Sector Interdependence: Transportation, Emergency Services, Healthcare

This report delves into the critical interdependence of transportation, emergency services, and healthcare sectors. It explores the vital links between these sectors, highlighting how transportation impacts public health through various factors, including access to services and pollution. The report details the interconnectedness of transportation and emergency services, emphasizing the reliance on transportation for emergency responses. Furthermore, it examines the relationship between emergency services and the healthcare sector, particularly through emergency medical services. The report also identifies critical infrastructure assets within the transportation, healthcare, and emergency services sectors, and discusses the National Transportation Recovery Strategy (NTRS) and Continuity of Operations Planning (COOP) to ensure resilience and continuity during disasters and emergencies, emphasizing the need for preparedness and effective recovery strategies within each sector. The report also touches upon security concerns within the transportation network and the importance of resilience.

Running head: SECTOR INTERDEPENDENCE
The interdependence of transportation, emergency services and public health care
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Author Note:

1SECTOR INTERDEPENDENCE
Answer one
The three sectors, transportation systems, emergency services, and healthcare and public
health sectors, are linked to each other inextricably. Transportation systems are associated
with significant health consequences through different levels of physical activities
undertaken, accidents, accessing a variety of services, and the effects caused by air pollution.
Despite the different modes involved in each, they are broadly referred to under the standard
term. The highly presiding modes of transportation consist of rail transport, aviation,
waterway transport, and roadway transport. However, other modes are also widely used such
as pipelines (Henjewele, Sun & Fewings, 2014). They are categorized into three basic types,
namely– land, water and air. WHO states that the impact of inadequate transportation to
deliver primary public health care as "The highly impoverished, specifically in rural areas
that have less health care services, or the modes of transport for patients in times of medical
assistance. Moreover, approximately 90% of the children die at home, in the absence of
seeking health care. Inadequate transport and cost of transportation are crucial explanations
for people not availing medical services. This demonstrates that transportation is directly
linked to the public health sector and vice versa.
Transportation and emergency services sectors are critically linked to one another in various
ways. Emergency services and responses require mobilizations in the form of ambulance and
fire brigades. In these instances, transportation demands are considered as unstable and
urgent, which requires a quick and adequate level of service. For example, emergency
services vehicles such as ambulances have to deal with an urgent and unpredictable demand
at any time. Emergency services rely on transport systems that have been designed to be
operated under specific conditions (Doyle Jr et al., 2015). Nevertheless, the occurrence of
disruptions, such as an accident or a storm, is comparatively common and mitigated
reasonably. On the contrary, a disruption at a larger scale or level occurs to the extent that the

2SECTOR INTERDEPENDENCE
security or safety of an entire region or nation is compromised. From the standpoint of
economics, the impacts of emergency responses are primarily dependent on three factors of
which the level of exposure and vulnerability of affected areas to transportation
infrastructures is crucial. Besides, emergency responses such as fires and their management
are based on the front-line action of fire brigades and their availability. Thus, it is evident that
transportation and emergency sectors are inter-dependent.
Again, emergency services are closely related to the health care and public health sector.
These sectors are closely linked together in the form of Emergency medical services (EMS),
which is also called paramedic services or ambulance services. These services are emergency
responses that help in treating injuries and illnesses that demand prompt medical assistance,
delivering treatment services outside hospital settings and transport to provide immediate
care. These services are also referred to as a first-aid squad, emergency squads, ambulance
squads, rescue squads, life squad and ambulance corps. These sectors are interlinked as the
healthcare staff is called by the public service professionals in emergency cases which
include medical assistance, other emergency facilities, authorities and businesses
through emergency telephone service that connect the emergency services to the health care
workforce. Ambulances are the first emergency vehicles to deliver health care (Mueller et al.,
2014). Emergency services and health care sectors work collaboratively during the delivering
transport services to non-emergency patients and have specific systems to provide technical
relief operations which include extrication, search and rescue as well as water rescue.
This indicates the interdependence of the three sectors, including transportation, health care
and emergency services. Transportation is critically linked to each of these sectors in
providing mobilization of the healthcare workforce and emergency staff.
Answer two

3SECTOR INTERDEPENDENCE
Critical infrastructure assets are referred to as those networks and systems, which on getting
damaged, can lead to reasonable consequences, including adverse effects on the national
economic security, public confidence, federal public health and safety, the community, losing
life, or some mixture of these.
1. Transport sector: The Transportation Systems Sector comprises of seven critical
infrastructural assets described as follows:
 Aviation comprises of aircraft, heliports, air-traffic control systems, and landing
strips. Besides, this asset also consists of both commercial and recreational aircraft
(human-crewed as well as unmanned) and diverse types of support services, such as
airship repair stations, fuelling infrastructures, navigation equipment, and flight
schools.
 Highway and Motor Carriers is another critical asset encompassing over 600,000
bridges, an extension of over 4 million miles of roadways, and a crossing 350 tunnels.
Vehicles consist of trucks and those carrying dangerous materials; some other
commercial vehicles include school buses and motor coaches; transport and driver
systems of license; traffic management systems; and internet systems used to manage
operations.
 Maritime Transportation System is another infrastructure asset that makes up
approximately 95,000 miles of coastal line, over 25,000 miles of waterway transport,
361 ports and internal landside connections that enable the different modes of
transport to transfer people and exchange merchandise on the water.

4SECTOR INTERDEPENDENCE
 Mass Transit and Passenger Rail involve operational systems, terminals, and assisting
infrastructure for services for the passenger by transit monorails, buses, subways or
metros, trolleybuses, passenger rail, and carpools.
 Pipeline Systems make up nearly three million miles of pipelines extended throughout
the nation and carry about the entire natural gas resources of the country, and nearly
65% consist of harmful fluids, as well as several chemical substances. Assets above
the grounds, which include pumping and compressor stations, are also involved
(Schweikert et al., 2014).
 Postal and Shipping transports nearly 720 million couriers and letters daily. It is
chiefly comprised of regional courier services, massive integrated carriers, mail
services, chartered and delivery services, and mail management firms.
2. Healthcare and Public Health Sector: This sector prioritizes its infrastructure to
protect the other sectors from dangers like outbreaks of contagious diseases,
terrorism, and natural calamities. As the vast extent of this sector's assets is possessed
and operated privately, information exchange and collaborations between the private
and public sectors is crucial to increase the flexibility of public health critical
infrastructure of the country. While healthcare services tend to be provided and
controlled by local communities, the component of public health of this sector is
regulated across the tribal, local, regional, territorial, state and national levels of
government. This sector critically depends on the co-existing services to continue
their work and delivery of services, which include food and agriculture, emergency
services, communication services, energy, information technology (IT), transport
systems, water and wastewater systems (Zhang, Li & Li, 2015). The critical
infrastructure includes:

5SECTOR INTERDEPENDENCE
 The Department of Health and Human Services holds the designation of the
sector-specific agency for the services of the Healthcare and Public Health
Sector.
 Vulnerability Assessments are performed on essential assets within reach of
the Health care and Public Health Sector through several programs, including
the DHS Protective Security Advisor (PSA) program and BARDA.
 Medical Facility and Clinical Laboratory Accreditation is another critical
infrastructure asset that promotes effective programs within the health care
services through the Joint Commission, along with other clinical laboratories
and accreditation certification organizations.
3. Emergency services: The Emergency Services Sector (ESS) consists of a community
of adequately-trained, skilled professionals equipped with the necessary physical and
digital facilities, providing a variety of preparedness, response, recovery, and
prevention services in times of daily operations and incident responses. The sole
objective of the Emergency Services Sector involves saving lives, protecting the
property and the community, help societies affected by calamities, and assist recovery
during emergency circumstances. Five distinct disciplines that serve as critical
infrastructural assets make up the ESS, enclosing a variety of emergency response
functions and roles:
 Fire and Escape Services
 Emergency Medical Services
 Emergency Management services
 Public Works sector
 Legal Enforcement

6SECTOR INTERDEPENDENCE
The ESS also involves special emergency facilities via individuals and groups. These
specialized services can be seen in several disciplines, based on the jurisdiction as follows:
 Tactical Teams (i.e., SWAT)
 National Guard Civil Support
 Canine Units
 Hazardous Devices Team
 Maritime Units
 Aviation Units (i.e., police and medevac helicopters)
 Search and Rescue Teams
 Public Safety Answering Points (i.e., 9-1-1 call centers)
 Fusion Centres
 Hazardous Materials (i.e., HAZMAT)
 Private Security Guard Forces
Answer three
When disasters such as the collapse of bridges, highways getting washed away, or rupturing
of pipelines hit a community, not just the infrastructure but the economy, environment and
the entire community get affected. Thus, it is vital to prioritize the recovery of transportation.
The National Transportation Recovery Strategy (NTRS) ensures the recovery and continuity
of the process of transport recovery. The NTRS is established to assist the stakeholders,
government officials and local people in preparing and managing the recovery of the
transportation industry after a major disaster. The NTRS initiates nation-wide effort for
promoting resilience of the community via the planning and implementing an effective
transportation recovery strategy. The recovery of transportation is conventionally seen as
restoring the infrastructure and assets before the incident. However, it is crucial to construct a
plan for recovery involving rebuilding the networks more extensively and to a more superior

7SECTOR INTERDEPENDENCE
standard than the previous conditions. The continuity of operations can be ensured by
enhancing the resources and construction methods to improve the infrastructure strength,
develop redundancies in the networks of transport, utilizing Intelligent Transportation
Systems (ITS) and upgrade the standard links between the different modes of transportation
and the communities. The continuity of operations in the transportation sector can be possible
by building resilience during the recovery stage such that the network can absorb any future
damage and bounce back immediately post the incident (Transportation.gov, 2020).
In the health care sector, the Continuity of Operations Plan helps to implement strategies to
activate, relocate and continue the operations of a healthcare organization that addresses all
the hazards, including natural, technological or human-made. The continuity of operations is
ensured beginning with prioritizing the activities focusing on Essential Supporting Activities
(ESA) and Mission Essential Functions (MEF). Then, a Common Operating Picture (COP) is
developed to examine and update the chief stakeholders on the status. The essential
requirements are communicated to the state health authorities and the local emergency
management officers to ensure critical services to be resumed. Then, the response partners of
local, state or federal resources need to be informed and accessing the required supplies,
transport, infrastructure and capital. Finally, the response partners need to be assisted in
preparing a reconstitution plan while transforming from emergency response to the recovery
phase via the continuity of operations of the incident (Phe.gov, 2020).
Continuity of Operations Planning (COOP) becomes exceptionally critical in emergencies
such as floods, fires, power failures, industrial accidents and cyber-attacks and is essential in
the emergency services sector. It helps the organizations to provide better services for
protecting, responding, recovering and restoring essential services of patient care. It includes
identifying and prioritizing essential function, minimum requirements of the working staff,
and management contingency for all the essential functions, resources and data systems

8SECTOR INTERDEPENDENCE
needed for each essential function also have to be identified. Methods and procedures have to
be set up for acquiring the required resources to continue the essential functions and
sustaining the operations for a minimum of one month. It also involves developing relations
with providers, sharing of staff, back-up vendors and patient coverage. The plan must also
consider a list of successors that will replace the chief leaders in emergencies when the leader
might not be available. Continuity of operations in the emergency services sector can also be
ensured by working together with local emergency management, contractors and service
providers for restoring the communications systems and information technology (Cisa.gov,
2020).
Answer four
The transport network is essential to the economy, security, and quality of life of our country.
Security issues are gaining more attention now— correctly, because the danger is real, and it
is hard to react. However, the transport system is remarkably resilient, but it is also accessible
and decentralized, making it challenging to respond to the threats. Firstly, a dual-use
approach, in which safety objectives are followed alongside other transport objectives, will
promote the introduction of security technologies and processes. Second, modeling should be
used further to increase understanding of the complexity of the security problem. Thirdly,
DOT will play a significant role in the creation and sharing of knowledge on best practices
using current technology and procedures, including low-tech alternatives. Safety should be
viewed as part of a larger image, not an entirely new and different concern but one that is
familiar and closely related to the previous history of the transportation community in
responding to incidents, natural disasters and hazardous materials. Transport vehicles and
installations are frequent targets of terrorist attacks, hijacking and sabotage, from airlines to
rail terminals. Sound security methods have enormous potentials, such as confusing and
deterring terrorist attacks, increasing the possibility of identifying and intercepting threats,

9SECTOR INTERDEPENDENCE
mitigating fatalities and disturbances, and rising confusion and encouraging travelers in a
crisis (Török et al., 2019). The method must be influenced by (1) well-structured, layered
security systems, (2) the flexible, practical and two-way application of security technology
and techniques, and (3) specific, innovative reasoning on terrorist risks and responses. The
recommendation of cyber threats includes usage of encryption, monitoring data traffic from
partner agencies and updating reliable partner relationship policies, and intrusion detection
system and “honeypot” to trap attackers.
The Emergency Services Sector (ESS) is a group of numerous qualified, trained emergency
workforce professionals, including the physical and cybersecurity infrastructure, which
provide a variety of preparedness and recovery assistance during both daily operations and
incident responses. The central line of defense is the emergency services system (ESS): local
police, fire and rescue, emergency clinical services, departments of public safety, and
departments of public works.U.S. Police departments and Fire and Rescue are increasingly
becoming victims of the new cyber threats such as the WannaCry ransomware. Such vital
services can be taken offline, which is alarming as people depend on such services daily. This
type of terrorism or even war, attacks on the 9-1-1 system could lead to chaos and loss of life
to the advantage of any enemy. To strengthen the sector's cybersecurity posture, the ESS
CSWG, a sub-component of the ESS Information Sharing Working Group (ISWG), is
responsible for implementing a comprehensive sector strategy. The strategy should at least
encourage understanding of cybersecurity problems, recognize cyber threats and associated
vulnerabilities, prioritizing and suggesting protective programs and flexible strategies and
facilitate the implementation of protective methodologies (Cerrudo, 2015).
Healthcare provides health and safety for all residents of the United States. The advantages of
this sector are primarily private, requiring a joint work and exchange of data among the
public and private sectors. This system has enormous confidential data and Personal

10SECTOR INTERDEPENDENCE
Identifiable Information (PII) that hackers inside healthcare organizations can manipulate. All
of these organizations take a holistic approach to cybersecurity by conducting tabletop
training drills, reviewing incident response plans, mandating a patch management system,
and protecting the IoT tools that doctors and nurses use across health care facilities. Other
than this, the healthcare sector is prone to outbreaks or bioterrorist attacks and these attacks
deprive people of urgent care (Grundmann, 2014). Establish a body of evidence to understand
better the scope and nature of the issue and its consequences for health care provision.
Strengthen dedication to action by robust lobbying to stop health-care attacks. Establish and
encourage best practices for the reduction of attacks and mitigation of their effects on the
provision of health services.

11SECTOR INTERDEPENDENCE
References
Cerrudo, C. (2015). An emerging US (and world) threat: Cities wide open to cyber
attacks. Securing Smart Cities, 17, 137-151.
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29 March 2020, from https://www.cisa.gov/emergency-services-sector-continuity-
planning-suite
Doyle Jr, J. J., Graves, J. A., Gruber, J., & Kleiner, S. A. (2015). Measuring returns to
hospital care: Evidence from ambulance referral patterns. Journal of Political
Economy, 123(1), 170-214.
Grundmann, O. (2014). The current state of bioterrorist attack surveillance and preparedness
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Török, Á., Szalay, Z., Uti, G., & Verebélyi, B. (2019). Modelling the effects of certain cyber-
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