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Even if safety managers have access
to accurate information and the resources needed to make safety
decisions, the results of their efforts will have little effect
on safety unless they are communicated effectively to the
workforce and reliably implemented by responders. Disaster
safety managers must have access to incident managers, sufficient
authority, and the leadership abilities needed to carry out
their roles within the incident management structure and to
ensure that necessary safety decisions are put into practice.
Doing so requires that organizational and preparedness measures
are in place to support safety management. This third stage
of the safety management cycle, taking action, relies on safety
managers having the following (see Figure
6.1):
- Effective Mechanisms for Implementing Safety Decisions.
Strategies to allow incident- wide communication of safety
decisions and effective action in multi agency disaster
response operations.
- Measures to Protect the Health of Responders. Enforceable
practices to sustain responder health during long-term response
operations.
- Human Resource and Equipment Management. Procedures to
manage responder resources, disaster volunteers, and safety-related
equipment.
|
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
|
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RAND MG170-6.1 |
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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].
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