain efforts to improve the nation’s health security (Savoia, Agboola, & Biddinger, 2014). The governments, as well as the private sector, have engaged one another in a wide range of activities in thwarting, protect, alleviate, and respond to and recovering from a myriad of prospective health threats (Gibson, Theadore, & Jellison, 2012). Among the Public Health Agencies actively involved in disaster response is the Center for Disease Control and Prevention (CDC).
Whether caused by natural forces or accidental or intentional human means, threats to public health are always imminent. They are therefore being prepared not only to prevent and respond but to recover rapidly from these events can save lives and protect the health security of the public (Office of Public Health Preparedness and Response (OPHPR), 2015). Because of its unique abilities and resource capabilities to respond to natural, occupational, infectious, or environmental outbreaks and events, CDC plays a vital role in Public health safety. They, for instance, ensure that federal, state, and local public health systems are prepared to respond adequately to all types of health threats (Office of Public Health Preparedness and Response (OPHPR), 2015). The CDC’s work build upon decades of progressive scientific development serves to prepare the nation for all types of potential threats to public health including nuclear, radiological, biological, and chemical incidents (ERCB, DEO, & OPHPR, 2016). Because national emergency preparedness requires a coordinated effort that involves all levels of government, the private sector, NGOs, and individual citizens, CDC’s role in national preparedness and response works to support the Department of Homeland Security (DHS) according to NRF Guidelines (ERCB, DEO, & OPHPR, 2016). The CDC emergency response begins at the local level where it prepares the relevant public health departments by providing funds and technical assistance to strengthen their response capabilities and build communities that are more resilient to all types of emergencies (OPHPR, 2015). When the local technical and resource capacities are overwhelmed, the CDC responds by supporting the national and state departments to save lives as well as reduce suffering. The CDC support comes in various forms notable of which are the provision of scientific and logistic proficiency and deploying staffs and essential medical assets to the emergency sites (OPHPR), 2015). Other CDC affiliates and organizational programs also make momentous contributions to emergency support, preparedness, and response.
References
Al-Ateeg, F. A. (2004). Isolation versus quarantine and alternative measures to control emerging infectious diseases. Saudi Med J, 25(10), 1337-46. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/15494798
CDC Emergency Risk Communication Branch (ERCB), Division of Emergency Operations (DEO), & Office of Public Health Preparedness and Response (OPHPR). (2016). Emergency Preparedness and Response: What CDC Is Doing. Retrieved April 18, 2016, from http://emergency.cdc.gov/cdc/
Diffen. (2016). Isolation vs Quarantine - Difference and Comparison. Retrieved April 17, 2016, from http://www.diffen.com/difference/Isolation_vs_Quarantine
Federal Emergency Management Agency (FEMA). (2013, May 2). Emergency Support Function #8 – Public Health and Medical Services Annex | FEMA.gov. Retrieved April 18, 2016, from https://www.fema.gov/media-library/assets/documents/32198
Gershon, R. R., Orr, M. G., Zhi, Q., Merrill, J. A., Chen, D. Y., Riley, H. E., & Sherman, M. F. (2014). Mass fatality preparedness among medical examiners/coroners in the United States: a cross-sectional study. BMC Public Health, 14(1), 1275. doi:10.1186/1471-2458-14-1275
Gibson, P. J., Theadore, F., & Jellison, J. B. (2012). The Common Ground Preparedness Framework: A Comprehensive Description of Public Health Emergency Preparedness. Am J Public Health, 102(4), 633-642. doi:10.2105/ajph.2011.300546
Hazlett, S. C. (2009). Assisting Individuals with Functional Needs During Evacuation and Sheltering. Retrieved from Kansas Department of Social and Rehabilitation Services website: http://www.kansastag.gov/AdvHTML_doc_upload/Assisting_Individuals_with_Functional_Needs.pdf
LaDue, L. R. (2010). Medical Surge Capacity: Workshop Summary: Fatalities Management Strategies. Paper presented at Institute of Medicine (US) Forum on Medical and Public Health Preparedness for Catastrophic Events, Washington DC. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK32852/
Mass Fatality Planning Committee. (2011). Mass Fatality Plan: Georgia Emergency Operations Plan (GEOP). Retrieved from Georgia Department of Community Health, Division of Public Health website: https://www.publichealth.uga.edu/dman/sites/default/files/documents/mass_fatality_plan_template_%20worddoc_05-20-11.doc
Massachusetts Emergency Management Agency (MEMA). (2014). After Action Report for the Response to the 2013 Boston Marathon Bombings. Retrieved from Commonwealth of Massachusetts website: http://www.mass.gov/eopss/docs/mema/after-action-report-for-the-response-to-the-2013-boston-marathon-bombings.pdf
National Council on Disability (U.S.). (2009). Effective emergency management: Making improvements for communities and people with disabilities. Retrieved from National Council on Disability website: https://www.ncd.gov/publications/2009/Aug122009
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Savoia, E., Agboola, F., & Biddinger, P. (2014). A Conceptual Framework to Measure Systems’ Performance during Emergency Preparedness Exercises. International Journal of Environmental Research and Public Health, 11(9), 9712-9722. doi:10.3390/ijerph110909712
