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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 ...

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