During routine response operations, individual organizations develop standard approaches and enforcement authorities for implementing safety decisions. However, implementing safety management decisions at a disaster scene is much more complex. Clear lines of authority for safety management frequently do not exist at the incident level for major disasters. While the Incident Commander coordinates the activities of all the organizations involved, he or she does not have direct command authority over all of them.¹ The involvement of many separate response organizations and, furthermore, the participation of independent, convergent volunteers in disaster response operations make taking effective action to protect responders more difficult.

Figure 6.1 Taking Action
Communicating and implementing safety decisions Providing health maintenance measures and medical care Managing human resources and safety-related supplies
RAND MG170-6.1

Effective Mechanisms for Implementing Safety Decisions: Improving Safety Implementation During Multi agency Response Operations

Because individual responding organizations retain primary responsibility for protecting the safety and health of their members, centralized mechanisms do not exist to enforce even minimum levels of protection across different responder groups. While it is important that organizations retain clear responsibility to protect their members, responders indicated that this inability to establish a common protection strategy for an incident can undermine all organizations’ efforts to implement safety measures. On the one hand, the presence of responders with little or no protection can lead others to question whether they really need to use protective equipment; conversely, if some responders use much higher levels of protection, this can result in questions and stress for others about whether they have been adequately protected.

These multi agency implementation difficulties are exacerbated by other characteristics of the post-disaster environment:

Large Geographic Scale. The size of disaster scenes makes it very difficult to implement safety decisions across all involved responders. Different groups often operate in different areas and may face different types and intensities of hazards, producing further barriers to effective coordination. The large scale of disaster sites also makes perimeter control less effective or impractical. In multi agency response operations, scene control can provide a critical safety enforcement mechanism because individuals monitoring the perimeter can verify that responders entering the scene are appropriately trained and equipped to operate safely.

Large Numbers of People Affected, Injured, or Killed. The selfless desire of responders to assist disaster victims as rapidly as possible can be a barrier to safety implementation. This drive to help victims can push responders to disregard safety practices perceived to reduce their response effectiveness. The perception among responders that respiratory protection hindered their ability to work was cited as a major reason for low usage of the equipment at the World Trade Center response [Jackson et al. 2002].

Damage to Infrastructures. Just as damage to technological and communications infrastructures hinders collection of safety-related information, it also presents a significant barrier to safety implementation as well.

Recommendation 6.1—As Part of Multi agency Preparedness Efforts, Address the Issue of Safety Implementation

Implementing consistent protection measures across multi agency disaster operations requires that all involved organizations abide by the safety decisions made by the disaster safety manager(s).² Because the Incident Commander does not necessarily have direct command over responders from all other responding organizations,³ a common approach must be built from broad trust in the safety leadership and an overall consensus that the minimum safety requirements put forward are reasonable for the conditions of the response. Individual response organizations and units enforcing common minimum safety standards for their members—or agreeing to support common, incident-wide enforcement efforts—support adherence to these standards.

Because the high-pressure conditions after an event are not conducive to the development of such a multi agency consensus, safety implementation should be included in preparedness efforts. Responders collectively labeled these efforts as building a common “culture of safety” among responding organizations [Study Interviews; Study Workshop]. Components that should be addressed in this preparedness process could include consensus safety policies for given disaster types and agreement on acceptable enforcement mechanisms for safety policies during response operations. Standardized planning tools—such as a model disaster safety and health management plan—could serve as a framework around which organizations could develop this consensus.⁴ Such a model plan could be adopted by emergency managers and responder organizations as a starting point for responder safety planning and modified to reflect the specific requirements of the local area. Use of Unified Command and regular multi agency exercises was also cited as an important mechanism to build this common understanding.

Recommendation 6.2—As Part of Preparedness Planning, Include Safety and Risk Communication

Given the communication problems often associated with disaster situations, it may be difficult for safety managers to effectively communicate hazard and safety information. Participants in study discussions indicated that improved mechanisms are required to communicate needed information in large-scale responses. For safety management, clear communication channels are needed to allow communication from incident command to response organizations, to response units, and, if appropriate, to individual responders. Because of the potential for disruptions after disasters occur, backup options are needed for critical communications.⁵ Because there are so many potential methods for providing communications—including a wide range of technological and organizational options—study research did not identify specific solutions. However, based on experiences in recent disaster operations, study interviewees did highlight the potential usefulness of multi agency safety meetings, responder briefings, and safety-related public information strategies in multi agency response operations.

Periodic safety meetings were cited as useful in disseminating safety information to the range of organizations involved at a major incident. Such sessions provided a centralized way for this type of communication at both the Pentagon and the World Trade Center responses. However, responders indicated that the effectiveness of information being transferred from the safety meeting through organizations to responders could differ considerably. Some organizations were very effective at transmitting new or updated guidelines to their members while others were less so. Interviewees cited particular problems in communicating effectively with skilled trade and other construction workers who are less frequently involved in disaster response operations.⁶

A primary strategy for communicating safety-related information is the consistent use of safety briefings or orientations before responders begin work at a response or at the beginning of daily work shifts. Because such briefings are familiar in a range of different response professions, they provide a structure that can be useful for a number of different groups. To be relevant throughout a sustained response, however, such briefings must be updated constantly and provided to responders regularly. Responders indicated that broader-based methods of communication could complement these on-site orientation briefings. Strategies and methods to get information directly to responders on protective equipment requirements or particular hazard information were seen as effective.

In particularly large-scale responses, study discussion participants indicated that the incident command’s public information strategy could be a key component of safety communication to responders. Because information released to the media has many avenues to reach individual responders, public releases of hazard information can be an important route to increase responder protection.⁷ Responders emphasized, however, that the release of conflicting, misleading, or otherwise unclear information by multiple response organizations does not benefit safety. As a result, there must be effective coordination of the information being released by all responding organizations, ideally through a single point of contact, so the incident management structure speaks with a single voice. In addition, public information release efforts must make clear any differences between hazards involved in response activities and more general hazards to which the public is exposed to minimize general confusion over any disparities in required protection levels.

Recommendation 6.3—Pursue Effective Scene Control As a Safety Enforcement Measure

Study discussions with responders suggest that there is broad agreement on the importance of scene control as a safety enforcement strategy. If a hard perimeter can be put in place around a scene and the entry points controlled, crossing the perimeter becomes an opportunity to make certain that all responders entering the scene are informed, trained, and equipped in accordance with the response safety procedures. Responders who are not in compliance can be identified and denied access to the scene.⁸ However, difficulties in establishing a perimeter at very wide area events, such as the Northridge earthquake and Hurricane Andrew, make this strategy problematic for enforcing safety for entire response operations. Establishing secondary or internal perimeters at a disaster scene is also crucial for enforcing safety practices for particular areas of the scene. At many disaster sites, particularly those involving the release or potential release of hazardous materials, Incident Commanders will seek to isolate areas of particular hazard by establishing an internal perimeter.⁹ Internal scene perimeters that define areas for equipment or other traffic, as part of an overall traffic safety plan for the incident scene, are also critical for protecting responders from vehicle- related hazards.

Although there is a range of operational reasons for why effective scene control is desirable at a major disaster scene, it can make a critical contribution to effective safety management and enforcement as well. Control of the scene perimeter and internal traffic provides the management structure with an enforcement mechanism that can cut across organizational boundaries. Therefore, response organizations should endorse and foster multi agency acceptance of scene control as a component of preparedness planning and rigorously implement scene control in the event of a major incident.¹⁰ This planning must include training for all relevant responders on effectively enforcing entry/exit, checking for required protective equipment, and other policies as part of monitoring the incident perimeter.

Recommendation 6.4—Provide On-Site Training, But Not As a Substitute for Pre-Incident Training

The diversity of response organizations involved in major disasters can result in some responders lacking needed information to follow safety policies or implement protective measures. One way of addressing these responder training needs is by providing workers necessary information on-scene at the disaster site. Although stressing the importance of on-scene efforts as an element of risk communication, site-safety orientation, or instruction in the use of particular protective equipment, individuals in the emergency response community interviewed for this study generally believe that such “just-in-time” training is an inadequate substitute for the more complete training that can be delivered before an incident occurs.¹¹ Such efforts may also be effective in providing “refresher” training for personnel who had previously received instruction or in providing specific information on nonstandard equipment or response techniques. Otherwise, any individuals or responding units lacking the necessary pre incident training for operating in the hazardous areas of a disaster scene should be removed from the site at the earliest possible time.

Measures to Protect the Health of Responders: Adopting a Force Health Protection Approach

In an analogy to concepts from the military, the study team drew on the idea of “force health protection” to broadly describe measures that can be employed by emergency response agencies to ensure that the force can “live to fight another day.” However, the characteristics of disaster response situations make it difficult to effectively implement measures to provide for responder health maintenance and treatment needs.

Large Numbers of People Affected, Injured, or Killed. During the early phases of response, medical activities are often focused on the needs of disaster victims; in situations where many victims require assistance, responders may ignore their own injuries to continue helping others [Study Interviews].

Prolonged Duration. The duration of major disaster response operations creates the need for additional safety implementation activities that are not needed in routine emergency response. From a drive to rapidly address the needs of the victims, responders often work for extended periods.¹² Such practices can result in exhausted responders losing their capacity to work effectively and, through poor decisions or direct action, hurting themselves or others. It was reported that responders and managers worked unsustainably long work shifts at Hurricane Andrew, the World Trade Center response, and the response to the anthrax attacks [Study Interviews].¹³

Multiple, Highly Varied Hazards. Disaster-specific hazards can require health protection and treatment options that may not be routinely available to responder organizations. Beyond physical injury or hazardous exposures, the traumatic nature of major disaster situations can result in significant critical incident stress issues.¹⁴

The effects of some hazards may not become manifest for some time, creating the potential for disaster-related impacts over extended periods.

Recommendation 6.5—Improve Health Maintenance by Preparing and Implementing Sustainability Measures

Workforce health protection encompasses a variety of activities designed to maintain the health of the responders through extended disaster operations. Regarding responder medical care, a study workshop participant described such sustainability efforts this way,

It’s basic preventive medicine and public health: eating, sleeping, drinking, washing hands, showering. There is a need to break down the management mind-set that allows emergency responders to work beyond the point of exhaustion and not have basic sleep hygiene [Study Workshop].

These measures include the provision of rehabilitation to reduce fatigue and provide near real-time medical monitoring of emergency responders [NFPA 2002c, 8], the enforcement of work/rest ratios, and the development and enforcement of decontamination procedures appropriate to threats involved at the disaster site.

Rehabilitation. Response managers must recognize the long-term nature of disaster response operations early and put rehabilitation measures in place both for managers and for workers. These measures must be mandatory, and it is critical that response leadership “lead by example” because of the tendency of emergency responders to emulate leaders who continue to work despite obvious exhaustion [Study Workshop]. Study workshop participants, while concurring with the importance of rehabilitation to the sustainability of the workforce, suggested that this concept is poorly defined in many emergency response systems. They pointed to a lack of adequate pre-planning as part of the problem [Study Workshop].

Rehabilitation should include an opportunity for a break (both physical and mental) from response activities. Effective mechanisms to ensure that food and drink are available to responders are also critical components of planning; the practical requirements of delivering such necessities to responders can differ considerably among disaster types [FEMA 1992]. A formal rehab process also should include simple preventive health assessments (such as monitoring heart rate and checking blood pressure) as well as a quick assessment for stress.¹⁵ Rehabilitation can also provide an opportunity to relieve some stress via information dissemination and rumor control [Study Interviews].¹⁶ In some major disasters, emergency responders and their families may be victims as well [Lewis 1993; Study Interviews]. Rehab breaks can provide an opportunity to reassure responders by giving them access to telephones to check in with their families.

The rehabilitation structure needs to be managed within the ICS and approached systematically rather than being left only to voluntary groups that deploy to the disaster site. It has also been argued that a formal process of rehabilitation, if used at every level of incident and not just major disasters, will become second nature to emergency responders, and that will help with compliance [Study Interviews]. Workshop participants endorsed the need for development of a “checklist” to help local communities prepare for responder rehabilitation activities, noting that a range of appropriate activities will be related to incident type and duration [Study Workshop].

Work/Rest Ratio. One of the specific issues in dealing with responder fatigue is the need for a near real-time mechanism for monitoring how long individual responders have been working at the disaster site. Although managing responder shift changes and work periods is a key function of the planning section of the ICS, when no one is monitoring how long individuals have been on-site, many will keep working well past exhaustion [Study Workshop]. In addition, as with rehabilitation policies, if leaders show no concern for their own welfare, the “troops” will follow their lead. Unfortunately, workshop participants felt that it was often true that “the ones least likely to give up the reins and put their weight behind rest and rehab are the ones at the top” [Study Workshop].

The appropriate work/rest ratio may change over the course of an incident. The first six hours may be the most physically and mentally demanding time for the Incident Commander and senior leaders at the scene [Study Workshop]. Therefore, although the pressure to stay at the scene may be intense, shift change in the most early phase of an emergency event may need to be sooner rather than later for senior leaders [Study Workshop]. An appropriate work/rest ratio has to be defined by what the emergency responders are doing and the equipment they are wearing; however, shifts of longer than 12 hours will undoubtedly result in risks brought on by fatigue [Brainard and Behrendt 1993].¹⁷ It is also important to recognize in planning for manpower at the scene that, when decontamination is required and travel time is included, a 12-hour work shift actually may amount to 14 or 15 hours or more. Inclusion of responders’ personal needs in safety planning—providing opportunities for them to obtain food, sleep, and personal hygiene facilities near the incident scene—can enhance opportunities for rest by reducing needed travel. Where possible, rotation of multi agency emergency teams is an alternate mechanism to allow for longer periods of “downtime” for emergency responders [Study Interviews]. Shifts are also much easier to enforce if all responder agencies are following the same shift schedule. If that is not possible, color-coded event badges (discussed previously) could be used to help with the enforcement of the work/rest ratio and rehab [Study Workshop].

Decontamination. A key aspect of responder health protection is effective decontamination procedures. Decontamination may be critical to the prevention of illness, especially in the case of a nuclear, biological, or chemical attack, and yet compliance with decontamination procedures, especially in the early phase of a major disaster, has proven to be a problem.¹⁸ In order to be used, decontamination facilities have to be readily accessible, and it is critical that response managers lead “by example.” If management neither takes responsibility for nor endorses decontamination efforts, any attempt at establishing a system will likely fail [Study Interview]. Insufficient decontamination can lead to the spread of contamination both on and away from the site. If workers who are contaminated at the site receive medical care, either on-site or in local hospitals, they can, in turn, contaminate emergency medical services (EMS) and hospital personnel [Study Workshop]. If workers who are contaminated leave the site to go home, they can contaminate their vehicles and homes, potentially exposing others to health risks.

There are some natural leverage points for enforcing decontamination procedures at major disaster sites. Hand washing can be required before access to food is allowed [Study Workshop]. If an effective perimeter has been established, trucks can be stopped for wash down before exiting the scene [Study Workshop]. Perimeter control also makes it possible to screen workers (including construction and trade workers and convergent volunteers) for contamination before they leave the disaster site [Study Interviews]. The FEMA Urban Search and Rescue (US&R) Program Staff’s after-action analysis of the September 11, 2001, response operations specifically highlighted the need for improved guidelines for “hygiene, gross decontamination, and technical decontamination” [FEMA US&R Program Staff 2002].

Recommendation 6.6—Provide Medical Care to Responders During the Early Phase of a Disaster Response Operation

Based on study discussions, there is a need for better strategies to provide medical care to emergency responders in the earliest stages of response operations. Although medical care for responders is a function within the logistics section of the ICS, during the high pressure and chaotic environment in the early phases of disaster response, effectively treating responder injuries is difficult without having medical providers directly connected to responder units involved in operations. The need for effective treatment of responders would be even more critical in some terrorist scenarios (such as attacks with nuclear, biological, or chemical weapons) that could result in significantly more responder injuries than have been experienced to date. Disaster preparedness must therefore consider potential responder injuries in different types of response operations and include plans to treat them. Key information to be factored in includes the capabilities of the local EMS system and local hospitals. Planning should also consider the potential public and responder health implications if responders or hospital staff suffer casualties in performing their missions.

One model suggested during study discussions to provide immediate treatment for responder injuries at the disaster scene is development of a “tactical medic role.”¹⁹ Workshop participants observed that, in Desert Storm, military commanders anticipated that mass casualties were a possibility; so they deployed significant numbers of qualified medics to the front lines with the troops. The fact that many firefighters have EMS training or certification means that significant capacity exists within the response community to implement this approach, although any potential impact on response units’ operational effectiveness would need to be considered.²⁰ However, assigning responders to such a role would have implications on available staff resources for other response tasks.²¹ Access to mobilized, self-contained medical teams, such as DMATs, that can be deployed on short notice is also important, especially when individual DMATs can be specifically tasked to provide medical support to emergency responders [Study Interviews].

The delivery of medical care on-site (or near-site in staging areas) often involves EMS responders and other medical personnel deployed under mutual aid agreements. In certain disasters, such as the September 11, 2001, Pentagon response and Hurricane Andrew, military medical personnel were also involved in the delivery of medical care. Deployment of military medical personnel and personnel under mutual aid agreements may raise licensing and liability issues. Any legislative actions or interagency agreements necessary to make such deployments possible should be accomplished in the pre-planning period so that they can be implemented rapidly in the event of a major disaster.²²

Recommendation 6.7—Protect the Mental Health of the Response Workforce by Managing Critical Incident Stress

Although the majority of responders exposed to critical incident stress are “normal people having normal reactions to abnormal situations” [Study Workshop], the traumatic nature of major disasters can have significant effects on individual responders and on response organizations as a whole. As a result, workshop participants indicated that there has been a “cultural change” in the responder community that has led to widespread implementation of some form of critical incident stress management in many organizations [Study Workshop]. Measures that seek to address these problems, including critical incident stress debriefing (CISD),²³ are now well established as routine practice in many organizations. Although the attention being given to this issue is considered positive, there is evolving controversy surrounding whether the measures that have been adopted to address them are sufficient.²⁴ The research performed in the course of this study was not focused on examining particular strategies to address critical incident stress. As a result, the recommendations are not focused on particular intervention methods or programs. Instead, the study examined this issue as an element of the overall hazard environment faced by responders to major disasters with respect to preparedness and response planning.

The central conclusion from both interviews and workshop discussions is that it is very important to consider critical incident stress in response planning. Beyond addressing the needs of traditional responder groups such as firefighters, police, and EMS personnel, planning should consider nontraditional responders as well. Many of those responder groups—including construction and trade workers, relief workers, and volunteers—may not have any post-incident stress management resources available [Study Workshop].

Interviewees and workshop participants also highlighted the importance of support for the families of emergency responders in addition to directly supporting the response workers [Study Interviews; Study Workshop]. Depending on the nature of the disaster, response activities could have a significant effect on all members of responders’ families. Addressing family needs can be an important component of addressing the needs of the responder, particularly when their families are at risk of being victims of the disaster.

As an element of preparedness, communities need to develop local resources for handling critical incident stress or have a plan to access other resources. Workshop participants indicated that employee assistance programs are one way to provide this sort of assistance within individual response organizations [Study Workshop]. The effectiveness of such programs is dependent on there not being barriers to employee use, such as stigma or other professional consequences.

Over the course of the study, responders suggested a range of more specific potential activities focused on periods before, during, and after the incident [Study Workshop]. For the pre-incident phase, suggestions focused on the need for responder agencies to address the overall wellness of their responders. As one workshop participant said, “if a responder went into an event with baggage, he will not come out with less baggage.” Therefore, responder organizations should be encouraged to address such wellness issues as alcohol abuse and marital problems.²⁵ Another workshop participant suggested that a routine assessment of stress issues could be done during the annual medical exam for firefighters, but the participant also indicated that not all responding organizations provide for annual medical exams.

“Stress inoculation” is another military concept that participants suggested may be applicable to the responder community. This “preventive” approach eliminates some of the element of surprise for the responder about to enter an area where there are known psychological stressors (such as dead or injured children). One workshop participant described this as similar to the model used in Vietnam with soldiers who had to transport dead bodies. Those leaving the scene would provide a “pre-briefing” for the next wave of responders, focused not on “feelings” but rather on operational issues such as what to expect in terms of sight, smell, dust, wind, and so forth.²⁶ The tactic of pre-briefing received widespread support among workshop participants, although it was noted that there is little research on stress inoculation and almost nothing on pre-briefing.

As mentioned previously, there is considerable controversy surrounding the efficacy of various approaches to stress debriefing and treatment after a traumatic incident has occurred. This lack of consensus indicates a need for further examination of this issue and further development of strategies to address the effects of traumatic incidents on individuals. In light of the potential long-term effects on individuals and response organizations, responders indicated that it was important to monitor workers during an incident for signs of excessive stress and follow up afterwards to ensure that individuals in need of treatment get it.

Recommendation 6.8—Improve Long-Term Surveillance of Responders’ Health Following Major Response Operations

The unusual hazard exposures and working conditions involved in major disaster response operations create the potential for significant, long-term health consequences of disaster response. Although there are long-term care and surveillance systems for World Trade Center responders,²⁷ such ad hoc efforts do not address the broader need for follow-up care and surveillance for responders to major disasters.

To effectively characterize the consequences to responders’ long-term health, it is clear that an accurate registry of involved responders, preferably compiled as the response is under way, is a prerequisite to any eventual surveillance or treatment effort. Workshop participants delineated a number of points of leverage during a response and in the post-incident period. As described above, perimeter control can provide the accountability information needed to determine who might have been exposed to what at the disaster site. Without information on who was involved, there is no guide for who should be screened for which potential long-term effects [Study Workshop]. Understanding where people were and what they were doing during the event is key for post-event intervention, and it is very difficult to reconstruct after the fact if the data were not originally collected.²⁸ Tracking of post-disaster health problems is also complicated by lack of baseline data and accountability information for responder activities during the response.

Human Resource and Equipment Management: Safety Effects of Responder Deployment and Supply Logistics

Although responders and equipment are needed to address the operational demands of a disaster, the uncontrolled entry of either one into a disaster scene can complicate safety management and create new safety problems. As a result, effective management of the flow of human resources and equipment into the response is critical for safety as well as operational reasons. The characteristics of disaster situations make it particularly difficult to address these areas during response management.

Large Geographic Scale. In all the disasters examined for the study, the size of the operational areas made it more difficult to effectively use responder and supply resources. In Hurricane Andrew, the uncoordinated entry of response units to the disaster area led to commanders “losing” units and significantly hindered attempts at coordinated action [Holsenbeck 1994, 191]. At the World Trade Center site, the size of the area complicated logistics and made it difficult for responders to get the supplies they needed [Jackson et al. 2002].

Prolonged Duration. Because disaster responses extend over long periods, logistics efforts must be put in place to sustain operations over days, weeks, or even months.

Multiple, Highly Varied Hazards. The presence of unusual hazards in some disaster operations creates the need for safety-related equipment that may not be maintained by all responder groups. This is particularly true for nontraditional responders. The need to provide supplementary protective equipment appropriate to the hazards increases the complexity of response logistics efforts.

Wide Range of Needed Response Capabilities. Differences in operating procedures among disaster response organizations can lead to units responding to a disaster without coordinating with the ICS. This was a central challenge at the Pentagon response [Arlington County 2002, 25 26, A-49] and in the response to Hurricane Andrew [Study Interviews]. When they do respond, members of different organizations may be equipped very differently or, in some cases, may not be equipped at all. Occasionally, interoperability and incompatibility problems among different organizations’ equipment make it even more difficult to ensure that all responders are properly equipped.²⁹

Damage to Infrastructures. Disaster effects on transportation systems can keep safety managers from getting needed supplies or response resources. For example, the shutdown of the air transport system on September 11, 2001, was a serious impediment to supplying the World Trade Center response operation and hampered FEMA US&R Incident Support Teams’ ability to respond at both the World Trade Center and the Pentagon [Jackson et al. 2002]. After Hurricane Andrew, traffic clogging surface transportation infrastructure had a similar effect [Study Interviews].³⁰

Influx of Convergent Volunteers and Supplies. Convergent volunteers, who are often not connected with any defined organization, present significant challenges to management systems.³¹ Similarly, uncoordinated delivery of supplies or equipment to the disaster scene can choke responder logistics systems. When incoming supplies are not systematically catalogued, responders may not be able to use them to support their efforts. At Hurricane Andrew, even though the state was inundated with over 2,400 tractor trailer loads of donated goods, the emergency support organizations frequently still sought supplies through contractors rather than trying to determine if the needed supplies had already arrived [Haynes and Charney 1993].

Recommendation 6.9—Adopt Better Measures to Manage the Recall and Mutual Aid Processes for Responders

Safety management depends on knowing who is operating at the disaster scene and in what capacities. Personnel accountability systems are a source of this information; however, a more effective strategy is to put measures in place to regulate how external assistance comes to, and is utilized at, the disaster scene. Although many response organizations do have such policies in place, the experiences at both the Pentagon and the World Trade Center demonstrated that the disruptions inherent in a major event can significantly hinder efforts to manage responder deployment.

Several operational and administrative measures can be employed to reduce the chances of individual responders, or even units, proceeding directly to the disaster scene without the knowledge of overall Incident Commanders. Local emergency organizations are likely to have contingency plans for managing the deployment of their own responders to the scene of a large disaster. However, such plans need to be exercised under realistic conditions that take into account the likelihood of communication failures, command problems, and strong psychological pressures on commander and rank-and-file responders to deploy directly to the disaster scene.

Similarly, local governments need to evaluate and exercise their workforce recall procedures. Entry of personnel to both the World Trade Center and Pentagon scenes was marked by substantial confusion as off-duty responders and volunteers deployed to the disaster scene and other locations [Arlington County 2002, A-39 A-41; McKinsey & Company 2002b, 10, 35 37]. The same situation occurred in Hurricane Andrew over an even larger incident scene [Study Interviews]. Well-designed workforce recall procedures can reduce the inclination of off-duty responders to rush directly to the disaster scene rather than reporting to pre designated personnel reporting sites. Better plans, redundant communications, and periodic and realistic recall exercises all strengthen workforce discipline.³² Given the protracted nature of major disaster responses, some responding units must be initially withheld so that they can eventually support multiple-duty shifts.

Mutual aid agreements with neighboring jurisdictions, within states, or at regional levels are also key mechanisms for regulating the flow of external assistance to a disaster response. To avoid exacerbating personnel accountability problems, units responding from outside the immediate area of the incident must be given and must accept authoritative guidance on how they should support the disaster response. Realizing the full value of mutual aid requires not only general compacts but also achieving a detailed understanding of how corresponding units are organized, trained, and equipped [Francis 1997]. In addition to putting effective compacts in place, this process of coordination requires significant preparedness efforts. Measures to address this issue have been under way for some time across the responder community (e.g., extensive local, statewide, or multi state assistance compacts).

Recommendation 6.10—Implement Better Mechanisms to Utilize and Manage Disaster Volunteers

Volunteers make substantial contributions during major disasters. Local, state, and federal agencies historically have relied on nongovernmental organizations, such as the American Red Cross and Salvation Army, to provide needed mass (population) care and support to responders.³³ Because of the scale of major disasters, the efforts of such groups are integral to serving the needs of both the victims of and responders to the events. Because of their experience in disaster response operations, such relief organizations are also better prepared to connect with the ICS at these events. This linkage makes it possible for the Incident Commander to coordinate volunteer activities and to link them to the safety management efforts for the response. Convergent, or independent, volunteers at the scene lack this organizational structure. Absence of this structure makes it more difficult to manage the incident scene and to protect these volunteers’ safety.

Effective safety management requires mechanisms to provide for the safety needs of all responders, including any volunteers. For some disasters, where the hazard environment is such that volunteers cannot be sufficiently protected, doing so would require all unaffiliated volunteers to depart the disaster scene as soon as possible. Effective scene controls, including identification and credentialing systems, will enable the Incident Commanders to “filter out” convergent volunteers and others from the hazardous areas of the disaster scene. If the efforts of convergent volunteers are needed, and measures can be instituted for their safety needs, then arrangements must be put in place to integrate them into the overall management system at the incident.

As cited above, a significant strength of volunteer organizations with experience in disaster response is their understanding of and capability to connect with incident management structures. As a result, responders urged connecting convergent volunteers to established organizations as a way of coordinating their activities and improving overall personnel accountability. This approach was used to good effect during the Hurricane Andrew response, where the scope of the devastated area and limited responder resources necessitated the use of volunteers in supporting emergency activities [Lewis 1993]. Integrating such volunteer coordination measures into preparedness, either through established organizations or as a separate activity, is critically important to ensuring that the response effort can benefit from volunteer efforts while still providing necessary safety and health protection [Florida Commission on Community Service 2003].³⁴ Putting this into practice would require a significant outreach component to educate the public on how volunteers can be most effective and useful in disaster response operations.

Recommendation 6.11—As Part of Preparedness Efforts, Establish Systems for Managing the Logistics of Safety Equipment

During the early phases immediately following a disaster, when resources are usually very constrained, safety equipment and supplies donated or provided by outside organizations can be very important in providing protection for responders. However, uncontrolled flows of supplies into the disaster zone as efforts continue can choke response logistical systems and prevent responders from getting needed safety resources. Responders emphasized that rigorous planning for equipment needs is the first step to controlling post-event logistics. If Incident Commanders have a clear idea of what supplies are needed, they can put out consistent messages about those needs and increase the chances that supplies sent to the area will be useful. In the wake of the huge amount of supplies that were sent to Florida after Hurricane Andrew, Miami-Dade County set up a hotline to coordinate donations and provide a way to educate people about what was needed and what was not [Johnson 2002]. In addition, just as scene control is important to organize personnel at an incident, maintaining staging areas to collect and organize donated equipment is also critical [Williams 1992]. Also, information systems are needed to inventory supplies and equipment delivered to the disaster scene. Without rapid methods to match on-site supplies to response needs, responders may not receive needed equipment [Haynes and Charney 1993].

Summary

Taking actions for safety management during disaster response involves implementing effective measures to protect the safety and health of responders and convergent volunteers. Response managers must be able to count on risk communication mechanisms for timely dissemination of safety policies and guidelines to the entire responder workforce. For the safety of all responders, enforcement measures are also needed to ensure that no individuals or responding units are permitted to be ignorant of, or to disregard, these safety practices, except under exceptional circumstances. Adopting a force health protection approach would go a long way toward providing a coherent organizing concept for identifying, treating, and monitoring responder injuries and health problems during disaster response operations and afterwards. Finally, responding organizations need improved tools and greater pre-planning to ensure that they are prepared for sustaining the safety and health needs of responders during protracted disaster response and recovery operations.

¹ A fire service expert indicated that, in his view, labeling the leader of a large-scale response as the “Incident Commander” is a misnomer since that individual “doesn't really command most of the people involved” [Study Interviews]. For example, organizations at different levels of government may have their own statutory or functional responsibilities to carry out at an incident and could connect with the ICS through liaison rather than command relationships [USCG 2001]. Furthermore, many participants in study discussions cited the difficulties with response organizations and units that should be integrated into the ICS but instead are “freelancing” —taking operational action independently of the ICS during major disasters—as an ongoing problem from both operational and safety perspectives.

² This recommendation does not consider regulatory requirements that may apply to specific post-disaster situations, such as those included in OSHA Regulation 1910.120, Hazardous Waste Operations and Emergency Response. Such regulatory requirements, applied across response organizations, would centralize elements of safety enforcement even without fully centralized command authority.

³ For example, agencies supporting or cooperating in the operation that connect to the command structure through liaison [USCG 2001].

⁴ A responder cited standardized health and safety planning that has been developed in hazardous materials response as an example of this approach.

⁵ Disaster preparedness planning should include what responding organizations need to obtain particular types of information. Laying out information flows and, to the extent possible, identifying particular information requiring immediate command attention can prevent later communications breakdowns. This process has been referred to as defining “critical incident factors” [Brunacini 2002, 124 126] or “critical information requirements” [Department of the Army 2001].

⁶ In a multilingual environment, serious problems can occur if safety information is not available in languages accessible to all responders [Study Interviews].

⁷ For example, discussion participants indicated that they observed increased compliance with respiratory protection use at the World Trade Center following media reports on airborne hazards at the site [Jackson et al. 2002].

⁸ Examples cited where this was effective include the response to the bombing of the Murrah Federal Building in Oklahoma City [Jackson et al. 2002], portions of the World Trade Center site [California Task Force 3 2001; Study Workshop], and individual collapse sites in the Northridge earthquake [FEMA 1994a].

⁹ Establishing operating zones is a standard practice at hazardous material incidents [Hawley 2000, 127 129].

¹⁰ In addition, response commanders and other leaders visiting the site must follow the rules to set a good example, or else respect for scene control policies will be undermined [Study Interviews].

¹¹ The experience at the World Trade Center site highlighted the challenges of undertaking on-site training for those in the construction trades and others, including the inevitable time lag in instituting such programs under the most difficult circumstances. One report notes that “months passed before the official training program” for skilled support personnel working at the World Trade Center site was approved and implemented. An envisioned two-day program of awareness training for workers was scaled back to three hours [Lippy and Murray 2002, 11].

¹² These issues were cited as problems in every response operation examined [Study Interviews].

¹³ In the response to major flooding in Pima County, Arizona, a public safety helicopter reportedly crashed as a result of responder fatigue due to “overwork in high-risk rescue operations and inadequate crew rest” [McHugh 1995].

¹⁴ For example, after the Oklahoma City bombing, critical incident stress issues had significant effects on the fire department involved, including premature retirements of employees as a result of post-traumatic stress disorder [Bunch and Wilson 2002].

¹⁵ Providing “mental health” assessments (that is, more than just a “quick look in the eyes”) during rehabilitation may pose some difficult confidentiality problems because rehabilitation space is often limited at a disaster site [Study Workshop]. It may be more appropriate to have responders suffering acute stress reactions leave the site and to receive additional assessment and intervention in a more confidential environment.

¹⁶ For example, there were rumors in Oklahoma City that human remains were contaminated with cholera, creating unnecessary stress in an already stressful situation [Study Workshop].

¹⁷ For example, a responder working in fully encapsulating protective equipment would require far more frequent rest than a responder working a “regular 12-hour shift” in standard clothing. While the latter might only need rest every four to six hours, the demands of fully encapsulating equipment might mean the former should be resting after two hours or less [Study Workshop].

¹⁸ For example, although the National Medical Response Team (NMRT) Task Force set up three decontamination corridors at the Pentagon site, compliance was initially incomplete, even among responders involved in recovery of bodies and debris removal [Study Interviews]. This situation was far from unique, according to interviewees with knowledge of a variety of such response operations.

¹⁹ The decision whether to treat responders at the disaster scene or to transport them elsewhere is often a function of the local EMS infrastructure, including the capabilities available to the local responder organizations and the level of preparedness at nearby health care facilities. Differences among localities preclude a “one size fits all” solution to the problem of delivering acute medical care to emergency responders at major disaster sites [Study Workshop].

²⁰ Workshop participants indicated that, if this model is adopted, it is important to define this medic role and designate particular responders to carry it out. In addition, those responders would need to be provided medical equipment—in addition to their firefighting gear—to carry out the medical support function [Study Workshop].

²¹ An alternate mechanism suggested to help ensure that responders receive care for injuries is to rely on a “buddy system.” While having pairs of responders assigned to look out for one another does not provide a new source of medical care, responders would be responsible for ensuring their partner obtained care if he or she were injured.

²² There may also be issues of legal liability for medical malpractice when military medical teams treat civilian responders as part of a disaster response [Study Interviews].

²³ CISD is an intervention to prevent or mitigate post-traumatic stress disorder among emergency responders. Typically, the model calls for a single session group debriefing that takes place within days of exposure to a critical incident. The model is based on military post-action debriefing [Mitchell and Everly 1996].

²⁴ Several critical reviews of CISD have been published in recent years. Although it is important to acknowledge that CISD has been used, applied, and researched differently in different contexts, these reviews have found little evidence to suggest that CISD can prevent post-traumatic stress disorder among emergency responders, and some have suggested that debriefing may be harmful to some individuals. There have been three comprehensive reviews of studies of CISD [DHHS et al. 2001; Rose et al. 2002; van Emmerik et al. 2002].

²⁵ A systematic study of psychiatric disorders among firefighters in the aftermath of the Oklahoma City bombing found high rates of alcohol disorders in firefighters post-disaster, with virtually no new cases occurring after the bombing, leading researchers to conclude that there is a need for ongoing programs targeting alcohol abuse. Generally, the researchers found that pre-existing problems strongly predicted post-disaster psychiatric problems [North et al. 2002].

²⁶ Along similar lines, one responder agency in New York City paired new arrivals to the World Trade Center site with experienced responders, both to provide safety orientation/training and to perform an initial “monitoring” role to assess the individual’s reaction to the disaster itself.

²⁷ For example, the World Trade Center Worker and Volunteer Medical Screening Program (http://www. wtcexams.org/factsheet.html).

²⁸ Particular concern was raised about two groups of responders who may be overlooked in long-term follow-up efforts. These include nontraditional responders such as construction workers and day laborers (especially laborers not represented by unions) and employees deployed under federal response systems [Study Workshop].

²⁹ This was cited as a particular problem at the Pentagon and World Trade Center response operations for breathing apparatus [Arlington County 2002] and respirator cartridges [NVFC 2002, 85; Jackson et al. 2002], among other supplies.

³⁰ Also, communications infrastructure problems can impede operational, logistical, and other functions [FEMA US&R Program Staff 2002].

³¹ In the case of terrorism, individuals converging on the scene could actually represent a direct threat to responder safety. One RAND interviewee cited the experiences in Israel with suicide bombings to make the point that some “volunteers” arriving at a disaster scene could easily bring secondary explosive devices with them [Study Interviews].

³² Although self-deployment of responders directly to an incident may enable more rapid rescue of some victims, the problems it generates for incident management have the potential to cost the lives of both responders and victims as the response effort continues.

³³ During the World Trade Center response, for example, the American Red Cross and Salvation Army took leading roles in supplying food services, dry clothing, first aid, and moral support for the responders at Ground Zero [Spadafora 2002].

³⁴ In addition to addressing volunteer management, preparedness should include systems to draw on critical volunteers after an incident. Skilled volunteers can make significant contributions to safety and to operational activities. For example, drawing on volunteer psychological counselors can be helpful [Brainard and Behrendt 1993]. Systems must be in place to call on these individuals to ensure their availability after an incident [Pine 1993].