The Role of Law Enforcement in Public Health Emergencies

2. The Role of Law Enforcement in Public Health Emergencies • Edward P. Richards, Katharine C. Rathbun, Corina Solé Brito, and Andrea Luna • Available at: • www.ojp.usdoj.gov/BJA • www.dr-kate.com • Email me - richards@lsu.edu

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

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

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

6. Overview of All Hazards • Institute vaccination programs for all recommended adult immunizations • Address policies that encourage employees to work sick • 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

7. Management Oversight Advantages • Provides measurable outcomes, which disaster only planning does not • 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 • Assures buy in • Identifies problems

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

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

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

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

12. Limited Response Options in Public Health Emergencies • 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 occupy significant territory

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

14. Day to Day Life Goes On • No federal plan acknowledges that there are criminals and the homeless • 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 • Only works for short periods

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

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

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

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

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

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

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

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

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

25. Realistic Preventive Strategies • Must fit in with real household management • Being Prepared • Examples • Gasoline • What to take in evacuations • How to keep food and water on hand • 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

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

27. Working with Other Organizations • 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 • Coordinate with retailers • Work with churches and other private organizations • Walmart and Home Depot can move goods more effectively than Northcom

28. Reinforcing the Message when Disasters are out of Fashion • Priorities are going to shift • 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 • We have a lot of social problems we have been ignoring • The problems will still be there

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