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Emergency Public Health & Disaster Medicine
1. Emergency Public Health
and
Disaster Medicine
Bobby Kapur, M.D., M.P.H.
Associate Professor of Medicine & Pediatrics
Associate Chief for Academic Affairs
Section of Emergency Medicine
2. Emergency Public Health
1
1. Present the scope & impact of Public Health
Emergencies
2. Define the concept of Emergency Public Health
3. Differentiate Emergency Public Health from
Disaster Medicine
4. Show how Emergency Public Health can lead to
Public Health Security
Objectives
9. Emergency Public Health
8
Increasing Threats to Cities
0
10
20
30
40
50
60
70
801988
1990
1992
1994
1996
1998
2000
2002
2004
2006
2008
Number of Declared US Disasters 1988-2008
(Source: Data from FEMA http://www.fema.gov/news/disaster_totals_annual.fema)
10. Emergency Public Health
9
Increasing Densities of Cities
0
10
20
30
40
50
60
70
80
90
100
PercentGlobalPopulationUrban
1950 1965 1980 1995 2010 2025 2040
Year
Current and Projected Percentage of Global Population Living in
Urban Areas
(Source: Data from UN. http://esa.un.org/unup/index.asp?panel=1)
12. Emergency Public Health 11
Emergency Public Health: A New Concept
• New field of academic study
• “Public Health” approach to large-scale
emergencies and crises
• Population-based analysis
13. Emergency Public Health
12
Emergency Public Health vs. Disaster Medicine
“Hazards”: events that cause Emergencies
– Natural (earthquakes, hurricanes, droughts)
– Deliberate (bombing, chemical attack,
biological attack)
– Accidental (nuclear plant malfunction)
“Disaster”: event that overcomes local
resources
16. Emergency Public Health
15
Emergency Public Health vs. Disaster Medicine
Emergency Public Health differs from Disaster
Medicine because it encompasses more than
just the management of specific hazards.
18. Emergency Public Health
17
Emergency Public Health vs. Disaster Medicine
Hazard
Patients
Govt:
EMS
Fire
Police Hosps
Private
Sector
NGOs
Public Health Law
Technology
Epidemiology
Rapid Needs Assessments
Surveillance
Monitoring
Disaster
Medicine
Emergency
Public Health
Acad
Centers
19. Emergency Public Health
18
Multiple components of society will be
disrupted by public health emergencies:
– Physical and Mental Health
– Security
– Housing
– Food and Water
Long period of rehabilitation
Emergency Public Health: Broad Impact
20. Emergency Public Health
19
Large-scale crises will affect all sectors:
– Government
– Private sector
– Non-governmental Organizations (NGOs),
– Civilians
Each sector will provide and utilize
resources during a crisis
Emergency Public Health: Multiple Sectors
24. Emergency Public Health
23
Resilience: a population’s capacity to
withstand adversity and to recover quickly
Cities will achieve greater levels of
protection from collapse by increasing:
– Systemized surveillance
– Assessments
– Coordination
– Communication
Emergency Public Health: Resilience
27. Emergency Public Health
26
National Government
Institute of Medicine (IOM) states there are 6
major roles of the government in public health:
1.Policy
2.Finance
3.Public health protection
4.Information gathering and dissemination
5.Capacity building
6.Direct patient health care services
29. Emergency Public Health
28
Key Components of Mutual Aid Agreements
Interoperability
of Communications
Credentialing
of
Responders
Financial
Responsibilities
Procedures for
Requesting
Resources and
Personnel
Command and
Control of Personnel
and Resources
Liability
(Source: Data from Department of Homeland Security. National Response Framework.
Washington, DC 2008. Available at http://www.fema.gov/pdf/emergency/nrf/nrf-core.pdf.)
30. Emergency Public Health
29
Public Health Law
Type of Law Example in Public Health
Emergency
Brief Description
Common Law Public/Private
Nuisance
Negligence
Preventing a person from maintaining an
unhealthy condition on his property and
from unreasonably interfering with
another person’s use and enjoyment of his
property.
Requiring a person to exercise the care
that a reasonable person would exercise to
prevent foreseeable harm.
Statutory Law National
Emergencies Act
Homeland Security
Act of 2002
Emergency Medical
Treatment and
Active Labor Act
Preventing open-ended states of national
emergency.
Creating the US Department of Homeland
Security which is charged with preventing
terrorist attacks in the US and responding
to natural disasters.
Requiring participating hospitals to treat
and stabilize patients with emergency
conditions, regardless of ability to pay.
Constitutional
Law
US Constitution,
Art. I, Sect. 8
US Constitution,
IV Amendment
Defining the powers of Congress,
including the power to collect taxes, to
provide for the common defense and
general welfare of the US, and to regulate
commerce among the States.
Prohibiting unreasonable searches and
seizures of persons or property.
Administrative Administrative
Procedures Act
Detailing the way in which administrative
agencies may propose and establish
33. Baylor College of Medicine 32
Public-Private Partnerships (PPPs): Incentives
1. Growing sense of corporate social
responsibility, which includes staff
motivation
2. Benefits of “positive branding”
3. Business intelligence
4. Pure willingness to do good
35. Emergency Public Health
34
Code of Conduct for NGOs in Public Health Emergencies
First priority is the Humanitarian imperative (the right to receive humanitarian
assistance, unimpeded access to affected populations).
Aid is given regardless of race, creed or nationality and is prioritized based on
need alone.
Aid will not be used as a tool to support a particular political or religious
standpoint.
NGOs will act independent of governments and not act as instruments of
government foreign policy.
Culture, structures and customs of communities and countries will be
respected.
Emergency public health response will attempt to strengthen local capacities
(staff, materials, companies, local NGOs), when possible.
Intended beneficiaries should be involved in the design, management and
implementation of assistance programs, when possible.
Relief efforts should not only meet basic needs but should strive to reduce
future vulnerabilities to public health emergencies (mitigation).
NGOs will be accountable to their partners, both the populations who need
assistance and the donors who wish to assist, in a responsible and transparent
manner.
NGOs will recognize victims as dignified people and not hopeless individuals in
their organization’s information, publicity and advertising activities.
37. Emergency Public Health
36
• Epidemiological Studies
• Rapid Needs Assessments
• Surveillance & Monitoring
• Evaluation Processes
Emergency Public Health:
Public Health Tools
39. Emergency Public Health
38
Role of Epidemiological Studies in Public Health Emergencies
Epidemiological Studies Data Collected Limitations
Case series: sequence of case reports
with common elements such as
similar clinical features and suspected
common exposures
Clinical features
Specialized treatment of specific
types of injuries
Lack of generalizations
Non-reporting of less severe
injuries treated outside the
hospital setting
Cross sectional: study of several
individuals at one point in time about
information on health status, health-
related behaviors, and other
exposure factors
Frequencies of mortality and
morbidity
Behaviors during and after
emergencies
Diversity of outcomes
experienced during the event
Absence of population counts
Poor sampling methods leading to
non-representative samples
Bias from selective survival,
population movement, and recall
Case control: study of individuals in
whom a disease has already occurred
in order to find out whether these
individuals have been exposed to a
particular risk factor
Risk factors Bias due to selection of cases and
controls
Cohort study: study of a group
exposed to a particular factor and
another group not exposed to this
factor is followed up over time to
determine occurrence of disease
Estimate incidence and
magnitude of risk
Short and long-term and direct
and indirect health effects
Emergency-related outcomes
Identification of a defined cohort
Logistics of long-term data
collection
Loss to follow up
41. Emergency Public Health
40
Feedback Mechanisms
• Surveillance
• Monitoring
• Evaluation
Professionalization of responding and
managing public health emergencies.
43. Emergency Public Health
42
Conclusions
1. Public Health Emergencies are broad-scale events
that impact many areas and have long periods of
recovery and rehabilitation
2. Public Health Security depends on a region’s
Resilience
3. Public Health Tools can help manage these
emergencies and guide decision-making
