This chapter will discuss the issue of disaster response by local, state, regional, municipal, and tribal authorities. Additionally, the issue of federal participation and the factors associated with an integrated and interoperable response process will be reviewed and federal response activities outlined. The management and mitigation of disaster response activities are multifaceted with significant negative consequences if not managed correctly. The federal assets available for local response and mitigation are significant and available for those that are aware of the full depth of resources.1–7 The federal assets are not only limited to logistical support but also include human resources that are significant in their expertise and organizational skills. Knowledge of the Federal Response Plan and associated legal statutes allow for informed emergency management planning and modifying the incident impact.
INTEROPERABILITY AND EMS SYSTEM DESIGN
Interoperability is the process by which information, communication, and data systems are designed to easily and consistently connect/interface with each other independent of the manufacturer, management system, or operating platform. This would apply to federal, municipal, state, tribal routine and/or disaster operations with respect to incident communication, mitigation, and response. One example of successful interoperability can be found in casual Internet computer access. This task is carried out countless of times per day independent of the computer manufacturer, platform, or even operating system, yet we accept the impossibility of this when it comes to medical information sharing.
Applied to disaster and EMS operations, interoperability is the ability of simultaneous responders and/or agencies to be able to freely communicate and/or share data on a real-time basis. Unfortunately, prehospital health information (clinical, demographic, incident data) is not routinely managed in an interoperable platform. In this case information sharing between different emergency response agencies and/or federal partners at a disaster scene is at best a cumbersome process (and we accept this as a given fact). In the ideal world, the ability to integrate differing systems and organizations to seamlessly interface and operate efficiently and effectively with one another should be the norm.8 This would allow all (local, civilian, federal, NGOs [nongovernmental organization] and military) end users to effectively perform disaster activities and enable end users to perform disaster operations as an integrated coordinated operation. This would allow for greater situational awareness and avoid duplication of services (ie, building searches).
Presently there are no existing national (or even regional) interoperability standards or guidelines for EMS systems or federal resources but concepts are in various stages of development and have been repeatedly identified as an issue (seen in Katrina and 9/11). Interoperability is defined by the Oxford Dictionary of the US Military as “… the ability of systems, units, or forces to provide services to and accept services from other systems, units, or forces and to use the services so exchanged to enable them to operate effectively together; the condition achieved among communications-electronics systems or items of communications-electronics equipment when information or services can be exchanged directly and satisfactorily between them and/or their users.”9
Department of Defense (DoD) Northern Command (NORTHCOM) while conducting rescue operations during Hurricane Katrina noted a lack of common standards among communications platforms which did not allow first responders to directly communicate with federal assets (or even sometimes between federal responders).1 In one situation, Urban Search and Rescue (USAR) assets were actively involved in a rescue of military and civilian personnel, from an overturned military truck in flood waters with multiple occupants. A circling military helicopter overhead produced significant wash of water over the victims while hovering over the incident location. The on-scene USAR group attempted to signal and contact the helicopter but was unsuccessful. Communication from ground FEMA (Federal Emergency Management Agency) USAR personnel to helicopter crew followed this process: USAR field operations to USAR base of operations that required a face to face with military personnel at the Zephyr base helipad to have them contact the circling helicopter to pull back (even though they were just above the civilian/military group). The rescue could not be affected until this was accomplished.
At this point in time, written communication (though inefficient) is the only universal method of interoperable information (data storage, transmission, and common information [language]) sharing that exists between civilian and/or federal assets. Interoperability is not just a technical concept, but is a practical information, communication, and management process. Existing EMS and military development is focused on single system needs (ie, NYC 9-1-1) and local operational needs, creating islands of development with closed information silos. This does not optimize resource utilization, but rather limits the effectiveness of a unified disaster response and mitigation process. Interoperability is not an all or nothing concept, but may in the future be implemented in a stepwise manner. A need exists for standards that create accurate, complete, private, secure data sharing systems. Interoperable health information systems should ideally work together within and across organizational boundaries in order to advance the effective/efficient delivery of health care resources for individuals and communities. This applies to different first-responder groups (local, neighboring, and distant EMS systems, police and fire) as well as federal (USAR, NDMS, DoD, etc) and civilian (Red Cross, Salvation Army, etc) groups.
Communications interoperability is probably the most critical necessary component in disaster and day-to-day EMS, military, and local government response (and mitigation) operations. Disaster operations fail or succeed as communication is maintained and managed. Communication interoperability avoids duplication of efforts and resources but requires crossing traditional jurisdictional lines of authority and reporting relationships (how, to or thru who). Traditional methods impair the free flow of critical “real-time” information and therefore situational awareness: disciplines (police vs EMS vs fire), civil versus military, federal versus municipal, or other responding agencies’ (NGOs’) ground operations to communicate with air assets (helicopter to ambulance). The goal is to allow any emergency responder to operate and work seamlessly with other systems without any special effort. Allow police, firefighters, EMS, military responding assets to better coordinate disaster efforts, that is, wireless communications that allows the sharing of information via voice and/or data platforms, in real time. Communication interoperability increases rescue operation efficiency and decreases redundancy/duplication of efforts while decreasing event impact (ie, single common evacuation and operations channel).
Interoperability planning allows for Standard Operating Procedures (SOPs), incident contingencies (Earthquake [EQ]), with Tsunami, with nuclear reactor containment failure), emergency evacuation procedures, medevac operations, or event deterioration (second EQ), event termination. Coordinated interagency decision making is required to establish priorities, support local municipalities, establish common rescue protocols (i.e. victim location, house marking post search, rescue, procedures, and body management-location).
National Incident Management System (NIMS) interoperability and compatibility mandates public/private partnerships to develop a functional integrated (technology use, support, technical integration), effective, efficient disaster response operation (data acquisition, utilization, interpretation, including information sharing), and incident management operations. This includes complimentary and compatible emergency management response and common and adapted standards, www.safecomprogram.gov/SAFECOM/interoperability/default.htm (including terminology). NIMS STEP (Supporting Technology Evaluation Program) is an attempt to develop an independent, objective assessment of commercial and government hardware/software projects. Interoperability is a critical component of the emergency management process (local and national) in order to foster the incident implementation of NIMS operations. In Citations from FEMA 501, National Incident Management System: “Systems operating in an incident management environment must be able to work together (across disciplines and jurisdictions) and not interfere but rather complement one another. Interoperability and compatibility are achieved through the use of tools such as common communications and data standards (ie, audio and video), digital data formats, equipment, and design standards.” RapidCom was initiated by President Bush in 2004; this program mandated a minimum level of emergency response interoperability that ultimately resulted in coordinated efforts in the cities of Boston, Chicago, Houston, Jersey City, Los Angeles, Miami, New York, Philadelphia, San Francisco, and Washington. This program was to assess city communications interoperability capabilities, identify deficiencies, propose and initiate solutions. When completed, incident commanders within the identified jurisdictions would have the capability of communicating between command centers (within 1 hour of an incident). Emergency Response Interoperability Center (ERIC) had the stated goal, to ensure national interoperability utilizing 700-MHz network. To establish interoperability regulations, license requirements, and technical standards. Project participating federal departments included Department of Homeland Security (DHS), National Institute of Standards and Technology (NIST), Department of Justice (DOJ), and Department of Commerce (DOC). Civil-military interoperability: Strategic concept for the defense and security of the members of NATO, to better coordinate the military civilian emergency response sector within the NATO group (multinational civil-military interoperability).2
Systems interoperability allows for the capacity to operate effectively, efficiently, and seamlessly. Compatible communication frequencies provide the ability to share (where appropriate) confidential medical information via common platforms and being capable to easily transfer data between systems. Interoperability system deficiency was identified during the attacks on 9-1-1 on the World Trade Center and the Pentagon and during Hurricane Katrina disaster response, yet to date this issue has not been fully resolved.
INTEGRATION AND INTEROPERABILITY DURING SMALL AND LARGE-SCALE RESPONSES
Department of Defense (DoD) is capable of the deployment of large assets in response to the need for the support of domestic disaster relief. DoD normally functions in a supporting role, but the Hurricane Katrina response left many unanswered questions as to the preparedness of the involved states and the need for federal support function.
US military role in Hurricane Katrina relief operations consisted of ∼72,000 service members assisted by 346 helicopters, 76 fixed-wing aircraft, 21 ships, amphibious landing crafts, satellite imagery, construction support, and mortuary teams. Thousands of Gulf coast residents were rescued and evacuated by military assets. The military provided greater than 30 million meals ready-to-eat (MRE) and 10,000 truckloads of ice and water for the civilian population. Hurricane Katrina was a Category 5 (with subsequent levee failure) and was of such a magnitude that there was a questionable level and capabilities of the municipality and state with respect to “preparedness” and their ability to save lives and property. It was clear that first responders at the local and state levels were overwhelmed and the need for federal response was critical. There were problems encountered between all levels of government and multiple involved federal agencies with respect to rescue operation integration, and lines of authority (who is in charge, establish search areas, house access, etc).
President Bush suggested the leadership role in disaster relief operations be entrusted to the Department of Defense. For example, the United States Navy (USN) has within its ranks significant assets that can be utilized for domestic disaster response but at the same time limited ability to communicate or integrate with existing local entities. USN response to domestic disasters is a nontraditional role, based on an independent unilateral Navy-centric operation, with minimal civil integration, resources. This was more often an accident of chance rather than the result of emergency management planning. The USN brings significant capabilities (aircraft carriers, amphibious vessels, and other vessels) and expertise (communications, logistics) to the table. As the Navy responded to Katrina the local power and communication systems (ie, 9-1-1) were inoperable, limiting the response capabilities of the state and municipality as they attempted to respond, limit and mitigate the disaster. The local authorities had insufficient awareness of military capabilities and/or limitations, to such a point that assets like the USS Bataan were underutilized (and simply stood off shore without a significant mission assignment). You had to know who had what and how to get it! Issues to resolve were the coordination and integration of communication systems, and the legal procedure to acquire and utilize these resources. Utilization of emergency resources (including the Louisiana’s National Guard) and equipment in the region lacked situational awareness regarding the impact of levee failures; insufficient civilian/military resources integration city to assist in the evacuation of the stranded population after Katrina’s landfall. The National Guard forces employed under State Active Duty or Title 32 status are under the command and control of the governor of their state and were not considered part of federal military response efforts. They performed exemplary via military command to rescue countless individuals from roof tops.
DoD developed a rapid and massive response that occurred through two major components, Northern Command (NORTHCOM) and the National Guard, but this was as an independent response system. At the same time, the Louisiana National Guard deployed the majority of the personnel from state activations during the initial response period as directed by the governor. NORTHCOM spearheaded federal efforts under its Joint Task Force Katrina (JTFK) with the following federal military units: Air Force, Navy, Marines, and Army. It deployed 77 aircraft, 18 vessels, >10,000 navy personnel to support JTF-Katrina’s operations. USNORTHCOM supported Department of Homeland Security (DHS) and Federal Emergency Management Agency (FEMA) and other federal agencies in disaster relief efforts for the mitigation of Hurricane Katrina with > 21,400 Active Duty personnel and 45,700 Army and Air National Guard members supported the effort in the Gulf Coast.16 The traditional US Navy operations utilize the organization of a Carrier Strike Group, helicopters, and aircraft carrier jets, supported by other vessels and personnel, but were not significantly modified for civilian disaster response. During Hurricane Katrina, many of the vessels (USS Bataan, USS Truman, USS Iwo Jima, USNS Comfort) normally utilized as support vessels assumed the leading role for disaster response. The subsequent push of military personnel, materials, and equipment did not have the immediate impact that many had envisioned. A postdisaster review from independent Congressional committeesa,b
aStatement by Paul McHale, Assistant Secretary of Defense for Homeland Defense; Before the 109th Congress; Select Bipartisan Committee to Investigate the Preparation for and Response to Hurricane Katrina; United States House of Representatives; October 27, 2005
bCivil–Military Relations in Hurricane Katrina: A Case Study on Crisis Management in Natural Disaster Response; Chapter 22; Jean- Loup Samaan and Laurent Verneuil
US Navy Resources Utilized in the Katrina Hurricane Response
|Vessel Name/Type||Event Operation/Function|
|Amphibious Assault Vehicles (USS Iwo Jima)||Smaller versions of aircraft carriers (but large-profile amphibious assault vessels); different capabilities: transport, rapidly deploy, direct large numbers of Marines, vehicles, and equipment to shore on smaller landing craft and helicopters; diverse usable disaster vehicles|
|USS Bataan||First vessel to respond during Hurricane Katrina|
|USS Iwo Jima|
Center for relief operations upon arrival on September 5, 2005; flagship for senior officials, including presidential visits, provided facilities and equipment to enable staff coordination, information dissemination, public affairs briefings. Proxy air traffic control agency (in lieu of the Federal Aviation Agency)
Only functioning dental clinic in New Orleans; ∼3000 meals per day for first responders and National Guard; produced 120,000 ga of water, 6.2 MW of electrical power to support ongoing relief activities while working pier side in New Orleans
|Amphibious Assault Vehicles||Air evacuation, sea-based logistics, medical support, command, and control functions; may be utilized to launch smaller vessels, helicopters; amphibious platforms to assist in a coastal disaster response|
|Hospital ships (USNS Comfort)|
Converted San Clemente–class super tankers, built to provide transcontinental oil delivery; not fully manned or operated at all times and maintained in a “reduced operating status”
Response to Hurricane Katrina, USNS Comfort mobilized and steamed around Florida to the Gulf Coast in less than 3 days; treated >1528 patients aboard ship in Mississippi; 7000 patients received treatment at clinics and hospitals staffed by naval medical corpsman and doctors who deployed from the USNS Comfort. Outpatient and advanced care to residents in land-based facilities. Hospital ships not likely to provide immediate response following a disaster can provide ongoing long-term nonemergent care
USNS Mercy, USNS Comfort’s sister ship, provided postdisaster relief for 40 days following the 2004 tsunami disaster in Banda Aceh, Indonesia. USNS Mercy provided relief following March 2005 earthquake that struck near Nias Island, Indonesia, and World Trade Center attacks in New York City in September 2001
Limited adaptability of hospital ships, limited berthing and medical capabilities make these vessels of limited value in the response to domestic disasters
|High Speed Vessels (HSV-2 Swift)||High-speed catamaran, relatively low profile, with helicopter platform. Sustain rapid speeds in excess of 60 knots/hour; able to complete transoceanic crossings without being refueled; extendable ramp enables large diesel trucks to drive directly onto vessel (decreasing) on/off-loading time; little capability to expand services, ie, medical facilities and command areas (minimal situational adaptability); during completed three round-trip logistic runs from Pensacola to the Gulf Coast; rapid delivery of over 800 tons of water, materials, and supplies; capable of people movement|
|Aircraft Carriers (USS Harry S. Truman)|
Single most expensive asset in the US military’s inventory, (>$4.5 billion per vessel), historically provided air combat support; activation notification (by Naval Command) after the New Orleans levees failed
Mass loading of food and water from nearby warehouses as the vessel steamed around Florida to the Gulf Coast, numerous helicopters were received on the flight deck. Altered the traditional mix of aircraft onboard the vessel (traditionally set aside for fighter jets); served as a fuel station; directed and supported air Search and Rescue operations; provide logistical support over extended distances to other vessels in the Gulf Coast; able to operate when air asset use is limited
Primary normal focus to manage, support, and direct long-range air operations, the capabilities aboard the vessel would have to be significantly modified to accommodate close-in disaster response; lack of ship-to-shore assets limits disaster support role
Able to support the delivery of logistical supplies (ie, 1-MW generator)
|Supplies, communication capacity, medical resources, command and control functions on USN ships allow for utilization and support for state and local leaders as command and control platform|
In summary the integration among federal assets responding to Katrina had variable degrees of success and failure.c
cThe Federal Response to Hurricane Katrina: Lessons Learned,; February 2006
FEDERAL AGENCIES AND DISASTER RESPONSE
DHS is responsible for the coordinated management of a terrorist attack, natural disaster, or other large-scale emergency with a comprehensive response and recovery effort. It has the primary responsibility for ensuring that emergency response is managed in a professional manner. It was developed in an attempt to create a home for coordination and integration of multiple federal agencies and programs into a single, managing agency by the use of 16 DHS subcomponents with specific responsibilities and areas of expertise. These range from assessment of threats to intelligence analysis.
Federal Emergency Management Agency (FEMA) is the lead federal agency (part of DHS as of 3/1/2003) for consequence management of a large-scale event response to a natural or man-made disaster. It functions to support general population and emergency responders at a disaster incident with statutory authority for most federal disaster response activities (Box 76-1). It partners with state, local emergency management agencies, federal agencies, civilian groups (ie, American Red Cross, Salvation Army, etc) to assist and support (not supplant) response, mitigation, recovery, and preparedness. FEMA is composed of >3700 full-time employees with 4000 standby disaster assistance employees who are able to deploy to disaster locations.
Box 76-1 National Incident Management System (NIMS)
Command and management
Communications and information
Ongoing management and maintenance
Incident Command System (ICS)
National Incident Management Resource Typing System
Emergency disaster management
National Response Plan (NRP) is the guiding document that integrates federal and domestic disaster activities into an all-hazards approach addressing prevention, preparedness, response, mitigation, recovery plans. The NRP allows the use and collaboration of multiple agencies (local, state, federal) such as Federal Bureau of Investigation (FBI), Department of Defense (DoD), Department of Justice (DOJ), all under jurisdiction of Secretary of Homeland Security. Department of Defense are the military assets such as local commanding officers who are authorized to activate their on-site resources (command and control, personnel, and/or equipment) to meet the request of a local authority, without (pre-) formal permission from their formal chain of command (ie, formal disaster declaration). They will act to preserve life, decrease impact or disaster potential on a local population, including property. It is clear that these local disasters may have national impact: Katrina, Oklahoma City (OKC) Murrow Building Bombing, 9/11 WTC/Pentagon; therefore, early support and participation is critical. DoD responsibilities include Search and Rescue (with DHS/FEMA, US Coast Guard, Department of the Interior), patient movement (with Department of Health and Human Services), augment public health and medical services, provide logistic support, distribution of commodities to quarantined and/or isolated persons, provide manpower and security support to points of (ie, antibiotics) distribution, provide subject matter experts, manpower, and technical assistance to augment mortuary support operations, provide transportation support, provide continuity of government, augment communications for local, state, tribal, and federal communications resources for interoperability, provide base and installation support to other local, state, and federal agencies, ensure protection of defense industrial base, critical infrastructure, and mission assurance, and provide military assistance to civil disturbance for restoration of civil order as it relates to quarantine and isolation enforcement.
US Marine Corps’ Chemical Biological Incident Response Force (CBIRF) respond to a threat of a CBRNE (Chemical Biological Radiological Nuclear Explosive) incident to assist local, state, tribal, federal agencies; conduct consequence management operations; agent detection, identification; Search and Rescue; personnel decontamination; emergency medical care, casualty stabilization.
Public Health Service (PHS) Commissioned Corps, uniformed service of public health professionals: rapid response to public health needs; essential public health and health care services, prevent and control injury and spread of disease, assess food supply, drinking water, drugs, environment, global health; public health and clinical expertise in response to large-scale local, regional, and national public health emergencies and disasters.