Adventures in disaster medicine: A United States experience that illustrates key public health policy principles

Public health policy for disasters is multi-faceted and complex at the local, state, and federal levels. Using a series of case studies, this manuscript illustrates issues at each echelon. The federal example of the anthrax letter attacks in the United States in the fall of 2001 demonstrates key differences between a classic bioterrorism attack with release of a weaponized, aerosolized agent and a sudden impact, defined scene event with a contaminated letter. Additional public policy issues arise regarding surveillance and detection, and regarding disaster nomenclature, including the lack of a standardized definition of the term “casualty”. A state level example of the influenza pandemic explains the importance of the 3S System of Surge Capacity, which consists of “Stuff” (i.e., supplies and equipment), “Staff” (i.e., personnel), and “Structure” (which contains two components: physical structure and management infrastructure). A local example (from an international source) reveals the challenges that arise from the actual and psychological effects of a complex event in Japan (i.e., the Great Tohoku Earthquake and Tsunami) that included a radiation release. The healthcare policy issues outlined in this paper are essential principles to guide emergency managers and others who are responsible for effective disaster management.