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Lessons Learned in Public Health Emergency Management: Personal Reflections

Published online by Cambridge University Press:  28 June 2012

Kenneth W. Kizer
Kenneth W. Kizer*
Affiliation:
President and Chief Executive Officer, The National Quality Forum
*
The National Quality Forum, 1875 Connecticut Avenue, NW Suite 640, Washington, DC, 20009, USA
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Abstract

Multiple environmental, ecological, and socio-political forces are converging to increase the occurrence of both natural and technological disasters. Ten forces are of most concern in this regard. These are: 1) global warming, with its consequent weather extremes and climate changes; 2) continued rapid human population growth and concomitant increased urbanization; 3) decreased bio-diversity and consequent ecological fragility; 4) deforestation and loss of natural habitat for animal species, with resultant greater overlap of human and animal habitats, human exposure to animal pathogens, and other ecological perturbations; 5) increased technological development throughout the world (especially in developing countries with their typically immature safety programs) 6) globalization and increased population mobility; 7) sub-national religious and ethnic conflicts, and their potential for conflict escalation and large scale displacement of populations; 8) the collapse of several major countries and consequent unraveling of national identity and social order; 9) the rise of terrorism; and 10) dramatic advances in the science and technology of computing, communications, biotechnology, and genomics.

This paper describes 10 lessons learned relative to the public health aspects of emergency management, especially as they pertain to disasters. 1) Planning pays; 2) A bad situation can be made worse by inappropriate responses; 3) Most life saving interventions will occur before the disaster happens and immediately afterwards by local action; 4) Public health emergency management is not a democratic process; 5) Psychological impacts are usually greater than anticipated; 6) Communications and information management are vital, but often are the weak link in the response chain; 7) Collaboration and partnerships are essential; 8) Unsolicited volunteers and aid are inevitable and must be planned for and managed; 9) Never assume anything, and always expect the unexpected; and 10) Post-event evaluation is important, and must be coordinated.

The paramount lesson learned from past emergencies is that the untoward impact of these events can be anticipated and significantly ameliorated by appropriate planning and preparation. On the other hand, preparation for emergency events has deteriorated because of health-care financial constraints, and resources to support planning and needed infrastructure have diminished. Given these realities, the major unresolved challenge is how to ensure that planning for the common good is supported and, in fact, gets done.

Resumen

Múltiples fuerzas ambientales, ecológicas y sociopolíticas convergen para aumentar la ocurrencia de desastres tanto natuarales como tecnológicos. Diez fuerzas son de la mayor preocupación en este aspecto: 1) Calentamiento global con sus consecuentes cambios extremos en el tiempo; 2) Crecimiento poblacional humano continuo y rápido y urbanización concomitante aumentada; 3) Disminución en biodiversidad y fragilidad ecológica consiguiente; 4) deforestación y pérdida del hábitat natural para especies animates, con mayor traslape de hábitat humano y animates, exposición humana a patógenos animates y otras alteraciones ecológicas; 5) Aumento en el desarrollo tecnológico a través del mundo (especialmente en países en desarrollo con sus típicamente inmaduros programas de seguridad); 6) Globalización y mobilidad poblacional aumentada 7) Conflictos subnacionales y étnicos, y su potencial para escalamiento y su consiguiente desintegración de la identidad nacional y el órden social; 9) El aumento del terrorismo; 10) Avances dramáticos en la ciencia y tecnología de la computación, comunicaciones, biotecnología y genoma.

Este trabajo describe 10 lecciones aprendidas en relación con aspectos de salud pública del manejo de emergencias, especialmente lo pertinente a desastre: 1) Planear paga; 2) Una situación mala puede hacerse peor con respuestas inapropiadas; 3) La mayoría de las intervenciones salvadoras de vida ocurrirán antes de que suceda un desastre e inmediatamente después a través de acciones locales; 4) El manejo de la salud pública en emergencias no es un proceso democrático; 5) El impacto psicológico es usualmente mayor que lo anticipado; 6) El manejo de las comunicaciones y de información es vital, pero a menudo son un eslabon débil en la cadena de respuestas; 7) La colaboración y las asociaciones son esenciales; 8) La ayuda y el voluntariado no solicitado son inevitables y se deben manejar y planificar; 9) Núnca asuma nada y siempre espera lo inesperado; 10) La evaluación postevento es importante pero debe ser coordinada.

La principal lección aprendida de las emergencias en el pasado es que el impacto de estos eventos puede ser anticipado y disminuido significativamente por medio de una adecuada planificación y preparación.

Por otro lado, la preparación para eventos de emergencias se ha deterioridado debido a las restricciones financieras de la salud y a que los recursos para apoyar la planificación y la infraestructura necesaria han disminuido. Dadas estas realidades el mayor reto no resuelto es asegurar el apoyo para la planificación del bien común y que de hecho, se efectúe.

Keywords

catastrophecollaborationcommunicationsdisasteremergenciesevaluationinformationlessonslife-savingmanagementpartnershipsplanningpsychological impactpublic healthresponsesrisk
Type
Public Health and Disasters
Information
Prehospital and Disaster Medicine , Volume 15 , Issue 4: The Role of Public Health in Disaster Medicine , December 2000 , pp. 83 - 88
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2000

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References

1.Kizer, KW, Garb, LH, Hine, CH: Health effects of silicon tetrachloride: Report of an urban accident. J Occup Med 1984;26:33–36.CrossRefGoogle ScholarPubMed
2.Kizer, KW, Abbott, D, Trent, RB: Response to the Loma Prieta earthquake. J Wilderness Med 1990;1:213–216.CrossRefGoogle Scholar
3. Earthquake-associated deaths — California. MMWR 1989;38:767–770.Google Scholar
4.Kizer, KW, Abbott, D: Response to the Loma Prieta Earthquake. Sacramento, California: Department of Health Services. 1990.CrossRefGoogle Scholar
5.Duelos, P, Sanderson, LM, Lipsett, M: The 1987 forest fire disaster in California: Assessment of emergency department visits. Arch Environ Health 1990;45:53–58.Google Scholar
6.Goldman, LR, Hayward, DG, Flattery, J, et al: Serum, adipose and autopsy PCDD and PCDF levels in people eating dioxin contaminated beef and chicken eggs. Chemosphere 1989;19:841–848.CrossRefGoogle Scholar
7. Multistate outbreak of poisoning associated with illicit use of gamma hvdroxy butyrate. MMWR 1990:39:381–383.Google Scholar
8. Clinical spectrum of eosinophilia-myalgia syndrome — California. MMWR 1990;39:89–91.Google Scholar
9. Listeriosis outbreak associated with Mexican-style cheese _ Californi MMWR 1985:34: 357–359.Google Scholar
10.Linnan, MJ, Mascola, L, Xiao, DL, et al: “Epidemic listeriosis associated with Mexican-style cheese. N Engl j Med 1988;319:823–828.CrossRefGoogle ScholarPubMed
11.Dales, LG, Kizer, KW: Measles transmission in medical facilities. West J Med 1985;415–416.Google ScholarPubMed
12.Kizer, KW, Feiton, JA, Jodar, VA, Yamamoto, HE, Montes, JM: Penicillinase-producing Neisseria gonorrhoea in California: Report of a major outbreak and control recommendations. West J Med 1989;151:292–295.Google Scholar
13.Dales, LG, Kizer, KW, Rutherford, GW, Pertowski, CA, Waterman, G: Measles epidemic from failure to immunize. West J Med 1993;159:455–464.Google ScholarPubMed
14.Goldman, L, Stratton, J, Kizer, KW, Kelter, A: California's Fourth of July Food Poisoning Epidemic from Aldicarb Contaminated Watermelons. Sacramento: California Department of Health Services. 1986.Google Scholar
15.Goldman, LR, Smith, DF, Neutra, RR: “Pesticide food poisoning from contaminated watermelons in California, 1985. Arch Environ Health 1990;45:229–236.CrossRefGoogle ScholarPubMed
16.CDC: Aldicarb food poisoning from contaminated melons — California. MMWR 1986;35:254–258.Google Scholar
17.CDC: Outbreak of severe dermatitis among orange pickers — California. MMWR 1986;35:465–467.Google Scholar
18.Kizer, KW, Lan, D, Freeman, C: Disaster Contingency Plan for the Acquisition and Distribution of Blood and Blood Products. Sacramento: California Emergency Medical Services Authority. 1984.Google Scholar
19.Grether, JK, Harris, JA, Neutra, R, Kizer, KW: Exposure to aerial malathion application and the occurrence of congenital anomalies and low birth weight. Am J Pub Health 1987;77:1009–1010.CrossRefGoogle Scholar
20.Alexeff, GV, Lipsett, MJ, Kizer, KW: Problems associated with the use of immediately dangerous to life and health (IDLH) values for estimating the hazard of accidental chemical releases. J Am Industr Hyg Assoc 1989;50:89–91.Google Scholar
21.Kizer, KW, Cushing, TS, Nishimi, RY: The Department of Veterans Affairs' role in federal emergency management. Ann Emerg Med 2000;36:255–261.CrossRefGoogle ScholarPubMed
22.Roselle, GA, Danko, LH, Krlovic, SM, Simbartl, LA, Kizer, KW: Tuberculosis in the veterans health care system: A six-year review and evaluation of program effectiveness. Chest 2000; In press.Google Scholar