Graduate School USA Regulatory Drivers Behind the Development of Emergency.docx
1. (Mt) – Graduate School USA Regulatory Drivers Behind the Development
of Emergency
15 CHAPTER Local Disaster Response Jerry L. Mothershead All disasters are local.
Regardless of type, magnitude, or progression, disasters affect communities. Community
responders will be the first on the scene and will remain for recovery operations well after
supporting resources and organizations have departed. Depending on the type of disaster,
various government, public, and private organizations responsible for public safety, public
security, and infrastructure maintenance will be tasked to save lives, preserve property, and
identify and rebuild essential services for the population served. Prioritizing and
coordinating these missions will require collaboration, cooperation, and understanding on
the part of the leadership and membership of these response and recovery organizations. In
general, these services are organized in the United States within a jurisdictional framework,
and overall coordination falls to the governing entity of the affected jurisdiction.
Unfortunately, these government systems are not identically established throughout the
United States. The general framework usually involves metropolitan areas (e.g., cities,
towns) within a county, which is within a state. However, many “states” are in fact
commonwealths, counties may be supplanted by parishes, and some states recognize
townships or independent cities not subordinate to surrounding counties. Thus no single
description of local response can be provided that is applicable to all localities. Rather, this
chapter will address functional entities and notional organizational structures, processes,
and responsibilities; concepts, rather than specifics, will be emphasized. LOCAL
GOVERNANCE Protection, prevention, and response to emergencies and disasters are well-
recognized government responsibilities. Depending on a number of factors, local
jurisdictions either have systems in place for emergency response or band together with
neighboring communities to provide overall emergency management to a larger
constituency. Certainly, jurisdictions with substantial populations tend to establish discrete
offices, referred to herein as emergency management offices, to provide coordination for
prevention, mitigation, planning, and response functions. However, even in those discrete
jurisdictional areas, there might be multiple government entities involved that provide
similar services. Law enforcement is but one example. Cities usually have a discrete police
department, with the chief of police reporting to the city governing entity (e.g., mayor, city
council). However, if that city is within a recognized county, certain law enforcement
responsibilities, even within city limits, may fall to the county sheriff’s office, and state
3. Community Essential Functions FUNCTION RESPONSIBLE ORGANIZATION Transportation
Communications Public works Firefighting Emergency management Mass care Public health
and medical Resource support Urban search and rescue Oil spills and HazMat Agriculture
and natural resources Energy Public safety and security Public works department * Public
works department Fire and emergency services department Local emergency management
agency * Jurisdictional public health department Various Fire and emergency services
department Fire and emergency services department * Recovery and mitigation External
communications * Jurisdictional law enforcement organizations Various Area emergency
warning agency *This function is not typically a responsibility of a local jurisdictional office
or entity or is not provided by government. Adapted from National Response Framework,
2nd Edition. Department of Homeladn Security. May 2013. Available at:
http://www.fema.gov/ media-library-data/20130726-1914-25045-
1246/final_national_response_ framework_20130501.pdf. Last checked 1/18/2014. Perusal
of Table 15-1 will make it clear that not only are multiple, disparate local government
agencies and organizations crucial to emergency management, but that participation may
be necessary with nongovernment and industry organizations if the response is to be fully
effective. Power, light, and natural gas resources and services are provided almost
exclusively by private corporations. Crucial communications with the public will entail
cooperation by local news media organizations and telecommunications corporations.
SUPPORTING ORGANIZATIONS AND CAPABILITIES It is clear from the discussion above
that a full accounting of all local resources is imperative during preparation and planning
for emergency response. The most common forum in which this occurs is through local
emergency preparedness committees (LEPCs). LEPCs and state emergency response
commissions (SERCs) are mandated by the Emergency Planning and Community Right-to-
Know Act.2 The act requires each state to set up an SERC.3 All 50 states and the U.S.
territories and possessions have established these commissions. Indian tribes have the
option to function as an independent SERC or as part of the state SERC in the state in which
the tribe is located. This can at times present complications, in that certain tribal lands fall
within more than one state. In some states, the SERCs have been formed from existing
organizations, such as state environmental, emergency management, transportation, or
public health agencies. In others, they are new organizations with representatives from
public agencies and departments and various private groups and associations. Duties of
SERCs include the following: • Establishing local emergency planning districts •
Coordinating activities of the LEPCs • Reviewing local emergency response plans •
Monitoring legislation and information management concerning hazardous materials •
Maintaining situational awareness of locations of all major quantities of defined toxic
industrial materials 91 • Establishing procedures for receiving and processing public
requests for information collected under the Emergency Planning and Community Right-to-
Know Act • Taking civil action against facility owners or operators who fail to comply with
reporting requirements LEPCs normally include elected officials and representatives of law
enforcement, civil defense, fire services, EMS, public health, local transportation agencies,
communications and media organizations, facilities involved with the handling of toxic
industrial materials, and the medical community.4 Others from the public at large may also
5. well appreciated by emergency managers and planners. EMS and Transportation •
Ambulance companies • Hospital ambulances • Military field ambulances • Air ambulance
services • School buses • Transit services • Taxi services Community Warning Diagnostic
Services • Freestanding laboratories • Diagnostic centers • Dialysis units Inpatient Facilities
• Nursing homes • Rehabilitation centers • Addiction treatment centers • Hotels •
Gymnasiums Outpatient Facilities • Physician offices • Physical therapy centers • Urgent
care clinics • Dental offices Logistics • Pharmacies • Medical supply centers • Department
stores • Furniture stores Allied Health Personnel • Veterinarians • Medical students •
Nursing students • Allied health training centers • Medical explorer units • School and
occupational health nurses program is to establish teams of local volunteer medical and
public health professionals who can contribute their skills and expertise throughout the
year as well as during times of crisis. The MRC program office functions as a clearinghouse
for community information and “best practices.” MRC units are made of locally based
medical and public health volunteers who can assist their communities during emergencies,
such as an influenza epidemic, a chemical spill, or an act of terrorism. MRC units are
community based and function as a specialized component of Citizen Corps, a national
network of volunteers dedicated to making sure their families, homes, and communities are
safe from terrorism, crime, and disasters of all kinds. Citizen Corps, AmeriCorps, Senior
Corps, and the Peace Corps are all part of the U.S.A. Freedom Corps, which promotes
volunteerism and service throughout the United States. LOCAL RESPONSE CONCEPTS OF
OPERATIONS Because no two disasters are identical, the actual concepts of operations
during response will vary depending on the circumstances. There are, The ability of the
community to be prepared for the disaster is predicated on adequate forewarning of the
impending event. Unfortunately, many disasters do not lend themselves to early detection
by any form of sensor, or analysis has not reached the point that actions may be
appropriately taken. It is well documented in the literature that false warnings actually
impede future community actions, a classic example of “the boy crying wolf” once too often.
Most warnings are issued by government agencies. Most dissemination and distribution
systems are owned and operated by private companies, and effective public-private
partnerships are required. Great strides are taking place in threat detection and warning
communications technology. Warnings are becoming much more useful to society as lead
time and reliability are improved. To be effective, warnings should reach, in a timely
fashion, every person at risk and only those persons at risk, no matter what they are doing
or where they are located. There is a window of opportunity to capture peoples’ attention
and encourage appropriate action. Appropriate response to warning is most likely to occur
when people have been educated about the hazard and have developed a plan of action well
before the warning. Warnings must be issued in ways that are understood by the many
different people within our diverse society. A single, consistent, easily understood
terminology should be used, which may need to be conveyed in several languages in certain
communities. If warnings are not followed by the anticipated event, people are likely to
disable the warning device. Examples of failed or ineffective warnings include the following:
• Alabama, March 27, 1994: A tornado killed 20 worshipers at a church service. A warning
had been issued 12 minutes before the tornado struck the church. Although it was
7. study, the morbidity and mortality of those who waited for EMS agencies were significantly
higher than for those who were transported to community hospitals by the most
expeditious method available. • Transportation of victims: This is also more complicated in
a disaster situation. Although the nearest hospital might be the best equipped, if it has
already been overwhelmed by the arrival of other critically ill victims, EMS will need to
invoke “first-wave” protocols.13 This occurs when the most critically ill patients are
distributed among potential receiving hospitals with little regard of proximity. • Retriage of
victims and receiving fixed-site medical treatment facilities: Procedures and policies must
be in place to handle this sudden surge of victims while still tending to already anticipated
patients not involved in the mass casualty incident. First responders will be overwhelmed
in a true mass casualty incident. As mentioned, most first responders and EMS personnel
have been trained in the START algorithm.14 This algorithm, which assesses mental status,
respiratory effort, and peripheral perfusion, can be performed in as little as 30 seconds and
allows only minimal treatment: repositioning of the head to decrease airway resistance and
bandaging of gross hemorrhage. Ambulance and vehicle control at the scene are important
considerations. In the 1979 Avianca plane crash on Long Island, so many rescue vehicles
arrived unsolicited that departing vehicles could not get on the one-lane road that provided
the sole ground access to the scene. All arriving vehicles should be sent to staging areas out
of the way, with at least one staff member remaining with the vehicle at all times.
Contaminated vehicles pose a risk to both patients and staff as a result of residual
contamination or off-gassing from patients in the confined treatment compartment. In
general, patients whose conditions are stable should undergo full decontamination at the
scene before transportation. Patients whose conditions are unstable may undergo gross
decontamination, which may entail removal of clothing only, and be placed in nonporous
patient wraps for transport. Once a vehicle 93 is used for a potentially contaminated
patient, it should be considered contaminated until fully cleaned inside and out. Receiving
Facility Considerations Receiving facilities must have capabilities to decontaminate
potential patients and should have sufficient space to maintain these patients for a period,
even if the patients are to be transferred elsewhere eventually. First-wave protocols should
be developed in communities with multiple hospitals. A first-wave protocol matches
hospital resources with total victim requirements. It does a victim little good to be taken to
a facility already overrun with critical patients merely because it is the nearest hospital,
while other facilities that are slightly farther away remain empty. Distribution of victims
throughout the entire hospital system will do the most good for the most number of
patients, and this may be considered a form of transportation triage. During planning,
treatment facilities must determine how to rapidly expand their services for a surge of
patients. This entails increasing staff through recall, expedient credentialing of volunteers,
canceling elective procedures, and premature discharge of patients whose conditions are
stable. It also means that additional bed space should be made available by using, for
example, cots, litters, cafeterias, other open spaces, and same-day surgery clinics. Although,
historically, few hospitals have suffered supply shortages in disasters in the United States,
some caches should be available to handle the disaster until outside resources arrive. Above
all, facilities must be protected. If a facility becomes contaminated, it threatens its entire
10. characterized as reactive. Typically, a significant event would occur, outside resources
would arrive from neighboring communities, and the event would be contained. Recovery
operations were often slow, prompting requests to state governments for economic
assistance. Only when the state was unable or unwilling to assist these local communities
would the federal government become involved. At that point, federal legislation was often
required to authorize the expenditure of supplemental funds to assist the state and
community involved. Certain disasters occurred with greater frequency than others did, and
when the frequency and severity of these events became significant enough to draw
national attention, Congress would establish an office or agency to address them. Thus
during the first half of the twentieth century, the Reconstruction Finance Corporation was
established to make disaster loans after certain types of disasters. The Bureau of Public
Roads provided funding for transportation infrastructure damage. The Flood Control Act,
which gave the U.S. Army Corps of Engineers greater authority to implement flood control
projects, was also passed. This uncontrolled and disorganized approach remained in effect
until after World War II.2 Civil Defense Era: 1945 to 1974 Although during World War II,
sporadic coastal watch groups and other organizations were established in various locales
for protection against possible invasion or attack, the development of modern emergency
management began in the 1950s, with the passage of two pieces of federal legislation1: the
Civil Defense Act, aimed at funding initiatives that prepared for civil defense against enemy
attack (shelter programs and packaged disaster hospitals),2 and the Disaster Relief Act,
which provided funds to state and local governments for rebuilding damage to public
infrastructure.3 During the 1950s and much of the 1960s, civil defense from enemy attack
was a federal government priority, as exemplified by the threat from nuclear attack during
the 1961 Cuban Missile Crisis. Moreover, state and local governments were contending with
significant natural disasters, such as the Alaskan Earthquake in 1964 and Hurricanes Betsy
in 1965 and Camille in 1969. Federal funding for civil defense greatly outweighed that
provided for natural disasters, and federal requirements prohibited the use of civil defense
funds for either preparedness or response to natural disasters. In addition, research and
guidelines for disaster response started to appear. Severe wildfires in Southern California in
the early 1970s gave rise to the congressional-funded project, Firefighting Resources
Organized for Potential Emergencies (FIRESCOPE), which developed the Incident
Management System (IMS) concept. The first standards for disaster management were
authored by the National Fire Protection Association (NFPA) and were aimed at health care
facility preparedness (J. Kerr, personal communication, 2000). The “first assessment” of
disaster research occurred in 1975, and it summarized the findings of the disaster research
community.4 Coordinating State and Federal Response: 1974 to 2001 In the early 1970s,
the National Governor’s Association (NGA) called for streamlining the fragmentation of
federal civil defense and disaster assistance programs. In 1974, Congress passed the Robert
T. Stafford Disaster Relief and Emergency Assistance Act, which unified federal funding of
civil defense and disaster assistance programs.5 In 1979, President Carter established the
Federal Emergency Management Agency (FEMA) to serve as the overall executive branch
coordination agency for disaster response.6 Parallel efforts at the state level resulted in the
establishment of either a state emergency management agency or the assignment of similar
12. Africa in 1998, which were followed by the maritime attack on the destroyer USS Cole.
These events drew the attention of both the executive and legislative branches of the federal
government. Under the Clinton administration (1992-2000), a series of executive orders,
referred to as Presidential Decision Directives (PDDs), were promulgated, and a number of
federal statutes were enacted, to improve the defensive posture of and to protect the United
States and its citizens against terrorist attacks. Several new offices and programs were
established in federal agencies, including in the Departments of Justice, Health and Human
Services, and Defense. The most significant legislation was the Defense against Weapons of
Mass Destruction Act,9 commonly referred to as the 83 Nunn-Lugar-Domenici legislation.
One of the act’s many purposes was to provide resources for equipment and the training of
local response personnel for mitigating a weapons-of-mass-destruction (WMD) incident.
These initiatives, while significant, proved insufficient to prevent the terrorist attacks that
totally destroyed three World Trade Center buildings in New York, significantly damaged
the Pentagon, and resulted in nearly 3000 deaths on September 11, 2001. One month later,
weaponized Bacillus anthracis (anthrax) spores were distributed through the U.S. mail
system, resulting in 11 deaths and another 11 infected persons. In combination, these
events resulted in some of the greatest restructuring of the federal government since its
inception. CURRENT CONCEPTS OF DISASTER RESPONSE The terrorist events of 2001 sent
shock waves throughout the U.S. government. New legislation was introduced in the first
three months after the attacks that surpassed all antiterrorism legislation of the previous
decade. President Bush, who had been recently elected, issued new and revised executive
orders, now termed Homeland Security Presidential Directives, which called for changes in
executive branch agencies to meet the current threat of terrorism. Funding to fight the
“global war on terrorism” at home and abroad, beyond massive expenditures needed to
fight the wars in Afghanistan and Iraq, increased by a full order of magnitude. To
understand the current emergency management system in the United States, first it is
important to realize that all levels of government have certain roles and responsibilities in
mitigation, preparedness, response, and recovery, and that various government entities
have different functions in preparedness and response. Regardless of the government level,
however, the designated emergency management agency is responsible for day-to-day
coordination of mitigation and preparedness activities involving agencies and organizations
at that level and for synchronization of these agencies during response and recovery phases.
The designated emergency management agency also serves as the focal point for
hierarchical coordination between local, state, and federal response agencies. Local Level
Emergency Management Because there are subordinate jurisdictions within each state that
are usually established by geographic boundaries, local emergency management may occur
at the city, township, borough, county, or (in some states) parish level. Largely, the attention
given to emergency and disaster preparedness and response will be dictated by the overall
population within the jurisdiction, actual or perceived threats to the area, and population
concentration. Ultimately, however, emergency management comes down to funding.
Regardless of the type of jurisdiction, an executive/managerial official will be in charge of
emergency management operations. This official may be the community safety official, the
fire chief, or the police chief. It is this individual’s responsibility to form a multicratic
14. Investigative Service teams to assist in the evaluation and containment of a contagious
disease outbreak. Under these circumstances, however, the funding stream to reimburse the
agencies would fall outside that which is established for presidential declarations and may
have to come through either state or agency resources. The Department of Defense (DoD) is
a notable exception to this. A number of specific statutes preclude autonomous response of
DoD forces to disasters, beyond local events that would affect military establishments in the
jurisdictional area. Department of Homeland Security Because of its pivotal role in overall
federal-level emergency management, the current organization and functions of the
Department of Homeland Security (DHS) are important to understand. Initially, DHS was
authorized to serve an advisory role to the president; however, a shift toward the concept of
“Homeland Security” evolved, and, through congressional efforts, DHS became the federal
entity focused exclusively on this issue. In November 2002, the president signed into law
H.R. 5005,10 the Homeland Security Act of 2002, which established the DHS11 as a cabinet-
level executive agency. DHS consolidated 22 agencies and 180,000 employees (now almost
250,000) and unified many federal functions into a single agency dedicated to protecting
the United States. Agencies under the DHS include the Transportation Security
Administration, the U.S. Coast Guard, and FEMA. FEMA’s traditional role as the lead
coordinating agency for all disaster response in the United States continues, but under the
oversight of DHS. The secretary of DHS was given extraordinary powers, including the
authorization to initiate a federal response under the Stafford Act, without prior
consultation with the president under certain exigencies. DHS has expanded from its
original 4 primary directorates, and it is now organized at the headquarters level, into 14
different subordinate directorates, offices, and components, plus a supporting, management
directorate. Additionally, it exercises operational control over seven independent federal
organizations, the most important of which from a disaster management perspective are the
U.S. Coast Guard and FEMA, the latter of which has absorbed many of the functions of the
original Emergency Preparedness and Response Directorate. All responses to disasters and
emergencies that reach the threshold for a presidential declaration of a national disaster fall
under the coordination purview of DHS. Under these circumstances, FEMA is the primary
operational arm of DHS in executing response and recovery initiatives, and it does so within
the framework of two documents, the National Response Framework and the National
Incident Management System (NIMS). On February 28, 2003, the president issued
Homeland Security Presidential Directive #512 to enhance the ability of the United States to
manage domestic incidents. To implement this directive, the secretary of DHS directed that
a single, integrated federal Emergency Operations Plan (EOP) be developed. The resultant
National Response Plan (NRP)13 paralleled the earlier FRP in format and linked the
following hazard-specific EOPs: • FRP14 • U.S. Government Interagency Domestic
Terrorism Concept of Operations Plan15 • FRERP16 • Mass migration response plans •
National Contingency Plan17 As further evolution of the shared responsibilities between
local, state, and federal response agencies ensued, and as shortcomings in the NRP were
highlighted by such catastrophic events as Hurricane Katrina, a shift in the focus of the
overall response plan was deemed necessary by DHS leadership. With this shift of focus, the
NRP was reissued as the National Response Framework (NRF), and as with its predecessor
16. Although not mandatory for use by the states and local jurisdictions, federal funding for
disaster and Homeland Security initiatives is directly tied with these jurisdictions’ use of the
NIMS in preparation, planning, and response SUMMARY Emergency management has
evolved over the past 200 years, and it continues to evolve. With the creation of DHS as an
authoritative central executive agency for oversight of all federal emergency management
activities, a level of cooperation and collaboration at the federal level never before achieved
is a possibility. Moreover, continued refinements of and support for emergency
management initiatives at the state and local levels have improved hierarchical integration
during response and recovery. Standardization is the watchword. Emergency management
has evolved from an exercise in on-the-job training to a degreed, scientific profession at all
levels. The challenge now is to maintain the momentum. Over a decade has passed since the
World Trade Centers collapsed, and, although there 85 have been many attempts, no major
terrorist incidents have occurred in the United States since. There have been, however,
major natural disasters, and these catastrophic events continue to highlight the challenges
of preparedness and response. Nonetheless, budgetary constraints, especially after the
“Great Recession” of 2008, have forced curtailment of funding for many programs, and
disaster preparedness programs were not exempted. If the local, state, and national
agencies responsible for national protection and response are to be best prepared for the
next “big one,” diligence within those respective organizations, as well as sufficient
resourcing, remains paramount. REFERENCES 1. Pine J. A Review of State Emergency
Management Statutes. Washington, DC: Federal Emergency Management Agency; 1989: 8. 2.
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http://www.fema.gov/about/history.shtm. 3. LaValla P, Stoffel R. Blueprint for Community
Emergency Management: A Text for Managing Emergency Operations. Olympia, WA:
Emergency Response Institute; 1983. 4. White GF, Haas JE. Assessment of Research on
Natural Hazards. Cambridge: MIT Press; 1975. 5. Robert T. Stafford Disaster Relief and
Emergency Assistance Act, as amended by Pub L No. 106-390; October 30, 2000. Available
at: http://www.fema.gov/ library/stafact.shtm. 6. Drabek T. The evolution of emergency
management. In: Drabek T, Hoetmer G, eds. Principles and Practices for Local Government.
Washington, DC: International City Management Association; 1991:17. 7. Federal
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Emergency Management Association. Emergency Management Assistance Compact.
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of Mass Destruction Act of 1996). 10. U.S. Citizenship and Immigration Services. HR 5005
Homeland Security Act of 2002. Available at: http://uscis.gov/graphics/hr5005.pdf. 11. U.S.
Department of Homeland Security. The Department of Homeland Security. Available at:
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http://www.dhs.gov/dhspublic/display?theme¼42& content¼496. 13. U.S. Department of
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