ADVANCEMENT OF THE SCIENCE
tion of healthcare systems (e.g., community hospitals, skilled nursing facilities, assisted- living facilities, and other long-term care enti- ties)—including the elimination of pressures potentially causing the activation of CSC. The integrated systems are reliant on a range of associated planning strategies and tools: the Common Operating Picture, the preemp- tive hazard vulnerability analysis and tabletop exercise, and functional real-time crisis simu- lation required by CMS, the Joint Commis- sion, and the National Fire Protection Associa- tion, among others (Sase et al., 2022). Our point of primary response emphasis is the public health-oriented crisis cycle, a system within a system, at the center of our revised disaster and emergency management cycle, which is a heuristic cue that facilitates amplified operational stance adjustment and enhanced situational awareness via the con- stantly evolving Common Operating Picture (a standardized breakdown of incident oper- ational information shared with all partners and stakeholders and focusing especially on healthcare coalitions). This supersystem model promotes heightened attention to steps necessary to respond to the waning and wax- ing phases of fluxional crises in accordance with appropriate and applicable statutory requirements and in harmony with the afore- mentioned federal doctrine. Regarding both the Fukushima nuclear disaster and COVID-19 pandemic, examples of relaxing focus on known threats and pre- dictable consequences can be noted repeat- edly, with severe consequences resulting. Additionally, during the incident response, observed incident complexity triggers should
be recorded for not only hotwash discussion but also the insertion into annually updated hazard vulnerability analysis to retain memory of incident unknowns, challenges, and suc- cessful and unsuccessful actions with accu- racy for planning updates and enhancement. Following the operational standards of NIMS and ICS, we consciously distinguish between steady-state prevention activity and active response and recovery modalities in our model by emphasizing hazard detection, containment, and immediate threat charac- terization throughout the crisis evolution as the primary operational emphasis, which is applicable to chemical, biological, radiologi- cal, nuclear, and explosive (CBRNE) hazards. Conclusion Our retrospective of the Fukushima nuclear disaster allows for a full spectrum concept of emergency preparedness and response, including the condensation of FEMA, HHS, CMS, and NIMS doctrine, to be integrated into practical diagrams that portray the multifacto- rial nature of crisis threats. This work enables a clear consideration of the threats to environ- mental health (Figures 1 and 2) that are the responsibility of state and local ocials who might not have deep exposure to federal doc- trine, significant CMS healthcare prepared- ness requirements, and cross-training between multiple disciplines (U.S. Centers for Medicare & Medicaid Services, 2021). By integrating the themes of each body of guidance, we present a practical all-hazards preparedness road map focused on the continuous analysis of environ- mental public health consequences. Further- more, the road map focuses on the recognition
of incident complexity trigger changes for state and local practitioners who will be the first responder. Most crises require an environ- mental public health response and/or solution. The core of our Public Health, Healthcare, and Emergency Management Command and Support Supersystem Model (Figure 2) is a continuously adaptive Common Operating Picture that informs partners and other key stakeholders of evolving operational objec- tive development and ICS posture adjustment based on the awareness of situational incident complexity triggers. While maintaining NIMS consistency, our model reinforces the sense of urgency for disaster planners and risk assess- ment experts necessary to prevent harm and loss caused by hazards and vulnerabilities. Our work provides a decision support tool for all-hazards emergency planning and response, which contributes to national and global health security from local up to state, federal, and international levels. The over- arching goal of our supersystem model is to support coordinated public health threat prevention and initial hazard containment at local, national, and international levels. Disclaimer: The conclusions in this article are those of the authors and do not necessarily represent the ocial policy of any particular agency, university, or other entity. Corresponding Author: Christopher Eddy, School of Science, Engineering, and Tech- nology, College of Nursing and Health Care Professions, Grand Canyon University, 3300 West Camelback Road, Phoenix, AZ 85017. Email: chris.eddy@my.gcu.edu.
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Volume 85 • Number 7
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