ESF-8: PUBLIC HEALTH PREPAREDNESS AND RESPONSE IN FLORIDA By KENNETH STURROCK A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY UNIVERSITY OF FLORIDA 2010 1 2010 Kenneth Sturrock 2 To those who race towards the very things that others fear most 3 ACKNOWLEDGEMENTS I thank my chair and supervisory committee members for their time, ideas and encouragement. I thank my professional colleagues for their competence, camaraderie, candor and patience. I thank my academic colleagues, both present and past, for their inspiration and humor. I also thank the citizens of Florida and Mississippi for allowing me to share their challenges and victories. Last, but not least, I am grateful to my wife, Amy, for her support and enthusiasm. 4 TABLE OF CONTENTS page ACKNOWLEDGEMENTS ............................................................................................... 4 LIST OF TABLES ............................................................................................................ 9 LIST OF FIGURES ........................................................................................................ 10 LIST OF ACRONYMS ................................................................................................... 11 TIMELINE OF NOTABLE EVENTS ............................................................................... 15 ABSTRACT ................................................................................................................... 16 CHAPTER 1 INTRODUCTION .................................................................................................... 17 2 EVOLUTION OF EMERGENCY MANAGEMENT .................................................. 20 The Organization of Emergency Management ....................................................... 20 Legislation and Finance .......................................................................................... 25 The Development of Civil Defense ......................................................................... 26 The Creation of FEMA ............................................................................................ 32 Emergency Management in Florida ........................................................................ 34 Summary ................................................................................................................ 37 3 EVOLUTION OF PUBLIC HEALTH ........................................................................ 43 Public Health Background ....................................................................................... 43 Public Health Culture .............................................................................................. 45 The Florida Department of Health ........................................................................... 48 Department of Health Responsibilities .................................................................... 52 Disaster Roles ........................................................................................................ 59 4 THREATS ADDRESSED BY PUBLIC HEALTH AGENCIES .................................. 62 Weapons of Mass Destruction and Public Health ................................................... 62 Explosives ............................................................................................................... 63 Radiological Weapons ............................................................................................ 65 Nuclear Weapons ................................................................................................... 69 Chemical Weapons and Hazardous Materials ........................................................ 78 The Aum Shinrikyo Attack ....................................................................................... 83 Biological Agents .................................................................................................... 86 Anthrax ............................................................................................................. 89 Smallpox ........................................................................................................... 91 5 Biological Defense ............................................................................................ 92 Military Biological Weapons .............................................................................. 93 The U.S. Bioweapons Program ........................................................................ 96 The Soviet Bioweapons Program ..................................................................... 99 Iraq’s Bioweapons Program ........................................................................... 103 Amerithrax ...................................................................................................... 104 The Rajneeshee Attack .................................................................................. 111 Crime versus Health ....................................................................................... 112 Extreme Weather .................................................................................................. 113 Roles and Organization ........................................................................................ 119 5 THE STRUCTURE OF PUBLIC HEALTH PREPAREDNESS .............................. 122 The Office of Emergency Operations .................................................................... 122 The Office of Public Health Preparedness ............................................................ 126 PHP Personnel ..................................................................................................... 128 Hiring Regional Emergency Response Advisors .................................................. 132 Contractors ........................................................................................................... 134 The RDSTF Co-Chairs as Networked PHP Leadership ........................................ 137 The Rise of the Division of Emergency Medical Operations ................................. 140 Finances of PHP ................................................................................................... 141 Exodus of the RERAs ........................................................................................... 147 Public Health Planning .......................................................................................... 150 Placement of PHP Personnel ............................................................................... 152 Transitions of Command ....................................................................................... 156 Extending the Structure – Federal Partners .......................................................... 160 Summary .............................................................................................................. 164 6 HURRICANE CHARLEY ....................................................................................... 168 Charley Hooks Right ............................................................................................. 169 The Incident Management Team .......................................................................... 173 Charlotte ............................................................................................................... 174 The Overhead Team ............................................................................................. 175 Disaster Community Health Assessment Teams .................................................. 178 Going Through the Motions .................................................................................. 181 Local Reactions .................................................................................................... 184 Summary .............................................................................................................. 186 7 HURRICANES FRANCES AND JEANNE ............................................................ 192 Organization of Field Teams ................................................................................. 192 Hurricane Frances ................................................................................................ 197 Hurricane Jeanne ................................................................................................. 210 6 8 HURRICANE IVAN ............................................................................................... 222 The Super Shelter ................................................................................................. 223 Ivan’s Landfall ....................................................................................................... 229 The Cavalry Arrives .............................................................................................. 239 Summary .............................................................................................................. 242 9 HURRICANE KATRINA ........................................................................................ 245 Katrina as a Symbol .............................................................................................. 245 Tracking a Monster ............................................................................................... 246 Katrina Visits Florida ............................................................................................. 247