The American Emergency Management and Public Health Preparedness System _review

Topic Progress:
Carrie, PJ and EM sit at a meeting table together, wearing face masks.
It may not look like it, but the people in this room are socially distanced.
EM, a white bald man in his 50s wears a facemask

EM: Terrye, in order to develop relationships with local emergency and public health preparedness planners you need to know something about the American emergency system.

đź’­ The American emergency system has 3 basic levels. What do you think they are?

The emergency “system” is really a system of systems. Because of the nature of the U.S. government, there are 3 levels of emergency planning and management. There are American emergency management agencies at the federal, state, and local levels. So, there is one federal system, 50 state plus 5 territorial systems plus hundreds of county, city, and town emergency systems. There are also regional systems within states and among states.

EM, a white bald man in his 50s wears a facemask

EM: Within each government level (federal, state, and local) there is a public safety emergency system and a public health emergency system. In some communities these offices coordinate well and in others they don’t.

We’re making this chart for the community. Take a look.

Emergency Management SystemPublic Health System
Federal LevelFederal Emergency Management Agency (FEMA)Office of the Assistant Secretary for Preparedness and Response (ASPR)
State LevelEmergency management agencyDepartment of Public Health
Local (city, town, county) levelEmergency management office or department Public health office or department

Local health departments protect communities from real or potential events that threaten community health, including emergencies, disasters and pandemics. They sustain national health security through public health preparedness, which includes emergency response and planning. They also help other entities during the recovery process. COVID-19 is an example of a public health emergency.

Local emergency management department or offices coordinate efforts to respond to, prepare for, recover from and mitigate against natural or other disasters and terrorist acts. Natural disasters include weather-related events like hurricanes or floods. Human caused disasters include hazardous chemical spills. Terrorism includes events like the Sept 11, 2001 attack on the U.S.

Each state also has healthcare coalitions (HCC). Coalitions include healthcare and emergency response organizations within a certain area, usually more than one community. Coalition members include hospitals, emergency medical services (EMS), emergency management and public health agencies. Coalitions coordinate member healthcare preparedness and response. Find your healthcare coalition here.

PJ, in their 30s, wears a facemask and glasses

PJ: As you can see, there are many parts and levels in this system of systems. If different parts of the systems don’t work well together, then we say there are “silos” which can be a challenge to moving forward. There can be conflicts among local, state and federal levels. There can also be conflicts between emergency management and public health preparedness at any level.

But the best practice is to work collaboratively. There are a number of communities that do just that.

2 silos side by side; one showing the emergency management system and one showing the public health system
Example of the levels of the emergency management and public health systems from the federal to local level
Carrie, a Black woman in her 30s wears a facemask, has a white cane and a miniature horse that serves as her service animal

Carrie: Notice that the higher levels of emergency management and planning are not in charge of and do not generally oversee the lower levels. FEMA and ASPR do not control state emergency or public health agencies, for example, and generally cannot direct them to take action.

In many states, the state emergency management and public health preparedness agencies don’t direct those at the local level. But note that in some states the state public health office has control over local public health offices.

EM, a white bald man in his 50s wears a facemask

EM: Let’s talk about how this works in practice, using the examples of two Lexingtons: Lexington, Kentucky, and Lexington, Massachusetts.

Logo reading "Town of Lexington Massachusetts"

Lexington, MA, is a Boston suburb with about 33,000 people. It’s known for the Battle Green, where the first shot of the American Revolutionary War was fired. In Lexington, the fire chief acts as the local emergency manager. There is also a local office of public health, within the Town’s Land Use, Health, and Development Department. Because the office is small, the public health director is also the public health preparedness planner.

At the state level, the state emergency management agency is called the Massachusetts Emergency Management Agency (MEMA), located in the Executive Office of Public Safety and Security. The state Department of Public Health, located in the Executive Office of Health and Human Services, has an Office of Preparedness and Emergency Management. MA is in FEMA Region 1 and Health and Human Services/ASPR Region 1.

Logo reading "Lexington" with an outline of a horse

Let’s look at Lexington, KY. Lexington-Fayette County has approximately 322,000 residents, and is known as the “horse capital of the world.” The Lexington-Fayette County Division of Emergency Management (DEM) is a division of Lexington-Fayette County’s Department of Public Safety.

Kentucky state Emergency Management (KYEM) is a division of the Kentucky Department of Military Affairs. The Kentucky Department of Public Health, part of the state’s Cabinet for Health and Family Services, has a Public Health Preparedness Program. Kentucky is in FEMA Region 4 and Health and Human Services/ASPR Region 4.

PJ, in their 30s, wears a facemask and glasses

PJ: What can you learn from these descriptions and the discussion above?

Carrie, a Black woman in her 30s wears a facemask, has a white cane and a miniature horse that serves as her service animal

Carrie: Terrye, when planning to engage (the first E in Prepared4ALL) local emergency and public health offices, do your homework!

Learn the local government structure, department names, and where these departments fit. Because public health and emergency management are often separate offices or departments, assume that they may need different approaches.

Beware of offices or departments that are stuck in silos. You may not be able to break down the silos but you may be able to work separately with each one.

The system certainly isn’t what I thought it was when I first learned about it.

EM, a white bald man in his 50s wears a facemask

EM: Many believe the most important system is the one on top, the federal level. Do you think this is true?

Carrie, a Black woman in her 30s wears a facemask, has a white cane and a miniature horse that serves as her service animal

Carrie: Pandemic planning and response is a public health activity. While the local public health officials should take the lead on COVID-19 planning and response, this may not always be the case. In some communities, there is tension around which local government office is in charge. There’s conflict and limited cooperation. In other communities, public health takes the lead and has strong relationships and cooperation from other local government offices. Even though pandemics are public health issues, there is a strong role for emergency management. For example, at the national level, FEMA is taking a very important role.