When disasters or emergencies strike, people expect their local government to take immediate action to deal with the problem. Local government must be able to act first to attend to the public's emergency needs. Municipalities have a legal responsibility to ensure that necessary and appropriate actions are taken to protect people and property from the consequences of emergencies and disasters. The State and Federal governments may also provide assistance, depending on the size and nature of the emergency.

Preparedness encompasses activities that can be taken before an emergency. The cornerstone of emergency preparedness is planning. Health departments need to clarify their roles and responsibilities and identify likely response activities before they are needed. The worst time to determine how to respond to an emergency is during the emergency.

To effectively discharge their emergency responsibilities, all levels of government need to develop an emergency operations plan (EOP). The local EOP focuses on the measures that are essential to protecting the public. The State EOP addresses those situations when the state may be the first responder, and also provides the framework under which local, State and Federal governments become involved and coordinate their response.

Local and State agencies tasked in the EOP need themselves to develop internal emergency operations plans with concrete checklists, resources listings and step-by-step procedures so that they can carry out their assigned duties during exercises and actual events. These guidelines are designed to address internal plans. In this report, they are referred to as Local Health Agency Response Plans.

What is an EOP?
According to the Federal Emergency Management Agency (FEMA), the nation's lead agency in disasters, an EOP is a document that:

• Assigns responsibility to organizations and individuals for carrying out specific actions at projected times and places in an emergency that exceeds that capability or routine responsibility of any one agency, e.g., the fire department
• Sets forth lines of authority and organizational relationships, and shows how all actions will be coordinated
• Describes how people and property will be protected in emergencies and disasters.
• Identifies personnel, equipment, facilities, supplies and other resources available-within the jurisdiction or by agreement with other jurisdictions-for use during emergency response and recovery operations.
• Identifies steps to address mitigation concerns during response and recovery activities.
  

FEMA recommends that planners take an "all hazards" approach. This entails the creation of 1) a basic plan that overviews the jurisdiction's emergency and response organizational policies, 2) annexes to the plan that focus on specific emergency functions, such as health and medical services and 3) hazard-specific appendices that address specific risks and disasters, such as Bioterrorism.

This approach is effective because while the causes of emergencies may vary greatly, the effects of emergencies do not. Many of the same tasks apply to multiple types of emergencies and disasters. For example, the communication role with the public around infectious disease prevention may be the same for weather disasters and suspected Bioterrorism events.

Where does a health department begin? The Centers for Disease Control and Prevention (CDC) suggests that health departments begin by developing a health-related EOP. It can provide the conceptual foundation upon which more specific plans dealing with biological and chemical terrorism can be built. However, plans can be developed in any order. If a health department has no emergency response plan at all, CDC says that it may be best to develop a terrorist response plan while undertaking the overall emergency planning effort.

Planning tips

• Health departments have the legal responsibility to identify public health concerns and control disease outbreaks. These duties form the foundation for a health department's role in emergency preparedness and response.
• Use a team approach to planning. An EOP is more likely to be followed if the responsible organizations have a sense of ownership.
• Conduct a hazard assessment. Build scenarios from the assessment. CDC recommends focusing on a more localized terrorist event for planning purposes to make it easier to see how various agencies can coordinate without being overwhelmed.
•  Determine the resource base. Plan around existing resources. Identify shortages and explore agreements with other jurisdictions or private suppliers to meet needs.

Working on a health-related EOP plan for your community? Worried that you might leave a critical component out?

Here is a list from the CDC of basic elements and protocols common to most health-related emergency operations plans.
Have you:

• Outlined the purpose of the plan?
• Cited the appropriate Federal, State and local public health authorizing legislation, ordinances and regulations?
• Outlined any assumptions on which the plan is based?
• Have you assigned responsibility for the ten essential services and other key emergency public health functions?
• Identified specific individuals and alternates authorized to direct the public health emergency response?
• Referenced the major scenarios or scenario categories?
• Explained all abbreviations and defined key or unfamiliar terms?
• Included procedures for maintaining a record of plan distribution and a record-of-receipt form?
• Provided update guidance and a record-of-change page?
• Included a signature block?

Does the plan contain the following protocols?

1. Convening police, fire, EMS, hospitals, public health officials, LEPC members, EOCs and other relevant parties on a periodic basis to review the content of the plan
2. Designating, by title, the public health personnel (and alternates) responsible for staffing the centralized EOC when activated
3. Coordinating public health responsibilities with law enforcement responsibilities
4. Notifying interagency, media and public of an emergency
5. Informing the public of population prevention measures including: hazards to expect, precautions to take, requirements for evacuation or shelter in place.
6. Conducting a credibility threat assessment (in coordination with FBI)
7. Implementing an emergency epidemiologic investigation for human and animal exposures
8. Implementing evacuation and mass casualty transportation
9. Initiating the public health response when a device is found that may contain a biological or chemical agent 
10. Methods for collecting, handling, decontaminating, transporting, preserving and storing biological and chemical evidence, including maintaining the chain of custody, referral to state public health laboratory and referral to federal laboratory
11. Interviewing potentially contaminated or infectious victims
12. Critical incident stress counseling for victims or response personnel, including public health and medical professionals
13. Protecting care-providers and victims from secondary exposures
14. Decontaminating mass casualties (pre-hospital) and patients upon their arrival at the treatment facility
15. Ensuring that contamination of treatment facilities does not occur when patients are evaluated or treated.
16. Instituting mass isolation within a health facility
17. Incorporating state and federal assets into the local response efforts
18. Requesting state or federal (civilian or military) pharmaceutical stockpiles
19. Receipt, security and distribution of stockpile assets
20. Instituting mass vaccinations or medical distribution to first responders and to medical/health care providers
21. Responding to mass mortuary needs 
22. Identifying and obtaining mental health resources that will treat both responders and victims
23. Baseline and post-incident medical screening for all personnel involved