Chapter 6 - The US emergency management and public health preparedness systems

Abstract

This chapter describes how the American emergency system evolved from disorganization to the still somewhat siloed “system of systems” that it is today, with parallel public health and public safety/emergency management systems at the local (city, town, county), state, territorial or tribal, and federal levels. A bottom up system, all response begins at the local level and then moves up through the state and federal levels. Authority is diffuse; FEMA does not have the power to control state or local emergency management agencies. The federal, state and local emergency systems are explored, including key actors, organizations, and roles within the emergency lifecycle phases of mitigation-preparedness-response-recovery. The chapter describes the overall guiding principles for the US emergency system, including its “all hazards” integrated approach with a focus on commonalities among risks, and the way the system operationalizes key principles through a specific planning and emergency incident management structure and framework. Next, there is an examination of two features of the local system, the level closest to the people likely to be most directly impacted by a disaster: registries (databases with the names and addresses of people with disabilities) and medical shelters (disaster shelters separate from general population shelters). Structural challenges related to the system’s silos are discussed, along with the exclusion of disabled people from disaster planning and response processes, and a description of the federal emergency agency offices responsible for emergency management and public health preparedness compliance with and enforcement of civil rights laws.