I was a local health department’s emergency operations center today, and I got to listen to a lot of different opinions on what to do in the event of an emergency or a disaster. The best comment from that discussion came from someone in the US Army. She said that, in the event of an intentional release of anthrax, she would give antibiotics to the people that make sure “clean water goes into my house and the dirty water is taken away.” I giggled for half a second and then it dawned on me that, yes, she was absolutely correct.
Think about it. If some biological weapon is released that is going to hurt and/or kill people — or if a pandemic comes around — is it really a good idea to start giving out medication or vaccines to “the top” of the social pyramid? Sure, you need a President, Congress, and the Supreme Court to operate, but the whole thing falls apart if no one is there to pick up the trash, wash the dishes, and fix the toilets. (It’s been my experience that politicians like to “crap things up,” not clean up crap.)
The discussion centered around whether or not to give a small supply of antibiotics to emergency medical services, fire department, and police officers and tell them to hold on to it at home. In the event of an emergency, they could start taking the antibiotic at home and not have to stand in line with the general population. Of course, an anthrax attack is not very likely, and you have several days to give antibiotics before the spores germinate and cause disease. But this was just a “what if” scenario discussion, and what the Army physician said rang true with most of us. You take care of the people who are going to take care of you, so you can be well taken care of.
If you don’t believe me, just see what has happened in cities around the world when trash collectors have gone on strike:
“The mountains of waste were a special gift from the New York City Department of Sanitation. The city’s fleet of garbage men had gone on strike over a paltry wage increase, immediately pulling almost 2,000 trash collectors from the street at one minute after midnight on December 1.
Many New Yorkers placed the blame squarely on union leaders with rumored ties to the mob. But the garbage strike was another symptom of the city’s failing infrastructure. The job of New York trash collector had become more rigorous and quite dangerous in many neighborhoods by the late 1970s.
Some New Yorkers stored garbage in their basements and garages, while others profited by driving trash outside the city and dumping it elsewhere. More commonly, building superintendents took garbage to nearly vacant lots – of which there were many in 1981. Soon the city had dozens of miniature garbage dumps, attracting vermin and disease to neighborhoods already affected by a decrease of public services in the 1970s. Dozens of trash-fueled fires raged out of control.
With fears that the pileup would last until the new year, the city ramped up negotiations with union leaders. The strike officially ended on December 17 with greatly improved wages for sanitation workers.
Crews promised to clear the streets within the week. “That’s our Christmas present to the city,” said one strike negotiator.
Residents woke up a couple days later to a wondrous holiday sight. But it wasn’t Santa Claus bringing presents; it was the local sanitation worker, finally carting away the foul accumulation that had turned New York City into a mountainous range of refuse.”
Now, imagine all that if the workers never came back from the “strike” because they were dead or otherwise incapacitated by a disease. And that’s just trash collectors. If the people who man the water treatment and pumping facilities go, we’re really going to be in trouble. Worse if police, fire, and EMS personnel go down as well. So I’m glad the Army physician brought it up, and I’m glad that the people who do the planning for those kinds of things in that very populated county listened and agreed.
I’m sure it’s not that it had not occurred to them. Rather, I think that we have been conditioned to think that the people “at the top” need to be kept safe. We need leaders and managers in emergencies to tell us what to do, and a “decapitated” government doesn’t function really well… But neither does a government that can’t wipe it’s own behind. So keep that in mind if you ever go into emergency planning and your planning documents state that your response needs to start at the top. Don’t do it that way. Start at both ends, making sure that your servers will be just as taken care of — or more — as the managers and leaders… Unless you know how to operate a nuclear power plant, a water treatment plant, and a trash collection truck.
René F. Najera, DrPH
I'm a Doctor of Public Health, having studied at the Johns Hopkins University Bloomberg School of Public Health.
All opinions are my own and in no way represent anyone else or any of the organizations for which I work.
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