Interoperating With Other Organizations

As we have discussed, disease surveillance by health departments involves daily interactions between health departments and many other organizations. During outbreak investigations, health departments interact with an even larger number of organizations, potentially every type of organization listed in Table 1.2 (see Chapter 1). In this section, we discuss interactions not discussed elsewhere in this book, including relationships among adjacent health departments and with law enforcement.

8.1. Other Health Departments

We have already discussed the "vertical'' relationships between health departments operating at the local, state, and federal levels. There are also "lateral'' interactions among state health departments, especially those that share geographic borders. There are similar interactions among local health departments. These organizations interoperate for many reasons; paramount is that communicable disease does not respect jurisdictional boundaries. Some specific examples of situations in which health departments interoperate include when an individual with a communicable disease, such as meningococcemia, is identified in one jurisdiction but exposed individuals live in another state, when an individual requiring directly observed treatment for tuberculosis moves to a different state, and when an individual becomes ill after returning from a vacation or trip in another state.

Importantly, many large population centers in the United States span jurisdictions. For example, the population centered on the city of Philadelphia extends into the states of Delaware, New Jersey, and Maryland. The population centered on New York City extends into New Jersey and Connecticut, with many individuals commuting to the city from eastern Pennsylvania.

The need to provide computer support for lateral communications and data exchanges among health departments is well understood. There are already basic capabilities in place. For example, the Epidemic Information Exchange (Epi-X), which is provided by the CDC, allows federal, state, and local epidemiologists; laboratories; and other public health colleagues to post health alerts to a Web site. Epi-X also supports secure, Web-based communication (e-mail) and allows for instantaneous notification, through e-mail, of urgent public health events. It also enables users to search the Epi-X database for information on outbreaks and unusual health events (Committee on Health Promotion and Disease Prevention, 2003).

The Metropolitan Medical Response System and the CDC Cities Readiness Project focuses on communication at the metropolitan level. Their goals are similar: to develop or enhance existing emergency communication systems to better handle a public health crisis, such as an act of bioterrorism. In particular, they focus on improving the communication and coordination among local law enforcement, fire, hazardous materials (hazmat), emergency medical services (EMS), hospital, public health, and other "first responders'' (Metropolitan Medical Response System, n.d.). We include

FIGURE 5.7 Health Alert Network. a, Screenshot of an official Pennsylvania Health Advisory related to the hepatitis A outbreak described in Chapter 2. This was distributed only to Pennsylvania clinicians and alerted clinicians about an immune globulin clinic and reminded them of their need to report hepatitis A cases (CDC, 2005f).

Continued

FIGURE 5.7 Health Alert Network. a, Screenshot of an official Pennsylvania Health Advisory related to the hepatitis A outbreak described in Chapter 2. This was distributed only to Pennsylvania clinicians and alerted clinicians about an immune globulin clinic and reminded them of their need to report hepatitis A cases (CDC, 2005f).

Continued

Web sites at the end of the chapter that discuss other groups that focus on facilitating communication and meetings between states and jurisdictions.

8.2. Law Enforcement

In the case of a bioterrorist or criminal act using a biological agent, criminal and epidemiological investigations occur concurrently. The steps necessary to identify a potential covert bioterrorism attack include a close coordination between those who collect and analyze medical and syndromic surveillance information and law-enforcement intelligence and case-related information. The best method for timely detection of a covert bioterrorist attack is early communication between the two communities and recognition of the extent and origin of the threat. For the Federal Bureau of Investigation (FBI), this recognition requires conducting a threat/credibility assessment, a process coordinated by the Weapons of Mass Destruction Operations Unit and FBI Headquarters, in conjunction with CDC and other federal agency experts (Butler et al., 2002).

The recent focus on biosurveillance requires health departments, national security communities, law enforcement, and EMS units to work closely together. This new requirement has motivated these organizations to develop new linkages and skills, to refine existing ones, and to foster new relationships. (Harper, 2000).

0 0

Post a comment