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Emergency Preparedness Involves More Than First Responders
By Dr. Irwin C. Harrington, PH.D., CHS-I, CDP-I

A crisis is brewing in America that necessitates immediate attention by lawmakers before cases of personal liability reach into the billions of dollars. In recent years, hospitals across the nation have had to alter the traditional role of their emergency rooms to accommodate the changes in need of America's health care system. Today's hospital emergency rooms that once were primarily occupied by the most seriously ill now resemble medical triage service departments for individuals incapable of paying for care provided by their primary doctors. Yet, for those hit the hardest during the current financial crisis the nation is enduring even turning to an emergency room for care is burdensome. The continuous rise in health insurance premiums despite the legislature passed by President Obama is placing many in this country in a state of health care despair. "More than 60% of U.S. residents rely on employer-provider health insurance. But in recent years, most of the major labor disputes which have resulted in strikes have included the employers' desire to reduce payments for employee health insurance and transfer those costs to the employees" (Haughton, 2005). Today, for every ten individuals in need of medical attention more than half are being turned away by their local emergency room because either they do not have adequate medical coverage or the emergency room lacked the necessary resources to address their needs. What has become of our society, whereby, the primary means of health care for millions is the emergency room? A volatile society that continues to change in result to recent events throughout the world has challenged the capability of emergency responders to respond efficiently to the most disastrous events. Everyone from local politicians, to those sitting in federal office, as well as the average citizen in the suburbs of Alabama, should be asking themselves whether as a nation we are prepared for the occurrence of the next major disaster.

Focus of Study

The focus of this study was to examine the inconsistencies of emergency response preparedness in America. The overt overcrowding of hospitals across the nation denotes that as a whole this country is not prepared to handle another major disaster if one was to occur today. During incidents of mass chaos where millions of lives are at stake, emergency preparedness involves more than fire and police personnel to mitigate disasters and potential public health liability associated with crises. In a volatile society the effectuation of any emergency response operation during incidents of mass chaos at the magnitude of the September 11, 2001 terrorist attacks, Hurricane Katrina, the 2004 Southeast Asia Tsunami, and the more recent the 7.3 magnitude earthquake in Japan has to include the health care industry. After all, it will be the body of professionals who make up the health care industry that will care for the sick and injured, who in the aftermath of any particular disaster will be essential for the efficient recovery of the affected area.

Reason to Prepare for Disasters

A recent study of the readiness of emergency responders denotes that areas in the emergency management industry still exists that are not a hundred percent prepared to respond to a disaster.

Ready or not, with tornadoes flattening towns, wildfires blazing in parts of the country, and hurricane season looming, Americans are fairly confident that local authorities are prepared for natural disaster—but they don't have much faith in the federal government. Two-thirds of respondents to a new Gallup/USA Today poll said that the feds aren't ready. Community first responders got the highest marks for readiness: 68 percent of respondents said that their local police and fire departments would be prepared to deal with a natural disaster. Sixty-two percent said that local hospitals were ready, and 60 percent said that their own families were prepared (Glazer, 2007).

As witnessed on March 9, 2011 in Japan, an emergency or disaster can occur at any time. There may be advanced warning signs such as in the case of hurricanes, tornadoes, or floods. There may be potential for an emergency occurring during a local event, such as the Olympics, the Super Bowl, or a visit by the high ranking government officials such as the President. However, during the most severe forms of disasters such as during an unexpected earthquake, there is often no advanced notice to prepare citizens for the worst. Subsequently, it becomes the responsibility of every public safety official to include public health professionals to take proactive measures to mitigate the potential destruction and loss of life that disasters leave behind.

During most incidents, health care facilities are considered essential for the care of the injured as the degree of emergency preparedness shifts from every day procedures to a heightened status. While at other times when everything is calm, the planning that most municipalities undergo to prepare for disasters rarely include the public health care system. Yet, in view of recent events, there should always be a need for interagency collaboration planning to include public health to assure optimal recovery from incidents in disaster prone areas subject to cases of a mass casualty accident, terrorist attacks, chemical plant explosions, and power outages. Despite the critical incident that demands the attention of emergency professionals (fire, police, EMS, and government agencies) the mode of response should be proactive. In a world filled with uncertainty, a proactive response to a disasterous situation is dependent on the ability of emergency managers to devise an effective emergency preparedness plan.

An independent study group conducted a survey of the nation's largest cities to get an actual glimpse of how truly prepared the nation was for another significant disaster. Overall, the results of the survey indicated that collectively the country was not as prepared for another disaster as many politicians perceived it to be. In particular, the area of transportation received the lowest scores of the areas considered crucial to the survivability of the American citizenry in the event of another major disaster.

The majority of America's urban areas received a failing grade on their ability to evacuate citizens in the event of a disaster, according to study released by the American Highway Users Alliance. It graded 37 of the largest urban areas in the country with more than 1 million people, and found 25 would have greater problems evacuating their citizens than New Orleans did during Hurricane Katrina. They failed on three criteria-internal traffic flow, capacity of major exit routes and accessibility to automobile transportation (Congress Daily, 2006).

Subsequently, considering that the last two major incidents in the United States, September 11, 2001 terrorist attacks and Hurricane Katrina, both occurred when the American citizenry least expected them, it should be apparent to public safety professionals that the reason to prepare for disasters is not only to protect their constituents from unexpected life threatening events, but also to develop contingencies to assure the infrastructure of their immediate environment could withstand the magnitude of the disaster. In planning for the worst, proactive preparations prior to an incident display a sense of professional diligence viable to the reduction of risk and presumptive liabilities.

Necessary Measures for Disaster Preparedness

At the onset of a disaster, a community's first line of defense is the brave men and women who put on uniform of first responders (local police, firefighters, and emergency medical professionals). These brave souls are trained to know that in the event of a disaster they must take appropriate actions to resolve the incident before it escalates out of control. Yet, despite training the first responders receive while attending their perspective training academies and subsequent on the job experience, most are unprepared to deal with the most severe form of disaster. In most cases, during severe circumstances when everything that could go wrong does, on-the-job training goes out of the window, and basic instincts dictate the of mode response for first responders. At this time, public safety personnel typically would turn to their pre-established critical incident plans to resolve the disaster as it escalates to a major catastrophic event.

Disaster management goes beyond simply developing operational plans that are placed on a wooden book shelf and revisited when incidents grow out of control. The effectuation of any disaster management plan should be fueled by the premise of constant review and revisions. In a volatile society filled with unknown potential crises, it is the responsibility of every public safety professional to develop emergency preparedness plans that take into consideration a wide magnitude of operational influences. Unequivocally, properly trained and equipped public safety professionals who proactively follow a pre-established emergency preparedness plan are invaluable in a world of uncertainty. Unfortunately, the current capabilities of public safety professionals are hindered by the lackadaisical approach of a few emergency managers who have yet to realize that emergency management is not a one-step approach to resolving a disaster. Rather, emergency management entails a full-scale approach that incorporates a team effort.

Operational Preparedness

In a post 9/11 environment, public safety professionals must come to realize that the success of their emergency operations is highly dependent on their ability to effectively plan and understand the concepts of disaster management. By failing to pursue their communal duties through a consideration of the concepts of disaster management, public safety professionals will continue to place the lives of their constituents at risk. Essentially, preparing for disasters to minimize future societal hardships amongst the socioeconomic sector involves a forward thinking approach by public safety professionals. "Planning for hardships ahead of time is vital for businesses that need to carry on daily operations" (Beichman, 2004, pp.18). To successfully mitigate disasters in a volatile society requires public safety professionals to develop an understanding of the National Incident Management System, challenges to the nation's infrastructure, and the ideologies behind risk management. Without these it would be difficult for any individual in a position of authority during a disaster to allocate essential resources effectively to fulfill mission requirements.

Even before 9/11, the federal government, in cooperation with local agencies, had been working diligently to develop emergency preparedness plans to address incidents such as the bombings of the Oklahoma City Federal Building and the first World Trade Center attacks. "Over the last decade, the federal government has mandated that its departments and agencies, including the U.S. Department of Housing and Urban Development (HUD), develop emergency preparedness and continuity of operations (COOP) plans" (Beichman, 2004, pp.18). However, with the unexpected occurrence of the 9/11 attacks, public safety professionals are now faced with the reality that they must include new forms of risk and hazards in their emergency preparedness plans. "Many conventional risks look set to take on new forms, and new hazards are emerging, some of which are characterized by considerable uncertainty on the one hand, and the possibility of extensive and perhaps irreversible harm on the other" (Lazo, 2003, pp.3).

The National Incident Management System

Considering the notion that disasters could occur at an unexpected moment, the first priority for emergency managers in the process of developing an emergency preparedness plan should be to form alliances with disparate entities. The National Incident Management Systems (NIMS) is a vehicle that affords emergency managers the opportunity to form necessary alliances to respond to disasters under a unified voice. "NIMS is the first standardized management approach that unifies federal, state, and local lines of government for incident response. The NIMS system evolved from the Incident Command concepts pioneered by the Phoenix, Arizona Fire Department and State of California" (Anderson, 2004, pp. 3).

In the past twenty years, the world has witnessed the advancement of technology and modes of transportation beyond the capacity of rational thought. The internet has made it possible for terrorist cells in one portion of the world to communicate in real time with cells in another. This increases the threat to communities in the process of recovering from a recent disaster, as they will be vulnerable to potential acts of terrorism. In consideration of the notion that terrorists would use any means to pursue their intent of malice, it only makes sense that public safety professionals glean from past experience that it is impossible to protect their constituents from a disaster without the aid of a disparate entity. Notably, when developing their emergency preparedness plans, emergency managers should step outside of their comfort zone and collaborate with other safety agencies to efficiently respond to a potential disaster through the application of the NIMS systems. The NIMS system not only provides the managerial ingredient necessary for effective communications between disparate agencies, but also assures these agencies efficiently achieve the four concepts of emergency management (preparing, mitigating, response, and recovery).


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