expertise, and functional resources under the NIMS/ICS system. We provide possible solutions for preven- tion and preparedness initiatives by unifying approaches to disaster planning and man- agement that are traditionally separated and variously identified as planning, manage- ment, response, and even recovery cycles. We emphasize the necessity to expand situ- ational awareness, which we describe as the continual analysis of incoming data and adjustment to changes based on the acqui- sition and assimilation of new knowledge. The Fukushima nuclear disaster revealed the imperative to take informed and cor- rect action to shifting vulnerabilities over time toward the separation of natural from technological influences, including ongoing mitigation attempts and their outcomes. The inclusion of active surveillance and appropri- ate response adjustment, as needed, mirrors the philosophy of the classic Planning “P” concept (FEMA, n.d.). Following traditional four-phase (does not include prevention) and five-phase disaster management cycles,we retain the five-phase elements that correspond directly to the National Preparedness Goal 5 FEMA Mission Areas (FEMA, 2018; University of Central Florida, 2022). Significantly, we merge the combined preparedness and prevention aspect as well as ongoing planning, training, and community hazard communication processes, with special focus on functional needs and at-risk and underserved populations. Impor- tantly, we clearly separate response and pre- vention processes and emphasize mitigation as a construct of prevention paired with pre- paredness. Eective Japanese medical counter- measures made by various local governments (e.g., the administration of thyroid-protect- ing potassium iodide to people potentially exposed to the Fukushima Daiichi Nuclear Power Plant fallout) is an appropriate example of a critically timed mitigation strategy at the very early onset of a disaster (Sase et al., 2021). Key to our Public Health, Healthcare, and Emergency Management Command and Support Supersystem Model (Figure 2) is the establishment and protection of eective health systems such as continuity of opera- tions, supply chain and essential infrastruc- ture, continuous surveillance and intelligence gathering, hazard communications delivered to the community, and ultimately the protec-
FIGURE 2
Public Health, Healthcare, and Emergency Management Command and Support Supersystem Model
Public Health Threat Prevention
1. Mitigation and Preparedness
2. Hazard Containment (IHR)
Response
4. Consequence Management Recovery
3. Health Systems Utility Protection (e.g., CSC)
Note. Red arrows represent potential incident complexity triggers, including: • No advance warning scenario(s) • Cascading or concurrent events • Escalating incidents • Heightened hazard severity (e.g., viral mutations) • Continued hazard exposure or release • Immovable vulnerabilities and populations with access and functional needs • Sheltering and evacuation factors • Multiple operational phases • Evolving or devolving environmental health risks • Secondary attacks on first responders • Loss of essential public health and security infrastructure • Extreme weather CSC = crisis standards of care; IHR = International Health Regulations.
dition is focused on assuring health secu- rity broadly. We condense and decomplicate NIMS federal doctrine and CMS regulations related to the traditional disaster cycle by including an action-oriented instrument for crisis adaption. The disaster cycle is patterned in concept and in part by our submitted manuscript (Sase et al., 2022). Furthermore, the cycle: 1. Integrates public health, emergency man- agement, and healthcare for the purpose of aligning presently underregulated assisted- living facilities with other long-term care facilities currently mandated to follow CMS emergency management regulation. 2. Emphasizes the expanding and contract- ing incident complexity triggers (repre- sented by arrows in Figure 2) that repre- sent ongoing, potentially increasing and decreasing incident situational pressures
that shape continuous incident opera- tional stance adjustment and alignment with the Common Operating Picture. 3. Follows the IHR and HHS National Health Security Strategy and advocates for a One Health approach to collecting situational awareness data across human, animal, plant, and environmental health realms by focusing on surveillance and intelligence systems to early detect counterterrorism, global epidemics, and pandemics, as well as assure food defense and security (Eddy & Sase, 2021; Eddy et al., 2013, HHS, 2019a; Sase et al., 2022). The model in Figure 2 expands to include One Health, public health, and all-hazards approaches in recognition of multiple stake- holders, agencies, regulations and guide- lines, and the need for interoperability, surveillance, and exchange of oversight,
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March 2023 • Journal of Environmental Health
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