The Role of Law Enforcement in The Role of Law Enforcement in Public Health EmergenciesPublic Health Emergencies

Edward P. Richards, Katharine C. Rathbun, Edward P. Richards, Katharine C. Rathbun, Corina Solé Brito, and Andrea LunaCorina Solé Brito, and Andrea Luna

Available at:Available at:

www.ojp.usdoj.gov/BJAwww.ojp.usdoj.gov/BJAwww.dr-kate.comwww.dr-kate.comEmail me - richards@lsu.eduEmail me - richards@lsu.edu

The ReportThe Report

Driven by bird flu fearsDriven by bird flu fearsStarted as a study of quarantine and Started as a study of quarantine and

isolationisolationDarlings of the DHS and CDC and others who Darlings of the DHS and CDC and others who

have never done public healthhave never done public healthBecame an all hazards approachBecame an all hazards approach

Why not Quarantine and Isolation?Why not Quarantine and Isolation?

Logistics of a wide spread quarantineLogistics of a wide spread quarantineLimited response optionsLimited response optionsSARS ExperienceSARS Experience

Why All Hazards?Why All Hazards?

Difficult to maintain readiness for a low Difficult to maintain readiness for a low probability eventprobability eventPlan must provide short term benefits to be Plan must provide short term benefits to be

supported in the long termsupported in the long term Impossible to change behavior patterns on Impossible to change behavior patterns on

short noticeshort noticePlan must incorporate new behaviors and Plan must incorporate new behaviors and

attitudes into everyday situationsattitudes into everyday situations

Overview of All HazardsOverview of All Hazards

Institute vaccination programs for all Institute vaccination programs for all recommended adult immunizationsrecommended adult immunizations

Address policies that encourage employees to Address policies that encourage employees to work sickwork sick

Develop and implement workplace surveillance Develop and implement workplace surveillance for infectious disease risksfor infectious disease risks

Include families in these plans because officers Include families in these plans because officers cannot work effectively if their families are at riskcannot work effectively if their families are at risk

Management Oversight Management Oversight AdvantagesAdvantages

Provides measurable outcomes, which Provides measurable outcomes, which disaster only planning does notdisaster only planning does not

Provides an economic and workplace Provides an economic and workplace benefits which will make the program benefits which will make the program easier to continueeasier to continue

Requires policies to be worked out with Requires policies to be worked out with unions and other stakeholdersunions and other stakeholdersAssures buy inAssures buy in Identifies problemsIdentifies problems

The Next Step:The Next Step:Resilient CommunitiesResilient Communities

Bring All Hazards Planning for Public Bring All Hazards Planning for Public Health Emergencies to the Health Emergencies to the

CommunityCommunity

Defining Characteristics of Defining Characteristics of Public Health EmergenciesPublic Health Emergencies

Long termLong termDays to longerDays to longerDepletes manpower and resourcesDepletes manpower and resourcesThe affected population requires supportThe affected population requires support

WidespreadWidespreadAffects a region or significant urban areaAffects a region or significant urban areaAffects everyone, including the policeAffects everyone, including the police

Significant RiskSignificant Risk

ExamplesExamples

EpidemicEpidemicBird fluBird flu

Hazmat incident with long term risksHazmat incident with long term risksAnthraxAnthraxDirty bombDirty bomb

Natural disasterNatural disasterHurricanes, Winter stormsHurricanes, Winter stormsEarthquakesEarthquakes

Traditional Emergency Response Traditional Emergency Response ScenariosScenarios

Geographically limitedGeographically limitedCrime scenesCrime scenesParade routesParade routesLook at the problems with riot control when Look at the problems with riot control when

whole neighborhoods become involvedwhole neighborhoods become involvedTemporarily limitedTemporarily limited

No one is staffed to do a 100% mobilization No one is staffed to do a 100% mobilization for weeksfor weeks

Limited Response Options in Limited Response Options in Public Health EmergenciesPublic Health Emergencies

You cannot shoot people who are just You cannot shoot people who are just trying to take care of their familiestrying to take care of their families

You cannot arrest large numbers of You cannot arrest large numbers of persons to restore orderpersons to restore order

You cannot occupy significant territoryYou cannot occupy significant territory

Your People are also VictimsYour People are also Victims

Widespread public health and Widespread public health and environmental crises affect law environmental crises affect law enforcement personnel enforcement personnel

Most personnel will look to their families Most personnel will look to their families firstfirstLaw enforcement families cannot be Law enforcement families cannot be

protected outside of the context of protected outside of the context of their communitiestheir communities

Day to Day Life Goes OnDay to Day Life Goes On

No federal plan acknowledges that there No federal plan acknowledges that there are criminals and the homelessare criminals and the homelessBiggest joke - Pandemic flu plan says they will Biggest joke - Pandemic flu plan says they will

close the bordersclose the bordersToo many plans can only be staffed by Too many plans can only be staffed by

assuming that no other law enforcement or assuming that no other law enforcement or first response activities will take placefirst response activities will take placeOnly works for short periodsOnly works for short periods

Why 9/11 is the Wrong ModelWhy 9/11 is the Wrong Model

Deaths, but not injuries - limited impact on Deaths, but not injuries - limited impact on health carehealth care

Relatively small percentage of the Relatively small percentage of the population displaced for a long period of population displaced for a long period of timetime

Relatively little infrastructure destroyedRelatively little infrastructure destroyed

Why Katrina is a Better ModelWhy Katrina is a Better Model

WidespreadWidespreadLong-termLong-termForeseeableForeseeableThe risks could have been mitigatedThe risks could have been mitigatedThe response needs outstripped all The response needs outstripped all

available resourcesavailable resources

What Do Communities Need in What Do Communities Need in Public Health EmergenciesPublic Health Emergencies

Food, waterFood, waterEnvironmental management such as heatEnvironmental management such as heatTransportation and shelter if an evacuationTransportation and shelter if an evacuationHealth careHealth careFamily support - where are the kids?Family support - where are the kids?

Complicating FactorsComplicating Factors

Physical and Personnel Infrastructure Physical and Personnel Infrastructure MismatchMismatchFailure to do maintenanceFailure to do maintenanceAllowing development to outstrip infrastructureAllowing development to outstrip infrastructure

Efficiency v. ReliabilityEfficiency v. ReliabilityWill your $100 microwave work in 5 years?Will your $100 microwave work in 5 years?Will your low cost electric power company Will your low cost electric power company

give you power 24/7/365 at 99.99%?give you power 24/7/365 at 99.99%?

Who Will Provide for the Public?Who Will Provide for the Public?

Federal modelFederal modelLocal first respondersLocal first respondersSupported by the military and federal supportSupported by the military and federal support

State ModelsState ModelsPublic health, supported by law enforcementPublic health, supported by law enforcement

RealityReality In most areas the police are the organizations In most areas the police are the organizations

with the most staff and resourceswith the most staff and resources

Who Will Fund This?Who Will Fund This?

The existing money is coming from other The existing money is coming from other essential services that cannot be essential services that cannot be postponed foreverpostponed foreverPriorities will shift as fears of disaster abatePriorities will shift as fears of disaster abateMany health departments are losing net Many health departments are losing net

moneymoneyBottom-line: No one is funding real public Bottom-line: No one is funding real public

supportsupport

Objectives of Resilient Objectives of Resilient CommunitiesCommunities

ReduceReduce the need for support from public the need for support from public servicesservices

ReduceReduce suffering and death suffering and deathReduceReduce the risk of public disorder the risk of public disorderMost important: Most important:

Build trust and credibility so the Build trust and credibility so the community will cooperate with community will cooperate with needed mitigation measuresneeded mitigation measures

Building Blocks for Resilient Building Blocks for Resilient CommunitiesCommunities

Honest risk communicationHonest risk communicationRealistic preventive strategiesRealistic preventive strategiesStart with your own peopleStart with your own peopleWorking with other organizationsWorking with other organizationsReinforcing the message when disasters Reinforcing the message when disasters

are no longer fashionableare no longer fashionable

Honest Risk CommunicationsHonest Risk Communications

Be realistic about the riskBe realistic about the riskBird flu v. yearly fluBird flu v. yearly fluHurricane v. terrorist attackHurricane v. terrorist attack

Just say No to Potemkin planningJust say No to Potemkin planningBig issue in public healthBig issue in public healthHurricane PamHurricane PamBeing a team player puts the public at riskBeing a team player puts the public at risk

Do not suppress market risk signalsDo not suppress market risk signals

Realistic Preventive StrategiesRealistic Preventive Strategies

Must fit in with real household managementMust fit in with real household management Being PreparedBeing Prepared

ExamplesExamples GasolineGasoline What to take in evacuationsWhat to take in evacuations How to keep food and water on handHow to keep food and water on hand How to treat water and what is safe to eat when the How to treat water and what is safe to eat when the

refrigerator goes offrefrigerator goes off When to go back and what to do when you get thereWhen to go back and what to do when you get there

Start with Your Own PeopleStart with Your Own People

Get the families of your own people Get the families of your own people involvedinvolvedBuilds support - they become part of the Builds support - they become part of the

solutionsolutionDirect benefits to the departmentDirect benefits to the department

Encourage them to involve their neighborsEncourage them to involve their neighborsStabilizes the neighborhood, making their own Stabilizes the neighborhood, making their own

situation more securesituation more secureDo not be the only person on your block with Do not be the only person on your block with

waterwater

Working with Other OrganizationsWorking with Other Organizations

Find out if your local public health plans Find out if your local public health plans are really staffed and supportedare really staffed and supported

Find out the plans of the local hospitals Find out the plans of the local hospitals and other health care providersand other health care providers

Coordinate with retailersCoordinate with retailersWork with churches and other private Work with churches and other private

organizationsorganizationsWalmart and Home Depot can move goods Walmart and Home Depot can move goods

more effectively than Northcommore effectively than Northcom

Reinforcing the Message when Reinforcing the Message when Disasters are out of FashionDisasters are out of Fashion

Priorities are going to shiftPriorities are going to shiftFEMA has already punted on realistic building FEMA has already punted on realistic building

standards in New Orleans and the Gulf Coaststandards in New Orleans and the Gulf CoastNo politician will keep supporting prevent No politician will keep supporting prevent

measures once the public gets interested measures once the public gets interested in other thingsin other thingsWe have a lot of social problems we have We have a lot of social problems we have

been ignoringbeen ignoringThe problems will still be thereThe problems will still be there

Political BenefitsPolitical Benefits

Most communities do not trust public Most communities do not trust public health (some do not trust the police)health (some do not trust the police)Anti-vaccination forcesAnti-vaccination forcesEquating trans-fat with the plagueEquating trans-fat with the plague Incompetent political appointees in critical Incompetent political appointees in critical

positionspositionsLaw enforcement will bear the risk of failed Law enforcement will bear the risk of failed

public health responsepublic health response