A “mass casualty” incident is generally thought of as a single occurrence so traumatic in scope that it overwhelms local resources and causes a crisis. There is; however, another type of severe drain on reserves, morale, and community cohesion that can be just as hazardous, but often takes much longer to recognize. This threat comes with outbreaks of disease.

A circulating illness may be major or minor in severity. In the past year alone, problems in the United States ranged from the ever present influenza and common cold, to the newly introduced and much feared MERS. As the H1N1 pandemic demonstrated in 2009, it can be extremely challenging to predict what strain or disease will lead to an outbreak, how widespread it will become, and the true severity of the illness by the time it has run its course. Seasonal strains will not gain the attention of a new and potentially fatal pathogen, but their frequency and ubiquity provide the chance to examine current procedures, and prepare for the possibility of a more formidable contagion.

Community Education

A major factor in the response to an outbreak is community preparation and education. A well-informed population can slow the spread of an illness, while reducing the burden to responders and hospitals of minor conditions being mistaken for a dangerous pathogen. At the same time, recent studies have shown that much of the popular televised presentation of medicine is actually hindering public awareness of disease, and reducing interest in public health measures such as organ donation. While this may seem like a substantial barrier to communication, focusing on short, easy points of interest can help in getting a proper message out. Despite the diversity of common and uncommon infections, there are a few public guidelines that remain fairly constant:

   •   Hand washing – this near universal precaution makes the prevention list on pathogens from seasonal colds, to norovirus and Ebola. It also has the potential to prevent almost 1 in 6 childhood respiratory infections, and may improve child development in some settings. Far and away the easiest and most cost effective prevention tool.
   •   Seeking reliable news sources – this includes information provided by local responders, hospitals, and educational providers, along with national reporting systems and direct sources.
   •   Vaccination (when applicable) – this tool for disease prevention protects the community as well as the person vaccinated, especially members unable to receive a vaccination due to a known health condition.
   •   Following directions – in the event of an outbreak, one of the most important things the public can do is to listen to responders and medical practitioners and follow their immediate guidelines. Having an established rapport and good general communication can be vital in promoting a receptive public.

Documentation and Communication

Hospital systems are generally self-contained, and many procedures are not standardized. While individual systems may suit their institution, this presents issues in rapidly responding to a form of illness that will be treated at different locations over roughly the same period of time. This includes concerns not only in identifying the illness, but understanding what it isn’t; hurried misdiagnosis can overextend personnel, reduce supplies, and promote resistance. Documentation and local sharing of disease information is of vital importance in ensuring an accurate representation of disease prevalence and in tracing the source of a contagion.

Follow Up

Disease outbreaks often follow a pattern, whether this is based on a transmission vector, such as West Nile Virus following the seasonal and regional rise of mosquitos, or Salmonella in tracing the spread of contaminated food. The best way of consistently tracking an outbreak to its point of origin or means of escalation is reliable, widespread data that follows set criteria for diagnosis and categorization. While pinpointing each occurrence may be ideal, this does not reflect the current system in place, leaving responders and analysts to make do with the data as it stands. At the moment, each state determines its own criteria for mandatory reporting, and an illness that must be documented in one area may be discretionary in another. The CDC compiles the data it receives on “notifiable” incidents into the National Notifiable Diseases Surveillance System (NNDSS); however, federal reporting of disease statistics by the states is voluntary (and due to inconsistencies in state requirements, a state that reports its collected data may still not provide full coverage).

Regardless of what’s legally required, taking a proactive stance in information sharing locally, federally, and to the general population can save lives, time, and resources. The better the data is the better and more precise the reaction can be, providing a more efficient, safer system in outbreak prevention and response.