NACCHO, in collaboration with the Department of Homeland Security Office of Health Affairs, Chemical Defense Program, has initiated an effort to understand the role local health departments play in responding to large-scale chemical incidents. As part of that effort, NACCHO last month hosted a one-day focus group with local health departments and community response representatives in the Washington, D.C. area, as well as representatives from state and federal agencies and nonprofits.
The study defines large-scale chemical incidents as a sudden event, whether accidental, an act of terrorism or of natural forces, that results in an acute onset of symptoms that could overwhelm local response capacity and resources. Incidents of this type include the 1995 Tokyo subway sarin attack, and the 2005 train crash in Graniteville, SC. NACCHO’s study in particular examines the local health department role during the initial 6-12 hours after an incident.
The study addresses a number of questions, including:
- From a basic, intermediate, and advanced perspective, what capabilities and recommendations can be offered to local health departments involved in a chemical incident response?
- How do local health departments perceive their role in responding to a high-consequence or a large scale chemical incident, and what is the basis for that perception?
- What barriers exist between local authorities (law enforcement, fire, EMS, hospitals, environmental health officials, etc.) in chemical incident response?
- How can local public health help with the reduction of chemical hazard vulnerability?
Focus group participants addressed these questions and more during both small and large group discussions. They identified a number of local health department needs, including: routine meetings and interactions that allow health department staff to integrate into the community; formalized relationships across organizations; and general primers of necessary information and frequently asked questions related to the specific incident. Participants also emphasized the need to think of public health as a system instead of a department, otherwise critical partners such as environmental health and healthcare might be excluded from response planning activities.
Some of the number of things participants identified as important for local health departments to know when making decisions included: determining whether something is an incident or an emergency; which organizations outside the health department should be involved in the response; whether surveillance is needed as part of the response; and how the health department will communicate risk to the community. Participants expounded on the last point, and urged local health departments to have some semblance of a plan in place in advance of any incident in order to answer community questions, and explain what strategies are in place even in situations that have a number of unknowns.
Federal participants placed a high emphasis on the need for a local health response, stating that the federal government doesn’t always have the capacity to respond to incidences within the first 12 hours, and even when they do, often various departments within the federal government won’t be synced on their response. In some cases, representatives indicated, by the time federal officials are even aware of an incident, local health officials have already moved into the recovery phase.
NACCHO will analyze the results of the focus group in order to develop a report for stakeholder dissemination, and identify next steps and future activities that help ensure local health departments are prepared to address large-scale chemical incidents.