To best assist community planners responsible for optimizing available community resources, this chapter will lay out the basic communication requirements for each agency called upon to respond to a terrorist event. The design, implementation, monitoring, and periodic redesign of equipment, policies, protocols, and personnel will flow from these basic requirements and provide emergency response
organizations with a foundation upon which to expand. The design of a communication plan for mitigation of a terrorist event must have a number of basic features Table 31-2.

Any given terrorist event will place specific populations at risk in a given geographic area, the mitigation of which may require multimethod functionality, which is the response and cooperation of multiple agencies. Thus, multimethod functionality of any municipal communication system is vital. The communication system developed by a municipal area should be flexible, integrating the information pathways of many different agencies, though each may have its own communication network. Public safety matters must be dealt with. People may be injured, requiring field triage, management, and transport. Hospital facilities must be put on notice, including the communication of an accurate rapid assessment of their capabilities and current load factors to appropriate agencies. The local, state, and/or federal emergency management agencies may require notice. A need for public works (water, power, sewer, road maintenance, etc.) to be placed on alert may also arise. Thus, appropriate community planning for terrorist events must, of necessity, provide for communications media that blend on a moment-to-moment basis a poly-agency network of providers from all areas of community response.

Inclusion is a basic feature of interagency communication. It is vital that all appropriate agencies be included in the communications network. Community planners must enumerate the facilities available for response to events that could affect their areas. Such planning requires the collective imagination of the members of all planning groups responsible for emergency preparedness. Entities at risk, such as public gathering areas, mass transit, and public works facilities, require identification and assessment of their unique vulnerabilities. Extrapolation of communication needs from potential hazards, merged with current and anticipated modes of information sharing that must take place during events, will reveal an appropriate functionality of community response to the planners.

Many jurisdictions have studied these areas extensively. The governor of Oregon in 1972, for example, established the Oregon Emergency Response System (OERS). It was designed to manage the resources of the state during various emergencies, including “natural and technological … and civil unrest.” Its program includes a prospective, multijurisdictional series of agreements between local, regional, and state levels, as well as with the private sector. OERS established a “primary point of contact” through which any responding entity would provide the state appropriate contact information and an assessment of the emergency event, including requests that must be forwarded to the state or federal government (1). OERS allows for a constant “state of readiness” of the state communications network, including routine testing and monitoring of available equipment and systems. This is an excellent example of a state-led effort to examine the needs of the citizenry within that governmental limit and provide a network of communications through prospective planning. However, appropriate limitations are highlighted in the Oregon Quick Response Report #149, which found that only 39% of representatives of responding agencies would be notified of the establishment and activation of an Emergency Communications Center (2). Clearly this state plan, at the time of that publication, had more work to do in developing an adequate notification system that would notify the appropriate agencies of a potential event. An important take-home message to community, regional, and state planners is the need for continuous monitoring of the readiness of on-call personnel. Communications systems must be hardened to withstand the impact of terrorist events. It is within the realm of imagination that attempts to injure a population might target the various communications agencies serving that population. The 911 call-taking centers and dispatch facilities must be reasonably prepared to withstand adverse events, including possible physical attacks. Precedent exists for such efforts. For example, the San Ramon Valley Fire Protection District in California has provided for the site hardening of one of its stations and its administration building, which is equipped with food, water, and emergency power so that it may serve as a principle emergency operations center for the municipalities that it serves. Thus, it may be strongly suggested both by reason and by precedent that adequate community protection includes an awareness of potential damage or destruction of central call-taking and dispatching agencies and the prudent securing of these facilities. In addition to hardening of the central call-taking and dispatching areas, redundant systems must be available to assume some or all of these responsibilities, should the central facility be damaged.

One potential method for technologically hardening a municipality’s central facility is to arrange for neighboring agencies to share communication responsibilities should the given municipality’s system be damaged. Another hardening possibility is the utilization of the Radio Amateur Civil Emergency Service, or RACES, under a standing protocol from the fire chief or other authorized agent of the
community. RACES could be used to contact a neighboring fire department or appropriate emergency management agency, to activate mutual aid, alert surrounding hospital facilities, and/or contact the vertical governmental structure, including notifying the state or federal governments for military assistance. Thus, limitations of community budgets need not place undue constraints on the capacity of an area or region to maintain hardened communications abilities, thus providing continual multiagency connection during the evolution of a hostile event against a community.

The value of simplicity in design and coordination of multiagency communication cannot be overemphasized. In the second section of this chapter, significant emphasis is placed on the potential for adverse outcomes when interagency communication is not part of community planning. Indeed, substantial information may be available to one agency that may affect the welfare of other responders, but without adequate planning for communication of that information, needless harm may fall to others responding to the event. Thus, it is stressed herein that barriers to interagency communication must be broken down at the drawing board. Egos must be sacrificed to the greater good of the citizens and the responders. The breadth of the commitment of public and private facilities appointed to plan for the common protection of citizens and responders must be a uniform agreement to bypass unnecessary interagency conflicts.

Emergency response systems have a common element, namely the requirement that these hardened systems have continuous functionality, defined as being available 24 hours a day, 7 days a week. EMS and fire agencies, as well as public safety entities, have maintained such accessibility to the public since their early days. This allows these groups to respond to emergencies with the appropriate resources in prompt order. Indeed, responders have arrived at the scene of explosions and bombings so rapidly that significant numbers of fatalities have occurred in the ranks of the responders themselves due to secondary explosive devices specifically targeted against them and timed to detonate just as they were staging or initiating patient triage.

These basic features are essential to interagency communications and can be demonstrated in many ways. Public health agencies must be included in the community planning for terrorist incidents such as biohazard releases. Public health agencies, for example, have significant control over the availability of vaccine supplies. If these supplies cannot be made available promptly to initiate widespread community immunization in accordance with community-wide plans, it could be reasonably predicted that the number of casualties might be greater; therefore, including public health agencies early in interagency planning is essential.

Interagency planning for community response to an epidemic of an especially deadly agent such as smallpox or perhaps the agent causing the Severe Acute Respiratory Syndrome (SARS) virus requires careful attention by community planners. For example, should the index case in the setting of a smallpox outbreak occur in an apartment complex, it may be necessary to exercise authority that limits the freedom of individuals, who either are already becoming ill or who have been exposed. The term “isolation” applies to the removal from public contact of those who are already ill, whereas the term “quarantine” applies to the removal from public contact of an individual who has been exposed, but is not yet ill. Preparation for either of these restraints on personal freedom requires a broad community agreement and prior education of the citizens as to what actions must be taken by agency officials in the event of such an outbreak.

To provide sufficient powers to allow for the isolation or quarantine of appropriate individuals, the United States Code Section 264, which is found in Section 361 of the Public Health Service Act, provides the Secretary of Health and Human Services with the duty to stop “the introduction, transmission, and spread of communicable diseases from foreign countries into the United States and within the United States and its territories/possessions” (3). This law comes under the aegis of regulations found in the 42 CFR Parts 70 and 71. Under its delegated authority, “the CDC is empowered to detain, medically examine, or conditionally release individuals suspected of carrying a communicable disease.” This regulation further states that “in the event a passenger infected with SARS were to arrive in the United States on board an international flight, the Executive Order provides HHS with clear legal authority to detain or isolate the non-compliant passenger and prevent the passenger from infecting others. This authority would only be used if someone posed a threat to public health and refused to cooperate with a voluntary request” (3). To provide such detainment, isolation, or quarantine in real time, a carefully thought-out community plan of cooperation between hospitals, public health officers, and public safety personnel is necessary. For example, if an index case were found to have exposed a significant number of persons at a sporting event, then the tracking and isolation of persons at risk of becoming ill, as well as exposing additional persons, would truly present a substantial problem for any community. Sufficient planning requires the collective cooperation and imaginations of community agencies. It is useful to comment at this point that the use of quarantine in the United States is a power that has been used rarely. Indeed, again from the CDC, “The last litigated case involving the involuntary quarantine of a passenger arriving into the United States occurred in 1963 and involved a suspect case of smallpox. On the other hand, CDC routinely temporarily detains incoming planes and interviews passengers for health reasons. For example, CDC temporarily detained an incoming plane and interviewed passengers in Seattle in December 2001 to verify that a report of smallpox aboard the flight was in fact a hoax” (3).

The medical response to terrorism involves gathering information from a wide variety of health care providers and facilities in a timely fashion. The earliest possible warning to a community at risk of a terrorist event is essential. Public service agencies in communities regularly receive vital data that, when submitted to analysis, can reveal patterns in the “background noise” of day-to-day life which might otherwise be undetected. In application to public health, this is referred to as syndromic surveillance, or the ability to detect diseases demonstrating a risk to the public health through patterns of illness recognition in a given area. Syndromic surveillance is not a new process. It has been used for generations by public health officers to determine if communities
are at risk through incidences of disease cases being reported. It is possible to use automated computer-aided techniques to filter through incoming information to public service agencies, such as 911 dispatch centers. However, the practices of physicians and community support services is now amplified by using computers to analyze cases reported to many 911 agencies or presenting to many emergency departments across the United States, indeed providing automated syndromic surveillance of these reports. The reports produced by such enhancements to the information systems of these agencies can provide for immediate data linking to area epidemiologists on an automated basis, with this data automatically falling within federal information-sharing guidelines. Information that can be sent includes patient demographics, the type of clinical problem, and the findings from specific clinical data points, focused by the patients’ postal codes. However, again according to the CDC, “syndromic surveillance will be affected by the selection of data sources, timeliness of information management, definition of syndrome categories, selection of statistical detection thresholds, availability of resources for follow-up, recent experience with false alarms, and criteria for initiating investigations” (4). Finally, recent work with computerized Emergency Medical Services (EMS) medical record creation has indicated that the field computers can instantly update the central data server regarding the chief complaints of patients presenting in the field. Thus, even the medical record data server can serve a useful role in the gathering of data useful in syndromic surveillance.