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HSPD 21: Initial Reactions

October 25, 2007

White House On October 18, the White House released the 21st Homeland Security Presidential Directive, finally addressing the public health and medical communities roles in preparing for and responding to a disaster.  While HSPD 10 dealt with bioterrorism and touched on the type of health response needed in such a situation, to say it was vague is being kind.  HSPD 10 devoted one paragraph to surveillance and detection, one paragraph to response planning, two paragraphs to mass casualty care, two paragraphs to countermeasure development and two paragraphs to decontamination.  The abstract of HSPD 10 could have easily been: in the event of a bioterrorist attack, we will respond quickly, effectively, appropriately and comprehensively.

HSPD 21, however, is more in-depth and even has deadlines.  My first reaction after reading it?  It’s completely undo-able.  I commend the drive, no doubt, but the timelines are totally pie-in-the-sky.  Additionally and totally aside, I’m growing more and more uncomfortable with the conflation of public health preparedness and disaster medicine, which is what this Directive essentially deals with, and that melding will only get worse (obviously, a loaded word) with the release of this document.

Public health preparedness is not, and should not be, concerned with the application of medical care, in a disaster situation or otherwise.  That is the focus of clinical medicine, and always has been.  Public health is concerned with surveilling the community for unusual disease trends; developing plans and policies to mitigate, slow and stop the spread of disease; and to ensure that medical care can be delivered.  One needs only look at the Ten Great Public Health Achievements 1900 – 1999, from the CDC, to see the glaring lack of medical care traditionally associated with public health efforts.  Yet somehow, when a disaster happens, treating blast injuries and proper triage becomes a public health function, or something.

Being as this document is the President’s plan for my, um, whole career, I’d like to spend a lot of time on it, so this post is intended to give you my initial reactions (hence the clever title).  Section 15 gives you insight into how this series of posts will go:

Currently, the four most critical components of public health and medical preparedness are biosurveillance, countermeasure distribution, mass casualty care, and community resilience.  Although those capabilities do not address all public health and medical preparedness requirements, they currently hold the greatest potential for mitigating illness and death and therefore will receive the highest priority in our public health and medical preparedness efforts.  Those capabilities constitute the focus and major objectives of this Strategy. 

As such, we’ll be covering biosurveillance (and touching on my favorite bugaboo, the NBIS), then countermeasure distribution (including the Strategic National Stockpile), mass casualty care, community resilience, then finishing up with a post on the remaining material (risk awareness, education and training, disaster health system, the National Health Security Strategy, and finally a brand new task force: the Public Health and Medical Preparedness Task Force.

To the best of my knowledge, this will be the first blog to go through this Presidential Directive in this level of detail – in fact, the only posts I’ve seen so far are from leftist blogs that seem to proclaim each HSPD as further proof of the fascism of the current administration.  You’ll be happy to know that I won’t be linking to them.  I am, however, interested in any other posts on this topic that go beyond simply announcing the release.  If you know of any other examination of this subject, please let me know using the email address at the top of the right side of this page.

As seemingly always, a hat tip to CIDRAP for the heads up on the release of HSPD-21.

Photo credit: Christopher Chan

8 Comments leave one →
  1. December 12, 2014 9:18 pm

    Sound object list – you have tto listen carefully oon this one and try to associate the sound with a hidden object.
    You can not only download it freely for you system also for you mobile and iphone too.
    When yyou use the laser, be sure not to shine itt in their
    eyes, because that could actually blind them (but I’m sur you knew that already ).


  1. HSPD 21: Biosurveillance « In Case of Emergency
  2. HSPD21: Countermeasure Distribution « In Case of Emergency
  3. HSPD21: Mass Casualty Care « In Case of Emergency
  4. HSPD21: Community Resilience « In Case of Emergency
  5. HSPD21: Everything Else « In Case of Emergency
  6. On Resilience « In Case of Emergency
  7. Quickly Noted: Sustaining Focus on Pandemic Preparedness: Introduction « In Case of Emergency

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