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1. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com.
CHAPTER 30
Emergency
Preparedness,
Post-9/11

2. Copyright
©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Types of Disasters
 Many natural disasters are predictable.
– Prior evacuation is conducted when possible.
 Technological disasters are less predictable.
– Terrorism is included.
 Response is similar for both types.
– Search and rescue
– Treatment and evacuation of injured
– Food, water, and shelter for survivors
– Minimizing environmental hazards
 All types of disasters require response planning.

3. Copyright
©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
World Trade Center Response
 13,000—15,000 people were evacuated.
 2,801 people died.
 Many failures of communication and coordination occurred.
 Protection of rescue and cleanup workers from environmental hazards failed.
 Victim location services were established, and shelters for displaced residents
were set up.
 Monitoring for biological agents was done.

4. Copyright
©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
World Trade Center Response: Routine Public
Health Functions
 Issued death certificates and burial permits
 Monitored safety of food and drinking water served to emergency workers
 Cleaned up food in abandoned restaurants
 Sampled dust and debris to assess risk
 Surveyed cleanup workers and area residents for symptoms
 CDC sent officers to monitor hospital emergency rooms for patients with
unusual symptoms.
 Arranged for mental health counseling

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©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Response to Hurricane Katrina
 Response was problematic.
– Lack of planning for populations with special needs (hospital patients, people
without cars)
– Poor communication
• Lack of clear directions on evacuation until too late
– Too little help from outside New Orleans
– Racist incidents
– Damaged housing, contaminated air in FEMA trailers, large displaced population
 Katrina was the deadliest hurricane since 1928 and costliest natural disaster
on record in the U.S.
 Hurricane Rita made landfall 26 days later, interfering with response activities.

6. Copyright
©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Principles of Emergency Preparedness
 Importance of advance planning involving all agencies
– Practice at least once.
 Importance of good communication and coordination
 Incident Command System
– ICS puts a single person in charge at the scene.
 National Incident Management System
– NIMS standardizes the organizational structures, processes, and procedures
that communities should employ.
 Federal government funding to states and metropolitan areas for planning
 Strategic National Stockpile of medical supplies, antibiotics, vaccines,
antidotes for chemical agents

7. Copyright
©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Bioterrorism Preparedness
 Preparedness strategy is very different than for natural disasters.
 Response must be the same as for a natural disease outbreak.
 Recognizing that an attack is occurring is very challenging.
– Surveillance is important.
– Salmonella outbreak in Oregon was not recognized as an attack.
 Response requirements include:
– Laboratory capability
– Public health laws enabling authorities to take action
• Public health officials need to have the legal power to take action to protect the public
and contain an outbreak of an infectious disease.
– Coordination between public health and law enforcement
 Whether uninsured will seek care is a problem.

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©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Possible Bioterrorism Agents
 Smallpox
 Anthrax
 Ebola
 Plague
 Botulism (Clostridium botulinum toxin)
 Tularemia (Francisella tularensis bacteria)
 Hemorrhagic fever viruses

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©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Bioterrorism Surveillance Activities
 Emergency room visits
 Calls to 911 and poison control centers
 Pharmacy records
 Veterinary diseases

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©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Smallpox Preparedness
 Most dreaded of possible bioterrorism agents
 Highly contagious, no immunity in population
 Tabletop exercise lessons:
– Public health is a major national security issue.
– An attack could cause massive civilian casualties, breakdown in essential
institutions, civil disorder, etc.

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©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Pandemic Flu
 Concern about pandemic avian flu
– High mortality but not transmitted easily from person-to-person
– Fear that genetic mutation could make it easily transmissible between people
 H1N1 (swine flu) in 2009
– Less severe than avian flu but more widespread
– Vaccine production was slower than expected.
– First flu pandemic since the Hong Kong flu in 1968

12. Copyright
©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Discussion Question 1
 Discuss the mistakes that were made during the World Trade Center
emergency response.
 What should have been done differently, and how many lives do you think might
have been saved if your suggestions had been used?

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©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Discussion Question 2
 Discuss the mistakes that were made during and after Hurricane Katrina.
 What should have been done differently, and how many lives do you think might
have been saved if your suggestions had been used?

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©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Discussion Question 3
 Think of a disaster that might be predicted to occur in your area.
 Considering the guidelines suggested in the Public Health Management of
Disasters, who should be included in a planning meeting?
 What special plans should be made so that your area will be prepared?

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©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Discussion Question 4
 Visit the website of the World Trade Center Health Registry,
nyc.gov/html/doh/wtc/html/registry/registry.shtml.
 Read the latest findings.
 What kind of follow-up studies are being done on residents, emergency
responders, and cleanup workers?

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©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Discussion Question 5
 Browse the websites of the CDC, EPA, FDA, HHS, NIH, USDA, AHRQ, and
your state health department.
 Do these agencies have information about planning for emergencies and
disasters?
 What special emergencies do they have plans for?
 For each agency, find one issue that it focuses on that is unique to its mission.