Prior to the creation of the HPP grants, preparedness and planning across healthcare facilities did not exist in most communities (Courtney et al., 2009).

Healthcare coalitions are a locally-based resilience-enhancing measure insofar as member institutions align their interests and commit their resources to conduct a cohesive, coherent medical response to the increase in, and unique needs of, patients during a public health emergency. In a major health event, individual healthcare facilities in a community need to engage effectively with one another, the larger response systems, and potentially neighboring jurisdictions. Such collaboration ensures that the personnel, supplies, and equipment distributed across otherwise autonomous facilities are applied in a systematic fashion to achieve the best medical outcomes for the community at-large (Courtney et al., 2009). Effective health care coalitions, while evolving in relation to local hazards, geography, politics, and prior institutional relationships, nonetheless exhibit an effective leadership and governance structure and strive to achieve their stated objectives (Box 5.6).

The committee saw direct evidence of the benefits of health care coalitions in discussions in Cedar Rapids, Iowa, with health care professionals affiliated with the state, county, and city. The potential for a nuclear power plant accident at a nearby facility motivated the city of Cedar Rapids and the county to establish a risk mitigation strategy for that hazard (see Box 2.4 in Chapter 2). The city’s emergency planners, hospital personnel, and citizens drill four times a year along established evacuation routes in the event of a nuclear accident. These drills, including the relocation of essential medical facilities and personnel were invaluable training and were implemented during the response to the flooding of the Cedar River in the second week of June 2008.

The health care issue that has yet to be addressed is that of access to medical records of medications routinely taken and major health conditions and risks. Access is currently not readily available in emergency situations. Among the solutions discussed is a nationally linked medical record system, such as the kind already maintained by several pharmaceutical store chains, and/or a personal card containing a chip with the relevant information. Privacy issues are clearly of critical concern in these discussions, but as the post-Hurricane Katrina problems in helping patients with chronic illnesses demonstrated, the need for this information is vital.

In summary, public—private coalitions are essential for the development and execution of plans to strengthen the resilience of a community’s critical infrastructure. A public—private partnership can evaluate and expand community capacity to address disaster-related risk to lifelines. Such partnerships can also help to integrate resilience into the infrastructure life cycle to ensure maintainability, sustainability, and operability of those systems before, during, and after a disaster.

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