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The institution of control measures must be the result of the epidemic investigation with appropriate laboratory diagnostic support. There are reasons why the instituting of control should not, however, be taken for granted during an emergency. Even under normal conditions, a country may not have the internal capacity for emergency control. Whether or not this is true, decision makers may assign higher priority to undertaking relief activities or providing medical services than to putting prevention or control measures into effect. The staff needed to carry out control measures may be diverted elsewhere during the emergency. Finally, control measures may not be taken because the responsibility for these may be divided between the relief coordinator and the national authorities who are ordinarily responsible for vector control, immunization programs, etc. Because epidemiology units do not have the authority or resources to adequately carry out control measures, it is critical to, as effectively as possible, present information from surveillance and the field investigations to key decision makers. Epidemiologic information, implications, and an outline of alternatives of action must be summarized in the presentation in nontechnical terms understandable to laymen. Ordinarily, first presentation should be made by the epidemiologist to the relief coordinator and/or the staff person responsible for health. Support on the part of the relief coordinator should suffice to secure available services and resources, since the relief coordinator has access to national and international resources, such as the Pan American Health Organization, and bilateral and voluntary agencies. This official is also able to initiate discussion with national authorities about overall responsibility for carrying out control measures. In the guide, Emergency Health Management after Natural Disaster (52), there is an overview of sources of international assistance and ways in which assistance is coordinated within the disaster-affected country.
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