Emergency Management Critical Infrastructure Protection
Introduction
The emergency management department was made with the intention of effectively dealing with any disaster or untoward situation arising which might harm the interests of the nation and its infrastructure and resources. The establishment of such a department, however, meant that a massive restructuring of government was required and it was important that the right foundations were laid out for the future. The organizational structure of the new agency, its ability to interact with other federal and state agencies, its technology deployment and even the administrative or support structures had to be carefully designed in order to have an effective agency. The Congress had allowed for the creation of the new department in stages which were marked by events and the widest possible counsel, debate followed by consensus was accepted at every stage under the supervision of a number of oversight committees. This essay takes a look at some of the issues associated with the reorganization of an efficient as well as effective Department of Homeland Security for the next century.
The President of the United States of America signed into law the Department of Homeland Security Act of 2002 in November, 2002 (DHSA, 2002), creating a new United States government department which involved the largest restructuring of government in over fifty years. Over 150,000 employees in over 25 bureaus and directorates were a part of this new agency of the government and although the final structure of the Department of Homeland Security was to remain in flux, it was expected that the new department will act to band together the functions of widely disparate government entities in order to transform homeland security and provide a higher level of security to the Americans from a number of diverse threats such as nuclear, chemical, biological, cyber, radio, computer and electronic as well as providing protection from terrorists and protecting vital national infrastructure. Homeland security referred to deterrence, prevention, and preemption of, and defense against, aggression targeted at U.S. territory, sovereignty, population, and infrastructure as well as the management of consequences of such aggression and other domestic emergencies (Jasak, 2002, P. 1).
Key Events and Emergency Services
Hurricane Katrina
Throughout American history there have been disasters of every sort but within recent years two main disasters, though unrelated, have caught and held American attention like no other the terrorist attacks of September 11, 2001 and Hurricane Katrina in late August of 2005. Each of these disasters initiated a local, state and federal response that enabled an undertaking of cleanup of the combined efforts of each level of government. Unfortunately, the responses to the different disasters came under harsh criticism by the American people. Due to this criticism, President Bush issued Homeland Security Presidential Directive-5(HSPD-5) and the beginning of the NRF which was put into place March 22nd, 2008.
The terrorist attacks on September 11, 2001 are a prime example of how at that point in time the United States was not prepared for such an explosive disaster. Local emergency response personnel arrived first on the scene to evaluate and help elevate the chaos that was occurring. At that time, different operation centers had been established so that numerous firemen could check in and be directed where to start helping with evacuations. Unfortunately, many firemen also showed up off duty, without checking in and without any radio equipment making the fire chiefs who were directing everything unable to have the ability to keep track of everyone that was assisting. Also the repeater system in the towers was malfunctioning due to the planes crashing into the building so although firemen had their radios, they were unable to call back to the commend central. This was a major problem because the chiefs werent able to hear progress updates or give orders and updates to the firemen as to what was happening throughout the Trade Center. They also didnt have access to local news broadcasters to be kept up on current events for the entire area. When the South Tower fell many of the firemen in the North Tower actually had no idea what was happening and due to the lack of communications, they would never know. The New York Police Department also arrived on scene to help but communications were down and they had the same issues the fire department had. When the towers collapsed a great plume of debris and particulates arose in the air quickly smothering everything in ash. The cleanup of the towers after they collapsed was chaos with lots of safety procedures being dismissed and ignored. Many workers wore simple painters masks or didnt even wear one at all. There were numerous toxins released into the air when the towers collapsed that required special respiratory systems but which no one used. Such a dismissal of health and safety procedures should not be allowed to happen in this day and age.
This disaster showed explicitly how much a set of procedures was needed to be set in place to control and organize such occurrences. In late summer 2005, another such disaster happened as well though altogether a different type. Hurricane Katrina hit New Orleans in August of 2005 breaching the levee system of the city and flooding thousands of people out of their homes and killing another two thousand. This was one of the worst United States natural disasters in recent history and the worst engineering failure for the U.S. ever. Historically researchers have provided guidelines and suggestions regarding the proper usage of emergency services in order to mitigate the impact of such disasters, for e.g. Drabek Boggs (1968). However, the U.S. knew that Katrina was going to make landfall and as the storm moved closer forecasters reported that it would hit New Orleans but the preparations to deal with it were inadequate. Predictions about the storms impact to New Orleans warned that there would be heavy flooding and damage but even with this information a mandatory evacuation was not issued until August 28 at 930 in the morning. To further magnify the coming disaster New Orleans government officials while using normal bus transportation to move residents to places like the Louisiana superdome, failed to take into account the significant number of 20,000-25,000 people who refused to evacuate and did not use all resources at hand such as school buses to help in the evacuation.
While some one million people had been evacuated out of the city in time to avoid the storm, once Katrina hit all transportation to and from the city was shut off stranding thousands of people within the city, some without food or clean water and many forced to escape to their rooftops to avoid the fast rising flooding. Those residents who never made it out of the city were transported to the refuge of last resort, the Louisiana superdome. This rescue was exceedingly slow and brought the residents to a superdome that itself had sustained heavy damage from the storm and was running short of food, especially water, as well as many other necessities further amplifying the humanitarian crisis. Hurricane Katrina took the lives of at least 1,836 people and it is said to have been the cause of over 81.2 billion dollars in damages. The catastrophic failure of the flood protection in New Orleans has prompted an extensive review of the Army Corps of Engineers, who was responsible for the design and construction of the breeched levee system as well as widespread criticism of federal, state and local governments for their slow and devastating reaction to the storm. This has lead to an investigation into the federal emergency management agency and subsequent resignation of FEMA director Michael D. Brown. Two primary documents are used by the Federal Emergency Management Agency (FEMA) to deal with day-to-day or large scale disasters. One is NRF (National Response Framework) and contained within it is the National Incident Management System (NIMS) which is a set of codes or guidelines set down by the Secretary of Homeland Security, due to HSPD-5 from the President. NIMS offer a new and different approach to handling such disasters as 911 and Katrina. At the time of these disasters, the National Response Plan (NRP) was what the country followed in regards to response to disasters.
2007 Southern California Wildfires
On Sunday, October 20, 1991, a grass fire in the Oakland-Berkeley hills of northern California that was believed to have been extinguished on the previous day flared into one of the largest urban fires in US history. The fire was fueled by dry vegetation resulting from five consecutive years of drought and was fanned by unusually hot and dry northeasterly winds. Over the course of the next two days, more than 1,600 acres of hilly residential land burned, destroying or damaging approximately 3,800 dwelling units, killing 23 civilians and 2 public safety workers, and sending scores of persons to area emergency departments. (Office of Emergency Services, 1992) A smoke and ash plume rose to between 1,800 and 5,000 ft altitude and extended over at least 30 miles (Bay Area Air Quality Management District, oral communication, October 1991).
More than 1,500 firefighting personnel from 244 local, 4 military, and 2 state agencies fought the blaze over a three-day period.(Office of Emergency Services, 1992) Local police and public safety officers evacuated residents and controlled traffic and crowds. Emergency medical services were provided by at least nine area hospitals. In this article we summarize the immediate health effects of the fire - through the first week after the fire - as ascertained from emergency department records and coroners reports.
Power Outage of Northeast
On Thursday, August 14, 2003, an electrical power failure of unprecedented proportion affected the northeastern United States and Canada. New York City (NYC) and its 13 million residents and workers suffered a blackout (complete power outage) at 400 pm, the beginning of the evening rush hour, with gradual restoration of power over the next day. Emergency medical service (EMS) and acute care hospitals, our first and second responders, are critical elements of any citys disaster preparedness planning. During this blackout, both experienced substantial demands, with increases in 911 calls, EMS ambulance responses, and hospital patient visits.
NYC last suffered citywide blackouts in 1965 and 1977. After the 1965 blackout, NY State regulations required mandatory backup power systems for its hospitals and long-term care facilities (NYCRR, 1998 NFPA, 1999)
In the July 1977 blackout, emergency backup generators again failed at several hospitals (Altman, 1977 McQuiston, 1977). At Bellevue Hospital, a major trauma center, the emergency department (ED) was closed and 15 patients on mechanical ventilation were manually ventilated with bagvalvemask devices by rotating staff two patient deaths may have resulted (Altman, 1977).
Since 1977, advances in medical care, communication, and information systems have greatly increased the power needs of a modern hospital. In the last decade, changes in healthcare delivery have encouraged the redistribution of substantial numbers of chronically ill patients dependent on electrically powered life-saving devices (mechanical ventilators, positive pressure breathing assist devices, nebulizers, oxygen compressors, and dialysis) to the community, living at home or in long-term chronic care facilities. Disaster preparedness planning for power failures must consider not only the modern acute care hospital, but also community-based patients dependent on electrically powered life-saving devices. This problem is made even more urgent when one considers that blackouts not only result from power failures, but also may occur during other major disasters (e.g., hurricanes, earthquakes, explosions, etc).
On August 14, 2003, a power failure cascaded through eight states, becoming the largest blackout in U.S. history. NYC suffered a citywide blackout at 400 pm, the beginning of evening rush hour. Municipal resources (Mayors Office, Office of Emergency Management, Police, Fire, and EMS) were quickly mobilized. By all accounts, disaster plans implemented by government, financial institutions, and private industry were successful, in large-part as a result of lessons learned from prior blackouts, the World Trade Center attack, and the coordinated response to recent biologic threats anthrax, smallpox, and severe acute respiratory distress syndrome (SARS). Communication to the public was rapid and well-conceived, crime did not increase, and critical computer systems were not significantly disrupted.
Commonality among the Events
These three events have depicted a common trend in the emergency service management of our nation. The emergency services were largely un-prepared for this catastrophe and were caught unaware in this time of need. Although prior information and awareness was common in all these events, still the emergency services appeared to be downplaying the magnitude and importance of these disasters.
Similarly, during the blackout, EMS and hospital activity surged dramatically, in large part as a result of unexpected increases in callsvisits from community-based patients dependent on electrically powered lifesaving respiratory care devices. It is likely that heat-related calls and hospital visits would have also significantly increased if not for a relatively mild night for NYC in mid-August. NYC EMS calls increased from a daily average of 3,274 in the weeks pre- and post blackout to 5,299 on August 14, 2003, and 5,021 on August 15, 2003, a 62 and 53 increase, respectively. Respiratory call types showed the greatest increase (189). During the blackout, MMC-ED visits increased by only 6 but respiratory visits increased by 74, mostly as a result of an influx of community-based patients dependent on electrically powered respiratory devices. These patients came from homes without backup power or from long-term care facilities with inadequate backup power. This increased patient acuity along with the news that power would not be restored until the next day, resulting in a 40 increase in MMC hospital admissions. Of the 65 MMC-ED visits for blackout-related respiratory device failure, 57 were admitted and the remaining patients received lengthy ED treatment, avoiding admission only when news reports indicated imminent power restoration on day 2. MMC hospital records indicate that it is rare to have even a single patient admission for respiratory device failure. (Heide, 2004)
This was not the first citywide blackout because power outages occur for many reasons, including natural and manmade disasters. Despite prior occurrences, we could find no study in the medical literature examining the effects of a blackout on a citys healthcare delivery system. Isolated power failures to a surgical operating room (Welch Feldman, 1989) and intensive care units ( HYPERLINK httpswtuopproxy.museglobal.comMuseSessionID50123fd3f9bf65b883132417f22b5cMuseHostovidsp.uk.ovid.comMusePathsp-2.3ovidweb.cgiSAJFPPDKCPFHFJOLPFNELEEOFMJDKAA00LinkSetS.sh.357c17csl_10 l 52 Hara Higgins, 1992, Schaeffer, 1978) have been reported, demonstrating the need for backup power systems. After the 1965 NYC blackout, NY State regulated mandatory power backup systems for its hospitals and long-term care facilities (NYCRR, 1998). Twelve years later, during the July 1977 blackout, there were still failures of emergency diesel-powered generators at several NYC hospitals (Altman, 1977 McQuiston, 1977). In response to this and other emergencies, standards for hospital power backup systems were improved and instituted at local, state, and national levels (NYCRR, 1998 NFPA, 1999).
Yet, over the last decade, advances in medical care, communication, and information systems have greatly increased the electrical power needs of acute and chronic care hospitals. Uninterrupted electrical power is now an absolute requirement for the care of critically ill patients. Our success in treating the critically ill has created a large and growing group of chronically ill patients dependent on electric power for varying degrees of life support. With increasing frequency, these patients now live in their own homes or in long-term care facilities.
Lastly, electrically powered medically necessary or lifesaving devices include not only respiratory care equipment, but also dialysis, cardiac support, arrhythmia monitoring, enteral and parenteral nutrition, and intravenous medication pumps. In a power failure, community-based patients requiring respiratory care devices are extremely vulnerable, whereas patients depending on other electrically powered medical devices remain relatively unharmed unless power failures are prolonged for days. Patients on mechanical ventilators living at long-term care facilities are the most vulnerable because they have the lowest performance status and complex medicalnursing needs.
Common Vulnerabilities
Our emergency services are still prone to failure during disasters and thus a lot of effort and consideration is needed from our nation, our government and our media regarding the awareness and handling of the common vulnerabilities in our emergency management system. The recommendations given below are key to the successful resolution of these problems and the proper solution to a serious problem which plagues our nation even till today.
Identifying and Protecting the Emergency Services
Since September 11, 2001, the NYC healthcare system, particularly acute care hospitals, has been extensively trained to respond to disasters, particularly terrorist events. Anthrax bioterrorism cases in October 2001, the spread of SARS in 2003, and the recent smallpox vaccination program have further conditioned our healthcare system to accept a central role in disaster response. The Department of Health and Human Services, Homeland Security, the Centers for Disease Control and Prevention, the NYC Department of Health and Mental Hygiene, the NYC Fire Departments EMS, and hospital trade groups such as the Greater New York Hospital Association have organized medical disaster planning sessions and drills to improve our response to nuclear, biologic, and chemical disasters. What this blackout made all too clear is that the success of our modern healthcare system, both during day-to-day activities and during disasters, depends on an uninterrupted electrical power supply operating at full or near-full capacity. Furthermore, just as our electrical grid was shut down by seemingly distant problems, our acute healthcare system was similarly affected by distant problems, i.e., those in the long-term care setting. Even with full electrical power, MMC did not have the staff, spare ventilators, or bed availability to accept both the expected flows of acutely ill patients from the ED and chronically ill, ventilator-dependent patients from home or long-term care facilities. Our data demonstrate that the blackout posed a severe test to the capacity of healthcare first responders (EMS) and second responders (acute care hospitals) in NYC. The ability of our healthcare system to respond to a prolonged blackout or to a simultaneous second event would have been severely constrained because EMS and hospitals (ED, inpatient, and critical care beds) were already at near-full capacity with little reserve.
Because many disasters, natural or unnatural, would be expected to compromise electrical power, disaster preparedness planning must account for medically needed electrical power requirements in healthcare facilities and the community. To maintain the capacity of our public health infrastructure to respond to acute medical needs in a disaster, backup power systems must be available for community-based patients and chronic care facilities, without reliance on acute care responders. Assuring an adequate power supply for acute and chronic healthcare needs must be considered a central component of future public health disaster planning.
The research in this paper above suggest that NYC current health-related power backup systems can be overwhelmed, threatening our overall disaster response, we suggest that public health disaster planning include the following 1) educating all healthcare providers (acute, chronic, and home-based) about the extent of their current backup power supplies and the need for maintaining and improving this supply 2) mandating acute and chronic healthcare facilities to have backup power adequate to supply clinical demands for at least 48 hrs 3) mandate health facilities to have backup systems for communication and computerized medical information systems 4) to regularly update and test these backup systems at full clinical load 5) through economic incentives, encourage healthcare facilities to install cogeneration plants 6) require home-based patients who are dependent on electrically powered lifesaving devices to have a backup system capable of lasting for at least 24 hrs 7) develop a registry, available to the local hospital and municipal authorities, of patients dependent on electrically powered lifesaving devices and 8) a coordinated blackout disaster plan for the resupply of fuel during prolonged blackouts andor the redistribution of patients (hospital and community-based) to sites with power in the event backup systems fail.
Healthcare institutions must learn the same lessons from this blackout that financial institutions have apparently learned from prior blackouts disaster preparedness planning must include assurance of uninterrupted power to the entire healthcare system, including not only hospitals, but long-term care facilities and outpatients dependent on electrically powered lifesaving devices.
The disasters of Sept. 11 and Hurricane Katrina were devastating to our country. The emergency services of America are still short of the expectations during such hard times. However, if persistent efforts are made to improve and enhance the emergency services and to proactively work for the well-being of our nation and its citizens, there is no reason why our emergency services cannot meet the natural and human made challenges plaguing our nation in the future.
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