Emergency medical response in a post-9/11 Washington, D.C.

planning becomes more evident. Resiliency of individuals dependent on electronically powered medical equipment is paramount. In addition, continued training and exercises reinforcing that training, is essential for maintenance of the knowledge and skills previously established over the past ten years as preparedness plans were developed and new equipment procured.

HSNW: What valuable lessons did 9/11 teach emergency responders? That is to say, how have emergency plans changed in the last ten years to adjust to new realities and threats?

BP: More than ever, emergency response agencies understand the synergistic power of the multi-disciplinary response; for example, we do not think of police emergencies, public health emergencies, or fire emergencies anymore. That mindset helped to create the stove-piping that was evident prior to 9/11. Recognizing that a major disaster or bioterrorism incident must be met with a team consisting of public health, fire hazard material (HAZMAT) experts, as well as law enforcement, behavioral health, environmental health, and other functional specialties has helped to provide a more seamless response process. This results in more lives saved.

In addition, the lessons learned from 9/11 include the development of much more robust disease surveillance systems including syndromic surveillance that will allow us to identify infection by a biological agent based upon a combinations of symptoms as reported through a variety of systems including school absenteeism logs, hospital emergency room visits, over-the-counter drug sale records, and other data sources, to detect unusual patterns of disease.

In the area of behavioral health, the District also developed a tiered Disaster Behavioral Health response system including a number of teams trained on grief, trauma, self-care and various trauma issues. These teams are also trained on spiritual and cultural dimension of grief and trauma and post-traumatic stress. In order to expand this capability across the community, Department of Mental Health is targeting community based mental health providers for inclusion into this training and incorporation into the D.C. Medical Reserve Corps (MRC).

HSNW: How is the growing ubiquity of smartphones and various apps designed to help residents communicate or prepare for disasters, affecting emergency response plans and what is your department doing to harness these new tools?

BP: Leveraging personal computing power and social media to communicate with the public in an emergency has been a part of preparedness planning for the D.C. Department of Health.

We are in the process of creating a dark website that is not visible to the public until revealed during an emergency which will contain specific instructions for emergency response based on their GPS location. We also have a project to enable smartphone users to download small data files to their device regarding various medications that would be dispensed instead of printing millions of pages of information to hand-out during an emergency response to the use of a biological agent. DOH also routinely follows certain twitter feeds as one method of maintaining situational awareness in emergencies and we have a twitter feed that we’ve used to disseminate preparedness and personal safety messages.

If you ask me this question a year from now, I’ll have twice as many examples to tell you about.

HSNW: Looking ahead, what do you foresee as the main challenges for emergency health services over the next decade?

BP: Since the 9/11 attacks and the anthrax crisis of 2001, public health developed a robust infrastructure and established some very effective prevention/response capabilities in an incredibly short span of ten years. With the economic downturn and resulting reductions in grants and local budgets, I am concerned about public health’s ability to maintain the systems we have invested so much to create. In addition, we need to continue to plan ahead for the evolving threats of terrorism, extreme weather hazards brought on by environmental changes, and new patterns of naturally-occurring diseases that have become evident over the past decade. We are going to continue to do as much as possible with the resources available, but I have to make the case for continuing the investment in public health systems. Without continued funding, it is going to be a challenge to maintain our current capabilities.