course material

1. BU Logistics Functions During a Disaster Reflection
CHAPTER 41 Operations and Logistics James J. Rifino Disaster management is most effective
when responding agencies are well trained, well practiced, and familiar with the hierarchy
needed for disaster response. Before a major incident, responding organizations and
personnel must be organized under a defined leadership structure to effectively coordinate
and carry out the tasks needed to properly mitigate the event. One of the hallmarks of a
developed country from the emergency response perspective is its ability to effectively
respond to and manage a complex disaster event in an organized fashion.1,2 By definition,
the Incident Command System (ICS) is a management system designed to enable effective
and efficient domestic incident management by integrating a combination of facilities,
equipment, personnel, procedures, and communications operating within a common
organizational structure. ICS is normally structured to facilitate activities in five major
functional areas: Command (directed by the Incident Commander [IC]), Planning (collects
and disseminates information about the incident and advises about resources), Finance and
Administrative (critical for tracking incident costs and reimbursement accounting),
Operations, and Logistics. These functions task individuals with different responsibilities
crucial for disaster response and recovery. They can also be applied routinely for local and
regional incidents, not just disasters. The Operations section is responsible for carrying out
the response activities described in the Incident Action Plan (IAP). This includes directing
and coordinating all operations, assisting in the development of response goals and
objectives, requesting and releasing resources, and providing situation and resource status
updates. The Logistics section is responsible for services and support necessary to sustain
the tactical objectives of the Operations section. This includes facilities, services, materials,
and personnel to operate the requested equipment for the incident. This function is most
significant with respect to longterm or extended operations when more resources are
required. Operations and Logistics are two completely separate functions and functional
entities, but an efficient and effective Operations section at a major incident is partly
dependent on a well-organized and properly functioning Logistics section. HISTORICAL
PERSPECTIVE History has documented disasters on many levels all around the world. Some
of the larger disasters were the result of infection (North American Smallpox Epidemic of
1775, Black Death of 1348 to 1351, Spanish Influenza in 1918) as well as natural disasters
(Great Earthquake of 1202, Aleppo Earthquake of 1138, volcanic eruptions in Greece and
the Pacific). These horrific events killed millions around the world. Documentation of
“disaster preparation” and “disaster response” internationally was very poor, essentially

2. nonexistent. In the United States, we have documentation of a series of fires in the city of
Portsmouth, New Hampshire, in 1803. After the devastating fires demolished the area and
injured many, the Seventh U.S. Congress passed the Congressional Act of 1803, which
provided relief for Portsmouth merchants by extending the time they had for remitting
tariffs on imported goods. This is widely considered the first piece of legislation passed by
the federal government that provided relief after a disaster.3,4 In 1900 Congress granted a
charter to the American Red Cross, which had provided disaster relief following the
Johnstown Flood in Pennsylvania in 1889. The charter included the mandate to “carry on a
system of national and international relief in time of peace and to apply the same in
mitigating the sufferings caused by pestilence, famine, fire, floods, and other great national
calamities.” This was the socalled American Amendment calling for peacetime disaster
relief.5 For the next several decades, disaster relief was expected to be delivered by
charitable organizations. Military assistance, however, was provided following the San
Francisco Earthquake in 1908. The next documented federal action came in 1932, when
President Herbert Hoover commissioned the Reconstruction Finance Corporation (RFC).
This federal assistance lent money to banks and institutions, with the goal of stimulating the
economy and is considered the first organized federal disaster response agency.6 Over the
last half of the twentieth century, the U.S. federal government continued to grow, while
disastrous events stimulated the growth of the idea of “disaster response” and “disaster
preparedness” largely as a result of the effects of war, hurricanes, earthquakes, and
wildfires. It is important to state that, like most laws in the United States, provisions for
disaster response have been more reactive rather than proactive. Disaster response in the
United States is largely legislated at the federal level, but it is also legislated at the state and
local levels. Local resources and personnel are ultimately responsible for coordinating and
deploying resources needed after an incident. All disasters are “local,” and most
jurisdictions across the United States authorize and recognize the Fire Chief (or designee)
as the IC of any incident involving imminent danger to life or property. The exception to this
is any situation that is more of a law enforcement issue (e.g., sniper, hostage situation). It is
the IC who has overall authority for any disaster operation, unless he transfers command to
another individual. The IC must assess every situation and determine the scope of resources
needed. If local resources are insufficient to manage the incident, additional manpower and
equipment and supplies are typically requested from neighboring communities (a concept
known as “mutual aid”). This may or may not be based on a formal agreement between
individual agencies and/or political jurisdictions. For any major incident, local resources
need to rely on each other as national resources typically take a few days to organize and
deploy. In more progressive fire-rescue systems, mutual aid resources are dispatched
according to 269 Downloaded for FAYEZ ALRUQI (feozy93@gmail.com) at Philadelphia
University from ClinicalKey.com by Elsevier on October 30, 2019. For personal use only. No
other uses without permission. Copyright ©2019. Elsevier Inc. All rights reserved. 270
SECTION IV Event-Response Topics a predefined algorithm or plan, and this concept is
known as “automatic aid.” The difference is that “mutual aid” is requested once the scene is
assessed and it is determined that there is a lack of resources. “Automatic aid” is requested
by the service upon dispatch to a situation that is recognized immediately as requiring

3. additional assistance not available at the time of the call (e.g., calling for a ladder truck from
a neighboring town for a fire in a tall building). If regional resources do not satisfy the needs
of a disaster response, the traditional next step has been to request aid from the state
emergency management agency. Governors can declare a state of emergency, thereby
allowing for access to necessary materials, equipment, and financial resources. The state
governor may also activate the National Guard. In the last 10 to 15 years, many states have
developed specialty response teams capable of mobilizing in response to a disaster. These
include urban search and rescue (US&R) teams, hazardous materials (HazMat) teams,
weapons of mass destruction (WMD) task forces, emergency medical service(s) (EMS) and
ambulance strike teams, and similar entities. In 1996, Congress enacted the Emergency
Management Assistance Compact, a mutual aid agreement that allows human and material
resources to cross state lines and operate in a declared disaster situation in a “state-to-
state” assistance operation when requested through the proper channels and approved by
the governor of the affected state. Because disaster preparedness and response evolved out
of the military in the United States, many of the Logistics and Operations processes today
have roots in military practice. Throughout Europe, the European Commission coordinates
emergency relief and assistance in the wake of all disasters. Floods and fires are quite
common in the summer months, although all disasters are monitored for and an
appropriate response is expected. The Monitoring and Information Centre (MIC) within the
European Commission is a centrally based center in Brussels that monitors emergencies
worldwide and coordinates European resources for relief operations. The MIC acts as a
communication hub between countries after a disaster occurs, whether natural or human-
made. Upon receiving a request for help, duty officers alert potential donor nations and
match offers of aid to the needs on the ground. In addition to rounding up equipment and
supplies, the MIC dispatches field experts to disaster sites.7 Asian Disaster Preparedness
Center (ADPC) is an organization that helps to reduce the impact of disasters on
communities and countries in Asia and the Pacific, the most hazard-prone region in the
world. Established in 1986, ADPC is an independent nongovernmental organization (NGO)
that promotes disaster awareness and the development of mitigation and management
policies in advance of a disaster. With headquarters located in Bangkok, ADPC also has
country offices in Bangladesh, the Lao People’s Democratic Republic (Lao PDR), and
Myanmar. ADPC raises awareness, helps establish and strengthen sustainable institutional
mechanisms, enhances knowledge and skills, and facilitates the exchange of information,
experience, and expertise. The organization also deploys disaster risk management (DRM)
information and systems to reduce local, national, and regional risk across this large
region.8 Australia has a system very similar to the United States. The states and territories
have primary responsibility for life and property within their borders, and they must rely
on their own plans and arrangements to respond to natural or human-made emergencies
that threaten life or property. When a jurisdiction deems that their resources will not be
able to effectively manage an incident it can ask for help from the Australian Government.
This request is delivered through the Australian Government Disaster Response Plan
(COMDISPLAN). Emergency Management Australia (EMA) receives the request for
assistance and responds through the Australian Government Crisis Coordination Centre

4. (CCC). CURRENT PRACTICE Operations Most disaster response begins with an immediate
response from bystanders on the scene. Some will immediately act, and others will run.
Most people, if able, call for help (911, 112, 118, 119, 999, etc.). Police, fire, and EMS
personnel are usually the first responders to the incident or disaster. Those first on-scene
will undoubtedly be overwhelmed, but these important rescuers need to sweep the scene
for safety, assess the scope or extent of the situation, identify the number of victims,
determine and summon additional resources needed, and then assess for the need for
immediate lifesaving techniques. Disaster mitigation very often starts with the very first
arriving group to the incident. Triage priorities change during any mass casualty incident
(MCI), and personnel must be well versed and well trained with the concepts of disaster
management and triage of multiple casualties. An initial command area, known as the
emergency operations center (EOC), will need to be designated and set up in an appropriate
area, followed by an assessment of short- and long-term additional resources needed from
local, state, and federal partners. This will simultaneously include organizing an ICS.
Disaster operations vary in size and complexity depending on the nature and duration of
the event, as well as resources needed to stabilize the incident. The operations section is
responsible for managing all operations directed toward reducing the immediate hazard at
the incident site, save lives and property, establish situation control, and restore the area to
normal conditions (Figure 41-1). This section establishes a methodical strategy and the
actions needed to accomplish the goals and objectives set by Command (IC, Safety Officer,
Public Information Officer, Senior Liaison, and Senior Advisors) to achieve response
objectives. Common tactical resources required at a disaster incident include fire
suppression, public health, public works, technical rescue, hazardous materials
containment, and EMS. The incident itself will define the type and quantity of resources
needed to attain the objectives set by command personnel. A hurricane, tropical storm,
tornado, or earthquake may often require a national response and will have specific
concerns and issues, but an act of war or terrorism will require other additional resources
to be deployed. The ICS is the national standard for providing guidance and organization
with respect to the assets needed to respond to an incident and the process of the response
through all stages of the event, no matter the size or complexity. The ICS introduces a
number of concepts, including “Span of Control” and “Unified Command” (all discussed
elsewhere in this book). It is a flexible management structure, allowing for expansion and
contraction of all sectors based on the dynamics of the incident. In Operations section
Branch(es) Divisions/ groups Resources FIG 41-1 Operations Functions. Downloaded for
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late 2004, the Department of Homeland Security (DHS) released the National Incident
Management System (NIMS) as a template to complement the ICS. NIMS is an essential
foundation of the National Preparedness System (NPS). Per the Federal Emergency
Management Agency (FEMA), NIMS is a “systematic, proactive approach to guide
departments and agencies at all levels of government, nongovernmental organizations, and
the private sector to work together seamlessly and manage incidents involving all threats

5. and hazards—regardless of cause, size, location, or complexity.”9 It provides a common
approach for managing all incidents consistently while allowing for flexibility. It is strongly
encouraged and recommended that all agencies practice the basics on a daily basis with
small incidents, so that a response to a larger incident is more seamless and practiced when
it occurs. The Operations Section Chief is the individual designated by the IC to manage and
command the Operations section. He is ultimately responsible for developing and
implementing strategies and tactics to meet the incident objectives set by the IC and the
IAP. This plan details the objectives of the mission and how they will be met. An IAP should
be written for every operational period during the disaster. Tactical decision making (i.e.,
how, when, and where to deploy certain resources to mitigate a disaster) is also the
responsibility of the Operations Section Chief. The ability to make these decisions in a
competent fashion, however, is predicated on a continual flow of information both from the
field and from the command sector. If an incident spans more than one operational period
(usually one work cycle), the operations chief may assign a deputy to work the opposite
shift to ensure adequate time for nourishment and rest. An Operations Section Chief should
be designated for each operational period. There are several goals that the Operations Chief
must accomplish during the initial stages of the response to a disaster. In addition to
managing all incident tactical activities and implementing an IAP, the Operations Chief must
decide how much to expand his or her organizational structure to match the size and scope
of the incident, and the numbers of personnel needed for assigned operations (span of
control). Supervisory personnel should be titled and placed in charge of subsidiaries within
the operations section by who is most qualified to perform the task rather than on a
person’s rank or predisaster title. Span of control within the Operations Section is
recommended to be 1:5, but may be as high as 1:10 in larger scale incidents. If this is
exceeded, branches need to be established with the same concept. The Operations Chief
must decide, in conjunction with the IC and Safety Officer, what degree of risk he or she is
willing to assume when sending emergency responders into an unstable environment to
perform search, rescue, evacuation, medical care, and mitigation activities related to the
disaster event. The Operations Chief must maintain an effective line of communication with
the various components within the section as well as with the other ICS sections and the IC.
Finally, the Operations Chief must understand the concept of flexibility when making
decisions. Disaster events may appear static to the civilian population, but emergency
responders understand that these events are dynamic in nature. Changing environmental
conditions, secondary hazards, fatigue, resource availability, psychological stressors, and
many other factors contribute to ever-changing disaster conditions, and these conditions
require adaptability and flexibility in decision-making. Thankfully, there is usually no
reason to expand the operations section of the ICS for the great majority of local incidents.
An event that the DHS labels an “incident of national significance,” however, may
necessitate creation of divisions, groups, branches, task forces, and strike teams. These
entities represent functional and geographic separation of duties. A good example of this
was demonstrated after the 9/11 disaster. The fire department of the City of New York
(FDNY) retained command and control of the entire incident and eventually developed a
271 “unified command structure” according to principles of the ICS. The terrorist attack

6. claimed many lives and resulted in a disaster site that spanned 16 acres. This required a
large-scale expansion of the Operations section. Divisions were created according to street
names that bordered the scene. Groups included functional components such as technical
rescue, fire suppression, and EMS. Branches of each group were composed of personnel
attached to a specific type of resource, such as the US&R branch. Within the US&R were
individual US&R task forces. EMS strike teams from FDNY and surrounding mutual aid
organizations were deployed in support of US&R task forces and other specialized
resources. Health and medical resources to support rescue and recovery workers on site
were provided by the National Disaster Medical System (NDMS) under FEMA’s Emergency
Support Function (ESF) #8, using disaster medical assistance teams (DMATs). A variety of
federal resources are available to assist local ICs in planning for and handling large-scale
disasters and their aftermath. Recognizing that government resources cannot meet the
needs of those affected by catastrophic events, the National Response Framework (NRF)
was developed to prepare communities. Updated in 2013, it provides context for how the
entire community works together as well as the response efforts related to other parts of
national preparedness. The NRF uses the comprehensive framework of NIMS and provides
mechanisms for expedited and proactive federal support. It is a more operational incident
management and resource allocation plan. The NRF aligns federal coordination structures,
capabilities, and resources into a unified, all-discipline and all-hazards approach to
domestic incident management. The priorities of the NRF include saving lives and
protecting the health and safety of all at the incident, ensuring security of the homeland,
prevention of imminent incidents, protecting and restoring critical infrastructure, and
facilitating the recovery of individuals as well as families, businesses, governments, and the
environment. Regarding federal assets and personnel, there are multiple emergency
response resources deployable through the DHS. US&R task forces specialize in the
response to collapse of reinforced concrete buildings, and other infrastructure and their
primary mission is to rescue persons trapped in confined spaces regardless of the etiology
of the event. They are dispatched under ESF #9 (Search and Rescue). (As noted above,
health and medical operations are deployed under ESF #8.) The NDMS is now located in the
U.S. Department of Health and Human Services, under the purview of the Assistant
Secretary for Preparedness and Response (ASPR) and the Office of Emergency Management
(OEM). DMATs are multidisciplinary teams of health care professionals that can provide
medical care for prolonged periods in a variety of formats, when local infrastructure is
incapacitated. Disaster mortuary operations response teams (DMORTs) can assist or
augment local medical examiners in victim identification and mortuary services, while
national veterinary response teams (NVRTs) can provide assistance when animal issues
arise.10 Logistics The Logistics section supports Command and Operations. This section
performs technical activities to maintain the function of operational facilities and processes.
Typical logistics functions during a disaster revolve around providing all the support needs
for the incident, including finding and ordering supplies and other resources; searching out
and setting up facilities (dining hall, incident command, etc.); arranging transportation for
personnel and supplies; equipment maintenance; maintaining fuel, medical, and
pharmaceutical supplies; food services; communications equipment or hardware and

7. capabilities; and medical services for incident personnel. The size, duration, and specific
needs of an incident dictate whether a separate logistics functional element must be created
within the ICS. Most disasters, by definition, meet the Downloaded for FAYEZ ALRUQI
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that any IC would use to establish a logistics section. Essentially, the Logistics section’s
function is to figure out how to obtain what is needed and get it to where it is needed in a
timely fashion. This is one of the most challenging sections, as resources are rarely
preestablished. Physical space that is structurally sound can be very challenging to find, and
manpower may be an issue depending on the scale of the event. The Logistics Section Chief
manages and commands this section. He or she has a list of tasks including briefing the IC,
determining which facilities can be used, notifying resource units when they are activated,
assessing the Incident Communications Plan, providing input with regard to preparation of
the IAP, ensuring coordination between Logistics and other Command and general staff,
attending planning meetings, ensuring the safety and welfare of Logistics personnel, and
ensuring proper documentation with respect to Logistics tasks. If an incident spans more
than one operational period (usually one work cycle), the logistics chief may assign a
deputy to work the opposite shift to ensure adequate time for nourishment and rest. The
section is typically divided into two branches (Figure 41-2): Service and Support. units
located within the Service branch require human interaction and include Communications,
Medical, and Food. The Support branch is composed of functions that typically do not
involve human interaction and include Supplies, Facilities, and Ground Support. The
Communications unit is responsible for installing, maintaining, tracking, and testing all
communications equipment. This unit is responsible for planning the radio frequencies,
establishing networks, setting up on-scene telephone and public address equipment, and
providing all communication links. This is possibly one of the most important units, as
efficient communication is the key to response and mitigation. This unit also supervises and
operates the incident communications center, as well as prepares a communications plan.
The Medical unit located within the Service branch warrants special attention. It is often
confused with the delivery of routine EMS at a large-scale incident. Emergency medical
functions fall within two distinct categories in the ICS. EMS is typically a branch within the
Operations section, and the responsibility of the EMS branch is to provide emergency
medical care and treatment to victims of the disaster. The Medical unit of the Logistics
section is designed only to provide emergency medical evaluation and treatment to disaster
responders and incident personnel. This unit is also responsible for developing the Logistics
section Service branch Support branch Supply unit Food unit Ground support unit
Communications unit Facilities unit Medical unit FIG 41-2 Logistics Functions. Incident
Medical Plan for incident personnel, providing basic public health medical needs (vaccines,
prophylaxis, mental health), transporting incident personnel if injured, and coordinating
mortuary affairs for incident personnel fatalities. The Incident Medical Plan needs to
include potentially hazardous areas or conditions, off-site medical assistance facilities,
procedures for handling complex medical emergencies, and information on medical

8. assistance capabilities at incident locations. The Food unit is responsible for planning
menus, ordering food, providing cooking facilities, maintaining food service areas, and
managing food security and safety. This unit is especially important for extended incidents.
This unit is often assisted by NGOs such as the Red Cross, who may provide personnel or
other assistance. If this is the case, the Operations Section Chief and IC need to be involved
to ensure operational continuity. The Supply unit orders, receives, processes, stores,
inventories, and distributes all supplies. It also handles all tool operations and is
responsible for projecting resource needs based on the IAP. The Facilities unit sets up,
maintains, and demobilizes facilities including the Incident Command Post, Incident Base,
camps, food and hydration areas, sleeping quarters, sanitation areas and showers, lighting,
and staging areas. It is also responsible for ordering lighting units, fire extinguishers for
tents, and portable toilets. The Ground Support unit maintains vehicles, all ground support
equipment, fuel supplies for the mobile equipment, provides transportation supporting the
operation, and develops the Traffic Plan. There are numerous examples of large, devastating
disasters that resulted in high mortality around the world. Many of the issues with regards
to rescue and medical assistance were a result of a severe deficiency with respect to
Logistics. The United Nations called the 2004 Indian Ocean 9.0-magnitude earthquake and
resulting tsunami a “logistics nightmare.” The tsunami killed more than 230,000 people, left
1.7 million people homeless, and traveled 375 miles in just 75 minutes. The response to the
tsunami disaster was quite complicated, but was also significant. NGOs and governments
from all over the world sent supplies to the area. Early in the response, flights to an airport
in Indonesia were suspended because there were too many airplanes already on the
ground, unable to unload their cargo because of lack of space at the airport. Ground
transportation was ineffective and in short supply, and washouts of the roadways made
delivery of the supplies difficult.11 Ironically, the biggest ongoing logistical challenge in the
response to the Southeast Asia tsunami was how to distribute the abundance of supplies
and funding. Similar issues with logistics were seen in Haiti in 2010 after a 7.0-magnitude
earthquake resulted in the deaths of 230,000 people and essentially displaced 2.3 million
people. The infrastructure there could not handle the international response, and many
issues persisted for years. In the United States, Hurricane Katrina struck the Gulf Coast in
2005, causing levee breaks that devastated New Orleans. It had quickly strengthened from a
category 1 hurricane to a category 5 hurricane after it crossed Florida, and struck as a
category 4 hurricane. A White House document from the office of President George W. Bush
called The Federal Response to Hurricane Katrina: Lessons Learned noted the following:
“The Department of Homeland Security, in coordination with State and local governments
and the private sector, should develop a modern, flexible, and transparent logistics system.
This system should be based on established contracts for stockpiling commodities at the
local level for emergencies and the provision of goods and services during emergencies. The
Federal government must develop the capacity to conduct large-scale logistical operations
that supplement and, if necessary, replace State and local logistical systems by leveraging
resources within both the public sector and the private sector.”12 Downloaded for FAYEZ
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9. ©2019. Elsevier Inc. All rights reserved. CHAPTER 41 Operations and Logistics PITFALLS
There are many systems internationally for the management of largescale disasters. The
basics of disaster management remain the same, but the application of these concepts to the
incident often illuminates the shortfalls and issues with all systems. Most problems are
predictable and recur at every major disaster to some degree, but there are some common
factors that are associated with ineffective disaster management (Box 41-1). ICs and Section
Chiefs must be flexible in decision making and delegate authority when necessary. They
must adapt to changes in incident conditions; maintaining mission priorities is essential.
Regardless of the amount of training and preparation, there are still predictable obstacles to
overcome during any disaster response. Personnel from different agencies are usually not
accustomed to working with each other, and terrorist events will especially create a level of
distrust and anxiety when interacting with others one is not familiar with. Communications
systems are commonly very different among responding agencies, and communication is
the key to facilitating any response. Tactical objectives, resource familiarity, personalities,
and political motivations are all additional factors that can make a response less effective.
While it seems obvious for every local government to have a discussion around emergency
preparedness, there is still an overwhelming false comfort that the cavalry (federal
government) will show up in a timely manner. The truth is that federal assistance will
usually take up to 72 hours to organize and deploy. This leaves many communities on their
own for the first 72 hours as they respond and begin recovery. Most communities have
developed fairly comprehensive emergency management plans to address the hazards in
their region, but they lack key personnel from the public health and medical sectors and
they fail to define everyone’s roles in advance of a major incident. They also usually have
one plan and no back-up plan. For example, they may designate a school for a shelter,
without taking into account that the school may also be affected, necessitating multiple
back-up alternatives. There are a number of resources for planning from many reliable
sources. FEMA has a website dedicated to preparedness. The World Health Organization
(WHO) has resources as well, and the Centers for Disease Control and Prevention (CDC) also
has resources readily available with regard to managing MCIs. Dr. Joe Barbera and Dr.
Anthony MacIntyre at George Washington University have BOX 41-1 Partial List of Factors
Associated with Inefficient or Ineffective Disaster Operations • Lack of accountability,
including inadequate supervision and ambiguous or absent chains of command • Poor
communications due to inefficient uses of available communications, failure of and lack of
redundancy in communications systems, and conflicting codes and terminology • Lack of an
orderly, systematic planning process • No common, flexible predetermined management
structure to enable delegation of responsibilities and manage workloads efficiently • No
predefined methods to integrate interagency requirements into the management structure
and planning process effectively • Inability to control access to the disaster site, to manage a
large influx of unsolicited disaster volunteers, and to curb “freelancing” among emergency
response personnel • Difficulty in coordinating, tracking, and documenting human and
materials resources 273 designed a comprehensive model for the management of MCIs as
well as more routine emergency incidents that have predominantly a health and medical
focus. The Medical and Health Incident Management (MaHIM) system describes an

10. “overarching system for organizing and managing the many diverse medical and public
health entities involved in mass casualty response.” It is based on principles of public health
and emergency management and attempts to delineate the community approach to
problem-solving and emergency response in the setting of a MCI rather than the individual
response of an EMS service, hospital, or public health department.13 The value of having an
area Medical Operations Center (MOC) was demonstrated during the 2007 wildfires in San
Diego County, California; its roles and involvement in evacuation of three hospitals and
multiple nursing home patients and their later repatriations have been well documented.14
Health care and hospital workers should be familiar with the Operations section of the
Hospital Incident Command System (HICS), which complies with the NRF. Finally, EMS is
different all over the world, and the concept of prehospital emergency care is still foreign to
many communities, countries, and governments. An effective disaster response works best
when prehospital personnel are trained, prepared, and ready to go. Skilled prehospital
providers are the key to mitigating and recovering from a large-scale incident.
Internationally, we must work to educate communities about the importance of EMS and
the absolute need to fund such initiatives. CONCLUSION The concepts of “Operations” and
“Logistics” are common ideas internationally, although initiated differently in different
countries. Around the world, disaster experts are talking about the operational and
logistical issues we all face within our regions. Some countries are rich in resources and
others are very poor in resources. With the Internet and “breaking news” on television we
hear of catastrophes shortly after they occur; international responses are not only planned,
but also immediately initiated. Eventually we are going to need to speak a similar language
internationally, conform to the same rules of conduct, credential our people to ensure the
safety of the victims as well as our humanitarian responders, and educate each other with
regard to our resources and needs ahead of time. Coordination and credentialing of
emergency responders, development of a command structure, tracking of resources, and
maintenance of functional communications systems remain challenges that will be
encountered at every disaster event. Anticipation of pitfalls in disaster response and
logistics support and development of adequate contingency planning may be the most
important lessons to teach to those who will fill command and leadership positions at a
disaster incident.15 It is time we start speaking the same language, remove the barriers, and
help each other prepare, educate, respond, and recover after a devastating event.
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