In early spring 2020, the DuPage County Health Department ([DCHD], IL) implemented an innovative special situation infectious disease alert system to raise situational awareness of first responders while ensuring the privacy of residents.

In our recently published case study, our team identified practical and legal considerations related to sharing protected health information about notifiable diseases, like COVID-19, with first responders during an emergency response. Due to an increasing number of public health threats, it became clear that DCHD needed a more structured process to share information and coordinate with first responders who may be responding to or caring for someone affected by an illness of public health significance.

Prior to COVID-19, DCHD established a process to notify Fire and Police Chiefs in each jurisdiction via direct phone call when an individual was being monitored for potential exposure to a highly infectious disease. Over time, DCHD further improved this system to add a Special Situation note to a physical address in the Public Safety Answering Point ([PSAP]/911) dispatch system. Cognizant of privacy and health information security requirements, DCHD limited the Special Situation notes to the minimum essential elements.

Key Takeaway 1: Consult with Legal Counsel

Before any actions were taken, DCHD consulted with legal counsel to ensure that the intervention would not expose the department to risk of privacy violations. Based on rulings at the federal level, DCHD determined that the HIPAA privacy rule (Health Insurance Portability and Accountability Act of 1996) permitted the implementation of an infectious disease alert process. Furthermore, the Illinois Attorney General’s Office noted that state statutes provided sufficient authority to share information to prevent the spread of a dangerously contagious or infectious disease.

Key Takeaway 2: Set Limits on Intervention

Based on recommendations from the State’s Attorney’s Office as well as guidance from the DuPage County Public Safety Task Force, limits on the infectious disease early alert system were intentionally implemented to achieve two separate but interconnected goals: raise situational awareness of first responders and protect personally identifiable information. Alerts were limited by time and only in effect when widespread shortages of personal protective equipment (PPE) existed. Ultimately, these alerts ended when they were no longer viewed as useful by DCHD and first responders as case numbers increased.

Key Takeaway 3: Establish and Maintain Multisector Collaborations

Read our article in JPHMP

DCHD relied heavily on their experts in the areas of public health emergency response, communicable disease, and epidemiology as well as others who had knowledge of long-term care facilities and other congregate settings in which residents were susceptible to disease transmission. Discussions about the infectious disease alert process were led by the DuPage County Public Safety Task Force, which included public heath, emergency management, law enforcement, Fire/EMS, PSAPs, and the DuPage County State’s Attorney’s Office.

DuPage County has historically been proactive in emergency response planning. Health officials observed that partners had worked together on various taskforces to address previous issues prior to the COVID-19 pandemic. Ultimately, well-established relationships and shared past experiences with emergency response allowed DCHD and its partners to operate at a high level of efficiency and effectiveness when the need arose for a new system of infectious disease alerts.

Read our article in the Journal of Public Health Management and Practice: Protecting First Responders While Maintaining Personal Privacy During the COVID-19 Pandemic: One County’s Approach 

We recommend:

• Exploring the preliminary steps of one county health department to manage the COVID-19 pandemic
• A conceptual model for evaluating emergency risk communication in public health
• Exploring the impact of the COVID-19 pandemic on the mental health of first responders

Matthew Fifolt, PhD, is Associate Professor in the Department of Health Policy and Organization at the University of Alabama at Birmingham.

Sean McMahon, MA, is Program Manager for the Lister Hill Center for Health Policy at the University of Alabama at Birmingham.

Christopher Hoff, MPH, is the Deputy Director, Public Health for the DuPage County Health Department in Illinois.

Lisa Smith, JD, is the Chief of the DuPage County State’s Attorney’s Civil Bureau. The Civil Bureau provides advice and representation to all County elected officials, departments, and entities.