This section of the Toolkit provides a descriptive look at the process that is required for developing an I & Q plan. It highlights essential considerations as well as strategies for implementing the planning process. The Tools & Samples section offers documents that can guide in the development of your own plan.
UNDERSTANDING THE NEED
There is a tremendous need for all health jurisdictions to develop a calculated and collaborative response plan for an event that would require a large-scale isolation and quarantine. Developing and practicing a community based plan should produce a coordinated and efficient response that could significantly minimize sickness and death in a serious outbreak.
Any plan for isolation and quarantine is built around a core set of principles, beliefs and parameters to guide the work. Rather than reinvent, we turned to the work of NACCHO's Bioterrorism Isolation and Quarantine subgroup, as well as to CDC guidance. These principals are a wise starting point but keep in mind that local plans must also be responsive to local and state laws and administrative codes.
Assessing what are the most likely threats can only be determined locally. Relevant diseases for I & Q are those transmissible from person to person and legally defendable, i.e. on the Federal list of quarantine diseases. These are diseases that pose a significant threat to public health. Toxin mediated disease, such as anthrax, botulism, or agents such as tularemia, would not involve I & Q, even with widespread community involvement.
Public Health Paradigm Shift
Public Health agencies are vested with the legal authority to isolate or quarantine people for the good of public health. This stretches Public Health's responsibility beyond its core competencies and resources, requiring Public Health to depend on community partners to do what they do best in coordinating the emergency response and comprehensively caring for those who are confined.
Preparedness planning and large-scale response are now considered "core functions" of Public Health's historic commitment to intervening on behalf of the community's health and safety. Public Health is now a first responder. This is a complex organizational shift and can't happen overnight.
In a large-scale, bioterrorism event or disease outbreak, all Public Health employees are essential employees. The most effective way to begin making this shift internally is to begin internal communication, recruit new employees with a responder role in mind, and encourage existing employees to volunteer in responder roles.
Key short-term steps include:
- Add "preparedness and response activities" to all job descriptions and personnel recruitment materials.
- Incorporate emergency response into initial and ongoing employee training.
- Educate bargaining units and employee representatives about this critical need/role, and negotiate to ensure that labor contracts allow for redeployment of staff in emergency situations.
- Work with agency leadership to strategize the integration of preparedness planning and response. Problem-solve regarding resource needs (staffing, time, funding, flexibility) to handle the preparedness workload.
- Promote the preparedness effort as an opportunity to craft new partnerships across programs/departments/ teams/agency divisions to build toward the goal of a unified response.
- Configure internal systems to support the assessment of employee skills and capacities to enable rapid redeployment of personnel in an emergency.
- Be clear that "something must give." Preparedness activities can't just be added to the plates of already busy staff with critical work to do in the absence of an emergency. During an emergency, many day-to-day services and programs will not operate, so that staff can help with the response effort.