The media blitz around the coronavirus has created fear that has manifested into significant economic impact, contributed to hate crimes, and resulted in food and supply hoarding. Although not yet described as a “pandemic,” at the time of writing this article, the World Health Organization (WHO) is expected to make the declaration as the virus spreads.
A multi-disciplinary response is necessary to address all the concerns that accompany a biohazard incident. The Incident Command System (ICS) structure is essential to determine the roles and responsibilities of each responding agency. It is also important to identify leadership and command for specific incidents. There are roles to be assumed by law enforcement, fire personnel and public health departments.
Post-9/11, there were fears around threats of biohazard releases in gathering areas, sporting events and along public transportation lines. Threats included dispersal through active and passive means. Improvised explosive devices (IEDs) called for a response led by police and fire. Biological threats, which included the release of anthrax and ricin, called for public health to lead the response.
Scenarios were created and exercises conducted to understand local agency preparedness, response, mitigation and recovery capacities. In cases where public health or fire were lead agencies, law enforcement maintained a presence as force protection and to help protect other first responders. Fears included prophylaxis distribution centers being overrun or looted. A similar response should be reviewed or prepared for this latest health hazard.
Public Health as Lead in Biological Threats
We must take the lessons learned from our post-911 efforts and turn them toward the threats posed by COVID-19, the disease caused by the coronavirus.
At this early juncture little is known about the transmission, incubation periods and lethality of COVID-19. The Centers for Disease Control (CDC) is the lead agency in helping understand and identify the threat and will pass along information to state and local agencies in determining the appropriate response and recommendations regarding identification, quarantine and isolation measures. The CDC also makes recommendations on effective personal protective equipment (PPE) for first responders. At the time of this article, the CDC has made preliminary and cursory recommendations for first responders, including the wearing of disposable gloves, gowns, respiratory protection by means of an “N95 mask or higher” and eye protection, as well as law enforcement-specific guidelines.
The Law Enforcement Role
When analyzing the role of law enforcement in regard to COVID-19, we should remember lessons learned from previous threats and disasters. Law enforcement members are tasked with preventing looters and identifying, deterring, or capturing those who seize opportunities during disasters for their own advantage. Law enforcement is key in protecting those tasked with mitigation and response efforts. Law enforcement had a tremendous response after Hurricane Katrina in 2005. A detailed report from the University of South Carolina remains an excellent guide to recalling lessons learned as they directly related to law enforcement.
Force Protection and Use of Force Policy Considerations
Law officers may be summoned to provide support and protection at shelters, hospitals and dispensary locations when panic ensues. Perimeter security will be an issue if isolation orders are given by public health. Agencies must prepare line officers with adequate PPE, which includes the most suitable respiratory protection, whether by mask or by way of, in extreme cases, Powered Air Purifying Respirator (PAPR) devices. Fit-testing for appropriate levels of respiration protection must be done early in the process since every member must be individually fitted.
Agencies should prepare or review policies and guidelines regarding levels of force that may be used to restrict the movement of contaminated individuals. Line officers should have a clear understanding of the guidelines long before confronted with individuals seeking to self-evacuate.
Officers may be asked to provide escorts, guard supplies and medicine, or protect pods from the Strategic National Stockpile. This is another area of critical need for personnel when supplies may become short. Agencies should determine personnel priorities and identify priorities before they arise.
The Fire/EMS Role
Fire departments will provide critical resources in providing immediate response and transportation for non-ambulatory patients requiring aid. EMS personnel will provide critical care and transportation. Fire agencies must have capacities to respond to biological threats with protective gear and equipment and will be the primary decontamination authority along with the public health agency.
Communications and Planning
It is expected that the primary first responders have plans in place to respond to multi-agency hazards. Agencies must meet to ensure that protocols are current and key policy leaders are identified. National Incident Management System (NIMS) compliance will ensure all local and state agencies are on the same page and that important federal resources are made available through NIMS. FEMA is another resource for training, education and tip sheets. The FEMA pandemic profession-specific guidelines are suitable for distribution and briefings.
Update communications plans to include checks of current 24/7 contact information and to assess call back plans for the return of personnel, as necessary. Considerations should include when to activate agency Emergency Operations Centers (EOCs), Department Operations Centers (DOCs) and Executive Leadership groups. The CDC maintains a website with weekly alerts and information and should be checked for updates. A template for a Pandemic Influenza Continuity of Operations Plan can be found on the FEMA website.
Agencies should take care to convey preparedness plans for line staff, including priority vaccinations when they become available, so they can adequately protect their personal homes and families and be able to respond for duty. As the DHS pandemic guidebook suggests:
- Create clear lines of communication. It is critical to brief early and brief often. Keep communication lines open and pass along information. Meet with public health and other agencies to assess risks and outline inter-agency response planning. Once determined, agencies should follow NIMS and ICS protocols by standing up an Emergency Operations Center (EOC) as a central location for news and information vetting to prevent conflicting information from being released. Every impacted agency should have a representative at the EOC to advise on protocols, control conflicts and disseminate information back to their respective departments. Risk assessments should be given to personnel to reassure them with accurate and timely information.
- Identify adequate and appropriate personal protective equipment (PPE). Supply and ensure personnel wear appropriate PPE. Direct officers to leave their homes in a clean work uniform, to bag their clothes after their shift and continue to rotate clean clothes for duty.
- Protect the workforce. Support each other and get vaccinated once vaccines are identified and distributed. Prioritize line staff and encourage distribution to their families as well. Agencies should allow personnel to take care of their families so they feel comfortable when reporting for work.
- Identify your agency’s key priorities and continuity of operations plan. Determine and prioritize the needs of your community should personnel staffing be impacted by sick officers. Review and prioritize calls for service with emergency dispatch operations. Review plans for custody transportation, booking and housing. Meet with public health and EMS to determine appropriate strategies to deal with symptomatic prisoners.
- Train personnel. Ensure personnel know what to look for and to keep safe distances allowing trained medical personnel to assist those affected. Officers should be able to recognize symptoms and know where to seek assistance for themselves or others. Have quarantine plans in place and convey the plans to personnel. Conduct infection control roll call training that identifies key information and risks to officers.
- Establish clear rules of engagement and use of force guidelines. Review force protection and use of force policies for perimeter security at healthcare facilities and for forced movement of infected individuals/quarantined individuals. The information should be included at roll call training for agency personnel. The EOC should disseminate policies across multiple disciplines (law, fire, public health and EMS) for clear understanding.
- Be part of a unified team for external communications. Establish a media team across disciplines, which is expected as part of the EOC. Social media should be addressed through the media team for clear information flow.
- Model desired behaviors. As EMS1’s resident expert Rob Lawrence advises: “Wash your hands, wash your hands, wash your hands.” Ensure that leaders are visible and are visibly supportive of the workforce. Appropriate leaders should represent the agency at multi-disciplinary meetings and the EOC to ensure their agency is appropriately represented and to prevent “mission creep.”
