Monthly Archives: June 2011

Emergency Management, Emergency Medical Services, Health Care, Politics, Public Health, Society

Critical Incident Response Plans

The possibility of a large-scale event threatening the health and safety of a large number of residents in Connecticut is sizable. Emergency response plans (ERPs) need to be in place to address concerns including epidemic/pandemic disease, the intentional or accidental release of a hazardous material, contamination of the food and/or water supply, and other incidents that might threaten the 3.4 million residents and could result in mass casualties. For this reason, the State of Connecticut Department of Public Health (DPH; 2005) has developed an ERP to guide the department in the event of a catastrophic threat the lives and safety of the residents of Connecticut. Additionally, the State of Connecticut has developed a State Response Framework, much like the National Response Framework, in order to allow for a modulation of an incident from a local level to a state or federal level (State of Connecticut, Department of Homeland Security, 2010; U.S. Department of Homeland Security, 2008). The ability of an incident response to grow and shrink as an incident dictates follows the natural progression of incidents starting and ending locally, whether involving state or local responses at any time during the response (Walsh et al., 2012).

The ERP (DPH, 2005) that guides the DPH allows for representation in the state EOC while forming a modular incident management team (IMT) to staff the DPH emergency command center. The DPH IMT is designed not only to support the state EOC when activated, but also supports the various local incident commands as a public health and medical service resource. In keeping with the modular aspects of the incident command philosophies and the state and national response framework, the DPS ERP becomes a valuable resource for both initiating a response to a significant threat to the public health and safety and allows for an expert resource when other incidents of magnitude, but not necessarily public health in nature, require or benefit from the availability of public health experts.

One criticism I do have, however, is that the plan (DPH, 2005) does not address the provision of emergency medical services (EMS). For some time, there has been much confusion as to where EMS falls in the realm of emergency service functions. EMS, for many jurisdictions, is a function of the fire department and may fall under the direction of ESF #4, firefighting, especially as many EMTs and paramedics are cross-trained to fight fire. However, ambulances are not firefighting apparatus. As ambulances do transport the ill and injured, perhaps EMS falls to ESF #1, transportation. This is unlikely, though, as the primary need is not the transportation provided but the care rendered. Public health and medical services, ESF #8, seems to me to be the logical category for EMS to fall under, but EMS has an expanded role that also fits ESFs #9, #10 & #13 (search & rescue, oil & hazmat response, and public safety & security, respectively), as well as the aforementioned ESFs #1 and 4. This lack of initial categorization may allow flexibility in the deployment of EMS personnel and equipment, but it could also lead to ineffective deployment strategies resulting in a shortage of EMS in one area and overutilization in another.

References

State of Connecticut, Department of Homeland Security. (2010, October). State response framework. Retrieved from http://www.ct.gov/demhs/lib/demhs/telecommunications/ct_state_response_framework_v1_oct_10.pdf

State of Connecticut, Department of Public Health. (2005, September). Public health emergency response plan: Emergency Support Function #8 Public health and medical services. Retrieved from http://www.ct.gov/ctfluwatch/lib/ctfluwatch/pherp.pdf

U.S. Department of Homeland Security. (2008, January). National response framework. Retrieved from http://www.fema.gov/pdf/emergency/nrf/nrf-core.pdf

Walsh, D. W., Christen, H. T., Callsen, C. E., Miller, G. T., Maniscalco, P. M., Lord, G. C., & Dolan, N. J. (2012). National Incident Management System: principles and practice (2nd ed.). Sudbury, MA: Jones & Bartlett.

Emergency Management, Emergency Medical Services, Health Care, Politics

Emergency Operations Center Leadership

The emergency operations center (EOC) is a decentralized and secure place for senior management officials to maintain operational awareness when confronted with a large scale events or disasters (Walsh et al., 2012). Although these events or disasters may dictate the use of local incident commands at various emergencies throughout an area, the EOC allows an incident management team to direct the overall response effort while maintaining complete situational awareness. This allows for increased interoperability and the availability of resources and a centralized planning and intelligence effort (Walsh et al., 2012). During a multi-state event, a joint field office (JFO) might serve as the primary EOC to support other EOCs that have been activated.

Within the EOC, there are a number of leaders and managers responsible for ensuring an effective response strategy for the emergency that is being faced. One of these leaders is the Area Command Logistics Section Chief (or, “Log Chief”). The Log Chief is responsible for procuring and otherwise acquiring the facilities and personnel to support the response initiative. This includes “resources from off-incident locations […] providing facilities, transportation, supplies, equipment maintenance and fuel, food services, communications and information technology support, and emergency responder medical services, including innoculations” (Walsh et al., 2012, p. 60).

In response to an impending an ice storm in Austin, Texas, in 2003, the city’s EOC was activated 24 hours in advance of the storm. One of the crucial area command members activated was the Log Chief. The Log Chief ensured that redundant communications facilities were available as power outages were interferring with some established communications equipment. The Log Chief also ensured that there was food available for delivery to each small-scale incident as it developed. This was important as the available resources were deployed, there was a lack of available manpower during shift change, so feeding hungry crews was a priority. The Log Chief, on this incident, had many other important functions, but as a responder working in these adverse conditions, it was most important for me to be fed and have solid communications in the event I was to be one of the motorists sliding off the road.

References

Walsh, D. W., Christen, H. T., Callsen, C. E., Miller, G. T., Maniscalco, P. M., Lord, G. C., & Dolan, N. J. (2012). National Incident Management System: principles and practice (2nd ed.). Sudbury, MA: Jones & Bartlett.

Emergency Management, Politics

Emergency Operations Center: EOC Coordination

The Emergency Operations Center (EOC) Coordinator is responsible for “[setting up the] facility, [providing] available supplies, communications and other equipment, and [monitoring] communications flow through FAX and email [, as well as] establishes and manages a system of EOC and field runners, and manages the check-in area for EOC staff [and] provides assistance to the EOC Director as necessary” (University of Alaska, Anchorage, 2008, p. 9). The EOC Coordinator supports the function of the EOC but is not directly involved in the decision-making processes of the incident management team. The most important function of the EOC Coordinator, however, is to ensure that all lines of communication to and from the EOC are operating correctly and have redundancy in place, usually in the form of low-tech ham radio operation teams (Walsh et al., 2012).

In this scenario (Laureate Education, Inc., n.d.), a bomb was activated in a train station and a request for additional coordination was made by the local incident commander. In order to minimize the loss of life and property, the EOC Coordinator should ensure that the EOC is ready for mobilization (Walsh et al., 2012). Three important steps towards this goal are 1) ensuring all avenues of communication, whether technical or analog, are functioning properly, 2) ensuring all network and computer terminals are functional with appropriate redundancies (i.e. whiteboards, poster paper, etc.), and 3) ensuring food and beverage stocks are adequate for three 24-hour operational periods, which would allow enough time for the Logistics Section to arrange catering as needed.

The goals of the EOC Coordinator are to ensure that the EOC is ready to support the operational needs of the incident command structure. The goal of the incident command system is to respond to and deal with actual emergencies. There are times, however, that the emergencies will be so encompassing that the current continuity of government (whether local, state, or federal) will be threatened. It is the function of the EOC Coordinator to ensure that there are clear lines of communication to government officials off-site, as well as clearly written orders of succession available on-site, in the case of catastrophic governmental failure. There also needs to be clearly documented continuity plans located on-site involving facilities, communications, and delegation of authority in the event of EOC failure or separation from governmental control (U.S. Department of Homeland Security, 2008a, 2008b; Walsh et al., 2012).

In addressing this scenario, it has occurred to me that, although the federal government has directed the use of common language, titles, and job descriptions, many still confuse the functions of NIMS. The EOC Coordinator and the EOC Director are frequently confused with each other, yet they are clearly two separate job titles with two unique and important functions. These functions are also frequently confused with the unified command structure that may use the EOC from time to time to manage small local multi-agency incidents.

References

Laureate Education, Inc. (n.d.). Critical incidents and cross-agency coordination: North metro rail line scenario [media]. Retrieved from http://mym.cdn.laureate-media.com/2dett4d/Walden/CRJS/4302/03/mm/metrorailscenario/index.html

U.S. Department of Homeland Security. (2008a, January). National response framework. Retrieved from http://www.fema.gov/pdf/emergency/nrf/nrf-core.pdf

U.S. Department of Homeland Security. (2008b, February). Federal continuity directive 1 (FCD 1): Federal executive branch national continuity program and requirements. Retrieved from http://www.fema.gov/pdf/about/offices/fcd1.pdf

University of Alaska, Anchorage. (2008, April). Emergency operations plan. Retrieved from http://www.uaa.alaska.edu/facultyservices/upload/UAA-Emergency-Operations-Plan.pdf

Walsh, D. W., Christen, H. T., Callsen, C. E., Miller, G. T., Maniscalco, P. M., Lord, G. C., & Dolan, N. J. (2012). National Incident Management System: principles and practice (2nd ed.). Sudbury, MA: Jones & Bartlett.

Emergency Management, Emergency Medical Services, Politics, Public Health

Unified Command and Cross-Agency Conflicts

Each and every day I am faced with incidents that involve a number of different agencies. A simple car crash, for example, can involve two police departments, two fire departments, three emergency medical basic life support services, and two emergency medical advanced life support services, yet we never use unified command, merely single command. Having been trained in ICS and incident management with a focus on unified command structures, it is disheartening to see my local responders attempt to manage incidents without this useful and effective facet. According to Walsh et al. (2012), responders frequently face incidents where multiple agencies and multiple jurisdictions are involved, and frequent use of unified command during incidents of smaller scale creates a familiarity which allows for seamless scalability when the need for a robust command structure presents itself.

A recent house fire brought this to the forefront of my mind. We had six fire departments, an emergency medical basic life support service, the state police, and two fire investigators onscene. We had one incident commander (the Chief of the jurisdictional department), no EMS command or law enforcement command, and no subordinate structure. The incident commander quickly found himself burdened with every detail of the incident and no one to help to alleviate the burden. Additionally, the incident commander (the only person who has detailed knowledge about the incident thus far) is finding himself walking in and around the fire building. If anything devastating happens, such as an explosion or toxic release, the entirety of command would be compromised and a whole command structure would have to be developed from scratch. More importantly, however, is the potential for conflict in determining who is ultimately in charge of each operational group (i.e. emergency medical services without an EMS command) or operational period, such as might occur in protracted incidents. Turf wars are notorious amongst public safety agencies, and planning the roles and responsibilities of each prior to responding to incidents can go a long way in preventing this conflict and confusion.

Compare the above with how we would approach almost every incident when I worked for the city of Austin, Texas. In Austin, we relied heavily on the unified command approach to incident management. For any motor vehicle accident, house fire, technical rescue, or any other multi-agency response, we would establish fire command, EMS command, and law enforcement command (depending on the involvement of each agency). At the least, law enforcement would plug in to the command structure as an operational branch. We would always establish a command, and if the incident warranted, we would build the command structure in top-down fashion starting with operations. Many incidents in Austin did, in fact, have pre-plans established that each agency was well versed in and trained on often. This allowed for rapid mitigation of any unforeseen circumstances that might occur. Additionally, the command post was always removed from the scene enough to prevent the command structure from succumbing to the effects (whether physical hazards or emotional) of the incident scene. In this paradigm, there is always a superior to represent the interests of each agency and guide their members safely and effectively through the incident.

There are many methods of effectively responding to and managing incidents, and many of these methods work most of the time; however, best practices, as described in Walsh et al. (2012), are designed to ensure effective and efficient incident management as well as maintain operational security and safety.

References

Walsh, D. W., Christen, H. T., Callsen, C. E., Miller, G. T., Maniscalco, P. M., Lord, G. C., & Dolan, N. J. (2012). National Incident Management System: principles and practice (2nd ed.). Sudbury, MA: Jones & Bartlett.

Emergency Management, Emergency Medical Services, Politics, Public Health, Technology

National Incident Management System

The National Incident Management System [NIMS] is a dynamic continuum of interrelated processes designed to allow for the systematic response to any incident, large or small, using standardized practices that transcend political and geographical boundaries and can be adopted easily without regard to specialty or professional focus (U.S. Department of Homeland Security, Federal Emergency Management Agency [FEMA], n.d.; Walsh et al., 2012). The five component philosophies of NIMS are:

  1. preparedness,
  2. communications and information management,
  3. resource management,
  4. command and management, and
  5. ongoing management and maintenance.

I have not included ‘supporting technologies’ as a component of NIMS merely because it is supportive in both description and function.

Supporting technologies are used to further enhance the efficiency and effectiveness of NIMS by providing tools that help to streamline processes (Walsh et al., 2012). Supporting technologies has to be the least important on the list as it can be used to facilitate each of the others, but the effectiveness of NIMS is not contingent on this component.

The strongest, or most important component, is arguably preparedness. Kirkwood (2008) outlines the importance of training when dealing with large and small events across multiple jurisdictions and demonstrates how preparing for the eventuality of an emergency allows for a greater degree of critical thinking without the burden of the emergency, itself. However, as NIMS is a continuum of systems and processes, each of the five components is strikingly important to the others and can be either complimentary or detrimental in the end.

References

Kirkwood, S. (2008). NIMS and ICS: from compliance to competence. EMS Magazine, 37(2), 51-2, 54-7. Retrieved from http://www.emsresponder.com/

U.S. Department of Homeland Security, Federal Emergency Management Agency. (n.d.). NIMS FAQ. Retrieved from http://www.fema.gov/emergency/nims/FAQ.shtm

Walsh, D. W., Christen, H. T., Callsen, C. E., Miller, G. T., Maniscalco, P. M., Lord, G. C., & Dolan, N. J. (2012). National Incident Management System: principles and practice (2nd ed.). Sudbury, MA: Jones & Bartlett.

Emergency Management, Emergency Medical Services, Health Care, Politics, Public Health

The National Incident Management System

The National Response Framework (NRF) is an evolution of a series of national readiness plans that have been adapted to handle various emergencies at the national level (Walsh et al., 2012). According to Walsh et al. (2012), the federal government developed a response plan to guide the efforts and deployable assets in the event of any emergency that overwhelmed local and state capabilities. The first of these plans was developed in 1992, called the Federal Response Plan (FRP), and proved ineffective when implemented during a hurricane response in Miami, Florida, primarily due to a lack of familiarity and a focus on federal efforts instead of local scalability.

At the time the FRP was in effect, many fire departments across the country were adopting a modular system of incident management referred to as the incident command system (ICS). Early in its inception, ICS was not standard between the various departments, but as the federal government began to improve upon the FRP, developing the National Response Plan (NRP) with a focus towards incorporating and standardizing ICS, the various fire departments began to refer to the federal government implementation of ICS which promoted its standardization. The NRP was created in 2004 to answer concerns that were outlined in Presidential directives HSPD-5, HSPD-8, and discussions regarding the recent terror attacks on September 11, 2001, and the federal response to Hurricane Katrina. The NRP, in addition to standardizing ICS, addressed the roles of each level of government (local, state, and federal), non-governmental disaster aid organizations, and private business (U.S. Department of Homeland Security, 2004; Walsh et al., 2012). This growth, evolution, and adaptation of ICS within the NRP grew into a further adaptation of a comprehensive incident management system, now known as the national incident management system (NIMS) which allows for implementation at each level of government, within business, and with each private citizen (U.S. Department of Homeland Security, 2008a, 2008b; Walsh et al., 2012). This scalability also allows for increased modulation by either increasing the scope of a response or decreasing it as needed. In 2008, the U.S. Department of Homeland Security (2008a), understanding the shortcomings of the NRP and the promise of NIMS, further refined the response guidelines while using NIMS principles to develop the National Response Framework (NRF; U.S. Department of Homeland Security, 2008a, 2008b; Walsh et al., 2012). Both NIMS and the NRF share the foundation principle that most incidents start and end at the local level and are best managed by local interests (U.S. Department of Homeland Security, 2008a; Walsh et al., 2012).

This was evident during the 2008 hurricane season. As a contractor under Emergency Support Function #8 – Public Health and Medical Services Annex – I was part of the largest single mobilization of emergency medical services in history. Although we could have taken over jurisdiction from the clearly overwhelmed local government (as might have occurred under the FRP), we continually offered our assistance and only responded when requested. This allowed for a more focused response with rapid demobilization and remobilization when confronted with a second and third hurricane that threatened another region. This effort was appreciated by the local emergency managers who not only learned from the event but also adapted their local response plans to include variations of significant mobilizations of each of the emergency support functions.
The continued development of the response plans, incident management systems, and command structures and systems is a testament of the government’s ability and readiness to assist in the event of an emergency, but it is also a testament to the understanding of self-reliance.

References

U.S. Department of Homeland Security. (2004, December). National response plan. Washington, DC: Author.

U.S. Department of Homeland Security. (2008a, January). National response framework. Washington, DC: Author.

U.S. Department of Homeland Security. (2008b, December). National incident management system. Washington, DC: Author.

Walsh, D. W., Christen, H. T., Callsen, C. E., Miller, G. T., Maniscalco, P. M., Lord, G. C., & Dolan, N. J. (2012). National Incident Management System: principles and practice (2nd ed.). Sudbury, MA: Jones & Bartlett.