September 11 at 10 Years: Public Health Preparedness for Disasters

An Expert Interview With Linda Y. Landesman, DrPH, MSW

Janet Kim, MPH; Linda Y. Landesman, DrPH, MSW


September 06, 2011

In This Article

Editor's Note:

September 11, 2011 will mark the 10-year passing of the 2001 attacks that took place at the Twin Towers of the World Trade Center in New York, New York; the Pentagon in Arlington, Virginia; and in a field near Shanksville, Pennsylvania. The tragic events that claimed the lives of nearly 3000 people served as a wake-up call of the vulnerability of our nation to terrorism.

Emergency and public health services and first responders, including firefighters, emergency medical staff, police officers, the Coast Guard, and others, were dispatched immediately to help with evacuation, search, and rescue. Various local, state, and federal agencies also were involved with the rescue, recovery, and clean-up efforts at "Ground Zero."

September 11, however, signaled the fact that our nation was not adequately prepared to respond to such a large-scale disaster, and the public also was left to question their safety to such threats in the future. Now that we are approaching the 10-year mark, what is our current state of disaster preparedness? Are we safer now than we were then, and is enough being done to prepare for and respond to the next potential disaster?

Linda Y. Landesman, DrPH, MSW, was the principal investigator for the first national curriculum on the public health management of disasters, sponsored by the Centers for Disease Control and Prevention (CDC) through a cooperative agreement with the Association of Schools of Public Health in the mid-1990s. She is the author of Public Health Management of Disasters: The Practice Guide, Third Edition, considered a landmark book as it is the only text that provides guidance on the activities that are required in the practice of public health when planning for or responding to disasters. Dr. Landesman has served on the Advisory Committee of the World Trade Center Evacuation Study and the Center for Public Health Preparedness at Columbia University's Mailman School of Public Health in New York, New York. She has worked as a clinician, administrator, educator, policymaker, and author throughout her public health career and is currently a candidate for the position of President-Elect of the American Public Health Association (APHA).

Medscape spoke with Dr. Landesman, a renowned expert on public health preparedness, about the present state of response to disasters in the wake of both September 11 at 10 years and Hurricane Irene.

State of Disaster Preparedness: Then vs Now

Medscape: Are New York hospitals more prepared now than they were on September 11, 2001 for disasters -- either natural or man-made?

Dr. Landesman: Given the minimal loss of lives that occurred during Hurricane Irene, our country's preparedness clearly has progressed over the past years despite the critics who will say that it has not. As we saw in New York, some wonderfully effective and efficient evacuations happened, and many, many people who were vulnerable and at risk were moved from harm's way. Still, there can always be room for improvement. Similar to a practice drill for any type of disaster, we learned that procedures in the written response plan may need to be tweaked or improved. The most difficult challenge for emergency preparedness and public health professionals is to demonstrate that preparedness, similar to other types of prevention, makes a difference because it's very difficult to measure something that didn't occur. The fine work by the healthcare systems up and down the East Coast in preparedness for and during Hurricane Irene really demonstrates that our readiness is much better.

Two overarching improvements have been made that contribute to this preparedness. First of all, the coordination among federal agencies and with state and local governments is stronger since the tragic events surrounding both September 11 [9/11] and Hurricane Katrina. Second, during the response following the attacks of 9/11, the hospitals in New York City began a collaboration that has resulted in extensive coordination among the many healthcare facilities in the region, an effort coordinated by the Greater New York Hospital Association. However, a critical caveat is that it is extremely challenging for hospitals and public health systems to stay focused on preparedness because core budgets are being cut as public health and healthcare systems are struggling to maintain daily operations and meet numerous requirements. In this difficult fiscal environment it is very hard to maintain and sustain the level of preparedness that would be required to respond effectively in the most devastating disasters.

Medscape: If we are more prepared now than before, what steps were taken? And what further steps need to be taken to help ensure public safety?

Dr. Landesman: Some specific steps that merit highlighting and recognition have been taken by the federal government; by The Joint Commission, the accrediting agency for hospitals and other healthcare delivery agencies; and by local and state communities. First, hospitals are now required to develop preparedness plans and to drill in a more comprehensive way to meet The Joint Commission's standards. [In the case of Hurricane Irene,] if you look at New York City's efficient evacuation of almost 9000 people from hospitals and nursing homes, including senior citizen residents and other vulnerable populations in high-risk flood zones, you see that even the largest healthcare systems are better prepared.

Second, an extensive surveillance system is now in place, and the national Laboratory Response Network is a key component of this system. This is a real boon to public health's ability to identify outbreaks of infectious disease in advance of massive spread to the community. Third, since Hurricane Katrina, many operational requirements have been established to improve public health preparedness, including standards for health departments to protect vulnerable populations. Fourth, public health has moved forward in establishing guidelines for planning on the basis of capabilities. This is at a national level through the CDC. As more and more systems implement these guidelines, organizational capacity will be enhanced and those responding will be better prepared for the next incident. Fifth, through CDC's Public Health Emergency Preparedness [PHEP] cooperative agreement, health departments are able to strengthen their capabilities to respond to the range of public health incidents. Preparing health departments to be ready to respond to any incident supports the goal of the Department of Homeland Security’s National Response Framework, which provides guidance on managing disasters. Finally, CDC has established national standards for [state and local planning of] public health preparedness by identifying 15 capabilities for public health professionals. These standards for public health planning are included as an appendix in the third edition of my book.


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