It's a mantra we've heard for decades: All disasters are local. Every emergency manager, public health director, first responder and local elected official knows that the initial minutes and hours responding to a large-scale incident will drive success or failure well before there is state and federal involvement.
As we look back at recent public health emergencies, several were identified by astute local clinicians or public health practitioners -- individuals who were willing to be open to seeing things they don't see every day. However, when we try to put these emergencies into traditional responses structures, we watch governments at all levels trying to fit the disaster to the existing response structure. Instead, we should be doing the opposite: adapting the response structure to fit the disaster.
Incidents such as pandemics, bioterrorism attacks, public health emergencies and health care IT compromises all require response support from a wide variety of agencies. Some of these agencies may have extensive experience responding to disasters; some may not. As we learned during several recent crises, such as the Ebola outbreak in 2014, it is hard to identify the various roles and functions that each government agency may have in a biological incident.
All too often, the approach is wrong. The wrong people -- or not enough people -- are invited to the table. This opt-in model is highly dependent upon the experience and background of the individuals initially charged with leading an incident, who may or may not be the people with the experience to look at the response with a wider lens. It can unintentionally lead to partners that have a significant stake in the situation or valuable potential contribution to make not having a seat at the table or engaging much later than they should. The people and timing are wrong at the most critical moments.
Instead, we should be encouraging leaders to allow their agencies to opt-out of engagement in a response. Invite all parties that could conceivably have a role to the table at the outset and let those that needn't engage identify themselves. While this may seem chaotic or unruly, those without a critical role will quickly depart. Those that do have something significant to contribute will remain. The benefits of strong engagement early on will greatly outweigh the discomfort of standing room only at the first few meetings.
An opt-out approach, for example, would have helped improve the response to the Ebola crisis. Public health agencies were managing the overall response in collaboration with a variety of partners, including emergency management, law enforcement, transportation and public-information officials. Medical waste was seen as a transportation challenge, not an environmental one. With medical waste regulated at the state level, some have suggested that earlier engagement with the environmental community, rather than just the transportation community, could have prevented some of the challenges that were encountered in the non-transportation aspects of dealing with the problem, such as on-site management of hazardous materials or the final disposition of medical waste.
Not having a seat at the table for the environmental community wasn't intentional. It was a product of not having a full understanding of the regulatory structure around medical waste management by those who do not engage with that community regularly. We cannot expect our local leaders to fully understand all of the nuances of all of our various government and industry programs, but ensuring that all parties have an early seat at the table and have a chance to opt-out if they don't have a role to play can help the management of health security incidents run more smoothly and hopefully also mitigate some negative outcomes.
One thing we know for sure is that there will be another disease outbreak or other health security incident in the future. It may not be this month or this year, but it will happen. Future incidents are likely to be complicated by a variety of new challenges, such as coordinated cybersecurity attacks. The only way to successfully tackle these new and emerging threats is with an open mind and a willingness to not do business as usual. By allowing emergency response partners to opt out, we have nothing to lose and everything to gain.