Depending on the nature of the MAA, a state legislator must formally approve a state`s participation in the agreement and commit it to the status, as in the case of the EMAC (see below). State law or regulation may also set out legal requirements governing the creation and operation of aid and assistance agreements in the state in general. These state-specific requirements may affect internal agreements between localities and other parties, as well as intergovernmental agreements between the state and other parties. The federal government, states, municipalities and other organizations involved in assistance agreements have developed specific guidelines, protocols and definitions for typing resources that prescribe aid. In addition to the legal requirements for aid management, ongoing training, implementation and updating of the assistance agreements and policies and protocols they implement is a key element in ensuring effective mutual assistance. These public health emergencies have reinforced the recognition of potential and real barriers to effective mutual assistance and have highlighted legal “gaps” to be filled, both inside and outside the EMAC. Although EMAC facilitated the transfer of unprecedented mutual assistance to the affected areas affected by Katrina, response gaps have been improved. For this reason, many states have not been able or unsure of how they can use the services of volunteers (who were not protected from legal liability) 4. However, some states are trying to address this problem.5 In addition, the provisions of the EMAC are triggered only by a governor`s declaration, the sharing of small-scale resources, emergencies not declared by agreements separated by the EMAC, must take effect.
The same applies to the exchange of epidemiological or laboratory data to detect endangered infectious diseases. In some circumstances, it may even be argued that routine public health functions would be more effective in concluding mutual assistance agreements for the exchange of relevant information, supplies or equipment. We describe the basic legal framework for states to provide mutual assistance between states and internationals, to identify gaps in this framework and to make proposals that could be taken to fill these gaps. We focus on: (1) types of mutual assistance; (2) current federal approaches to promoting the increased use of mutual assistance agreements by states; (3) State mutual assistance projects, including efforts to assess legal competences; and (4) Constitutional and other legal issues relating to mutual assistance (Tables 1▶-3▶▶ include laws and other authorities in relation to international and intergovernmental mutual assistance).