In revising this chapter for the second edition of this text, it is interesting to review our “outside the box” thoughts from nearly 10 years ago. Defining “the box” is a challenge in and of itself. The boundaries of “the box” are further imposed by many, intertwined variables: budgets, policies, personalities, processes, protocols, and unseen interdependencies. Thinking outside “the box” is a lot like “futuring”—identifying drivers, using scenarios, and recognizing emerging themes that direct and refine strategy, development, and execution, and help steer us toward outcomes that are more favorable. These drivers include variables such as knowledge, science, technology, cultural values, geopolitics, environmental changes, and resources, and they factor into a complicated, dynamic, nonlinear system. Throw in innate human factors, and the system becomes complex: the domain of the “wicked problem,” where adaptive iteration, that is, repeated consideration and analysis, is required both to refine problem structure and to find the best solution. Some of the drivers have had clear effects on efforts. Goals and objectives have been refined by significant austerity in government spending and grants programs. The windfall of spending in science and technology, homeland security, and related emergency preparedness efforts that occurred after 9/11 is gone. The financial crisis of 2008 further punctuated that decline. In its place are severe cuts to budgets and programs, delays in projected development cycles, and supplies and equipment rapidly becoming outdated. However, the “technology era” offers the worthy goals of integration, innovation, and collaboration as ways for improving preparedness and response cost effectively. Constrained budgets refine priorities and introduce necessity as a driver for invention. Realizing success depends on seeing how things could be, developing a shared vision, aligning efforts, and moving into the right direction.

Our adaptive iterating has gradually added further architecture to our emergency management efforts. The Federal Emergency Management Agency (FEMA) and other government agencies work closely with communities to standardize, customize, and integrate preparedness efforts. Information is readily available to share with individuals, businesses, volunteer organizations, communities, states, and regions on a multitude of disaster preparedness and response activities if senior leadership so desires (see www.fema.gov ). The Department of Homeland Security (DHS) works through Sector Coordinating Councils, directly with key members of the private sector in critical infrastructure sectors to coordinate protection, response, and recovery activities. This build out, combining the private sector energy and innovation with the bureaucracy of government, continues to flourish, refining roles, responsibilities, swim lanes, and trust. Unfortunately, progress is still largely captured officially in glossy, paper reports with semantic text. These high-level, “portrait”-oriented documents provide static, snapshot views of ongoing, dynamic, and evolving events occurring in a “landscape” mode, which are of limited value unless operationalized.

Meanwhile, technology continues to advance at a rapid clip. Information management has changed significantly, and, no doubt, will be substantially different 10 years hence. Social networking applications allow for human interaction and establishment of trusted social networks linked around the globe. Search engines put the bulk of current information at our fingertips. Mobile communications allow for near ubiquitous coverage with various modes of talk, data, and streaming video for information retrieval and exchange. The Web is maturing from its early, basic Web 1.0 informational pages to Web 2.0 collaborative wikis, moving on through the semantic Web 3.0 “Internet of Things” (IoT), *

* The term “Internet of Things” (IoT) refers to uniquely identifiable objects and their virtual representations in an Internet-like structure. The term is used to denote the advanced connectivity of devices, systems, and services that go beyond machine-to-machine (M2M) communications and cover a wide variety of protocols, domains, and applications.

where objects in the world are tagged, characterized, and interconnected, to Web 4.0 “Singularity,” where computers are capable of independent reasoning, learning, and decision making. In the medical sector, telemedicine, robotics, and point-of-care diagnostics are transforming the way medicine is practiced. Diagnostic algorithms are just around the corner. Genomics is progressing to proteomics, metabolomics, and customized medical approaches geared toward our individual genetic requirements. Electronic health records systems are transforming the way we provide individual and population-based health care. The massive amounts of data now captured in these systems offer enormous potential for innovation, yet also pose incredible security risks.

So what defines the “box” now, and what lies outside of it? In focusing on the need to improve health service support for emerging asymmetric threats, the first steps outside that box must include a leveraging of the benefits to be gained from the confluent areas of information management and technology, opportunities to be gained by embracing network- and coalition-centric hospital and health system architectures, and fully developing public-private partnerships for enhanced preparedness and response collaboration. The goal must be the ability to achieve the change needed to increase “overall resilience,” which may be defined as the ability to function as normally as possible in the abnormal environment, across all levels of the operational spectrum.

Information, Integration, Interoperability, and Interdependency

The Wide Area Resiliency and Recovery Program (WARRP), looking at the chemical, biological, radiological, and nuclear defense (CBRN) incident scenario set, extended the work done on the Interagency Biodefense Restoration Demonstration (IBRD), using the “whole of community” approach in conforming to FEMA’s Disaster Recovery Framework development. IBRD included involvement of the private sector, and it led to some startling revelations for recovery time windows of opportunity that government alone could not have realized. For example, if “big business” corporations cannot regain access and operations within 6 months, they terminate their lease, cut their losses, and abandon the location. Small businesses have about a 3-month window before most are out of business. Both big business and small entrepreneurs are highly incentivized and willing to participate actively in preparedness, response, recovery, and restoration phases; their livelihood in that city depends on it. WARRP uses an engineered approach to further identify key components to Disaster Recovery Frameworks that highlights otherwise nonobvious risk-mitigation actions. Initiatives of this sort raise the thresholds for preparedness and mitigation from disasters, as well as facilitate response and recovery within a given region.

The key lessons from IBRD and WARRP are the importance of public-private partnerships and the creation of mechanisms for efficient data sharing and knowledge management. Orienting the effort through recovery frameworks using a “systems engineering” *

* Systems engineering is an interdisciplinary field of engineering that focuses on how to design and manage complex engineering projects over their life cycles. Issues such as reliability, logistics, coordination of different teams (requirements management), evaluation measurements, and other disciplines become more difficult when dealing with large or complex projects. Systems engineering deals with work processes, organizational methods, and risk management tools in such projects. It overlaps technical and human-centered disciplines, such as control engineering, industrial engineering, organizational studies, and project management. Systems engineering ensures that all likely aspects of a project or system are considered and integrated into a whole.

approach further leverages the skillsets, tools, and lessons learned within various disciplines, sectors, and stakeholders, often even conforming to or highlighting related best practices across or within those disciplines. Public-private partnering expands the stakeholder pool and promotes broader interoperability efforts that are otherwise missed or ignored. For example, consider building codes in hurricane-prone areas. Insurance analysts, engineering experts, and homebuilders working in partnership with the public sector could determine the right mix of controls, standards, and distribution of homes and buildings able to withstand specific categories of storms. Broad collaboration across government and the private sector is critical. A deliberate planning process then promotes development of common goals and objectives of the partners and stakeholders while still considering the economic impact. These are linked to activities and tasks assigned to specific response plans and requirements. This can be done in real time and modified in crisis planning efforts to adjust to incident specific response requirements. Evolution of the incident management systems permitting further integration and “spread sheet detail” allows for cost/benefit risk analysis, prioritization of objectives, and better decision making. The process established the “new normal.” The improved state then provides options for short-term response and longer-term recovery that are better informed and understood, as well as more aspirational. Bringing the private sector into the mix allows for incorporating modernized engineering controls and building codes, dual-use capabilities, and advanced technologies into the next generation of the impacted area. Like the rebuilding of cities in Europe, devastated after World War II, a deliberate planning process propels the “new normal” forward in modernization, and it confers advantages only seen when the longer view is considered.

The approach for these programs and efforts is sound. Our society is a complex and dynamic system. A systems operations, engineered approach that identifies all potential nodes in the system, where they are, and how they react and interact in crisis, should provide a better understanding of the effects, course, and harm of the disaster. The IoT allows us the potential to identify and monitor any critical node in a system. Many of these monitoring systems are already in place or are being built out. What is more difficult is to capture the cascading, higher-order effects, the interdependencies of these nodes, individually and when acting within a system. Being able to view over 2 million publicly available data layers is in “the box,” as can be seen at Collaborate.org ( www.collaborate.org ). By combining the right combination of these data layers available in the public realm into customized “mashups,” these data layers that show effective cause and effect, which explain or predict behavior or outcomes, an approach that, currently, is just barely out of the box.