The Role of Law Enforcement in Public Health Emergencies Edward P. Richards, Katharine C. Rathbun, Corina Solé Brito, and Andrea Luna Edward P. Richards, Katharine C. Rathbun, Corina Solé Brito, and Andrea Luna Available at: Available at: me - me -

The Report Driven by bird flu fears Driven by bird flu fears Started as a study of quarantine and isolation Started as a study of quarantine and isolation Darlings of the DHS and CDC and others who have never done public health Darlings of the DHS and CDC and others who have never done public health Became an all hazards approach Became an all hazards approach

Why not Quarantine and Isolation? Logistics of a wide spread quarantine Logistics of a wide spread quarantine Limited response options Limited response options SARS Experience SARS Experience

Why All Hazards? Difficult to maintain readiness for a low probability event Difficult to maintain readiness for a low probability event Plan must provide short term benefits to be supported in the long term Plan must provide short term benefits to be supported in the long term Impossible to change behavior patterns on short notice Impossible to change behavior patterns on short notice Plan must incorporate new behaviors and attitudes into everyday situations Plan must incorporate new behaviors and attitudes into everyday situations

Overview of All Hazards Institute vaccination programs for all recommended adult immunizations Institute vaccination programs for all recommended adult immunizations Address policies that encourage employees to work sick Address policies that encourage employees to work sick Develop and implement workplace surveillance for infectious disease risks Develop and implement workplace surveillance for infectious disease risks Include families in these plans because officers cannot work effectively if their families are at risk Include families in these plans because officers cannot work effectively if their families are at risk

Management Oversight Advantages Provides measurable outcomes, which disaster only planning does not Provides measurable outcomes, which disaster only planning does not Provides an economic and workplace benefits which will make the program easier to continue Provides an economic and workplace benefits which will make the program easier to continue Requires policies to be worked out with unions and other stakeholders Requires policies to be worked out with unions and other stakeholders Assures buy in Assures buy in Identifies problems Identifies problems

The Next Step: Resilient Communities Bring All Hazards Planning for Public Health Emergencies to the Community

Defining Characteristics of Public Health Emergencies Long term Long term Days to longer Days to longer Depletes manpower and resources Depletes manpower and resources The affected population requires support The affected population requires support Widespread Widespread Affects a region or significant urban area Affects a region or significant urban area Affects everyone, including the police Affects everyone, including the police Significant Risk Significant Risk

Examples Epidemic Epidemic Bird flu Bird flu Hazmat incident with long term risks Hazmat incident with long term risks Anthrax Anthrax Dirty bomb Dirty bomb Natural disaster Natural disaster Hurricanes, Winter storms Hurricanes, Winter storms Earthquakes Earthquakes

Traditional Emergency Response Scenarios Geographically limited Geographically limited Crime scenes Crime scenes Parade routes Parade routes Look at the problems with riot control when whole neighborhoods become involved Look at the problems with riot control when whole neighborhoods become involved Temporarily limited Temporarily limited No one is staffed to do a 100% mobilization for weeks No one is staffed to do a 100% mobilization for weeks

Limited Response Options in Public Health Emergencies You cannot shoot people who are just trying to take care of their families You cannot shoot people who are just trying to take care of their families You cannot arrest large numbers of persons to restore order You cannot arrest large numbers of persons to restore order You cannot occupy significant territory You cannot occupy significant territory

Your People are also Victims Widespread public health and environmental crises affect law enforcement personnel Widespread public health and environmental crises affect law enforcement personnel Most personnel will look to their families first Most personnel will look to their families first Law enforcement families cannot be protected outside of the context of their communities Law enforcement families cannot be protected outside of the context of their communities

Day to Day Life Goes On No federal plan acknowledges that there are criminals and the homeless No federal plan acknowledges that there are criminals and the homeless Biggest joke - Pandemic flu plan says they will close the borders Biggest joke - Pandemic flu plan says they will close the borders Too many plans can only be staffed by assuming that no other law enforcement or first response activities will take place Too many plans can only be staffed by assuming that no other law enforcement or first response activities will take place Only works for short periods Only works for short periods

Why 9/11 is the Wrong Model Deaths, but not injuries - limited impact on health care Deaths, but not injuries - limited impact on health care Relatively small percentage of the population displaced for a long period of time Relatively small percentage of the population displaced for a long period of time Relatively little infrastructure destroyed Relatively little infrastructure destroyed

Why Katrina is a Better Model Widespread Widespread Long-term Long-term Foreseeable Foreseeable The risks could have been mitigated The risks could have been mitigated The response needs outstripped all available resources The response needs outstripped all available resources

What Do Communities Need in Public Health Emergencies Food, water Food, water Environmental management such as heat Environmental management such as heat Transportation and shelter if an evacuation Transportation and shelter if an evacuation Health care Health care Family support - where are the kids? Family support - where are the kids?

Complicating Factors Physical and Personnel Infrastructure Mismatch Physical and Personnel Infrastructure Mismatch Failure to do maintenance Failure to do maintenance Allowing development to outstrip infrastructure Allowing development to outstrip infrastructure Efficiency v. Reliability Efficiency v. Reliability Will your $100 microwave work in 5 years? Will your $100 microwave work in 5 years? Will your low cost electric power company give you power 24/7/365 at 99.99%? Will your low cost electric power company give you power 24/7/365 at 99.99%?

Who Will Provide for the Public? Federal model Federal model Local first responders Local first responders Supported by the military and federal support Supported by the military and federal support State Models State Models Public health, supported by law enforcement Public health, supported by law enforcement Reality Reality In most areas the police are the organizations with the most staff and resources In most areas the police are the organizations with the most staff and resources

Who Will Fund This? The existing money is coming from other essential services that cannot be postponed forever The existing money is coming from other essential services that cannot be postponed forever Priorities will shift as fears of disaster abate Priorities will shift as fears of disaster abate Many health departments are losing net money Many health departments are losing net money Bottom-line: No one is funding real public support Bottom-line: No one is funding real public support

Objectives of Resilient Communities Reduce the need for support from public services Reduce the need for support from public services Reduce suffering and death Reduce suffering and death Reduce the risk of public disorder Reduce the risk of public disorder Most important: Most important: Build trust and credibility so the community will cooperate with needed mitigation measures Build trust and credibility so the community will cooperate with needed mitigation measures

Building Blocks for Resilient Communities Honest risk communication Honest risk communication Realistic preventive strategies Realistic preventive strategies Start with your own people Start with your own people Working with other organizations Working with other organizations Reinforcing the message when disasters are no longer fashionable Reinforcing the message when disasters are no longer fashionable

Honest Risk Communications Be realistic about the risk Be realistic about the risk Bird flu v. yearly flu Bird flu v. yearly flu Hurricane v. terrorist attack Hurricane v. terrorist attack Just say No to Potemkin planning Just say No to Potemkin planning Big issue in public health Big issue in public health Hurricane Pam Hurricane Pam Being a team player puts the public at risk Being a team player puts the public at risk Do not suppress market risk signals Do not suppress market risk signals

Realistic Preventive Strategies Must fit in with real household management Must fit in with real household management Being Prepared Being Prepared Examples Examples Gasoline Gasoline What to take in evacuations What to take in evacuations How to keep food and water on hand How to keep food and water on hand How to treat water and what is safe to eat when the refrigerator goes off How to treat water and what is safe to eat when the refrigerator goes off When to go back and what to do when you get there When to go back and what to do when you get there

Start with Your Own People Get the families of your own people involved Get the families of your own people involved Builds support - they become part of the solution Builds support - they become part of the solution Direct benefits to the department Direct benefits to the department Encourage them to involve their neighbors Encourage them to involve their neighbors Stabilizes the neighborhood, making their own situation more secure Stabilizes the neighborhood, making their own situation more secure Do not be the only person on your block with water Do not be the only person on your block with water

Working with Other Organizations Find out if your local public health plans are really staffed and supported Find out if your local public health plans are really staffed and supported Find out the plans of the local hospitals and other health care providers Find out the plans of the local hospitals and other health care providers Coordinate with retailers Coordinate with retailers Work with churches and other private organizations Work with churches and other private organizations Walmart and Home Depot can move goods more effectively than Northcom Walmart and Home Depot can move goods more effectively than Northcom

Reinforcing the Message when Disasters are out of Fashion Priorities are going to shift Priorities are going to shift FEMA has already punted on realistic building standards in New Orleans and the Gulf Coast FEMA has already punted on realistic building standards in New Orleans and the Gulf Coast No politician will keep supporting prevent measures once the public gets interested in other things No politician will keep supporting prevent measures once the public gets interested in other things We have a lot of social problems we have been ignoring We have a lot of social problems we have been ignoring The problems will still be there The problems will still be there

Political Benefits Most communities do not trust public health (some do not trust the police) Most communities do not trust public health (some do not trust the police) Anti-vaccination forces Anti-vaccination forces Equating trans-fat with the plague Equating trans-fat with the plague Incompetent political appointees in critical positions Incompetent political appointees in critical positions Law enforcement will bear the risk of failed public health response Law enforcement will bear the risk of failed public health response