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When disaster strikes, the nation
depends on the emergency response community. No events demonstrated
this truth as dramatically as the catastrophic terrorist attacks
of September 11, 2001. But the same holds true every time
the nation faces a major natural disaster or industrial incident.
Emergency responders are an indispensable part of the country’s
homeland security system. To ensure that this system can meet
the challenges of major disasters, the nation must take every
measure to protect emergency workers from the safety and health
risks inherent in their work.
In the aftermath of the September 11 terrorist attacks, the
National Institute for Occupational Safety and Health (NIOSH)
and the Science and Technology Policy Institute (S&TPI),
formerly managed by the RAND Corporation, organized a conference
in New York City on the protective equipment needs of emergency
responders during responses to terrorism. Over the course
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of this meeting, participants repeatedly emphasized that, in addition
to protective equipment, responders need effective safety management
to ensure their well-being as they bring these devastating situations
under control.
As a result, NIOSH and S&TPI undertook this study to develop
a better understanding of safety management in major disasters,
both manmade and natural, and to develop recommendations for improving
safety management for emergency responders. Through an extensive
literature review, interviews with members of the response community,
and workshop discussions including more than 100 participants, the
research team determined areas for improvement and developed recommendations
to guide needed changes. This report provides a comprehensive set
of strategies and tactics for enhancing the safety of responders
by preparing thoroughly before an event and managing effectively
afterwards.
Major Disasters Make It Difficult to Safeguard
Responders
Unlike the smaller-scale emergencies normally handled by one or
more local response organizations, major disasters have special
characteristics that present unique safety risks and management
challenges. Major disasters can
- affect, injure, or kill large numbers of people
- cover large geographic areas
- require prolonged response operations
- involve multiple, highly varied hazards
- require a wide range of capabilities and resources not routinely
maintained by local response organizations
- attract a sizeable influx of independent (“convergent”)
volunteers and supplies
- damage vital transportation, communications, and public works
infrastructures
- directly affect the operational capacity of responder organizations.
These characteristics make it particularly difficult to manage
the safety of responders.1
Safety Management Is Risk Management
Because the work of emergency responders is inherently dangerous,
managing their safety is more accurately described as managing their
level of risk. When handling safety issues at the scene of a major
disaster, decision makers must weigh the potential benefits of a
responder’s action against the risks involved in carrying
it out. This risk management process can be broken down into three
functions: (1) gathering information about the situation, (2) analyzing
available options and making decisions, and (3) taking action to
implement decisions. As shown in Figure S.1, decision makers carry
out these three functions continuously until the response operation
ends. Most response organizations have their own standard procedures
for carrying out these activities during smaller-scale events. But
in the unfamiliar, chaotic, and complex environment of a major disaster,
their methods may not be practical, creating real problems for efforts
to ensure responder safety. To improve responder safety in major
disasters, mechanisms must be put in place to allow safety management
to readily scale up to meet the needs of the more complex and hazardous
circumstances.
Figure S.1
The Safety Management Cycle |
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RAND MG170-S.1 |
Making Safety Management Better: Overcoming
the Challenges of Major Disasters
Significant systems and capabilities are already in place to protect
emergency responders as they carry out their critical missions.
But the results of this study show that opportunities exist to build
upon those foundations—by both improving functional capabilities
to protect responders and improving the organizational structures
needed to manage the effort. Indeed, during a major disaster, when
potentially hundreds of agencies2
must work side by side to cope with a barrage of situations, safety
concerns cannot be fully resolved without effective multi agency
coordination. To improve responder protection, steps must be taken
to address problems that can arise in executing the three functions
of the safety management cycle and to adopt a more fully integrated,
incident-wide approach to protecting the welfare of responders.
Improving Effectiveness Within the Safety Management Cycle
Gathering Information. Decision makers responsible for
safeguarding responders at the scene of a major disaster depend
on accurate, comprehensive information to assess the risks that
workers face. But the scale and complexity of a major disaster can
prevent response organizations from gathering all the information
they need. For example, local agencies may have difficulty
- identifying, measuring, and monitoring unfamiliar hazards
- maintaining and coordinating information on responding individuals
and units, especially those from other jurisdictions
- collecting and communicating timely data on responders’
injuries, illnesses, and exposures to toxic substances and physical
hazards.
Hazard Information. Collecting information
about existing and potential hazards at a major disaster site is
a critical component of safety management. Safety managers need
timely, unambiguous information. However, major disasters present
numerous impediments to the information collection process. For
example, most response agencies lack the capabilities needed to
monitor the wide variety of hazards potentially involved in disasters
of this magnitude, and the involvement of many separate agencies
in monitoring efforts can present problems coordinating hazard data.
Over the course of the study, the following recommendations for
hazard information were developed.3
Recommendations: Hazard Information |
4.1. |
As part of preparedness efforts,
put in place a coordinated, multi agency plan for monitoring
hazards. |
4.2. |
Develop assessment methods, checklists, guidelines,
and standards to assist in hazard monitoring efforts among multiple
agencies. |
4.3. |
Develop information management systems and processes
so that response organizations can use hazard data more effectively. |
4.4. |
Undertake joint exercises that include multi
agency hazard monitoring efforts. |
Information on the Responder Workforce.
To assess risks, implement safety decisions, and account for responders,
managers need to know which emergency workers are taking part in
the operation, where they are, what they are doing, and what capabilities
they bring. However, because major disaster scenes cover such large
areas and require the involvement of so many response organizations,
it is difficult to account for all responders.
Recommendations: Information
on the Responder Workforce |
4.5. |
Bolster the role of response units
in accounting for personnel. |
4.6. |
Develop personnel identification and credentialing
systems better suited to major disaster response operations. |
4.7. |
Utilize scene control to improve cross-agency
accountability. |
4.8. |
Develop minimum standards for safety and health
training for all responders involved in disaster response operations. |
Information on Responders’ Health and Injuries.
Data on responders’ injuries, illnesses, and exposures to
toxic substances and physical hazards—as well as the general
status of their health—is another critical information category.
It enables safety managers to address the health and safety issues
of specific workers and to intervene to reduce risks for the responder
force as a whole as an operation evolves.
Recommendation: Information
on Responders’ Health and Injuries |
4.9. |
Develop systems to provide timely
information on responder injuries and exposures. |
Yet in a major disaster, with so many people seriously injured
or killed, responders frequently focus on victims’ medical
needs instead of monitoring and reporting on their own health. The
large number of response organizations that take part in large-scale
operations further complicates the collection and coordination of
information about injuries and health status.
Analyzing Options and Making Decisions. With reliable
information in hand, safety decision makers can assess its importance
and decide on a course of action to protect responders in the trenches.
But in the aftermath of a major disaster, this process may encounter
serious obstacles. Major disasters make it challenging for decision
makers to
- assess hazards
- manage risks
- choose among protective options
- plan for safety needs.
Assessing Hazards. Effective safety decision
making requires managers to draw together the technical expertise
to evaluate the hazards present at the disaster site and the risks
these hazards pose to responders. But because of the wide variety
of hazards involved in major disasters, individual response organizations
frequently lack the expertise needed to assess every possible danger.
The many different response organizations taking part in an operation
of this scale may also use different criteria to assess hazards,
providing an uneven foundation on which to base decisions.
Recommendations: Assessing
Hazards |
5.1. |
Identify and connect with experts
in hazard assessment during preparedness planning. |
5.2. |
Develop a better understanding of relevant exposure
thresholds and guidelines for disaster response conditions. |
Managing Risk. To evaluate any possible
action, decision makers must weigh its potential gains in protecting
lives against its level of risk, factoring in the overall needs
of the operation. But in a major disaster, where the extent of the
destruction can be so great and the number of victims so high, it
is hard to establish a clear boundary between when “rescue”
is still possible and when the operation needs to move into the
“recovery” phase. When many different organizations
bring separate approaches to this issue, determining the appropriate
transition point becomes even more problematic.
Recommendation: Managing
Risk |
5.3. |
Address the transition between the
rescue and recovery phases of disaster response operations in
preparedness planning. |
Choosing Protective Options and Planning for Safety
Needs. Effective safety management involves selecting
appropriate protective equipment for responders. Managers must understand
the options available and how to choose among them. They must also
be able to determine what additional safety resources the many different
participating organizations may need when an operation begins and
as it evolves. However, the high degree of uncertainty about the
hazard environment during a major disaster complicates efforts to
select among protective options and project future needs.
Recommendations: Choosing
Protective Options and Planning for Safety Needs |
5.4. |
During disaster planning, address
issues concerning safety equipment and multi agency coordination
of safety logistics. |
5.5. |
Develop guidelines for selecting protective equipment
to use in the early phase of response. |
5.6. |
Develop guidelines for estimating the safety
equipment requirements for disaster response operations. |
Taking Action. The most effective efforts to gather
information, analyze options, and make decisions would not benefit
responder safety without the ability to turn those decisions into
actions. Implementing and enforcing a course of action during a
major disaster can prove to be highly problematic, however. Crises
of this magnitude can prevent safety managers from having access
to
- effective mechanisms for implementing safety decisions
- measures to protect the health of responders
- human resource and equipment management.
Effective Mechanisms for Implementing Safety Decisions.
Putting decisions into action during the response to a major disaster
depends on the ability to coordinate the efforts of multiple agencies.
Safety managers must have successful strategies for communicating
safety information, policies, and procedures to all participating
response organizations. Mechanisms to enforce standard procedures
incident-wide are also critical. But with so many independent response
organizations involved, each taking its own approach to safety management,
it is difficult to consistently implement safety measures across
an operation.
Recommendations: Effective
Mechanisms for Implementing Safety Decisions |
6.1. |
As part of multi agency preparedness
efforts, address the issue of safety implementation. |
6.2. |
As part of preparedness planning, include safety
and risk communication. |
6.3. |
Pursue effective scene control as a safety enforcement
measure. |
6.4. |
Provide on-site training, but not as a substitute
for pre-incident training. |
Measures to Protect the Health of Responders.
Safety managers need to be able to meet the medical needs of responders
at every stage of a response operation. Meeting these needs entails
not only caring for responders after injuries happen, but doing
everything possible to keep responders out of harm’s way—for
example, enforcing reasonable work shifts and providing decontamination.
Yet the prolonged duration of operations during a major disaster
requires response organizations to implement unfamiliar sustainability
measures. In addition, the effects of many hazards stemming from
major disasters may not appear until well after the response operation
has ended
Recommendations: Measures
to Protect the Health of Responders |
6.5. |
Improve health maintenance by preparing
and implementing sustainability measures. |
6.6. |
Provide medical care to responders during the
early phase of a disaster response operation. |
6.7. |
Protect the mental health of the response workforce
by managing critical incident stress. |
6.8. |
Improve long-term surveillance of responders’
health following major response operations. |
Human Resource and Equipment Management.
To protect responders, safety managers must be able to control the
flow of volunteers, safety resources, and safety related equipment
to an incident. But in addition to a huge influx of responders from
multiple organizations, major disasters typically draw large numbers
of independent, or convergent, volunteers. The large number of volunteers
makes it difficult to manage human resources during extended disaster
operations, particularly if no mechanism exists to connect them
with the incident command system. Moreover, the complex hazards
at the scene of a major disaster complicate efforts to manage safety
logistics.
Recommendations: Human Resource
and Equipment Management |
6.9. |
Adopt better measures to manage the
recall and mutual aid processes for responders. |
6.10. |
Implement better mechanisms to utilize and manage
disaster volunteers. |
6.11. |
As part of preparedness efforts, establish systems
for managing the logistics of safety equipment. |
Implementing Integrated, Incident-Wide Safety Management
Instituting better ways for organizations to carry out the three
functions of the safety management cycle is a key step toward improving
responder safety during responses to major disasters. But for operations
that demand the involvement of multiple organizations, these measures
are not enough. Indeed, many of the preceding functional recommendations
require some form of multi agency coordination. To optimize safety
management during an operation of this magnitude, in our judgment
it is vital to integrate the safety resources of multiple organizations
into a single, incident-wide effort.
During routine operations, response organizations tend to regard
safety management as an activity carried out primarily by individual
organizations. But the ad hoc efforts to coordinate safety management
during the World Trade Center and Pentagon responses show that response
organizations recognize a need for multi agency safety efforts during
major disasters. To build on these models of integrated, incident-wide
safety management, safety must be viewed as a multi agency function
within the response management structure. After that, there are
a number of important initiatives that are needed to formalize this
approach in disaster preparedness efforts.
Recommendations: Implementing
Integrated, Incident-Wide Safety Management |
7.1. |
Build an integrated safety function
into the Incident Command System. |
7.2. |
As part of preparedness efforts, coordinate plans
for implementing safety management. |
7.3. |
Develop a group of highly trained safety managers
to facilitate coordination at major incidents. |
7.4. |
Improve joint exercises and training by incorporating
realistic safety and health issues. |
7.5. |
Develop a common terminology for disaster safety
and health issues and processes for use during response operations. |
Next Steps: Preparing Now to Protect
Responder Safety
To better protect responders to the next potential natural disaster
or terrorist attack, the nation has the opportunity to improve preparedness
for responder safety management. Many of the recommendations emerging
from this study can be pursued right away by individual response
organizations, with immediate gains. Others involve a longer-term
effort but may provide greater gains. These include recommendations
that are still conceptual and consequently require pilot projects
and other evaluation efforts, those that require the coordinated
efforts of multiple agencies, and those that need leadership and
coordination at the national level.
Every time emergency responders take action, they put their lives
on the line. The risks to their health and safety are particularly
intense during responses to major natural disasters and terrorist
attacks. Although the dangers can never be eliminated, much can
be done to manage the risks involved and protect the nation’s
responders as fully as possible.
1 Disaster response
operations involve large numbers of responders. In addition to traditional
responders such as firefighters, police, emergency medical services,
and emergency managers, they also require many other workers such
as federal, state, and local personnel; public health professionals;
skilled support personnel (including construction/ demolition workers,
transit workers, and utility services workers); disaster relief
workers; and members of volunteer organizations. For the purposes
of this study, these workers are referred to collectively as “emergency
responders.”
2 Throughout the text, we use the term “multi
agency” to describe disaster response operations. This term
is intended to convey the involvement of not just many government
agencies but nongovernmental and private organizations as well.
3 Page numbers refer to the corresponding discussion
of the recommendation in the main body of the report.
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