This article summarizes public health legal issues that need to be considered in preparing for and responding to nuclear detonation. Laws at the federal, state, territorial, local, tribal, and community levels can have a significant impact on the response to an emergency involving a nuclear detonation and the allocation of scarce resources for affected populations. An understanding of the breadth of these laws, the application of federal, state, and local law, and how each may change in an emergency, is critical to an effective response. Laws can vary from 1 geographic area to the next and may vary in an emergency, affording waivers or other extraordinary actions under federal, state, or local emergency powers. Public health legal requirements that are commonly of concern and should be examined for flexibility, reciprocity, and emergency exceptions include liability protections for providers; licensing and credentialing of providers; consent and privacy protections for patients; occupational safety and employment protections for providers; procedures for obtaining and distributing medical countermeasures and supplies; property use, condemnation, and protection; restrictions on movement of individuals in an emergency area; law enforcement; and reimbursement for care.

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Legal considerations in a nuclear detonation.

Recent public health emergencies, such as the 2009 Influenza A/H1N1 Pandemic and Hurricane Katrina, underscore the importance of developing healthcare response plans and protocols for disasters impacting large populations. Significant research and scholarship, including the 2009 Institute of Medicine report on crisis standards of care and the 2008 Task Force for Mass Critical Care recommendations, provide guidance for healthcare responses to catastrophic emergencies. Most of these efforts recognize but do not focus on the unique needs of pediatric populations. In 2008, the Centers for Disease Control and Prevention supported the formation of a task force to address pediatric emergency mass critical care response issues, including legal issues. Liability is a significant concern for healthcare practitioners and facilities during pediatric emergency mass critical care that necessitates a shift to crisis standards of care. This article describes the legal considerations inherent in planning for and responding to catastrophic health emergencies and makes recommendations for pediatric emergency mass critical care legal preparedness.

Legal Considerations During Pediatric Emergency Mass Critical Care Events

Introduction Recent public health emergencies, such as the 2009 Influenza A/H1N1 Pandemic and Hurricane Katrina, underscore the importance of developing healthcare response plans and protocols for disasters impacting large populations. Significant research and scholarship, including the 2009 Institute of Medicine report on crisis standards of care and the 2008 Task Force for Mass Critical Care recommendations, provide guidance for healthcare responses to catastrophic emergencies. Most of these efforts recognize but do not focus on the unique needs of pediatric populations. In 2008, the Centers for Disease Control and Prevention supported the formation of a task force to address pediatric emergency mass critical care response issues, including legal issues. Liability is a significant concern for healthcare practitioners and facilities during pediatric emergency mass critical care that necessitates a shift to crisis standards of care. This article describes the legal considerations inherent in planning for and responding to catastrophic health emergencies and makes recommendations for pediatric emergency mass critical care legal preparedness. Methods The Pediatric Emergency Mass Critical Care Task Force, composed of 36 experts from diverse public health, medical, and disaster response fields, convened in Atlanta, GA, on March 29-30, 2010, to review the pediatric emergency mass critical care recommendations developed by a 17-member steering committee. During the meeting, experts determined that the recommendations would be strengthened by a manuscript addressing legal issues. Authors drafted the manuscript through consensus-based study of peer-reviewed research, literature reviews, and expert opinion. The manuscript was reviewed by Pediatric Emergency Mass Critical Care Steering Committee members and additional legal counsel and revised. Task force recommendations While the legal issues associated with providing pediatric emergency mass critical care are not unique within the overall context of disaster healthcare, the scope of the parens patriae power of states, informed consent principles, and security should be considered in pediatric emergency mass critical care planning and response efforts because parents and legal guardians may be unavailable to participate in healthcare decision making during disasters. In addition, practitioners who follow properly vetted and accepted pediatric emergency mass critical care disaster protocols in good faith should be protected from civil liability, and healthcare facilities that provide pediatric care should incorporate informed consent and security protocols into their disaster plans.

Legal considerations during pediatric emergency mass critical care events.

In response to the 2009 H1N1 influenza pandemic, the governments of Japan and the United States for the first time authorized the emergency use of unapproved drugs. In this article, we comprehensively review the different regulatory approaches of Japan and the United States, countries with advanced regulatory and healthcare systems, to emergency authorization of the use of medical products as a countermeasure to public health emergencies. We outline the legal system, range of targeted products, requirements for the application dossier, legal stance for authorization, product availability, and termination of the Japanese Emergency Approval (EA), and we compare characteristics with those of the US Emergency Use Authorization (EUA). We also review the actual cases of these 2009 emergency authorizations. The Japanese EA importation of novel H1N1 influenza vaccines with adjuvant is presented, with lessons learned, and contrasted with the US EUA of peramivir.

Emergency authorization of medical products: Regulatory challenges from the 2009 H1N1 influenza pandemic in Japan

Augmented intelligence—as the fusion of human and artificial intelligence—is effectively being employed in response to a spectrum of risks and crimes that stem from the online sexual exploitation marketplace. As part of a study that was sponsored by the National Institute of Justice, the National Center on Sexual Exploitation has documented 15 tactics that have been used in more than 2650 US cities and counties to deter sex buyers from engaging with prostitution and sex trafficking systems. One of these tactics, technology-based enforcement and deterrence methods, has been used in more than 78 locations in the United States. This paper explores the issue of technology-facilitated trafficking in the online sexual exploitation marketplace and juxtaposes this with the use of augmented intelligence in collaborative responses to these crimes. Illustrative case studies are presented that describe how two organizations employ technology that utilizes the complementary strengths of humans and machines to deter sex buyers at the point of purchase. The human(e) touch of these organizations, combined with artificial intelligence, natural language processing, constructed websites, photos, and mobile technology, show significant potential for operational scaling, and provide a template for consideration by law enforcement agencies, criminal justice systems, and the larger multidisciplinary counter-trafficking community for collaborative replication in other settings.

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Discouraging the Demand That Fosters Sex Trafficking: Collaboration through Augmented Intelligence

During certain emergencies (naturally caused or deliberate) that can have a significant impact on the public's health, the Secretary of the U.S. Department of Health and Human Services (HHS) has broad discretion to declare a Public Health Emergency (PHE). While many public health emergencies will not require a formal declaration, this type of declaration can be an important and necessary step to authorize the secretary to take a variety of actions that enable the department to respond optimally to an emergency. This article outlines the HHS Secretary's PHE authority, discusses possible discretionary actions that the secretary may take after declaring a PHE, and provides examples of PHE declarations that have been issued.

Federal declaration of a public health emergency.

In the anti-human trafficking movement, multi-disciplinary teams have emerged as a best practice for collaborating and coordinating efforts in combating human trafficking. Many multi-disciplinary teams are comprised of federal, state and local partners representing law enforcement, prosecutors and service providers. The concept of sustaining the multi-disciplinary teams is a relatively new area of discussion in the anti-human trafficking movement. This paper explores the Greater New Orleans Human Trafficking Task Force sustainability process as an illustrative example to shed light on the issues that arose during the process for this Task Force, and which may be salient for other Task Forces. This retrospective presentation of the comments and observations made by the Greater New Orleans Human Trafficking Task Force members suggest emerging themes that may help to clarify the concepts other Task Forces should consider and to predict the sustainability outcomes. The members’ accounts incorporated in this article are presented as valid points of view for framing conclusions that may be applicable in other contexts and to further the conversation in this understudied area of sustainability. The key focal points related to sustainability explored in this conceptual paper include leadership, funding, collaboration, trust and relationship building, and change is constant.

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Jennifer Ray

Papers

Federal declaration of a public health emergency.

Conceptualizing Task Force Sustainability