When a sudden on-set emergency or disaster affects a region or the whole country, communities and neighborhoods should plan for the possibility that emergency and other civic services will be disrupted and unavailable (District of Columbia 2003a, 2003b, 2004; Doyle 2004; Siskiyou County Public Health/NorCalBT.com 2004). The event may be severe enough that the routine public health surveillance and monitoring system will be disrupted or the system will not be able to provide data quickly enough to support state and local decisionmaking. A temporary post-disaster system should be planned for and implemented. The epidemiologist supporting the local decision makers must have an early warning system that identifies when a given symptom complex or disease may be occurring in an affected area (Pan American Health Organization. 1981, 1982, 2000; World Health Organization Regional Office for Africa. and Centers for Disease Control and Prevention. 2001).

A number of metropolitan city disaster plans call for the creation of local community or neighborhood emergency preparedness committees, Emergency Coordination Centers and Community Emergency Response Teams (CERT) using The Incident Command System (ICS) and its forms and communications plans to support the city or regional emergency plans (Bigley and Roberts 2001; District of Columbia 2003a, 2004; McInnis 1999). These plans must enable the communities and neighborhoods to sustain themselves for at least 72 hours (District of Columbia 2003a, 2003b, 2004; Doyle 2004; Siskiyou County Public Health/NorCalBT.com 2004). These plans must also include support for the Public Health Surveillance and Monitoring System.

A term paper submitted in partial fulfillment of the requirements for EMSE 239 Health and Medical Issues in Emergency Management, Fall Spring, 2005, Instructor: Joseph A. Barbera, MD, Associate Professor, Engineering Management and System Engineering, George Washington University