The Application of the Haddon Matrix to Public Health Readiness and Response Planning

Article excerpt

State and local health departments continue to face unprecedented challenges in preparing for, recognizing, and responding to threats to the public's health. The attacks of 11 September 2001 and the ensuing anthrax mailings of 2001 highlighted the public health readiness and response hurdles posed by intentionally caused injury and illness. At the same time, recent natural disasters have highlighted the need for comparable public health readiness and response capabilities. Public health readiness and response activities can be conceptualized similarly for intentional attacks, natural disasters, and human-caused accidents. Consistent with this view, the federal government has adopted the all-hazards response model as its fundamental paradigm. Adoption of this paradigm provides powerful improvements in efficiency and efficacy, because it reduces the need to create a complex family of situation-specific preparedness and response activities. However, in practice, public health preparedness requires additional models and tools to provide a framework to better understand and prioritize emergency readiness and response needs, as well as to facilitate solutions; this is particularly true at the local health department level. Here, we propose to extend the use of the Haddon matrix--a conceptual model used for more than two decades in injury prevention and response strategies--for this purpose. Key words: dirty bombs, emergency, Haddon matrix, injury prevention, preparedness, public health, readiness, response, SARS, terrorism. doi:10.1289/ehp.7491 available via[Online 2 February 2005]


Hypothetical Cases

SARS Preparedness and Response It was an unseasonably warm Friday morning on 12 March 2004 in Anytown, Maryland. Since 1 March 2004, the Department of Homeland Security had raised the U.S. terror alert level to code orange (high) based on fresh intelligence reports from interviews with Al Qaeda detainees at Guantanamo Bay.

The Baltimore Orioles were in the process of gearing up for another season. On Monday, 8 March 2004, 75 diehard baseball fans returned to Dulles Airport on Orioles Airways Flight 000, after watching the Orioles play a series of spring training exhibition games in Florida over the weekend.

One of the passengers on this Orioles Airways Flight 000 was Mr. Smith, an Anytown, Maryland, businessman who had traveled to Taipei, Taiwan, for meetings during the week of 1 March 2004. He had taken a direct flight to Taipei from Dulles Airport on Monday, 1 March, with a stopover that day in Munich, Germany; he had flown back to Dulles on Thursday, 4 March, also with a stopover in Munich. Upon returning to Dulles, he spent the night at a hotel in McLean, Virginia. He flew the next morning, 5 March, from Dulles to Fort Lauderdale, Florida, on Orioles Airways Flight 007 to watch his beloved Orioles play a weekend's worth of spring training games, before returning to Dulles on the 8 March Orioles Airways Flight 000.

Early on the morning of 8 March, before boarding Flight 000, Mr. Smith developed a sudden fever and dry cough, along with chills and muscle aches. Despite these symptoms, after the flight he still managed to drive from Dulles Airport to Anytown, Maryland. Within 2 hr of arriving at his apartment to his wife and two children in Anytown, Mr. Smith's condition rapidly deteriorated, and he began to have difficulty breathing. His wife drove him to General Hospital emergency department in Anytown.

Mr. Smith was admitted to the intensive care unit at General Hospital on 8 March, with a suspected clinical diagnosis of severe acute respiratory syndrome (SARS).

Three days later (11 March), doctors at one hospital in Washington, DC, one hospital in Baltimore, and General Hospital in Anytown admitted three patients each (total = 9 patients) with histories of acute onset of high fever (> 38[degrees]C) and dry cough followed by shortness of breath. …