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In the post-September 11 world, clinicians need a basic understanding
of the national homeland and public health security structure. Fundamentally
there are two major areas of responsibility in the event of any
emergency: crisis management and consequence management. In 1995,
President Clinton signed Presidential Decision Directive 39 (PDD
39), the purpose of which was to define agency-specific responsibilities
during an emergency. PDD 39 delegates crisis management authority—defined
as overall control of the local, state, or national response to
a bioterrorism event—to the law enforcement community.
In the event of a terrorist attack, any and all criminal investigations
would be controlled by the Department of Justice, specifically the
FBI. PDD 39 assigns responsibility for consequence management—defined
as the public health and safety issues resulting from a terrorist
attack—to FEMA. In this organizational structure, health
care and public health are the jurisdiction of FEMA.
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The demands of law enforcement and the public health responsibilities
are not mutually exclusive domains. That being said, it is important
to acknowledge that historically these two communities have very
different missions and culture. These differences cannot help but
influence how each arm of the nation’s security system
will react in the event of an emergency. Recognizing these distinctions
has relevance in the context of emergency preparedness and emergency
response. The nation’s preparedness efforts have included
a great deal of cross-institutional community building in recognition
of this fact.
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An important example of an outgrowth of PDD 39 is the creation
by the CDC of the Health Alert Network (HAN). The HAN is a dedicated
CDC-sponsored website where state and local health directors may
view securely posted documents, submit or collect data, obtain town-
and district-specific aggregate data, enter planned absences, e-mail,
or view a bulletin board. The overall goal of the HAN is to
securely facilitate communication of critical health, epidemiological,
and bioterrorism-related information on a 24/7 basis to
local health departments, health organizations, clinicians, and
other organizations with a vested interest in staying abreast of
developments with potential public health implications. As a nationwide
service, the HAN can disseminate late-breaking, updated, or new
public health information. The HAN is intended to rapidly alert
local health departments, public health officials, and the medical
community to any issues that may impact the public’s health.
It also offers educational and training programs for public health
and medical professionals. The HAN should improve communication
between state and local health agencies, departments, and care providers
for better coordination of knowledge, information, and practices
in the event of an emergency of any variety. For example, it was
widely and effectively used during the 2003 international SARS epidemic.
The nation’s public health response to SARS is a fine example
of the “dual use” approach to bioterrorism preparedness
and planning. Simply defined, broadening and strengthening the nation’s
public health infrastructure and resources—spurred at least
in part by September 11th and the anthrax attacks—provides
public health benefits well beyond bioterrorism. This system played
a direct role in ...