Tuesday November 10, 2009



Big Medicine is published by Team EMS Inc.


Managing Editor

Hal Newman  


Contact: ideas@tems.ca




Avi Bachar

Steve Crimando

Angela Devlen

David Newman

Hal Newman

Chris Piper

Norm Rooker

Ghassan Michel Rubeiz

Jim Rush

Blair Schwartz

Geary Sikich

Ric Skinner

W. David Stephenson

David Suzuki

Sacha Vais

Beryl Wajsman


Contributor Emeritus

Erik Ronningen




Special Feature

H5N1 Briefings

News & Terrorism






Middle East





Disaster Mgmt





Hazard Research



Stop Violence Against Women & Girls






The views expressed here reflect the views of the authors alone, and do not necessarily reflect the views of any of their organizations. In particular, the views expressed here do not necessarily reflect those of Big Medicine, nor any member of Team EMS Inc.





















Pandemic Preparedness Decentralized Operational Capabilities


by James Rush [written first in 2008 - brought back to Big Med for another run on September 14, 2009]



Public Health officials tell us that a Pandemic is only a matter of “when” and not “If.” If organizations plan to require employees to work from home during a Pandemic, it just makes sense to periodically test an organization’s ability to function in a decentralized mode before the actual Pandemic. Social distancing is a tried and true method of limiting contagion, so


1. Develop standard office procedures for decentralized work, establish standards and measurements for working from home, including expected work outputs. Train all employees on working from home procedures. Prepare Management Information Systems (MIS) division to relocate to an alternative site using hardened, redundant communication systems.


2. Select a division (or other operating unit) monthly and announce all employees will "Work from Home" and will sign on to their electronic workspace from home for a week.........Afterward, determine what worked well and what did not. Learn, implement corrective actions, and re-test in 30 days.


3. Once a quarter have a multi-divisional (or Total Program) "work from home week"....Determine what worked well and what did not. Learn and re-test as soon as practical.


4. Once a year have an agency-wide work from home week.  Learn, implement corrective actions and replace ineffective managers and executives as necessary. Firing ineffective employees may be distasteful and unfortunate, but the Nation's future and the lives of millions of American's may depend on organizational Readiness.


It makes no sense to me to identify a few "Mission Essential" functions like the Executive Command Group and then find out in an actual disaster that the Executive Command Group cannot effectively control the necessary functions of the Agency. It would seem a little late to say to Americans "Your Social Security checks will be discontinued until further notice." ...or tell hospitals "We'll process your reimbursements as soon as the pandemic is over."


I really do appreciate how hard this effort will be, but I don't see any real alternative to hard work and proactive measures. I believe that problems experienced by one Division during a "Work from Home Week" would almost certainly be common problems that can be corrected for all future Divisions exercising the "Work from Home" program. Thus, the learning curve may be much shallower than initially expected. These exercises will be extraordinarily challenging but they are the stuff of true Readiness and the essence of real Emergency Management.


Advanced Policy Directives


Imagine how many hospitals in America will fail if the Centers for Medicare and Medicaid Services (CMS) and major American healthcare insurance companies fail to  implement simplified reimbursement and billing procedures to hospitals for use during a Pandemic. The saddest aspect of this would be the same Agency that predicted the Pandemic failed to prepare for it. It needs to be said that HHS and DHS both have wonderful dedicated folks working hard and serving America with distinction. This paper is not intended as a criticism to any agency or firm.  I am simply concerned about our overall lack of National Readiness as evidenced by a lack of advanced policy directives.


The same concept of Readiness applies to many other Private and Public Sector organizations providing critical products and services. How many Americans have sufficient financial reserves to survive a 12-18 month Pandemic if their place of employment should fail and work is scarce? Are state unemployment offices prepared to pay the number of unemployment claims associated with a Pandemic?


The fact is checks have to get out, payroll has to be electronically transmitted, Healthcare and Public Health services need to be provided, Public Safety, and Public Works (like waste management) services have to be performed. We had better understand how essential services will be provided using a decentralized paradigm before Disaster Day (D-Day).


I know I have been harping on things for a long time now; like developing a patient evacuation system and a citizen relocation and resettlement plan for select Federal Planning Scenarios where relocation is necessary.  New Orleans during hurricane Katrina taught us how critical emergency services were, especially for persons with disabilities, patients and seniors. I hope those very sad lessons were in fact learned and not just observed (as one IAEM-Lister put it). A repeat of that 2005 experience would be a failure of historic proportions and a repeat of what was already a National disgrace.


Also, we need to develop Federal Reserve Inventories (FRI) of food (Meals Ready to Eat), medical supplies and equipment, over the counter (OTC) medications, chronic condition pharmaceuticals, test kits and supplies and life's necessities ..........like the things everyone seeks to purchase just prior to a forecasted hurricane or major snowstorm. 


There is nothing America can’t do when it puts its collective mind to it.  We proved this point in 1969 when we put a man on the moon and we can do it in Domestic Preparedness. It is time to set lofty goals and to achieve them for America’s sake.


Economic Consequences of Swine Flu Outbreak

by Geary Sikich [August 24, 2009]


A paradigm is broadly defined as: a philosophical or theoretical framework of any kind.  A paradox on the other hand, is an apparently true statement or group of statements that leads to a contradiction or a situation which defies intuition.  A paradox, while seemingly self-contradictory or absurd in reality expresses a possible truth.

At the time of this writing H1N1 known as Swine Flu has spread through much of the world.  Its low mortality rate has made it a relatively mild pandemic.  Yet to be determined is what will happen when the flu season arrives in the northern hemisphere this fall.  The World Health Organization (WHO) and Centers for Disease Control (CDC) have been revising much of their guidance and we are seeing almost daily some revelation from the WHO, CDC and the popular media.

Far Greater Immediate and Long Term Impacts?

The economic impact of the swine flu virus in some countries may be drastic, the chief economist for the International Monetary Fund has warned.  Chief economist Olivier Blanchard said the tourism industry in some countries may be negatively affected during a speech at the Carnegie Endowment for International Peace in Washington.

Thomson Reuters reported recently that fears of a deadly swine flu pandemic wrecking an already wobbly global economy.  These fears have materialized with a vengeance in the commodities markets.  Hog futures dropped dramatically and cascaded to share prices of U.S. meat companies which also dropped.  Egypt reported that it will slaughter its entire pig population of approximately 300,000 in an effort to stem the Swine Flu virus.  Early sell-offs in commodities recall market reactions to the SARS and H5N1 bird flu in 2003. Those outbreaks also raised concerns over demand for food commodities.

Economic Impacts are already being felt

The impact of Swine Flu on the markets combined with the current financial crisis and an already weak world economy could make Asia’s experience during the Severe Acute Respiratory Syndrome (SARS) outbreak in 2003 pale by comparison.  This is partly due to the fact that the current Swine Flu virus is spreading faster than SARS did.  Secondly, we have seen a much quicker reaction by the WHO and CDC, raising the Pandemic Phase from 3 to 5 in rapid succession.  The cascade effects will be seen in commodity prices, stocks of food companies, energy prices, pharmaceutical company expenditures to find a vaccine and any measure of things to come, the region's economies may find themselves in a much deeper hole should swine flu spread.  Economists and industry leaders are closely watching the spread of the swine flu.  Should a severe outbreak of the flu occur in Asia, economists and industry executives fear the economic damage would be worse than that of the Severe Acute Respiratory Syndrome outbreak in 2003.

In an article entitled, “Matthews borrows against turkeys” (By Iain Dey, Sunday Telegraph, published on 24/06/2007) the following excerpts reveal the economic impact that H5N1 is already having:

Bernard Matthews, the poultry farmer whose eponymous empire was blighted by avian flu earlier this year, has been forced to refinance his business by securing its future against his stock of turkeys.

Sales of the company's "bootiful" turkeys have been hammered by the health scare. Recent research suggested sales of both frozen and fresh turkeys across the UK are down around 30 per cent in the wake of the outbreak. The last figures provided by the company suggested a 20 per cent plunge in sales.

Bernard Matthews has now been refinanced through an asset finance deal struck with Burdale, a subsidiary of Bank of Ireland, and supported by a handful of other major international lenders.

The loans have been secured against some of the company's 56 farms, its plant and equipment, as well as its livestock, according to banking sources.

Matthews founded the business in 1950 with 20 turkey eggs and a second-hand incubator. The business turned over about £400m last year and employs more than 6,000 people worldwide. The company produces 7m turkeys in the UK every year.

The avian flu disaster is estimated to have wiped around £70m from Matthews personal fortune. The business is run from his Norfolk mansion, Great Witchingham Hall, set in 36 acres, which he restored from dereliction.

My colleague, John Stagl and I transcribed some notes as we were preparing to discuss the economic consequences of a pandemic at a luncheon in Chicago in 2006.  We had come to the conclusion at the time, that a pandemic will have a domino effect worldwide.  We all know that a pandemic will create a unique set of conditions that impact society, the business markets and medical support systems.  One of the differentiating characteristics of a pandemic, unlike any other disaster, is its wide-spread impact.  We have already seen that this impact has occurred without human-to-human contagion occurring.  The economic consequences to the poultry industry have been dramatic.


However, let’s turn our attention to the human-to-human aspects of the post-pandemic period.  While we know that the medical community will be one of the hardest hit areas, it is by no means the only area that will suffer extensive near-term and severe long term impact.  The medical impact, for that matter it will most probably be the most short-lived impact factor of the pandemic (in terms of deaths, etc.) and post-pandemic periods (people will alter their lifestyles to, perhaps do with less medical services).  The longer term ramifications will be felt economically throughout the world.  Below is a list of some of the various elements that will feel the impact of a pandemic, either directly or indirectly.  Impacts will reverberate through various sectors of the worldwide socio-economic system.  The key point to note is that the reverberation and cascading effect will be painfully uneven.  Some countries will fare better than others.  Some companies will fare better than others.  Collectively though, each will feel the impact of the other as if they were dominos falling creating a cascade effect.  An analogy would be to compare the cascade effect of a pandemic to a tsunami wave.  The initial wave may be hardly noticeable however, as it ripples out it gains strength until it surges over the land causing devastation and destruction.  Current thinking about pandemic generally starts with the recognition of the illness and a projection on its societal impacts.  We know that: 

  • People are affected

  • Society is unprepared

  • Governments are unprepared

  • Private Sector Enterprises are unprepared

  • Medical Institutions will be impacted

  • Economic Sectors Worldwide will be impacted

  • Medical Support Systems are impacted

  • Social Behavior will reflect be Susceptible to Significant Degradation

But what we do not know and can only speculate about is the scalable variables brought about by random chance.  Biological variables (mortality and morbidity rates as a result of the pandemic) can be estimated based on the lethality of the virus (currently at almost 60% versus the Spanish Influenza virus which was around 2 – 3%).  There is an excellent study that has been published regarding the impact of a pandemic on the Life Insurance Industry (I will cite from it later).  With scalable variables, as Taleb says in the Black Swan, “the longer you wait, the longer you will be expected to wait.”  This is as a result of the scalability of random events – randomness runs counterintuitive to conventional logic and the normal bell curve deviations that we are used to. 

So, here are some purely speculative projections as to what the post-pandemic recovery, restoration and realignment may look like.  I have based some of what I am about to project on limited historical evidence from the Plague and Spanish Influenza.  I use the term “limited” as a reference to the differences in technology, population, education, industrialization, etc. that was present at the time of the Plague and Spanish Influenza (a mere 89 years ago as of this writing in 2007).   

Here are some fast facts (courtesy of Maplecroft Index – August 2007) to ponder as we get ready for our journey into post-pandemic speculation.

Nearly two billion people (mostly in developing countries) do not have access to electricity 

Nearly half the world's population (three billion people) have never made a phone call 

Enabling digital inclusion is most urgent in Africa – a continent that houses 1 in 8 people (12%), has only 1 in 40 fixed line telephones (2.5%), 1 in 30 mobile telephones (3%), 1 in 70 personal computers – PCs (1.5%), 1 in 150 Internet users (0.7%) and 1 in 500 Internet hosts (0.2%).

Developing countries now account for almost half (49%) of total telephone subscribers in the world,  up from just 19% in 1990 

Globally only 650 million people have PCs. In the developing world, figures average at about 1/100 people but can be as high as 8/100 in Argentina or as low as 0.18/100 in Burundi 

In 1990 only 20 countries were connected to the Internet.  In 2003 there were 209. 

Consider these aspects of predicting the future.  In the material that follows, I have calculated a possible error rate of 100%.  I could be completely wrong.  Other than that what I am writing is pure speculation based on a random event occurring at some time in the future.  However, I have cleverly, I hope not cast my forecast with any date specific timeframe and therefore could be 100% right – eventually!  Forecasting without incorporating an error rate uncovers, according to Nicholas Taleb (The Black Swan) three fallacies all arising from the same misconception about the nature of uncertainty.  His first fallacy is that variability matters.  I agree; that is why I am not taking my projections too seriously and casting them with a date, hence I propose a range of possible outcomes.  Second, he states that there is the fallacy of failing to take into account forecast degradation as the projected period lengthens.  Here again, I agree; we do not realize the full extent of the difference between near and far futures.  H5N1 is extremely lethal at present.  Viruses mutate in order to survive.  I would speculate that the influenza virus that creates a pandemic will be far less lethal than the current strain of H5N1.  This, however, also allows for the virus to spread faster, longer and to infect more people – because we stay alive longer and can pass it to many others over time (evidence my projection figure from the previous chapter.  Finally, Taleb offers his third, and according to him possibly the most grave fallacy that concerns a misunderstanding of the random character of the variables being forecast.  We do not realize the consequences of the rare event.  It is the lower bound of estimates (worst case scenario) that matters when engaging in a decision.  The worst case is far more consequential than the forecast itself. 

Remember – 

A black swan is a highly improbable event with three principal characteristics: it is unpredictable; it carries a massive impact; and, after the fact, we concoct an explanation that makes it appear less random, and more predictable, than it was.”

Nassim Nicholas Taleb

The Black Swan: The Impact of the Highly Improbable

The following are the initial albeit speculative impacts that we can attribute to a pandemic:

Business (all forms of Private Enterprise) Impact

Reduction in workforce this leads to a reduction in output capacity

Reduction in consumption (people staying at home) leads to a decrease in demand

Reduction in revenue leading to less profit, leading to less taxes being paid

Lack of consumption demand leading to employees being laid off; leading to loss of benefits (healthcare insurance, etc.)

Reduction in disposable income leads to further consumption declines and consumption focused on necessities (healthcare insurance may become a luxury)

Redistribution of family asset spending – necessities only


Medical (if you can pay health insurance, you still have deductibles; will the influenza be covered under your existing plan?)


Private transportation – if possible

More layoffs due to a worldwide sloughing off of demand and some countries closing borders as they attempt to isolate themselves

Business bankruptcies medium and small businesses will feel the pain because they have limited cash reserves.  Large enterprises will suffer as a result of loss of consumers and suppliers (how dependent is your business on the small to medium size supplier/vendor? Or, is your small/medium size business heavily dependent on a customer (large enterprise) that may experience a drop in demand putting your operations at risk?) 

Medical Support Systems (All Medically Related Endeavors)

Doctors in demand for patient diagnosis – office visits

Hospitals overwhelmed with patients

Patients must be isolated, from traditional patient care

Isolation supplies become limited, if available at all

Respiratory equipment in short supply - for secondary pneumonia

Committees will decide who gets respirator support & who does not

Limited supplies of medication (no vaccine for 6-9 mos.)

Hospital & public pharmacies must increase security for medications

Investments Fall (Anything that can be Monetized)

Redistribution of family assets – reduced investing

Companies need cash for operations vs. reduced investments

Investors seek “safe havens” for investing – no 3rd world investments

Reduced capacity to process investment activity – up to 40% of staff sick

Stock and Bond Markets behave erratically leading to less and less investment in publicly traded stocks, bonds

Private equity investments in companies drops for all the above reasons cited previously and all the subsequent points yet to come  

Commodity Markets

Demand becomes erratic leading to reduced trading

Open pit operations are limited due to physical concerns – exposure to others in the trading pit

Electronic trading (heavier now than ever) becomes erratic as power supply systems and Internet are less consistent

Commodity delivery erratic

Investors seek “safe havens” for investing – no 3rd world investments

Reduced capacity to process investment activity – 30% of staff sick

Business Assets Depleted

Lack of investing

Redistribution of company assets to current expense issues

Growth is replaced with survival strategies

Revenue continues to slip

Unemployment grows

National disposable income declines

Human capital (talent – an overlooked asset) not easily replaceable, long lead times to train, less loyalty, more dependent  on technology

Business Failures Increase

More Unemployment

Loss of personal disposable income

Increased demand for government services (at all levels) 

Government Impact

Substantial drop in revenues (tax base drops)

Quarantine and Isolation requirements will us most of government assets

Limited ability to provide of traditional support services

Increased demand for services

Social unrest ferments – “someone has to help us” mentality      


Business failures increase to unprecedented levels

Increase in personal and commercial bankruptcies

Backlog in court processing of bankruptcies

Creditors wait longer for assets from courts

Creditors see drop in assets from bankruptcies

Creditors become more restrictive in loaning money and extending credit

Credit and loan availability drops

More companies fail due to lack of loans & credit

Creditors Fail

Delays in bankruptcy processing & asset distribution results in lender failures

Bankrupt company assets are not redistributed into the market

Business market contracts because of operational asset decline

Lender failures compounds bankruptcy backlog and asset distribution


Large numbers of qualified, trained individuals available for employment

Companies prepared to identify these people will grow stronger & faster

Substantial number of opportunities will exist as a result of company failures

Let’s take a look at one sector, transportation.  Within that sector take the slice dealing with passengers and cargo.  Just on the basis of moving people and stuff you can already project the complexity.  Below are the world’s thirty busiest airports in 2005 ranked by passengers and by cargo.  What was your estimate that a person, who knew that they had a highly infectious form of Tuberculosis, would be capable of flying internationally on several flights?  Now, take that projection and add the variability factor and random character of the event and think about the consequences in the context of flying from any one of these airports with a case of influenza.



World’s 30 busiest Airports

Total passengers

World’s 30 busiest Airports

Total cargo


Atlanta, Hartsfield (ATL)


Memphis (MEM)



Chicago, O'Hare (ORD)


Hong Kong (HKG)



London, Heathrow (LHR)


Anchorage (ANC)



Tokyo, Haneda (HND)


Tokyo, Narita (NRT)



Los Angeles (LAX)


Seoul (ICN)



Dallas/Ft. Worth (DFW)


Paris, Charles de Gaulle (CDG)



Paris, Charles de Gaulle (CDG)


Frankfurt-Main (FRA)



Frankfurt-Main (FRA)


Los Angeles (LAX)



Amsterdam, Schiphol (AMS)


Shanghai (PVG)



Las Vegas (LAS)


Singapore (SIN)



Denver (DEN)


Louisville (SDF)



Madrid (MAD)


Miami (MIA)



New York (JFK)


Taipei (TPE)



Phoenix, Sky Harbor (PHX)


New York (JFK)



Beijing (PEK)


Chicago, O'Hare (ORD)



Hong Kong (HKG)


Amsterdam, Schiphol (AMS)



Houston (IAH)


London, Heathrow (LHR)



Bangkok (BKK)


Dubai (DXB)



Minneapolis/St. Paul (MSP)


Bangkok (BKK)



Detroit (DTW)


Indianapolis (IND)



Orlando (MCO)


Newark (EWR)



Newark (EWR)


Osaka (KIX)



San Francisco (SFO)


Tokyo, Haneda (HND)



London, Gatwick (LGW)


Beijing (PEK)



Singapore (SIN)


Atlanta, Hartsfield (ATL)



Philadelphia (PHL)


Guangzhou (CN)



Tokyo, Narita (NRT)


Luxembourg (LUX)



Miami (MIA)


Dallas/Ft. Worth (DFW)



Toronto (YYZ)


Oakland (OAK)



Seattle/Tacoma (SEA)


Brussels (BRU)


NOTES: Total passengers enplaned and deplaned, passengers in transit counted once. Total cargo loaded and unloaded, freight and mail (in metric tons).

Source: Airports Council International World Headquarters, Geneva, Switzerland. Web: www.airports.org. 

There were almost two billion passengers traveling in 2006; that is roughly three million people every day flying from one city or one country or one continent to another.  The potential is obvious for someone with an infectious disease unwittingly perhaps carrying it from one part of the world to another. 

Air New Zealand had an unexpected downturn in revenue of 11% while cities with SARS were transformed by the SARS outbreak.  Sherry Cooper from Toronto explains: 

During its four-month run in Toronto, ending in June, SARS killed fewer than 50 people.  Even China and Hong Kong, the two places hardest hit by the virus, suffered ‘only’ 648 deaths in total.  On April 23, the WHO sent out a warning against all unnecessary travel to Toronto, Beijing, and China’s Shanxi province.  Travel to and from Toronto plummeted overnight.  Overall SARS cost the city’s hotel industry more than $125 million Canadian; more generally, the tourism industry in the province of Ontario lost more than $2 billion Canadian in income and jobs.

In another example, an article titled, “Just plane gross” published on August 14 2007 in the Wall Street Journal (WSJ): 

This summer, rampant flight cancellations and delays are forcing many travelers to languish, sometimes for hours, before they can board their flight.  Unfortunately, that's nothing compared with what may await them on the plane.

Airplanes may be some of the best breeding grounds for illness.  The WSJ article further cited the following incident:

Indeed, delays can affect cleanliness and comfort, particularly with planes now flying fuller.  The percentage of on-time flights fell to 74.5 percent in July from 76.4 percent a year earlier, according to flightstats.com.  Summer thunderstorms have been to blame, as have technical glitches like the Federal Aviation Administration computer snafu on June 8.

On Saturday, more than 20,000 international passengers were stranded for hours at Los Angeles International Airport, waiting on airplanes and in packed customs halls while a malfunctioning computer system prevented U.S. officials from processing the travelers' entry into the country.  The U.S. Customs and Border Protection system went down around 2 p.m., forcing some planes to sit on the tarmac for so long that workers had to refuel them to keep their power units and air conditioning running.  Maintenance workers ran trucks around the airport hooking up tubes to service lavatories.

So what does this mean from a pandemic and post-pandemic perspective?  Just take a look at what the article reveals regarding the cleaning schedule for airplanes: 

JetBlue says its planes undergo a "maximum deep clean" once a month, same as before, a process that includes a thorough cleaning of the lavatories and galleys, vacuuming of carpets and cleaning of seats, seat trays and side walls.  Southwest Airlines says its deep-cleaning cycle is 30 days too.  American Airlines says it also keeps a 30-day average.  Continental Airlines, like many airlines, says its planes also undergo an overnight cleaning, which includes replacement of soiled pillows and blankets, vacuuming of cabin floors and cleaning of lavatories and passenger seating areas.

Between flights, though, the cleaning tends to be cursory.  American says it picks up trash and cleans seat-back pouches between flights, but it doesn't wipe down tray tables or vacuum while at the gate unless there's an obvious mess that must be addressed.  ATA Airlines also says it doesn't wipe down tray tables between flights unless there's a clear need because of the limited ground time.

I am sure that after reading this, you are probably thinking about carrying disinfectant wipes with you on your future travels!  If the above examples are common practice, the spread of viral illness could extend the post-pandemic meltdown for the transportation industry, or the industry could be required to employ more stringent cleaning standards to their fleets of aircraft.  And this is only one example of only one segment of one industry sector! 

Business Impacts – How Long Can You Survive? 

Impacts can be immediate and expensive.  It is therefore prudent that your pandemic planning efforts consider the dynamic nature of the world’s markets as part of your overall strategy.  This makes good business sense.  It can be readily applied to situations other than a pandemic.  With this broader perspective in mind your pandemic preparations can be leveraged into greater management awareness and perhaps, more of a competitive edge for your enterprise.  This is true, for public sector entities too.  Government can be more competitive and forward thinking and gain leverage with the constituents (taxpayers) whether they are individuals or businesses. 

One key issue that businesses face with a pandemic that is different from other disasters is that multiple locations could be affected simultaneously.  This is complicated by loss of personnel that could occur for several reasons – sickness, caring for sick individuals, school closures, fear of contamination at the workplace, etc.  Most of the current business continuity models are based on the recovery of technology and facilities (“brick and mortar” type structures).  Few are addressing the human component and if they do they are not doing it very well.   First and foremost a basis for ensuring that communication and information flows seamlessly vertically and horizontally throughout the enterprise is essential.  This means that you have to have common terminology within and with all the external touchpoints (customers to vendors) that is clearly understood by all.  Most organizations come up short when an analysis of the communication and information flow is undertaken.  The general finding is that fragmentation and a lack of seamlessness exists. 

Decision making regarding governance issues can only be addressed by senior executives.  Senior executives will establish and manage voluntary compliance mandates as well as ensure compliance with regulatory driven requirements. 

Strategy requires management engagement in order to achieve 3600 coverage.  This coverage consists of: 1) forward looking capabilities “active analysis” and situational awareness; 2) awareness of challenges; 3) executable goals and objectives and 4) ability to capitalize on experience and past successes.  Operating in a pandemic will require that your organization have a flexible and responsive strategy.  Incorporating business strategy elements into the management decision making process at all levels of contingency planning can facilitate greater flexibility. 

A tactical focus on processes rather than a strategic focus that is broader based – business goals, objectives and response to market demands can equal less than effective business continuity. 

Pandemic – Business Continuity Planners what are you doing?

We, as business continuity planners seem to be wary of addressing the issue of a pandemic as a viable scenario for planning.  I recently did a tabletop simulation for a client and a presentation on pandemics at a business continuity summit for another client.  The tabletop participants reflected on the experience and uniformly expressed to me that the tabletop was one of the most stressful and frustrating experiences that they had participated in.  The business continuity summit attendees and many of the speakers who followed me, continued to comment on the material presented, stressing that they needed to rethink their plans.  Participants in both events expressed the hope that a pandemic would not materialize.


Pandemics cause major economic losses due to absenteeism.  Experts predict that during a pandemic up to 30% of the global workforce could either be off work due to sickness or stay away due to fear.  Absence levels at the expected rates would cause severe problems.

The economic impact of H5N1 will be felt around the world.  The impact will initially appear in two primary aspects of business.  The first will be the availability of the workforce, the second and more unique impact will be in the market place. 

Helen Branswell of the Canadian Press wrote on August 17, 2005 in her article entitled, “Flu pandemic could trigger second Great Depression, brokerage warns clients”:

A major Canadian brokerage firm has added its voice to those warning of the potential global impact of an influenza pandemic, suggesting it could trigger a crisis similar to that of the Great Depression. 

Real estate values would be slashed, bankruptcies would soar and the insurance industry would be decimated, a newly released investor guide on avian influenza warns clients of BMO Nesbitt Burns.  

"It's quite analogous to the Great Depression in many ways, although obviously caused by very different reasons," co-author Sherry Cooper, chief economist of the firm and executive vice-president of the BMO Financial Group, said in an interview Tuesday.

"We won't have 30-per-cent unemployment because frankly, many people will die. And there will be excess demand for labour and yet, at the same time, it will absolutely crunch the economy worldwide." 

A leading voice for pandemic preparedness said the report is evidence the financial and business sectors - which have been slow to twig to the implications of a flu pandemic - are finally realizing why public health and infectious disease experts have been sounding the alarm.  

"I think that this particular report really signifies the first time that anyone from within the financial world, when looking at this issue, kind of had one of those 'Oh my God' moments," said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.  

"The financial world is finally waking up to the fact that this could be the boulder in the gear of the global economy," he said, suggesting a pandemic could trigger an implosion of international trade unlike anything seen in modern history.  

"All the other catastrophes we've had in the world in recent years at the very most put screen doors on our borders. This would seal shut a six-inch steel door," Osterholm said.  

Cooper, a highly influential figure in the Canadian financial sector, wrote the report with Donald Coxe, a global portfolio strategist for BMO Financial Group.

They warn investors the economic fallout out of a pandemic would inflict pain across sectors and around the globe.  

Airlines would be grounded, transport of goods would cease, the tourism and hospitality sectors would evaporate and the impact on exports would be devastating, Cooper wrote.  

"This would trigger foreclosures and bankruptcies, credit restrictions and financial panic," she warned, suggesting investors reduce debt and risk in their portfolios to be on the safe side.  

Absence of purchases due to illness and psychological reactions to a pandemic will present a new form of business impact that is currently not assessed as part of the traditional business impact assessment; and as such, it is not addressed in any business continuity, disaster, crisis management or recovery plans.  Another area that has not been addressed in impact assessment or plans is the loss or restriction of a company’s revenue.  Traditional plans start with an assumption that the marketplace is still viable; a potentially false assumption.  Traditional plans are designed to get an organization back into their market as quickly as possible – RTO, RPO and MTO come to mind (RTO = Recovery Time Objective, RPO = Recovery Point Objective, MTO = Maximum Tolerable Outage).  In the case of a pandemic markets may no longer be viable.  If your market is materially impaired, a consequence is that the revenue that is derived from that market may be restricted and/or completely gone. 

In another article, published on October 7, 2005 (NewsTarget.com) entitled, “Economic Shock Waves From Avian Influenza Spreading Faster than the Disease the following is pointed out: 

The Avian influenza crisis in Asia has already caused more than $10 billion dollars in damage in the economies of the most-seriously affected countries, but this is just the tip of the iceberg compared with the possible global economic consequences of a human influenza pandemic according to a study, Thinking Ahead: The Business Significance of an Avian Influenza Pandemic, released today by Bio Economic Research Associates (bio-era™). 

“According to the quantitative measures we developed for assigning relative economic risk exposure to infectious disease outbreaks for countries in Asia, Hong Kong and Singapore are especially vulnerable to the initial economic shock waves that would ensue from a pandemic,” said James Newcomb, Managing Director and principal author of the bio-era report. “However, the secondary impacts on other countries, especially China, could have far-reaching impacts for economies around the world, including the US,” he added.  

Other key findings in the report include:  

Avian influenza is the latest in a series of major livestock disease outbreaks that have caused more than $60 billion in economic damages worldwide over the past 15 years.

Concerns about a possible influenza pandemic are already providing stimulus for increased spending and accelerated research and development efforts in some parts of the economy, ranging from custom microarray chips for rapid diagnostic testing to antiviral drugs.

Governments around the world have recently made commitments totaling an estimated $1.4 billion to stockpile oseltamivir (Tamiflu)—an antiviral drug produced by pharmaceutical giant Roche.

Manufacturers of flu vaccines are gearing up for what may be an unprecedented global demand for a vaccine effective against H5N1 variants, but it is not known whether the vaccines being developed now would be effective against the influenza strains that might emerge.

New “DNA vaccines” offer an alternative to conventional production technologies and could speed the vaccine industry’s ability to respond, but these technologies are not yet approved by FDA.

“We’ve been looking at how things might unfold under six very different but highly plausible scenarios for the evolution of the outbreak,” said Stephen Aldrich, President of bio-era. “In the process, we’ve made assessments of potential outbreak risk by country, the relative economic exposure by country — and how selected industries and companies are likely to be affected.” 

We have not experienced this type of business problem in our lifetimes.  The last generation to have to address such a widespread issue was that of our grandparents and parents during the Great Depression. 

During the Great Depression the revenue component of the free enterprise system was significantly impaired.  Just as important, today on a worldwide basis we do not have any leadership in business or government who has lived through the 1918 Spanish Flu Pandemic or the Great Depression and so that experience base is lost to us.  Our best option, therefore, is to start to think about the possible problems we may have to confront and take steps to avoid or deal with them in our businesses.  If we wait until the pandemic starts, it will be too late. 

Even if a pandemic were mild, it is estimated that about a third of the world's population would fall sick over a period of months and millions would die.  If the strain is virulent, the death toll could mount to several million, over a relatively short period.  If we look at previous pandemics (Spanish Flu 1918 – 1919, Asian Flu 1957 – 1958, Hong Kong Flu 1968 – 1969) they generally run their course in 18 to 24 months.  As an example, the economic consequences could be staggering; SARS wreaked economic devastation on affected cities and countries in a relatively short period.  

The Health and Human Services Department plan outlines a worst-case scenario where more than 1.9 million Americans would die and 8.5 million would be hospitalized with costs exceeding $450 billion. 

Current Forecasts – Business Continuity Planners where can you add value? 

We often use the phrase “value added” when we promote business continuity planning.  We say that we “add value” to an organization by preparing it to respond and recover from incidents.  At this time I think that we can earn our keep, so to speak, by providing that “value added” service that we speak of.  Current forecasts predict that the H5N1 pandemic will spread around the world in a historically short period of time.  One expert stated that if this pandemic is identified on the west coast of the United States it will spread across the country in a week.  When SARS spread from China just a couple of years ago, it was in 5 countries in 3 days and in 24 countries in 3 months.  Time to react will be virtually non-existent.  And if we are to earn our merit as business continuity planners, we need to react now!  The companies that survive this extraordinary disaster when it occurs will have heeded the words of Sun Tzu centuries ago, “Victorious warriors win first and then go to war, while defeated warriors go to war first and then seek to win.”  Planning today will prove to be the only viable strategy to ensure a company’s “victory”. 

What If…? 

What if the pandemic does not materialize?  Do we have the proverbial “egg on our face”?  In the event that this pandemic does not materialize, your planning will not be lost.  Most of it will be transferable.  There will be future pandemics (and they occur approximately every 30 – 40 years) and to the ever present threat of terrorist attacks using chemical/biological/nerve agents.  Business survivability in the face disasters is imperative to the economic strength of the world community. 

We as continuity planners have an obligation to be forward thinking and to see what others choose not to recognize until it is upon them.  

Steps to take…Now 

The ability to effectively respond to and manage the consequences of an event in a timely manner is essential to ensure an organization's survivability in today’s fast paced business environment.  With the emergence of new threats, such as cyber-terrorism and bio-terrorism; and the increasing exposure of companies to traditional threats such as, fraud, systems failure, fire, explosions, spills, natural disasters, etc. an “integrated” approach to Business Continuity Planning is essential.  The “integrated” approach, as presented in this article, is based on the concept of graceful degradation and agile restoration.  “Graceful degradation” refers to the ability of an organization to identify the event, classify it into a level of severity, determine its consequences, establish minimal stable functionality, devolve to the most robust less functional configuration available and to begin to direct initial efforts for rapid restoration of services in a timely fashion. 

Several steps can be taken to prepare your organization.  First, put in place an effective surveillance program; meaning, expand your business impact assessment activities.  In my article, “"Futureproofing" - the Process of Active Analysis” written in 2003, I recommended that we rethink the business impact assessment process: 

Traditional analysis such as that performed at the initiation of the business continuity plan development is recognized as necessary to develop a baseline of information.  However, it should also be recognized as having certain limitations: 

·         Pre-Event - Best guess as to what could occur

·         Static - Best guess based on available facts and models 

Traditional analysis creates undecidability due to the inability to predict all behavior in a dynamic environment.  Therefore one should adopt an Active Analysis methodology, such as that developed by Logical Management Systems, Corp. (LMS).  LMS' methodology is based on the U.S. Military's "Joint Special Operations Targeting and Mission Planning Procedures" (JP 3-05.5 10 august 1993).  It is detailed herein. 

The advantages that can be realized by adopting this methodology and maintaining an active analysis process are: 

·         Uses Static Analysis as a basis

·         Touchpoint complexity factors

·         Dynamic - based on creating a mosaic

·         Time Factors (Time Critical, Time Sensitive and Time Dependent) act as drivers 

Termed "Futureproofing" by LMS the active analysis process is designed to create a mosaic that enhances decision making by identifying behavior patterns in a dynamic environment. 

Active analysis can be subdivided into three categories of possible threats/occurrences that could befall an organization.  Dr. Ian Mitroff refers to the three categories as Natural Accidents, Normal Accidents and Abnormal Accidents.  I have renamed them and to differentiate the three aspects of each.  That is, the threat, the actual occurrence and the consequence of the occurrence. 

·         Natural Threats/Occurrences/Consequences consisting of such things as drought, floods, tornadoes, earthquakes, fires and other naturally occurring phenomena.

·         Normal Threats/Occurrences/Consequences consisting of such things as Economic Disasters, such as:

·         Recessions

·         Stock Market Downturns

·         Rating Agency Downgrade, etc.

Personnel Disasters, such as:

·         Strikes

·         Workplace Violence

·         Vandalism

·         Employee Fraud, etc.

Physical Disasters, such as:

·         Industrial Accidents

·         Supply Chain

·         Value Chain

·         Product Failure

·         Fires

·         Environmental

·         Health & Safety

·         Abnormal Threats/Occurrences/Consequences consisting of Criminal Disasters, such as:

·         Product Tampering

·         Terrorism

·         Kidnapping & Hostages, etc.

Information Disasters, such as:

·         Theft of Proprietary Information

·         Hacking, Data Tampering

·         Cyber Attacks, etc.

Reputation Disasters, such as:

·         Rumors

·         Regulatory Issues

·         Litigation

·         Product Liability

·         Media Investigations

·         Internet Reputation, etc. 

Please note Abnormal Threats/Occurrences/Consequences are becoming more of the norm than abnormal as we see the normalization of threats such as hacking and data tampering. 

Five key assumptions were used as a basis to for the developmental framework of the "Futureproofing" methodology.  These are: 

·    Assumption # 1: The modern business organization represents a complex system operating within multiple networks 

·    Assumption # 2: There are many layers of complexity within an organization and its "Value Chain" 

·    Assumption # 3: Due to complexity, active analysis of the potential consequences of disruptive events is critical 

·    Assumption # 4: Actions in response to disruptive events needs to be coordinated 

·    Assumption # 5: Resources and skill sets are key issues 

Based on the above assumptions and the results of the baseline analysis (static analysis) one realizes that the timely identification, classification, communication and response, management and recovery from a disruptive event are critical.  As depicted in the graphic on the next page over time uncertainty will decrease, as will available options for response and recovery. 

This is contrasted with increasing numbers of issues and higher and higher costs associated with response and recovery efforts.  As such, an organization should seek to continually analyze situations so as to develop a clear picture of the current state of the business system network.  Referred to as "Data Fusion - Constructing a Mosaic" by LMS; this is a process of getting enough bits and pieces of information in place in order to transform seeming chaos into recognizable patterns upon which decisions can be made.

Second, recognize that you cannot depend on public authorities (read this as government at all levels) to be there for your organization.  They will have too many issues to deal with and they will also be impacted by the pandemic – remember that 30% of the population could be affected; that means that civil authorities are just as susceptible to contracting the disease.   Your organization and its “value chain” must its own comprehensive plan for dealing with the business consequences of a pandemic.  Rethink the basis on which you developed your plan – talk to the risk management and strategic planning personnel in your organization and find out what they are looking at with regard to business expansion, contraction, risk mitigation, etc.  They should be very conversant as a result of the recent hurricanes, earthquakes, tsunami and general competitive forces in the economy.  Revise your business continuity plan.  Develop the ability, as an organization, to sequence back your operations while ensuring that your business system and its network (“value chain”) can maintain level of functionality while operating at reduced capability.  When your business system and its network reaches the state of minimum functionality, the organization can begin to conduct a campaign of "agile restoration" until it achieves a state of full functionality and a return to normal operations. 

If you do the first step, putting in place an effective surveillance system, you will develop "detectors and indicators of change" metrics that can be employed to facilitate the constant analysis of the state of the business system and its complex "value chain" network.  The "detectors and indicators of change" provide the early warning basis for event classification at the lowest (least severe) levels. 

Third, train, drill, exercise.  All the planning in the world is never going to be effective unless it can be implemented.  One key to implementation is having a trained organization.  That means that we have to train not only the primary position holders in our organization, but we have to train the secondary and even a third level within the organization.   

If Only We Had Known…A New Paradigm for Planning Strategists 

In my latest book, “Integrated Business Continuity Planning: Maintaining Resilience in Uncertain Times” I asked: 

"Is Business Continuity integrated into your business operations as a way of doing business; or is Business Continuity an adjunct to the business that you are involved in?" 

As you ponder this question, you need to reconsider the value proposition offered by having an integrated approach to business continuity. 

I offer the following definitions for the purpose of this article and as a basis for developing an “integrated” approach to continuity: 

Crisis: "A disruptive event that is amplified, elevated and magnified." 

Business Continuity: "All initiatives taken to assure the survival, growth and resilience of the enterprise." 

Executives have an obligation to their stakeholders to assure that everything that can reasonably be done to protect the business and ensure its competitiveness in the marketplace is done.  Unless executives rethink the relationship between how they do business (strategy, competitive intelligence, etc.) and the way they currently address business continuity (managing disruptive events, security, etc.), the imbalance between "security" and competitiveness will not be resolved.  Therefore, businesses must rethink their recovery strategies to be able to deal with and survive pandemics.  This is a whole new paradigm for planning strategists. 

The table below is a look into the proverbial “crystal ball” at what could be some of the possible outcomes when the pandemic strikes.  

Economic Effect of a Pandemic – Business Continuity Planning Analysis


Short-term Effect

Long-term Effect


Commercial Real Estate


Demands for office space will potentially decline in affected areas.  Suburban areas may see an increase in demand due to businesses relocating from areas that have been quarantined.

Fixed costs for businesses holding leases will remain the same, even in the face of declining occupancy and declining revenue.

Presidential Executive Order: Amendment to E.O. 13295 Relating to Certain Influenza Viruses and Quarantinable Communicable Diseases

Subsection C added:

"(c) Influenza caused by novel or reemergent influenza viruses that are causing, or have the potential to cause, a pandemic.".


(Electric, Gas and other infrastructure  power supplies)

Potential loss of worldwide workforce could see system degradation due to lessened ability to respond to normal maintenance and emergency situations.

Loss of expertise within the workforce could result in a permanent destabilization of the energy sector, leaving it more susceptible to disruption than at present.

Utilities in general, need greater business continuity assistance due to the lack infrastructure being replaced.  Integrated grid systems are susceptible to disruptions that can cascade throughout a system quickly.

Energy Industry

(Oil & Gas)


Potential loss of employees worldwide due to pandemic could cause inability to meet demands resulting in higher prices for energy and related products.

Potential long-term demands may not reach current levels as a result of loss of life worldwide.  Fixed costs for businesses would remain the same regardless of utilization or demand.

Worldwide refining capacity is currently under pressure.  A pandemic could see facilities forced to shutdown either by quarantine or due to lack of workforce.


Dependence on information systems to operate facilities, pipelines, etc. creates security vulnerabilities for this industry.


Communications Industry (Voice, Data and other information systems, etc.)


Potential increase in demand due to pandemic causing more people to work remotely, greater need for information, greater need to communicate with others.  Potential loss of worldwide workforce due to pandemic.

Fixed costs remain unchanged regardless of demand.  Due to potential loss of workforce, system reliability may be impaired.

Heavy dependence on information systems for operations creates security vulnerabilities for this industry.  Loss of skilled workforce creates potential system vulnerabilities.

Banking & Finance


Potential demands for cash can outstrip the amount of cash in circulation.  Credit and Debit systems (cards) use could decline as a result of pandemic.  Volume based businesses could see a decline in revenue (i.e., SARS created decline in volume for many car companies).


Potential for significant short term disruption to economies worldwide.

Potentially having to live in a cash society (i.e., earthquake aftermath) could create continued high levels of demand for cash.  Potential for inflation remains high.  Businesses impacted due to loss of workforce and falling revenue.  Markets worldwide could see significant declines that will last for long periods.  Potential for long term disruption to economies worldwide.

Heavy concentration in large metropolitan areas, dependence on information systems for operations, low reserves of cash could create vulnerabilities.   Loss of workforce due to pandemic could create inabilities to function effectively.



Pandemic could be the single most devastating event for this sector ever. Quarantine, flight restrictions, lack of workforce, inability to ship goods to markets, lack of security of Intermodal systems could create havoc with businesses and consumers.  Shortages would occur immediately (i.e., hurricane effects)

Air, land, sea transport potentially effected in such a way that they never recover.  Cargo security will be a high profile area. Port, distribution and staging areas will receive heightened scrutiny due to the high potential for transmission of virus tainted produce at these touchpoints.

Quarantine could have devastating effects. Difficult to ensure security, information systems are vulnerable. Human resource issues will be ongoing concern.



Economic Effect of a Pandemic – Business Continuity Planning Analysis (continued)


Short-term Effect

Long-term Effect


Water Supply Systems


Potential loss of worldwide workforce could see system degradation due to lessened ability to respond to normal maintenance and emergency situations.

Loss of expertise within the workforce could result in a permanent destabilization of the energy sector, leaving it more susceptible to disruption than at present.  Water systems would remain highly vulnerable due to a lack of security resources.

Water systems need greater business continuity assistance due to the lack infrastructure being replaced.  Potential loss of workforce has long term impact on water systems resulting in degradation to service.

Emergency Services


Potential loss of worldwide workforce could see system degradation as demand for service would escalate to unprecedented levels.  Hospitals worldwide could not manage the amount of patients.  Possible collapse of medical systems worldwide.  Lack of antiviral drugs would have immediate impact.  Police, fire and other services could be severely impacted due to loss of workforce at a time when demand escalates.

Potential loss of worldwide workforce could see system degraded for a long period even in the aftermath of the pandemic.  Demand for general services would be impacted.  Hospitals worldwide would take long periods to recover.  Possible long term collapse of medical systems and healthcare worldwide.  Lack of antiviral drugs would have long term impact.   Police, fire and other services would be short of employees for long period.

Degradation of Emergency Services combined with degradation Transportation could present significant infrastructure concerns for continuity planning efforts.  Possible return to late 19th century medical services capabilities due to loss of skilled workforce.  Significant regional and local impacts for continuity planning.

Continuity of Government


Potential collapse of governmental control worldwide.  Use of military by governments worldwide to maintain order could result in negative effects.  Loss of workforce could create inability to implement current pandemic plans.  Possible inability to protect population and infrastructure.

Demands for action will grow; lack of antiviral medication could have major negative impact.  Potential chaos with targeting of government facilities for disruption.  Worldwide tensions as scarce resources are in demand and loss of population leave governments vulnerable.

Disruption of government could happen, although it is difficult to foresee a total collapse.  Governments worldwide would be under tremendous stress.  From a continuity planning perspective, the need for collaboration would never be greater.  Government could invoke orders to force business cooperation (i.e., U.S. Presidential Executive Orders)

Conclusion: Seize the Initiative - It Makes Sense

A Chinese proverb states that "Opportunity is always present in the midst of crisis."  Every crisis carries two elements, danger and opportunity.  No matter the difficulty of the circumstances, no matter how dangerous the situation… at the heart of each crisis lays a tremendous opportunity.  Great blessings lie ahead for the one who knows the secret of finding the opportunity within each crisis. 

Today business leaders have the responsibility to protect their organizations by facilitating continuity planning and preparedness efforts.  Using their status as “leaders,” senior management and board members can and must deliver the message that survivability depends on being able to find the opportunity within the crisis.   

Market research indicates that only a small portion (5%) of businesses today have a viable plan, but virtually 100% now realize they are at risk.  Seizing the initiative and getting involved in all the phases of crisis management can mitigate or prevent major losses.  Just being able to identify the legal pitfalls for the organization of conducting a crisis management audit: can have positive results. 

We cannot merely think about the plannable or plan for the unthinkable, but we must learn to think about the unplannable.  Business continuity planning must be overlapping in time, corrective in purpose complimentary in effect. 



Drabek TE, Tamminga HL, Kilijanek TS, Adams CR. Managing multi-organizational emergency responses: emergent search and rescue networks in natural disaster and remote area settings. Natural Hazards Research and Applications Information Center. University of Colorado, Boulder CO, 1981 

Harris, Gardner, October 8, 2005 – New York Times; Bush Plan Shows U.S. Is Not Ready for Deadly Flu  

Meyer, Gerald C., "When it Hits the Fan: Managing the Nine Crises of Business," 1986 

Mittelstadt, Michelle, Dallas Morning News, Sunday, September 11, 2005 “Four years after 9-11, Katrina reveals flaws in emergency planning” 

Mitroff, Ian, I., Avoid "E3" Thinking, Management General, 1998 

Mitroff, Ian, I., Smart Thinking for Crazy Times: The Art of Solving the Right Problems, 1998 

Sikich, Geary W., The Financial Side of Crisis, 5th Annual Seminar on Crisis Management and Risk Communication, American Petroleum Institute, 1994 

Sikich, Geary W., Managing Crisis at the Speed of Light, Disaster Recovery Journal Conference, 1999 

Sikich, Geary W., Business Continuity & Crisis Management in the Internet/E-Business Era, Teltech, 2000 

Sikich, Geary W., What is there to know about a crisis, John Liner Review, Volume 14, No. 4, 2001 

Sikich, Geary W., The World We Live in: Are You Prepared for Disaster, Crisis Communication Series, Placeware and ConferZone web-based conference series Part I, January 24, 2002  

Sikich, Geary W., September 11 Aftermath: Ten Things Your Organization Can Do Now, John Liner Review, Winter 2002, Volume 15, Number 4 

Sikich, Geary W., Graceful Degradation and Agile Restoration Synopsis, Disaster Resource Guide, 2002 

Sikich, Geary W., “Aftermath September 11th, Can Your Organization Afford to Wait”, New York State Bar Association, Federal and Commercial Litigation, Spring Conference, May 2002 

Sikich, Geary W., "Integrated Business Continuity: Maintaining Resilience in Times of Uncertainty," PennWell Publishing, 2003 

“It Can’t Happen Here: All Hazards Crisis Management Planning”, Geary W. Sikich, PennWell Publishing 1993. 

Sikich, Geary W. and Slavik Nelson S., Industry Expectations Concerning Healthcare Response to OSHA 1910.120 "Hazardous Waste Operations and Emergency Response"; Environmental Health Manager; Spring Issue 1990, VOL. 4, No. 1. 

Sikich Geary W., "The Emergency Management Planning Handbook", McGraw Hill, 1995.

Sikich Geary W., Stagl, John M., "The Economic Consequences of a Pandemic", Discover Financial Services Business Continuity Summit, 2005. 

Zuckerman, Mortimer B., New York Daily News, 20 June, 2005, “A Nightmare Scenario – H5N1 Pandemic” 

Economic Shock Waves From Avian Influenza Spreading Faster than the Disease Source: http://www.prweb.com/releases/2005/3/prweb220610.htm 

The following citations are taken in total from The Lancet carried an article entitled,H5N1 influenza pandemic: contingency plans(The Lancet 2005; 366:533-534 DOI: 10.1016/S0140-6736(05)67080-8): 

1. World Health Organization. Cumulative number of confirmed human cases of avian influenza A/(H5N1) since 28 January 2004. May 4, 2005 http://www.who.int/csr/disease/avian_influenza/country/... (accessed May 8, 2005)

2. Ungchusak K, Auewarakul P, Dowell SF, et al. Probable person-to-person transmission of avian influenza A (H5N1). N Engl J Med 2005; 352: 333-340. CrossRef

3. Zeitlin GA, Maslow MJ. Avian influenza. Curr Infect Dis Rep 2005; 7: 193-199.

4. Kirkbride HA, Watson J. Review of the use of neuraminidase inhibitors for prophylaxis of influenza. Commun Dis Public Health 2003; 6: 123-127. MEDLINE

5. World Health Organization. National influenza pandemic plans. 2005: http://www.who.int/csr/disease/influenza/nationalpandem... (accessed May 8, 2005).

6. GlaxoSmithKlineRelenza datasheet. Issue number 5. June 8, 2000. Evreux, France: Galxo Wellcome Production, 2000: http://www.msds-gsk.com/uk_presc/11057406.pdf (accessed June 1, 2005).

7. Hoffmann-La RocheTamiflu datasheet. Core data sheet version 1.5. May, 3 2004. Basel: F Hoffmann-La Roche, 2001: http://www.medsafe.govt.nz/profs/Datasheet/t/Tamiflucap... (accessed June 3, 2005).

8. The MIST (Management of Influenza in the Southern Hemisphere Trialists) Study Group. Randomised trial of efficacy and safety of inhaled zanamivir in treatment of influenza A and B virus infections. Lancet 1998; 352: 1877-1881. Abstract | Full Text | PDF (80 KB) | MEDLINE | CrossRef

9. Treanor JJ, Hayden FG, Vrooman PS, et al. Efficacy and safety of the oral neuraminidase inhibitor oseltamivir in treating acute influenza: a randomized controlled trial. JAMA 2000; 283: 1016-1024US Oral Neuraminidase Study Group. MEDLINE

10. McKimm-Breschkin JL. Management of influenza virus infections with neuraminidase inhibitors: detection, incidence, and implications of drug resistance. Treat Respir Med 2005; 4: 107-116. MEDLINE

11. Kiso M, Mitamura K, Sakai-Tagawa Y, et al. Resistant influenza A viruses in children treated with oseltamivir: descriptive study. Lancet 2004; 364: 759-765. Abstract | Full Text | PDF (95 KB) | CrossRef

12. Tran TH, Nguyen TL, Nguyen TD, et al. Avian influenza A (H5N1) in 10 patients in Vietnam. N Engl J Med 2004; 350: 1179-1188. CrossRef

13. Imuta F, Toyoda M, Toyoda T. New application method of zanamivir with a straw. Pediatr Int 2003; 45: 366-367. MEDLINE | CrossRef

14. Murphy KR, Eivindson A, Pauksens K, et al. Efficacy and safety of inhaled zanamivir for the treatment of influenza in patients with asthma or chronic obstructive pulmonary disease: a double-blind, randomized, placebo-controlled multicentre study. Clin Drug Invest 2000; 20: 337-349.

15. Cass LM, Brown J, Pickford M, et al. Pharmacoscintigraphic evaluation of lung deposition of inhaled zanamivir in healthy volunteers. Clin Pharmacokinet 1999; 36 (suppl 1): 21-31.

16. Hill LS, Slater AL. A comparison of the performance of two modern multidose dry powder asthma inhalers. Respir Med 1998; 92: 105-110. MEDLINE | CrossRef

17. Webby RJ, Webster RG. Are we ready for pandemic influenza?. Science 2003; 302: 1519-1522. CrossRef

18. Tzeng HM. Nurses' professional care obligation and their attitudes towards SARS infection control measures in Taiwan during and after the 2003 epidemic. Nurs Ethics 2004; 11: 277-289. MEDLINE | CrossRef


Editor's note: Big Medicine is very proud to present a sneak preview of the first chapter of W. David Stephenson's upcoming book 'Democratizing data to transform government, business & daily life'. I had the privilege of hearing/seeing David in action over the past several days at the Ogma gathering at NPS in Monterey, California. His thoughts on social media provide a compass heading for many of us as we consider where we need to go and how we're going to get there. - HN [July 4 2009]


Access to data
triggers transformation

by W. David Stephenson

When many of us go to Washington D.C., we like to visit historic landmarks.

We don’t necessarily like carrying maps and guidebooks, especially since most try to be comprehensive, while you might be particularly interested in one aspect, such as Lincoln, so the other material would be irrelevant to you. Now you can use the D.C. Historic Tours application on your iPhone[i]. Just type in “Lincoln,” and it instantly creates a walking tour only of Lincoln-related places, then guides your actual path block-by-block. As for the content of that tour? Your author and other willing volunteers located the places to include in the tour and uploaded the data and photos about them to the Web for use in the application!

In New Zealand, Aukland drivers use an application that uses real-time data from the government’s InfoConnect program[ii] to show where there are traffic jams & then zero in on a local traffic cam. They can change their routes to steer around the jams.

In the Netherlands, companies have the option of filing a single set of numbers instead of the multiple reports to multiple agencies that they formerly had to file. Participating companies can save up to 25% on their reporting costs, and the agencies can actually do a better job regulating the companies.[iii]

What makes these innovation work?

Free, real-time access to unfiltered, valuable data.

Data pervades our lives.[iv]

Government agencies and companies collect data around the clock about our births, deaths, education, jobs (or lack thereof), our race and gender, our spending and saving, our health. Then they use that data to make decisions affecting our incomes, our buying options, even whether we qualify for special benefits.

Data determines how much governmental assistance our communities receive.

Data determines which services companies will market to us, and where they’ll build stores to deliver them, as well as which they will scuttle because data says there’s not enough demand.

Data determines where roads will be built, then our GPS devices process data from government satellites to guide us down those roads and help us find services.

Yet, for all of data’s influence on our lives, you and I have surprisingly little direct access to it ourselves to use as we might like.  That’s particularly true with the most valuable type, real-time data. Because it is made available as it is gathered, this data can be used to automate equipment and services and/or help us make decisions, rather than simply analyze the past, as can be done with historical data.

Despite those benefits, this data is more likely to remain buried in data warehouses and be costly and/or difficult to obtain. When we do get it, it’s often in a form that is difficult to use.

That’s outrageous.

As you will see, if you did have access to that data we could do our work more efficiently and cheaply, engage in more productive political debates, and even contribute directly to new ways to deal with some of our era’s most pressing problems, such as global warming or health care cost containment.

Yet, there’s little sense of public concern, and even less outrage, about our relative lack of unfettered access to critical information.

Frank DiGiammarino, former vice-president of strategic initiatives at the National Academy for Public Administration and now the Obama Administration’s deputy coordinator for Recovery Implementation, says that’s a major problem in the United States (and worldwide, for that matter):

“We as a country need to treat data as a national asset and resource. It is a valuable commodity but we don't treat it that way. We don't think in terms of where it is. In current structures, it is stovepiped but, needs to be moved fluidly  …. The default question has to be why can't we share it? Data has to become a core component of how government works and how leaders think of dealing with issues.”[v]

We’ve been in this situation regarding critical information before: in the 16th century when it was the written word that was inaccessible to all but a few.  How that situation changed – in less than a decade – may provide us some valuable insights into how direct access to data could come about in far less time, and the revolutionary change it would bring.


Luther provided a roadmap

In 1517, Martin Luther’s theology, especially his 95 Theses attacking the practice of selling indulgences and other forms of corruption in the Roman Catholic Church, created controversy. It also mobilized the church establishment to defend the status quo.

In hindsight, the means Luther used to spread his Reformation message had as much lasting global impact as the message itself.

Gutenberg invented the printing press in 1439.  In 1502, a printer opened shop in Wittenberg, where Luther wrote and taught,[vi]  but printed materials were still relatively rare in 1517.

In 1514-5, Luther began to lecture on the Psalms. He had psalters printed for his students, with wide margins so they could write notes.  He removed medieval priests’ commentary, forcing the students to interpret the Bible themselves. [vii]

Thus began Luther’s efforts, crowned by his translation of the New Testament into German during 1521-2[viii] (and eventually all of the Old Testament as well) to make the Bible directly accessible to the lay public, through printed copies they could own and interpret themselves, instead of having to rely on the priesthood as intermediaries.[ix]

Printing and distribution of his revolutionary message was immediately effective, at least as measured by the amount of printed matter. In Germany alone, 390 editions of Luther’s works were published just in the year of 1523. By 1525, about 3 million copies of pamphlets relating to Luther were printed.[x]

Making the Bible changed the very nature of scholarship. As Diarmaid MacCulloch observed in The Reformation: a history:

"Now that printed copies of texts were increasingly available, there was less copying to do, and so there was more time to devote for oneself … Copying had been such a significant activity that in previous centuries of Christian culture, it had been given a privileged place against original thought.  Now the order was reversed, and original thought became more important.[xi]

In a tangential result of the impact of the newly-empowered congregations, some of the early seeds of democracy were planed that were to flourish in the New World. Zwingli, another of the early Reformation leaders, won the right of each parish in a village to decide by majority vote of the male members which religion they would adopt.[xii]  

Management consultant Wendy Jameson pointed out to the author the parallel between Luther’s impact and what might happen if we liberate data:

"Martin Luther was effective because he both translated the Bible into language that the general public could understand and made it widely available through printed versions.   The confluence of translation and availability enabled the transformation. A literate person in a home or community could now read it to the other community members, the genesis of the empowered layperson.

“The Internet today serves as the analogous means for widespread distribution of data, combined with new tools that make data understandable to everyone.  For the first time, data will become a valuable tool for many to whom it was an impenetrable mystery in the past."[xiii]

However, we tolerate a mind set regarding data not all that different from what was commonplace with the written word before Luther. Sara Wood, a leader in the nascent movement to make data both available and understandable to the general public, says that:

 “It may not be obvious to everyone, but there exists an important problem of data apathy.  No one cares about data. And by no one, we mean in the democratic sense…. “Good data should affect policy - but politicians don't care because they know their voters don't care. People who vote don't care because data is not engaging, not to mention accessible, usable, and relevant to their lives.”[xiv]

Data apathy is no longer tolerable. Data is so important to our lives that we must all care about data and demand access to it.


The transformation from democratizing data

The time has come to emulate Luther’s example and make data as freely available as he made the printed word ubiquitous

The results, as demonstrated by the limited examples from around the world where democratizing data has taken hold, are astonishing.

Take some simple steps to transform your organization’s raw data into a more versatile and usable form, place that data at the center of your organization’s operations, make it accessible to everyone who really needs it, and everything changes.

Data that has been “processed, organized, structured or presented in a given context so as to make [it] useful” is elevated to the status of information.[xv] It is this more elevated, valuable sense of data as information that will be used throughout this book.


A handful of tools that you will learn about in this book, none of them radically innovative by themselves but revolutionary when combined, make it simple for organizations to make valuable information available to those who need it, when and where they need it, to improve their decision-making and actions. Since that was never possible before, the potential for change in every aspect of how we work and live is profound and pervasive.

Let us call this transformation democratizing data:

"Democratizing data makes it automatically available to those who need it (based on their roles and responsibilities), when and where they need it, in forms they can use, and with freedom to use as they choose -- while simultaneously protecting security and privacy."

It seems audacious to claim that an act as modest as modifying the way you treat your organization’s raw data can lead to sweeping economic, governmental, and social change.

That is precisely what Democratizing Data will demonstrate.

For far too long, we have been more concerned with creating data warehouses in which to store data than we have been with actually using that data to its full potential. In fact, it’s rather astonishing that organizations have prospered to the extent they have, considering how limited access to real-time, actionable information has been.

This remained true even recently, when we have had powerful computers to gather, accumulate, and disseminate data. It still remained costly and difficult to deal with data, so access to it was typically limited to management, analysts, and other elites. Even these power users rarely had access to the most important data, in real-time, non-aggregated form, which allows the user the most freedom and makes its ability to affect current actions most powerful.

Putting data squarely at the center of everything we do, and making it usable – and shareable -- by everyone, not just those with statistical skills, is a dramatically different approach from how we’ve regarded data in the past.


Democratizing data sparks wide range of change


Making data automatically available when and where it is needed triggers widespread and fundamental changes.


To begin with, with easy access to real-time data, we can make better decisions. As we will explore in Chapter 3, for the first time groups can easily analyze data collaboratively. The result is fundamentally different from when an individual analyzes it in isolation. Different perspectives come into play, assumptions are challenged, and the chances of uncovering problems in advance that might otherwise only be discovered after a decision is reached are increased.


Because this data is machine-readable, i.e. encoded in a way that a computer or machine can automatically scan or process, it can provide the real-time information necessary to operate a wide range of devices, which has both economic and quality-of-life benefits.


Perhaps the most common example today of real-time data spawning an entirely new industry would be global positioning systems (GPS). Location-based services (LBS), just one components of the range of businesses made possible by GPS, are expected to grow by 104% through 2011.[xvi] Can you imagine the potential economic development and quality-of-life opportunities if all of the non-confidential geospatial data compiled by government agencies was routinely released on a real-time basis?


In the political realm, debate and disagreement will always be with us, so one should not over-estimate the benefits of access to data. However, beginning debate on proposed legislation from a pool of data that was accessible to all on a simultaneous basis  might increase the chances of reaching consensus or at least isolating the most extreme positions that were clearly not supported by data. The more data is analyzed and debated before passage of legislation, the less likely it will be that critical data that only comes to light after passage would undermine the law itself, or significantly alter public opinion.


Similarly, when data on government operations, campaign finance and “earmarks” are made public, it is much harder to conceal corruption or unjustified disbursements. For example, making campaign contributions public allows watchdog groups and the media to create visualizations that explore possible correlations between contributions and votes that might favor a particular contributor. 


Equally important, although few organizations have tried it so far, making real-time, actionable data available to your entire workforce (with the exact amount and type available filtered depending on your role: this is not a one-size-fits-all approach) can elevate all workers to the status of “knowledge workers.”  That will help workers increase their efficiency and reduce costs. They will be able to see which other employees have access to the same data and therefore are likely to share tasks, responsibilities and oversight and interests, engage in the kind of “collaborative data analysis” mentioned above. They can see potential synergies, overlaps, and gaps between programs that must be addressed.



Democratizing data essential today

The lack of broad public access to real-time data was regrettable in the past. Given the unprecedented worldwide organizational and social changes facing government, the global economy, and our personal lives today as a result of the global crisis that began in 2008, it is intolerable.

We need every potential tool and piece of information at our disposal to deal with these conditions.

For business people, given the massive layoffs over the past few years, it is essential that your remaining workers be able to be as efficient and effective as possible. As mentioned above, democratizing data will make it possible for the first time to give your entire workforce the raw, real-time information needed for them to work more efficiently, new tools to help them better analyze that information, and to collaborate as never before.

Businesses will also be able to significantly reduce their non-labor costs when data is democratized. They will be able to improve business process management (BPM) and supply-chain management because all of those needing to coordinate procedures, procurement, and logistics will be able to communicate more readily.

In addition, embedded-devices[xvii] activated by real-time data will have access to it at the same time, automating previously manual processes. Data will give us usable information on everything from traffic to our personal carbon footprints to our health conditions in applications and devices that will allow us to act on that data and improve our lives.

The regulatory system, in shambles after revelations of lax enforcement in the past decade, was at least in part to blame for the sub-prime mortgage scandal and its cascading effects on the overall economy. Regulation can be reinvigorated through a shift to “smart” regulation, which substitutes a single data file for countless traditional forms. All of the agencies responsible for reviewing a company’s operations will be able to share data simultaneously, allowing coordinated review and enforcement for the first time. This should improve the quality of regulatory review and uncover suspicious activities sooner. The same single-business reporting approach will allow companies to reduce their regulatory compliance costs, perhaps as much as 25%.[xviii]

In the past, effective regulation would inevitably have driven up corporate reporting costs, because the only way to have increased scrutiny would have been to require filing more forms. Now a radically simplified, but more informative and integrated, system can benefit government, the public, and corporations.

Equally important, government agencies and corporations alike must rebuild public confidence after widespread revelations of shoddy management, lack of oversight, and imprudent investments that brought the global economy to the brink of disaster in 2008-9. They will be able to do so through democratizing data.

Demeaning, “trust us” platitudes are no longer enough in the face of consumer and voter outrage. Instead, by releasing large amounts of unedited data directly to stockholders, voters and watchdogs, they can take a “don’t trust us, track us” approach, inviting unfettered scrutiny by watchdogs, the media, and the public.

The soaring federal budget and deficit have united the political spectrum in demands to cut out waste and inefficiency, and to open up the legislative process so that the public can be heard.

Vivek Kundra, the former District of Columbia chief technology officer, named by President Obama as the first chief information officer of the United States, refers to this approach as the “digital public square.”[xix]

“… technological advances now allow people from around the world unfettered access to their government. Through these advances, constituents can hold their government accountable from the privacy of their own homes. The District of Columbia is bringing people closer to government through collaborative technologies like wikis, data feeds, videos and dashboards.  We’re throwing open DC’s warehouse of public data so that everyone—constituents, policymakers, and businesses—can meet in a new digital public square. “[xx]

Kundra, incidentally, was originally to Democratizing Data’s co-author. His new responsibilities required that he recuse himself, so he didn’t actually write or edit any of the book. However, because of several long Saturday discussions of the democratizing data philosophy during the fall of 2008 --- long before he assumed his new job -- and a small project on the future of transparency that the author did for him in his prior job, Kundra’s  thinking is a powerful influence throughout the book.

Finally, and perhaps most exciting, democratizing data can lead to innovation.

It is now possible, by allowing free access to real-time data streams, to unleash “crowdsourcing” of new services for government and industry alike, better serving diverse groups’ needs at low or no cost.

Crowdsourcing, as explained in the book by the same name by Jeff Howe,[xxi] is the phenomenon in which communities, whether intentional or ad hoc ones, come together using Internet resources, especially open-source software, to accomplish a task collaboratively, by each providing a small portion of the overall solution.[xxii]

Even better, the more organizations embrace this revolution, the more the benefits will multiply, because democratized data inherently fosters linkages and synergies between programs and services that share the same data, and open source solutions that all can share and improve upon. Because these programs use global standards, free to everyone, the revolution can and must be global in nature, benefitting nations of all sizes and development status.

stumblesafely: the revolution in microcosm

Democratizing Data will introduce you to some revolutionary examples of the democratizing data transformation. One, for instance, integrates all data to help a state handle natural disasters or terrorist attacks. Another provides emergency room doctors with critical information in life-or-death situations. A third gives soldiers dealing with the unprecedented challenges of asymmetrical warfare all of the data they need to both fight battles and wage “soft peace.”

But to get a basic introduction to the approach and its power, let’s begin with a far more modest example.

A group of young Washington D.C. application developers developed “stumblesafely” to help them and their friends navigate home on foot safely after a convivial evening in bars in the city’s Northwest section. While stumblesafely wasn’t intended to change the world, it turns out to tell us a lot about democratized data’s power to transform every aspect of our lives.

Illustration 1.1 Stumblesafely

 “stumblesafely” was an after-hours product of DevelopmentSEED, a leading D.C. web development firm that does ambitious online projects for clients such as the World Bank, the UN Millennium Campaign, and the American Institute of Architects.

In fall 2008, Kundra announced a first-of-its-kind contest that caught the company’s attention.

The Apps for Democracy Contest (“Apps” being developer-shorthand for computer applications) offered nominal prizes for developers who took one or more of the real-time data feeds that the city issues as part of its “Citywide Data Warehouse,[xxiii]” and developed an “open-source” application that others are free to use or improve upon that, in some way served the public interest.  How the entries served the public interest was intentionally left vague to encourage creativity.

Oh, and the teams had only a month to prepare their entries.

The DevelopmentSEED team jokingly called Apps for Democracy “Iron Chef for developers,” referring to the TV show in which chefs are given a limited number of ingredients and length of time to create dishes.  Their “ingredients” were the 270+ data feeds the city issues through the Citywide Data Warehouse, and the time frame the one-month deadline to submit applications. Given those limits, the team decided to have some fun, and do an “Apps for Democracy” entry that they’d like to use themselves.

According to firm strategist Eric Gundersen, stumblesafely, which they call a “guide to bars and avoiding crime in NW [Washington]”[xxiv]:

“.. was one of those ideas that happened when we were working late one night. We figured it would be cool to show off some of our favorite drinking spots in DC. We like to joke that it doesn't matter when or where you start drinking for stumblesafely to help you, since you can see crime data based on daytime, evening  or night.”[xxv]

As you can see from the screengrab, stumblesafely is attractive, resembling an aerial view of the neighborhood at night, with large squares that represent popular bars (“stumblesafely” is very popular with bartenders!), gray circles that show the location of recent robberies, red x’s that show assaults. Following the map are phone numbers to call a cab (for those who really had too much of a good time), and the right sidebar lists real-time Twitter “Tweets” referring to nightlife in the area, re-enforcing the message that this isn’t just a canned, static map, but a real-time tool.

Cute, and probably fun for pub-crawlers, but a closer analysis of stumblesafely shows that it combines most of the important elements regarding free access to valuable data that this book will explore, and which underlie much more serious work:

·         Creatively use data formerly inaccessible to the public.
The District of Columbia issues more than 270 “structured” data feeds from their massive city databases (Structuring data, as we will explore in the next chapter, means bracketing the data with “tags” that describe it and give it context,” such as <description> or  <phone>. DevelopmentSEED used 6 of the feeds, most of which are delivered automatically as new data is entered, so they are always current.
The names illustrate the wide range of data, especially geo-spatial data, that agencies compile and could be valuable to the public or within agencies as well (since, as we will see, most workers also didn’t have real-time access to it in the past):

·                     DC Crime Data

·                     DC Road Polygons

·                     DC Liquor Licenses

·                     DC Water Polygons

·                     DC Parks

·                     DC Metro Stations

·         Use universal standards.
The DC data is valuable because it is identified by a standardized “tag” system that attached additional information to the data so it can be recognized and processed by any program or any device that is programmed to draw in that data. Those tags are based on global standards that are free and accessible to all, which increases their versatility, and makes it easier for others to copy and improve upon pioneering applications.

·         Visualize data & evaluate it collaboratively, which makes it valuable.
Most of this data would be incomprehensible to non-statisticians in its traditional tabular form. However, when presented graphically, the data instantly becomes understandable to the general public.

Also, the fact that the DevelopmentSEED staff examined the DC data feeds collaboratively rather than individually improved the quality of results. When many perspectives examine the same information, the interpretation will be richer and more nuanced than what even the most brilliant individual could do in isolation.

·         Use open-source software.
Open-source software (i.e., software whose source code is freely available to use and improve) is usually cheaper than proprietary alternatives, and built on open standards, just as the structured data feeds are. DevelopmentSEED only used open-source applications to create stumblesafely, increasing this versatility and ease of adapting the program to other cities. Gundersen said, “A couple of years ago we could not have done this kind of stuff with government data because the tools were not there. Now open-source tools are more powerful and more secure than proprietary applications. We were able to build this in a couple of days with the only cost being our time.”[xxvi]

·         Create 0pen-source solutions to encourage constant improvement.
One of the contest rules required that the solutions themselves be open source, so that others could copy and/or improve on them. This will significantly speed adoption of democratized data solutions worldwide, because other governmental entities that begin to offer the necessary structured data feeds can easily examine then share or improve on the work of the pioneers.

·         Create mashups.
Each data stream by itself would only provide a small part of the information needed to create interesting and informative maps. However, when all 6 of them were combined – “mashed up” (in developers’ lingo) -- the picture was comprehensive and valuable.

·         Don’t prejudge what data to not release. Someone may find it valuable.
Management may be tempted to decide that certain data doesn’t need to be released because it would be of little interest to others. However, it was combining 6 of the data feeds that DevelopmentSEED used that made stumblesafely possible. Some data feeds may be appealing only to a relatively small number of people, but may be invaluable to them (the long-tail phenomenon at work[xxvii]), so access shouldn’t be arbitrarily limited.

·         Partner for innovation.
DevelopmentSEED’s Eric Gunderson learned after the Apps for Democracy that stumblesafely had some unexpected users: the DC Police. The city administrator told him that the police “… were using our map to better visualize crime hot spots near bars to improve their coverage during the key times of the day when it mattered. This is a great example of a positive externality coming from open data… open data will have many benefits for taxpayers that we can’t even imagine now. It is not like the government would have ever paid us to build a drinking site!”
[xxviii] When government agencies – or private companies, for that matter – release data, others will use them in creative ways that may create new revenue streams for the company or help a government agency better serve the public interest.

As an added bonus, Gundersen says that the project for fun directly benefited some of their prestigious regular clients: “the same mapping tools powering the bar site are also being used to help USAID map [food security operations in Africa] and by non-profits like New America to map public health data in the U.S. In fact it was New America that helped pay for a lot of the mapping work with Drupal that gave us the tools to do this.  Everything we do ends up getting reinvested back in. It feels great.”

On further examination, stumblesafely looks like much more than a group of friends’ fun little project for themselves and their buddies.

It’s a harbinger of a new era in which free access to data leads to innovation in every aspect of our lives.

Democratizing data happening now

stumblesafely isn’t the only example of democratizing data in practice today. This is not just a vision of possible transformation in the future. True, the amount of innovation is severely limited by the lack of freely-available structured data that is the underpinning of democratizing data.

Despite those limits, pioneers in government and industry worldwide are already realizing tangible results with innovative data-centric strategies that would have been impossible only a few years ago.

In the Netherlands, companies now have the option of filing a single data file with the government instead of the traditional 30-40 quarterly and annual reports to a wide variety of agencies. The change is possible because all of the agencies have reprogrammed their mandated reports so that they can automatically access relevant data from the unified file.  Multiple agencies can examine the company’s filing simultaneously, improving the quality of regulatory scrutiny. Participating companies can cut 25% off of their compliance costs. Australia will follow the Dutch government’s lead with a similar program in 2010.[xxix]

Wacoal, the Japanese apparel firm, had 32 different legacy IT systems in place, which it had added over a number of years. The company went to a new system based on universal access to the same data. As a result, they consolidated their financial reporting, shortened the closing of accounts by two days, and added real-time cash management.[xxx]

In the District of Columbia, Aki Damme, director of the District of Columbia’s IT ServUs team, had to manage a project to buy and install 6,000 computers in city classrooms for a high-visibility new program. The original estimate was that the project would take an entire year to complete. However, an expedited purchasing program and his ability to plan the installations using a Google Maps mashup cut the total length to only 7 weeks, and saved thousands of dollars in costs.[xxxi]

Agencies responsible for disaster preparedness and response in Alabama can now access “Virtual Alabama,” a comprehensive, integrated array of real-time geospatial information – right down to the layout of individual classrooms – that helps them change emergency evacuation routes, know instantly where response vehicles are located, and monitor real-time sensors locating chemical releases and their plumes.[xxxii]

The US Patent Office now allows individuals outside its staff to participate in the review of patent applications under the trial “Peer to Patent system” designed in part by NYU Law Professor Beth Noveck, now an Obama Administration official. The project promises to reduce the “patent thicket” that slows innovation.[xxxiii]

Although these examples are impressive, the organization that perhaps epitomizes the use of democratized data better than any other at the time of this book’s publication is the District of Columbia’s Office of the Chief Technology Officer (OCTO).

Under former CTO Vivek Kundra, OCTO pioneered numerous innovations, including:

·         publishing a wide range of real-time data streams to invite public scrutiny and allow mashups[xxxiv]

·         introducing rigor and accountability to project management by treating each project as a “stock”[xxxv]

·         treating every worker as a knowledge worker, and giving them real-time data to do their jobs more effectively[xxxvi]

·         running the precedent-setting “Apps for Democracy” contest, which resulted in an astonishing array of crowd-sourced open source applications—and reaped a return on investment of 4,000% [xxxvii]

Now that Kundra has become the first CIO of the U.S. government, his innovations at OCTO will provide valuable clues to the kinds of changes he has already begun spreading throughout the US government. Those in turn will likely stimulate similar initiatives in the private sector and other governments worldwide. Accordingly, an entire chapter of the book will be devoted to a case study of his accomplishments there.

All of these examples, and more, will be discussed throughout the book.  Since, as mentioned above, these pioneering examples are made possible by international, open-source standards for handling data, it becomes very easy for other companies and agencies to launch their own programs of these sorts, building on the experience of the pioneers and adding to the “library” of data-based solutions to complex problems.

That will mean that those who begin democratizing data now can directly benefit from the case studies detailed in the book. The benefits, should other government agencies and companies move quickly to take the basic steps required, should increase exponentially because of the synergies between initiatives worldwide.


Keys to the strategic shift

Effective democratizing data initiatives require a paradigm shift from past ways of regarding data. The book will explain in depth these key goals:’

·            Make your organization data-centric.
 In the past, because the tools to distribute and use data were primitive, it was understandable that access to data was primarily second-hand. It was usually warehoused, embedded in proprietary software, and/or interpreted by an elite group of analysts and executives. Today, open source software, metadata and other tools that we will examine allow the data to remain independent, accessible to all whose jobs require access to it. Truly, data must be thought of as at the heart of everything the organization does.

·            Treat all workers as knowledge workers.
When data was hard to access and the software to interpret it costly, limiting access to real-time data to a relative few was justifiable. Now it isn’t. Every worker’s job performance and satisfaction can be increased by direct access to data (the exact mix of data delivered to individual workers will be determined on the basis of his or her role.)

·            When appropriate, release real-time data for outside use and scrutiny
Government agencies and businesses accumulate vast amounts of data that could be used externally, not only to earn public trust through transparency, but also (especially with real-time and geo-spatial information) to create valuable new services that can complement what the agencies and companies do themselves, or, in its machine-readable form, to drive embedded devices in a wide range of products. That data is also more valuable when it is released in the original, granular form in which it was collected, rather than as interpreted and aggregated by others.  Today the default must be to release data. Exceptions to that rule must be justified.

·            In no way does a democratizing data strategy justify breaches in personal privacy and/or security standards.
In fact, as we will see, establishing the right access standards can mean people ranging from those with no security clearance at all to top-secret clearance may all access portions of the same data set based on the situation and their roles, but with widely-differing specific levels of access. A comprehensive democratizing data strategy should in fact help uncover security and privacy breaches rather than encourage them.

·            Above all, adopt a new collaborative attitude toward data.
In the past, if data was shared at all, it was usually sequentially, because data was effectively captured and altered by various proprietary programs. Now, with open-source, open-access programs and structured data, data can be more effectively analyzed and used if it is shared on a real-time basis. Collaborative data analysis is fundamentally different than analysis by individuals, harnessing different perspectives and expertise to yield a richer, more comprehensive picture that benefits from all of these perspectives and is more nuanced and balanced.

Democratizing Data’s overall goal is to introduce you to the benefits of democratizing data and to the simple tools you can use to structure and automatically distribute data, the fundamental building blocks of the democratizing data approach.

Along the way, you’ll learn that democratizing data is both a process and an attitude. The more people who can access data and use it, the more valuable the data will become, the more workers will be able to improve their performance, government and corporations will become more accountable and transparent, and average people will become both better consumers of data and be able to use it to become active participants in creation of goods and services.

Let us begin to explore this profound transformation and its implications for our government, our workplaces, and our daily lives.

Given the monumental challenges facing us today, we don’t have a moment to spare, and data, used in innovative ways, can provide many of the solutions.

[i] Boalt Interactive, “DC Historic Tours,” http://www.dchistorictours.com

[iii] Schneider, Bob. “Dutch Taxonomy Project Cuts Red Tape,” Hitachi Interactive. http://hitachidatainteractive.com/2007/03/17/the-dutch-taxonomy-project-cuts-red-tape/

[iv] Strict grammarians remind us that data is the plural of datum in Latin. However, has become common practice to use a singular verb with data, so that will be the practice observed in this book.
In case you’re interested, here’s the argument:
“The word data is the plural of Latin datum, “something given,” but does that mean you should treat it as a plural noun in English? Not always. The plural usage is still common enough Sometimes scientists think of data as plural, as in These data do not support the conclusions. But more often scientists and researchers think of data as a singular mass entity like information, and most people now follow this in general usage.” The American Heritage® Book of English Usage.A Practical and Authoritative Guide to Contemporary English. New York: Random,  1996..

[v] DiGiammarino, Frank. Interview with author, December 05, 2008.

[vi]MacCullogh, Diarmaid. The Reformation, a history. New York:  Viking, 2004., 113.

[vii] Ibid., 114.

[viii] Ibid., 128.

[ix] Ibi.d., p. 72.

[x] Ibib., p. 147.

[xi] Ibid.

[xii] Ibid., p. 171.

[xiii] Wendy M. Jameson, CEO, Potentiate, email to author, March 30, 2009.

[xiv] Wood, Sara. “Breaking the Vicious Cycle,” Tasty Data Goodies blog, July 14, 2007. http://blog.swivel.com/weblog/2007/07/breaking-the-vi.html

[xvii]Embedded systems are special-purpose computer systems designed to perform a single or a few dedicated functions on a real-time basis, which increasingly drive equipment and processes.

[xviii] Schneider, Bob. “The Dutch Taxonomy Project Cuts Red Tape.” Hitachi Daata Interactive blog. March 17, 2007. http://hitachidatainteractive.com/2007/03/17/the-dutch-taxonomy-project-cuts-red-tape/

[xix] Kundra, Vivek. “Building the Digital Public Square,” Oct. 15, 2008. http://www.appsfordemocracy.org/building-the-digital-public-square/

[xx] Kundra, Vivek. “Building the Digital Public Square,” unpublished essay.

Chief Technology Officer, District of Columbia Government

[xxi] Howe, Jeff. Crowdsourcing: why the power of the crowd is driving the future of business.” New York: Crown Business, 2008  310 pps.

[xxii] Arrington, Michael. “Search for Steve Fawcett Extends to Amazon’s Mechanical Turk.” TechCrunch, Sept. 8, 2007. http://www.techcrunch.com/2007/09/08/search-for-steve-fossett-expands-to-amazons-mechanical-turk/

[xxiv] DevelopmentSEED.”Stumble Safely.” http://www.outsideindc.com/stumblesafely

[xxv] Eric Gundersen, email to the author, March 17, 2009

[xxvi] Ibid.

[xxvii] As detailed by Chris Anderson in his book The Long Tail: Why the Future of Business is Selling Less of More,  the long-tail refers to a strategy in which you serve a large aggregate number of customers with products (in this case, data streams) that each serves a small niche.

[xxviii] Gundersen, op. cit.

[xxix] Schneider. op. cit.

[xxx] Wacoal Case Study, XBRL.org. http://www.xbrl.org/nmpxbrl.aspx?id=90

[xxxi] “OCTO Delivers Computers to Every DCPS Classroom,” News Release, District of Columbia Office of the Chief Technology Officer, Jan. 31, 2008. http://tinyurl.com/5wkarl

[xxxii]Alabama Department of Homeland Security, “Virtual Alabama Fact Sheet,” http://www.dhs.alabama.gov/virtual_alabama/home.aspx

[xxxiii] Scola, Nancy. “Better Patents Through Crowdsourcing.” Science Progresss, http://www.scienceprogress.org/2008/08/better-patents-through-crowdsourcing/   President Obama appointed Noveck as deputy director of open government in the Office of Science and Technology Policy.

[xxxiv] Office of the Chief Technology Officer. “Citywide Data Warehouse.” http://data.octo.dc.gov/

[xxxv] Harris, Blake. “Vivek Kundra: Engineering a Radical Transformation.” Digital Communities, March 5, 2009. http://www.govtech.com/dc/articles/625346

[xxxvi] Peirce, Neal. “A High-Tech Czar’s Scorecard.” Washington Post Writers Group, March 15, 2009. http://www.postwritersgroup.com/archives/peir090315.htm

[xxxvii] Collective Insight. “ROI on Apps for Democracy?” Collective Insight blog, Jan. 28, 20089. http://collectiveinsight.net/2009/01/roi-on-apps-for-democracy/


Creative Common: Attribution Non-Commercial No Derivatives


Editor's Note: June 2009 - Hurricane Season is upon us and many of the lessons learned post-Katrina still ring true today. This should be required reading for emergency managers and community leaders. - HN


Post-Katrina Emergency Messaging for the Disability Community


Brenda Phillips, PhD

Jennifer Mincin, MPA

[December 2005]


National Emergency Management Resource Center

NEMRC 2.0 www.nemrc.net


The purpose of this document is to provide a general overview of ideas, principles, research and basic strategies to assist emergency managers and public health planners to better communicate with the disability community during disasters.

Accurate information and aggressive outreach prior to, during and after emergencies improves the ability of individuals and communities to prepare for, mitigate, and cope with the impact of a disaster. People with special needs may have a variety of limitations that prevent information from getting to them, which could be a matter of life and death. Additionally, people with special needs may be particularly vulnerable if their service providers, home health services, outpatient clinics, etc. are impacted by the disaster and they are unaware of alternatives.

The development of the information itself, what is addressed and what is not addressed is very important. Sometimes what is adequate for the general public does not address the specific concerns of many individuals with special needs. The information that is critical will change from stage to stage of an emergency. Disability communication planning should address dissemination of information among special needs communities and professionals. This must include:

• Preparedness messages prior to disasters

• Notification and warning just prior to and during emergencies

• Critical information resulting from an emergency

• Recovery and re-entry information.


The following is a list of challenges most emergency management and public health agencies face when planning for and considering communicating with the disability community during disasters:

• Providing accurate and timely information to professionals and to the public;

• Utilizing alternative formats (Braille, large font, plain language) and multiple modes (TV, radio, call-down systems, etc.) to disseminate information to the most people possible;

• Determining when special needs sheltering or other information should be shared with the public;

• Involving communities at risk to help themselves;

• Involving agencies and organizations that work with those at risk;

• Coordinating the dissemination of information with different healthcare, long term care agencies and other organizations providing daily or regular services;

• Ensuring that agency/organizations press officers are attuned to special needs issues and can present accurate information that is helpful and clear.

Limitations of the Research

A small body of scientific, empirical research exists on disasters and persons with special needs. Use of that body of knowledge, though helpful, is nonetheless limited in several ways (Tierney and Petak 1983; Parr 1987; Jones 1987; Mansour 1993; Ragsdale and Simpson 1996). First, because the research is relatively small, verification of research findings by repeated studies is a concern. Second, the body of research tends to be generic rather than specific to certain populations of interest. Third, the size of the samples (numbers of persons or organizations studied) tends to be relatively small; a related concern is that the much of the research is not generated from randomly selected, representative samples, which raises questions about its broader application to all persons with special needs. Fourth, the research is scattered across the phases of emergency management although most does address preparedness and response. Fifth, the research rarely addresses the intersection of such issues as disability, age, income, gender and culture. For example, research about the deaf may not acknowledge that deafness may originate in birth or later life. Each situation carries different challenges and different solutions. Sixth, research is produced by a variety of scholars across a range of disciplines.

To illustrate, warning messages may be addressed by social scientists, meteorologists, communication specialists and disability researchers, all of whom present research from different perspectives. Finally, limited research exists on specific channels for communicating messages. For example, is text messaging more effective than closed captioning? What circumstances, such as type of disaster, target population characteristics (income, literacy levels) and cellular service ranges might affect a choice to use text messaging versus closed-captioning?

The good news is that general research findings tend to overlap with those from studies on other vulnerable populations (the poor, women, the elderly, children). Further, research has tended to support recommendations from governmental reports, including those generated recently on Hurricane Katrina. Consequently, it is possible to use the body of research, including well-done governmental studies, to generate principles for this report.

Conceptual Model for Warning Messages

The conceptual model most frequently acknowledged in scholarly research is the "Source-Channel-Message-Receiver-Effect-Feedback" model (Lasswell 1948 as cited in Tierney, Lindell and Perry 2001). This multi-stage model should be viewed as a process that may be experienced differently, at any stage, by various populations. To illustrate, the source (emergency manager, media) may be seen as credible or not; the channel (text message, phone call-down) may be accessible or not; the message may be understood in varying degrees; the receiver may not receive the message; the message may generate desired behavior (as possible) within the target population; receivers may then seek additional information to onfirm the message content (Tierney, Lindell and Perry 2001). What is key to understand is that emergency messaging takes time to deliver, interpret, and act upon.

Research Derived Principles for Disability-Related Emergency Messaging

This section employs the conceptual model described above to organize research-generated principles for disability-related emergency messaging.

SOURCE (media, emergency manager, groups, organizations, friends/family/neighbors): the vehicles through which communications are transmitted vary from formal to informal sources. Those sources vary in terms of their credibility to the public, their abilities to transmit information accurately, and their experience in reaching out to the target populations. A number of principles can be derived from the existing research to enhance the source’s abilities to transmit messages.

Build trust and credibility. Direct connections between the source and the recipient can enhance credibility and build trust. Emergency managers, media personnel, advocates and social service providers can all reach out to target populations through direct media campaigns, presentations at public meetings, targeted brochures, service on each other’s boards, and working with community groups. The more frequent the contact, the more likely it is that trust and credibility can develop. However, it is crucial that the person(s) involved in the direct connection be able to connect with the target population in a sincere fashion. Doing so may take considerable time with some populations reticent to shed decades of mistrust.

Educate the media. The media can serve as an important and crucial point of dissemination for warning messages. However, media personnel rarely have enjoyed the benefit of training or education in such information dissemination. Further, in the urgency of the moment, crucial details can be glossed over or reported inaccurately. To address these concerns, it is important to develop prior relationships with the media, to engage in mutual training workshops with authorities and the target population, and to practice warning transmission. Mutual aid agreements with the media, though unusual, may serve as a useful public service activity between all parties.

Link with advocates and service providers. Typically not involved in warning dissemination, preparedness, and response initiatives, researchers concur that local community organizations and service providers should be more fully involved. Local providers and advocates know their populations well and can serve as resources for preparing and assisting target populations. Their expertise as important linking organizations to the target populations cannot be overlooked.

Use social networks (family, friends, neighbors). Warning research consistently demonstrates that receivers confirm the warning message with those they trust: their family members, friends and neighbors. Such social networks can be used to help with buddy systems, delivery of prophylactics, information dissemination, transportation, evacuation to emergency shelters and more. Authorities an motivate connections to social sources too, such as asking the media to have neighbors check on each other. Disaster research also shows that gender matters, in that women tend to want to respond to warning messages at higher levels than men. Women also tend to be more likely to shoulder responsibility for the target populations. Thus, engaging in outreach to women’s organizations (faith-based, civic, neighborhood, workplace) is a potential way to increase awareness and enhance the usefulness of social networks.

Transmitters should be similar to the target population. Receivers tend to listen more closely—and to trust—persons that are similar to them. This principle of homogeneity can be used when selecting a source. Consider, for example, using a person with a disability in a public service announcement and in a warning message. As another example, a local emergency manager could involve the elderly in direct outreach to each other, such as through building a Community Emergency Response Team at a local senior center.

CHANNEL (audio, print, technologies, authorities in uniform): a variety of media can be used to transmit information including radio, television, e-mail, text messaging, call-down systems, electronic billboards, communication boards, newspapers and even individuals going door-to-door. No one single channel is the perfect solution for an audience diverse in how it may access, interpret and respond to information.

Employ diverse means to reach populations. Multiple and redundant systems tend to reach more persons over a broader stretch of time. Thus, using a combination of channels to reach persons is key. Pre-established messages can be activated expeditiously as a strategy to reduce effort during a response time frame.

Recognize that technologies are not necessarily available, affordable or used by populations at risk. To illustrate, consider that text message served as a popular communication strategy for persons that are deaf during Hurricane Katrina. However, text messaging requires that an individual be able to afford, read and understand that text. Elderly persons who are hard of hearing are less likely to use text messaging, e-mail or web sites. Thus, in order to truly reach the deaf and hard-of-hearing community, it is necessary to use not only technologies but traditional vehicles as well. Post Katrina, persons that are deaf used newspapers and web sites as a major source as well.

Understand that federal policies do not guarantee that emergency messaging will be delivered. Although FCC policies expect that closed-captioning will occur during emergencies, a number of exemptions have been granted to cable and satellite channels. Further, research suggests that even local networks experience difficulty in affording or providing caption during emergencies, especially rapid-onset events.

Involve well-trained first responders. Firefighters, police, EMS and other uniformed personnel tend to carry higher levels of credibility especially when direct, face-to-face communication is the medium of communication. Involving such first responders can increase warning compliance. However, Hurricane Katrina revealed a number of gaps in how first responders understand and interact with the targeted populations including communication, evacuation strategies, assistive devices and service animals. Thus, involving first responders as a channel through which to transmit information requires training, preferably in concert with the organization sending the message and representatives from the receiver population.

MESSAGE. The content of a warning message is crucial. It must carry certain components: (1) identify the hazard (2) locate the warning area (3) specify actions to be taken (4) be understandable to the target population (5) apply to the target population. In writing and transmitting a message, it is important to follow certain principles:

Develop and test message content for specific scenarios and populations with those populations. Research indicates that those at risk represent a useful source of information for message content. Accordingly, messages should be written, tested, assessed and revised in concert with those at risk.

Be specific, giving actions to be taken appropriate to the population. Audiences require that the source give specific information on actions that need to be taken. It is not enough, for example, to direct receivers to a location. Rather, specific information on the route and the resources that can be used to reach the location must be included. Or, if shelter-in-place is the recommended action, instructions on the best location or strategy to SIP is required. For a population that is unable to take the preferred action, alternatives must be given including the activation of social networks, linking organizations, and other viable, pre-established connections to the target population.

Repeat a consistent message through multiple sources and channels. All sources and channels used must give consistent, correct information. Variations from the official warning message cause confusion, increase confirmation behavior, and delay compliance. Pre-event training of sources should be undertaken to increase compliance with this principle.

Rehearse, exercise and assess message relays. Drills and exercises can include test messages coupled with an assessment or research component. Use opportunities to test content, for example, testing a message with a representative group during a severe but non-life threatening weather event.

RECEIVER. Reaching those at risk and motivating the desired behavioral compliance is the goal. Although a fair amount of research exists on behavioral response in general, only a limited amount exists on persons with disabilities.

Acknowledge and address diversity. Assume that any given population is considerably diverse. Persons with mobility, cognitive and sensory limitations may vary from low functioning to high functioning levels. Persons from varying backgrounds will filter their understanding of the message through their cultural frameworks.

It’s just another challenge. Disasters, for persons with disabilities, may represent just another of life’s many challenges. Preparedness consequently may take a back seat to other requirements of daily survival. For those with a limited income, preparedness and mitigation may be simply impossible. Response to warnings may occur only after the person at risk becomes convinced that the message applies directly to them and that the risk is imminent.

Expand efforts to reach those at risk. People do not simply live with one life circumstance, such as using a wheelchair. For a low-income elderly paraplegic, for example, a warning device or television access may be financially impossible. If that person is also hard-of-hearing or socially isolated (more common with elderly men), expanded efforts may be necessary to reach the individual. Community and civic groups may be a source to raise funds and deliver assistive devices such as pillows attached to vibrating devices, visual smoke alarms, text messaging devices, protective kits, emergency bags, etc.

Develop multiple means to communicate beyond English and Spanish, including Braille, audio, and visual (i.e. for non-literate or non-English/Spanish speakers). Materials should be developed for use by the source and receiver. Understand that Spanish sign language differs from English sign language and that persons capable in those languages must be involved in message development.

Empower those at risk and build their capacity to respond. Vulnerability researchers concur that the least used and most effective strategy is to work with those at risk to design, test, and refine warning messages, to develop preparedness materials, and to motivate self-initiated response. In the aftermath of Katrina, for example, schools for the deaf organized student volunteer crews. In Pittsylvania County, Virginia, a deaf CERT has been formed. Assuming that persons with disabilities cannot be an active part of preparedness and response efforts further disables that population.

Develop educational and outreach programs. Those who understand their risk are more likely to take action. People who know what to do and who have undergone frequent training are more likely to take action. Empowering those able to respond may also reduce unwillingness to register as having special needs out of fear of privacy invasion or loss of independence.

EFFECT. This section addresses how persons with disabilities might respond to warning messages. Although it is anticipated that many persons will be motivated to comply with warning messages, it is also true that delays can and will occur in behavioral compliance.

Anticipate disbelief. Research indicates that most people, regardless of disability status, tend to not believe a warning message. Typically, most persons delay compliance until they have confirmed the message content with another source, usually a trusted social contact. To motivate compliance, those at risk must understand that the message applies directly to them and that their life is in immediate danger. Sources must connect to their target population.

Anticipate reluctance or inability to respond. Persons with disabilities may be tied to the locations, persons and routines that sustain their lives. It is therefore understandable that they may be reluctant or unable to respond as desired. Providing alternatives to the recommended action may be necessary. Providing resources to those able to alter the living arrangements, social networks and routines may increase compliance. Multiple interactions from trusted social contacts may be necessary before the desired behavioral response is reached. Consider, for example, persons that were deaf in New Orleans who never received or understood the hurricane message. Buddy systems could have made a difference. Working through schools or religious organizations for the deaf and blind could have made a difference as well.

Anticipate that the target population will question whether message pertains to them. Research indicates that receivers in general delay response while determining if the warning applies to them. Specifying areas by zip code as well as specifying populations can clarify this. For example, after the Three Mile Island nuclear incident, messages that targeted pregnant women motivated higher levels of evacuation.

Anticipate delays in appropriate response. Motivating the most rapid and appropriate response is the desired goal. Yet, many warning recipients delay response. Delays occur for varying reasons. During Hurricane Floyd, some persons with disabilities did not evacuate because their one "buddy" was absent or because they did not believe that shelters could provide appropriate accommodations. Elderly may respond more slowly due to "Delayed Response Syndrome" or because of hyperthermia or hypothermia. The effects of the evacuation for Hurricanes Katrina and Rita for future events remain unknown. It is likely that the horrific scenes may motivate higher compliance but it is also possible that non-governmental linking organizations may need to be increasingly involved to overcome issues of trust and credibility.

Anticipate that the target population may not be able to respond as desired, including shelter-in-place or travel restrictions due to their circumstances (dialysis, inappropriate shelter location). Inabilities to travel to a given location for prophylactics or shelter may be due to a lack of transportation resources, mobility limitations, connections to life-sustaining devices, fear of the unknown or not knowing if a location is accessible, or even fear of urban areas or highway driving.

Rehearse the desired behavior. Linking organizations, civic and community organizations can work with local authorities to train those at risk in the desired behavior. Persons that rehearse desired behaviors tend to respond more appropriately and more quickly. Such activities have the potential to build and/or strengthen social ties useful during an emergency.

Anticipate altruism. Research clearly indicates that in a disaster situation, people help each other. In the 9/11 attacks, co-workers stayed behind to help colleagues with disabilities. In the aftermath of Katrina, deaf students mobilized to help those left homeless. In most disasters, the first person most likely to reach you will be a neighbor. Emergency managers and authorities can assume that, in most cases and most circumstances, people can and will help each other. Planning, preparedness and response activities can be based on this principle.

FEEDBACK. The final part of the conceptual communication model addresses feedback. There are several dimensions to this including the need to solicit feedback from target populations prior to an event and the behavioral reality that people will solicit feedback from socially significant others prior to taking action.

Solicit feedback prior to actual implementation from target populations. The audiences they seek to reach should review warning messages for content. Focus groups can be used for this effort. Assessment of the focus group conversations and refinement of messages should follow.

Anticipate confirmation behavior and time messages accordingly. Do not delay messaging. Because confirmation behavior routinely occurs, emergency managers and local authorities should not delay warning messages. A number of research studies document deaths and injuries when officials have chosen not to act expeditiously.

Encourage interaction among family, friends and neighbors to activate and spur confirmation behavior. Activating social networks spurs feedback behavior. Messages should include requests for people to contact friends, family and neighbors.

Existing Practices and Strategies in Use

In general, and as expressed above, there is not much data supporting various and existing practices. In addition, it is also clear that in the area of special needs planning, there is a serious deficit on the local, state and federal planning and response levels. However, there are generally accepted strategies that are employed in certain jurisdictions. Plans should be designed to address accessibility and accommodations so that special needs issues are incorporated into all aspects of disaster planning. In addition, emergency management offices should provide, when feasible, emergency information to the special needs population through the following methods:

• Public information materials, which may be provided in alternate formats including audiotape, electronic, and written materials in large type.

• Public Service Announcement (PSA) should be Closed Captioned for the hearing impaired.

• Coordination with the disability community in establishing trainings and alternate format of materials should be considered.

• OEMs and other government agencies should have functioning Telecommunications Device for the Deaf (TDD) as well as a public email address. These numbers and addresses should be published in all public information materials and websites.

According to a National Organization on Disability (NOD) and Harris Poll Interactive1, incorporation of special needs issues on local and state levels have increased.

However, these plans are not comprehensive and lack adequate planning for children with disabilities, do not utilize experts with disabilities, and have limited training and funding (NOD, 2004). In addition, the survey found that vital information was not in accessible formats (NOD, 2004). In many regards, special needs issues are more complicated than general population issues. However, special needs issues are equally important and cannot be disregarded simply because they are more challenging. A 2004 NOD survey revealed that 66% of people with disabilities do not know whom to contact regarding emergency plans, 61% have not made plans to evacuate their homes, and 32% say no plans have been made to evacuate the work place (NOD, 2004). This survey points to the need to better educate, provide more information, and establish outreach methods to the disability community. In addition, the disability community must become more prepared themselves. This level of preparedness within the disability community must be considered within planning and exercise initiatives.

Risk communication and outreach initiatives must always be ability focused and inclusive in terms of disability type and criteria with planning efforts that assist special needs populations. The following issues may directly affect the special needs population during various types of emergencies and disasters and should be anticipated:

Hesitancy/refusal to evacuate especially if the home is retrofitted (made accessible)

• Emotional trauma and physical discomfort because of an evacuation

• Loss of possessions and/or homes (again, an issue for homes that have been retrofitted or other accommodations were made)

• Disorientation and confusion caused by disaster conditions resulting in a temporary loss of memory or the triggering of other cognitive issues

• Increased need for assistance services to residents at home (meals, at home nursing, chore services)

• Increased demand for placement in residential care facilities

• Increased mortality rate following a catastrophic disaster

• If feasible and appropriate, efforts should be made for local municipalities to consider voluntary special needs registry focused on assisting the most medically vulnerable populations (i.e., those medically dependant and bed bound with little support). This is where a special needs task force will play a crucial role in assisting emergency managers on whether to pursue a registry and if so, how.

Below are some questions and items to consider when initially developing a disability communication component to an emergency plan:

• Are all public information materials accessible and available in alternate formats?

• Are interpreters readily available for meetings and counseling sessions?

• Do outreach workers (disaster staff), first responders and planners fully understanding issues concerning the disability population affected by the disasters?

• Are people aware of sensitivities regarding people with disabilities and terminology? What kind of education are you providing to first responders, disaster staff, and planners regarding disability issues?

• Are disability issues being incorporated and integrated into the whole program?

• How are you ensuring accessibility and "reasonable accommodations?"

Are you incorporating the disability community in the actual development plans and exercise design?

• Needs of each target group (i.e. MRDD, Hearing Impaired, etc).

• Existence of internal service agency disaster plans.

• Communication of member agency disaster plans.

• Existence of inter-agency and community partnerships.

• Information relayed during a disaster from governmental agencies and during the following recovery period as well as having the availability of local, state and federal resources.

• Ongoing identification of service gaps and failures as well as recommended improvements for the overall response and human services disaster system.

• Communication and planning for the needs of people with disabilities during disaster and recovery periods.

• Identify the specific needs of each special needs target group.

• Ensure that member agencies and others develop their own internal disaster plans, and provide assistance with development of individual plans for member agencies and others.

• Establish communication with local emergency management and other VOAD affiliate agencies and planning groups.

• Development of inter-agency and community partnerships.

• Development of a system for making referrals in coordination with other available resources.

• Provide emergency preparedness workshops and presentations for the disability community and train those in the community to provide presentations.

• Identify the specific challenges of each special needs target group.

• Identify ongoing service gaps and failures based on disaster experiences and make formal recommendations on improvements for the system.

• Establish an advocacy group or special needs task force that will identify and support individuals with disabilities and retain the required services from local, state, and federal government entities as well as other social service agencies.

Working with the Disability Community

It is imperative to recognize the importance of reaching out to and incorporating all agencies that provide traditional services (mental health, employment and job training, home health aids, etc.) to the disability community as well as disability advocacy agencies (independent living centers). Coupling advocates with professionals allows for better outreach and delivery of services during a disaster as well as better informing during the planning and exercise design phase. Outreach to the disability community includes holding a special needs meeting with key agency representation and perhaps establishing it as a special needs task force. Disability leaders, experts, and people with disabilities themselves can help emergency managers tailor the planning initiatives and drills to meet the needs of the community as well as instruct how to best reach out to the community to increase awareness on emergency preparedness. The planning and exercise process should include not only disability experts, but people with disabilities to allow for a deeper understanding of the issues and ways to build awareness and resiliency.

It is also important to work with advocacy organizations to discuss ways to conduct meaningful outreach, problems or concerns with the development of emergency plans and exercise design. For example, in New York City during the 2001 terrorist attacks, some independent living centers located in predominantly low-income, minority communities had several different and complex issues to address in addition to disability. Issues of disability, race, economics, and inequity of services around the terrorist attacks became prominent during mental health service delivery. Engaging the independent living centers and similar advocacy agencies was one way to address these types of concerns as well as enhancing outreach, awareness and services to the disability population. A communication plan that specifically considers the needs of people with disabilities during an emergency or disaster should include close working relationships to community and advocacy-based organizations. They have resources and ways in which to communicate and reach out to the disability population that may otherwise be missing.

Lessons Learned from Hurricane Katrina

A number of reports have been issued in the aftermath of Hurricane Katrina, including the White House, the U.S. Congress, the G.A.O., and various researchers and think tanks. It is clear that, even where warning messages succeeded in reaching the populations at risk, the desired response did not always occur. Problems in effecting the desired response include:

• Medical models were used to manage the target populations rather than models that would have retained independence and useful social connections.

• Messaging was not accessible for large numbers of persons.

• Affected states and localities continue to struggle to find sufficient numbers of transportation vehicles with appropriate lifts. Linking with community organizations may be one route to access such vehicles.

• Shelters were overrun in all locations; many were not prepared to admit or work with persons with disabilities.

• Shelters did not have sufficient capacity to communicate with persons with cognitive disorders.

• Shelters did not have sufficient capacity to communicate with persons who were blind, deaf, hard-of-hearing or a combination.

• Shelters did not have appropriate types of food for specific conditions including diabetics, persons with stomach disorders, etc.

• Medications were not available in the types and quantities needed at first aid stations, at evacuation centers or at shelters.

• The target populations died in numbers disproportionate to their percentages in the general population.

• Injuries and deprivation (medications, food, shelter, first aid) were higher among the target populations.

• Many persons with disabilities, who could have remained independent in shelters, were forced to go to special needs facilities.

• Persons with disabilities were separated from their families, friends, neighbors and social networks.

• Hundreds of evacuees were separated from durable medical equipment, assistive devices and service animals.

• Local jurisdictions had not planned sufficiently for both service and companion animals; many residents refused to leave their animals behind or to be separated thus delaying their evacuation.

• Nursing home administrators have the power to decide whether to evacuate their facilities, even under mandatory evacuation orders.

• The transportation-disadvantaged (frequently persons with special needs, individuals with disabilities, the elderly, the poor) were left behind and died in disproportionate numbers.

• Local and state governments exhibited "mixed efforts" at assisting the transportation disadvantaged during the evacuation. Two locations, for example "did not yet have a good understanding of the size, location and composition of the transportation disadvantaged in their communities" (GAO-06-790T, p. 4).

The National Disaster Medical System does not have agreements with nursing homes that could evacuate residents.

• Nursing homes, and presumably other residential settings, are more likely to respond appropriately if they are part of a larger network. Single-owner settings are those most at risk.

• Assisting those without transportation "requires additional planning, time and resources" including "additional planning of pick-up routes; extra time to load and unload evacuation vehicles; and special resources, such as buses equipped with wheelchair lifts.

• Voluntary registries though promising, are expensive and time-consuming to maintain.

• Effective plans involved social service providers.

• Social service providers were underused.

• Katrina financially injured social service providers within the disability community.

• Effective plans tested coordination between evacuating agencies and social service providers through regular drills and exercises.

• The disaster generated new codes and ordinances that are disabling formerly independent persons. Elevation requirements along the coastline mean that those with mobility limitations must relocate or enter a residential care facility.

Ongoing Initiatives that Merit Continued Attention

Some important work that merits continued attention is now being done on emergency communication. Examples include:

National Center for Accessible Media (NCAM)

The CPB/WGBH National Center for Accessible Media (NCAM) is a research and development facility dedicated to the issues of media and information technology for people with disabilities in their homes, schools, workplaces, and communities. NCAM's mission is: to expand access to present and future media for people with disabilities; to explore how existing access technologies may benefit other populations; to represent its constituents in industry, policy and legislative circles; and to provide access to educational and media technologies for special needs students. For more information, please click on the following website: http://ncam.wgbh.org/ 

Access to Emergency Alerts for People with Disabilities Program

(October 2004 - September 2008). The Access to Emergency Alerts project unites emergency alert providers, local information resources, telecommunications industry and public broadcasting representatives, and consumers in a collaborative effort to research and disseminate replicable approaches to make emergency warnings accessible. For more information, please click on the following website: http://ncam.wgbh.org/alerts/

General Recommendations for Planners to Consider

In order to provide equal access to emergency prophylactic medications, equal information to all population groups, meet the highest level of comprehension that each group can receive, and enhance public trust and compliance, the following recommendations are given:

General Preparedness

Preparedness efforts occur at the institutional planning level and the individual planning levels. The goal is to ensure that individuals with special needs are afforded the same safety opportunities as individuals without special needs in the face of disasters or emergencies.

Institutional Planning Level

Special needs issues should be included in all emergency planning for the jurisdiction, workplaces, residential buildings, and other commercial buildings. These plans must be communicated to the public.

Individual Planning Level

Awareness and preparedness messages and material should be customized for groups of people to address specific special needs, and also be available in alternate formats. This includes information about plans that are in place within the community such as evacuation or sheltering plans. Often, when provided adequate resources, individuals with special needs (or their friends/family members) can put plans in place that suit their needs best.

Outreach to Individuals with Special Needs

There are several strategies that can be used to get information to individuals with special needs that may include:

• Coordinating teams in the community to go door-to-door, senior centers or other community meeting places to provide information;

• Implementing a Reverse 9-1-1

• Utilize peer counselors (professionals or paraprofessionals) who have special needs themselves

• Meeting with service providers to plan outreach strategies including a call-tree program (see below Industry call-downs and phone trees).

• Establishing sites with accessible accommodations where information can be provided

• Providing information on websites

• Working with individuals that are deaf, deaf-blind, or hard of hearing to develop communication/outreach plans

• Identify areas in the community such as NORCs where there is a high concentration of people with special needs. Work with leaders in the community (both formal and informal) to address strategies for sharing information with individuals within the area.

• Involve schools, residential care facilities, senior centers and other similar organizations to relay information.

• Send information out through utility bills or with governmental mailings.

• Involve civic and community organizations in door-to-door campaigns.

• Hold events at schools, residential care facilities, senior centers, county fairs, public malls, special Olympics, para-olympics and other events.

• Promote disaster preparedness during Disability Awareness Week events.

• Promote disability awareness during Disaster Day and Emergency Management Month events.

• Invite representatives from disability organizations and the disability community onto LEPC’s, CERT’s and other local committees.

• Serve on boards of disability organizations.

Partners for Preparedness Efforts


The media can be a very important partner in getting emergency massages out to the public at large. Emergency professionals are encouraged to remind these partners that there are things they can do to further ensure members of the community with special needs receive the message.

• Ensure captioning/crawlers/text on television.

• Include sign language interpreters on television.

• Do not block mapping and messaging with crawlers or on-air personnel.

• Include TTY/TDD and fax information when hotlines or other phone numbers are given.

• Ensure website information is in an accessible format.

• Provide information in alternate formats (e.g. Braille, large font, audio cassette, etc.)

• Use Plain Language.

• Be aware of new technological options.

• Providing information that is relevant to special needs populations which includes consideration of a full range of varying circumstances and needs.

• Encourage audience to check on family, friends, neighbors, co-workers, patients—especially those home alone.

Industry (i.e. home health care agencies, dialysis centers)

A phone tree patterned after existing internal notification and call-down systems is a particularly effective way to reach people with special needs. In addition, through a "reverse tree" members of the disability community can alert emergency professionals to issues of which they may not be aware. Emergency mangers should be responsible for initiating communication to the top-level contact persons on each branch of a phone tree. With a well-designed phone tree system in place, a consistent message is communicated, and people with special needs have the opportunity to identify any emergency service gaps that may exist. This must be updated and tested regularly.

Social Networks

During a disaster, friends, family and neighbors will be among the first to engage in search and rescue. Co-workers will often go to great lengths to assist each other, including persons with disabilities. Those at risk can also be involved in helping other persons including those with disabilities. In short, those at risk and their social networks can be employed during all phases of disaster. Because social networks are so important to warning dissemination and confirmation behavior, activating those networks becomes a crucial component of any warning messaging system. Working with and through these social connections (using some of the ideas expressed in these and forthcoming documents) is highly recommended.

Centralized Information and Referral Systems

After an emergency, most jurisdictions will establish centralized information and referral services, such as a hotline or service centers, where residents can call to request assistance and/or information, which is extremely beneficial. These services should be made available in multiple forms to ensure that they are accessible to PSN. Also, hotlines and centers should be staffed with individuals that are knowledgeable about SN issues, and familiar with using alternate communication methods such as TTY, or relay messaging, or interpreters.


Administration on Aging, http://www.aoa.gov, downloadable guide on aging and disaster.

Andrews, Jill H. 2001. "Safe in the ‘Hood: earthquake preparedness in midcity Los Angeles." Natural Hazards Review 2/1: 2-11.

Blanck, Peter. 1995. Disaster mitigation for persons with disabilities: fostering a new dialogue. Washington D.C.: The Annenberg Washington Program in Communications Policy Studies of Northwestern University.

Bruyere, Susanne M. ad William G. Stothers. 2002. "Enabling Safe EVACUATIONS." Hr Magazine: 65-67.

Christiansen, Keith et al. 2006/Forthcoming. "The relationship between the design of the built environment and the ability to egress of persons with disabilities." Review of Disability Studies/Forthcoming.

Davis, Keren. 1990. "Emergency Alarms." British Medical Journal 300, pp. 17113-6.

Dow, K., Cutter S.L., 2002. Emerging hurricane evacuation issues: Hurricane Floyd and South Carolina. Natural Hazards Review 3 (1), 12-18.

Fernandez, Lauren et al. 2002. "Frail elderly as disaster victims." Prehospital and Disaster Medicine, April/June, available at http://www.gwu.edu/~icdrm/publications/67-74_fernandez.pdf.

G.A.O. 2006. Disaster Preparedness: preliminary observations on the evacuation of vulnerable populations due to hurricanes and other disasters. AO-06-790T.

Haney, Janell I. And Russell T. Jones. 1982. "Programming maintenance as a major component of a community-centered preventive effort: escape from fire." Behavior Therapy 13: 47-62.

Hanna, James. 1986. "Emergency evacuations in chronic care facilities." Emergency Planning Digest 13/4: 24-27.

Heinz Center. 2002. Human Links to Coastal Disasters, available at http://www.heinzctr.org.

Imperiale, Paul. 1991. "Special needs in emergency planning and preparedness." Networks: 8-10

Jones, Brian K. 1987. "Fire safety for disabled persons." Emergency Preparedness Digest 14/4: 14-18.

Kuba, Michelle et al. 20004. "Elderly populations in disasters: recounting evacuation processes from two skilled care facilities in Central Florida, August 2004." Quick Response Research Report #172. Natural Hazard Center, University of Colorado. www.colorado.edu/hazards

Lasswell, H.D. 1948. "The structure and function of communication in society." Pp. 37-51 in L. Bryson (ed.) Communication of Ideas. NY: Harper.

Litman, Todd. 2006. "Lessons from Katrina and Rita: what major disasters can teach transportation planners." Journal of Transportation Engineering: 11-18.

Loy, Beth and Linda Carter Batiste. 2004. "Evacuation preparedness: managing the safety of employees with disabilities." Occupational Health and Safety 73/9: 112-117.

Metz, W., Hewett, P., Muzzarelli, J., Tanzman E., 2002. "Identifying special-needs households that need assistance for emergency planning." International Journal of Mass Emergencies and Disaster 20 (2), 255-281.

National Organization on Disability. 2005. Report on Special Needs Assessment for Katrina Evacuees (SNAKE) Project. www.nod.org

Ngo, Ehren B. 2001. "When disasters and age collide: reviewing vulnerability of the elderly." Natural Hazards Review 2/2: 80-89.

Parr, Arnold R. 1987. "Disasters and disabled persons." Disasters 148-159.

Parr, Arnold R. 1997. "Disasters and human rights of persons with disabilities."

Australian Journal of Emergency Management: 2-4.

Perry, Ron and Michael Lindell. 1997. "Aged citizens in the warning phase of disasters: re-examining the evidence." International Journal of Aging and Human Development 44/4: 257-267.

Phillips, Brenda et al. 2006/Forthcoming. "Disaster threat: preparedness and potential response of the lowest income quartile." Environmental Hazards (forthcoming).

Proulx, Guylene. 2002. Evacuation Planning for Occupants with Disability. Ottawa, Canada: Fire Risk Management Program, National Research Council Canada.

Ragsdale, Kate and Janice Simpson. 1996. "Being on the safe side." C&RL News: 351-354.

Rahimi, Mansour. 1993. "An examination of behavior and hazards faced by physically disabled people during the Loma Prieta earthquake." Natural Hazards 7: 59-82.

Rahimi, Mansour. 1994. "Behavior of mobility-disabled people in earthquakes." Earthquake Spectra 10/2: 381-401.

Snyder, Janice. 1982. "Special emergency circumstances: helping those who can’t help themselves." Emergency Preparedness Digest, October-December: 21-22.

Tierney, Kathleen, Michael Lindell and Ron Perry. 2001. Facing the Unexpected. Washington D.C.: Joseph Henry Press.

Tierney, Kathleen and Bill Petak. 1983. Disabled Persons and Earthquake Hazards. Boulder, CO: Institute for Social and Behavioral Science.

United States Access Board. 2005; Resources on Emergency Evacuation and Disaster Preparedness. www.acess-board.gov/evac.htm

United States House of Representatives. 2006. A Failure of Initiative. Washington D.C.: U.S. Government Printing Office.

United States Fire Administration. 1999. Removing the Barriers: a fire safety factsheet for people with disabilities and their caregivers." Emmittsburg, MD: Office of Fire Management Programs.

Van Willigen, Marieke et al.. 2002. "Riding out the storm: experiences of the physically disabled during Hurricanes Bonnie, Dennis and Floyd." Natural Hazards Review 3/3: 98-106.

Wagner, Cynthia G. 2006. "Disaster planning for the disabled." The Futurist: 13.

White House. 2006. Federal Response to Hurricane Katrina: Lessons Learned.

Wisner, Ben. 1993. "Disaster vulnerability: scale, power and daily life." GeoJournal 30/2: 127-140.

Wood, Vincent T. and Robert A. Weisman. 2002. "A hole in the weather warning system: improving access to hazardous weather information for deaf and hard of hearing people." American Meteorological Society, 187-194.

Working Group on Natural Disaster Information Systems, Subcommittee on Natural Disaster Reduction. 2000. Effective Disaster Warnings. National Science and Technology Council, Committee on Environment and Natural Resources.

Practical Resources Consulted

EAD & Associates, LLC, "Resources for Emergency Planning Regarding Persons with Special Needs": This is a short list of suggested resources at the institutional planning level and the individual planning level.

IAEM March 2005 Bulletin "A New Perspective: Focus on Limitations that Interfere with Receipt of Information" by Cecily Westermann (p.1,4) "Communicating with Deaf, Deaf-Blind, Hard of Hearing" by Donna Platt (p.10

IAEM April 2005 Bulletin "Community Emergency Response Teams for the Elderly" by Brian Bovyn (p. 5) National Organization on Disability’s "Emergency Preparedness Guide on the Special Needs of People with Disabilities." This guide can also be found at www.nod.org/emergency.

University of New Mexico’s "Tips for First Responders Cards"

Tips on making printed material more legible at http://www.lighthouse.org/print_leg.htm






Foreword by Donald W. Walsh, Ph.D., EMT-P

International Emergency Medicine & Disaster Specialists



We need to re-think our course of action in treatment & safety


I am happy to introduce three cutting edge educational supplements to Big Medicine. As the Founder and Past President of the Cyanide Poisoning Treatment Coalition (CPTC), a non-for-profit 501(c)(3) organization comprised of fire service organizations, fire fighters, EMS professionals, and physicians; CPTC provides educational and research information through joint strategic initiatives to focus on the awareness and risk of fire smoke cyanide exposure and early recognition and appropriate treatment.


The first publication is “SMOKE – Perceptions, Myths, and Misunderstandings” and addresses the unrecognized threat of cyanide to the American fire fighter, air management critical issues, respiratory protection, the importance of prompt recognition and treatment for pre-hospital care EMS operations. This  supplement was first published in 2005 and discusses acute cyanide poisoning of fire fighters in the United States and Republic of France where new treatments are being used to treat fire smoke inhalation cyanide poisoning.


The second publication published in March of 2009 is "SMOKE – Cyanide and Carbon Monoxide: The Toxic Twins of Smoke Inhalation” goes even deeper into the fire smoke inhalation issues and new drug treatments now available in the United States. The supplement covers smoke chemistry complications, fire fighter air management needs, mandates, and solutions; in addition to fire fighter rehabilitation, cyanide exposure and recognizing the signs and symptoms and the new available treatment treatments in the United States.


The third publication, “SMOKE – The Toxic Twins: An Advanced Perspective on Cyanide and Carbon Monoxide Poisoning” is a new publication written by Dr. David G. Penney, Professor, retired, and special consultant in toxicology from the School of Medicine at Wayne State University in Detroit Michigan. Dr, Penney addresses the physical properties, sources, and physiological effects of cyanide and carbon monoxide poisoning. The supplement also addresses signs and symptoms, cardiac effects, long term CNS effects, and treatments for cyanide and carbon monoxide poisonings.


Together, the three supplements give a cutting edge perspective on this growing issue in America and new solutions to reduce morbidity and mortality through research, science, and education.


Note from Big Med: Please download these documents and share them with your colleagues, coworkers, professional organizations, organized labor, and your families. Know the risks. It's in your hands.


For more information, please go to www.FireSmoke.org.


SMOKE – Perceptions, Myths, and Misunderstandings 2MB


SMOKE – Cyanide and Carbon Monoxide: The Toxic Twins of Smoke Inhalation 4 MB



SMOKE – The Toxic Twins: An Advanced Perspective on Cyanide and Carbon Monoxide Poisoning

1 MB


Cyanide Poisoning Treatment Coalition
P.O. Box 301123
Indianapolis, IN



For more information, please visit www.FireSmoke.org

Copyright® 2009

All supplement photos courtesy of FirefighterSafety.net or FireGroundImages.com


Please share these publications with your colleagues, coworkers, and professional organizations



 Dr. Donald W. Walsh
International Emergency Medicine & Disaster Specialists
A Service of Walsh & Walsh Associates, Inc.
Chicago, Illinois, USA



About the Author

Dr. Donald W. Walsh has a vast array of experience from his 30-year Chicago Fire Department career, and continues his involvement at all levels in public safety. Dr. Walsh began his career with the Chicago Fire Department’s Bureau of Operations in 1976 where he has served as a Chief Officer and an Assistant Deputy Fire Commissioner until his retirement 2007. His public safety background includes being an Adjunct Faculty Member of the National Fire Academy under the U.S. Department of Homeland Security, and elected Fellow of the Institute of Medicine of Chicago. Dr. Walsh’s extensive background in public safety and private industry has fostered new technologies and programs in the area of antiterrorism training, incident command, rescue equipment development, and disaster management response programs. His most recent research on fire smoke and cyanide treatments has been published in peer review and professional publications. In 2004, Dr. Walsh served as a subject matter expert for the United States Army and NASA on Fire Fighter safety issues in coordination with the US Fire Administration. Dr. Walsh’s most recent publication, "The National Incident Management System Principles and Practices" was a collaboration with six national experts and authors in emergency management and public safety to produce the nation’s first resource education supplement instruction manual to meet the United States Department of Homeland Security NIMS mandated under Homeland Security Presidential Directive Five. Dr. Walsh is currently working on new fire safety technologies and research on the dangers of fire smoke, cyanide identification and treatments protocols, and antiterrorism preparedness programs related to cyanide weapons and disasters.

Dr. Walsh can be reached via email at  drdonwalsh@aol.com 


Tracking Human Factors in the Financial Crisis:

Lessons for Pandemic Planning


A Special Report from

Extreme Behavioral Risk Management

A Division of ALLSector Technology Group Inc.


by Steven M. Crimando, MA, BCETS

and Cynthia L. Simeone, CBCP, PMP


[Feb 14 2009]



There are significant similarities between the current global financial crisis and a pandemic disease outbreak. These similarities are particularly pronounced in the area of human factors, specifically in the psychosocial response to adverse events that involve elements of uncontrollability, unfairness and loss. The sudden and dramatic onset of the economic crisis resulted in many organizations suspending their pandemic preparedness efforts in order to focus on the dire threat at hand. As the economic situation transitions from a "sudden crisis" to "smoldering crisis", business continuity planners and others charged with an organization’s pandemic influenza preparedness may benefit from identifying, understanding and benchmarking these dynamics to inform policies, plans and preparedness efforts for a pandemic.

Effective pandemic planning must be predicated on accurate assumptions about the individual and collective response to the threat. The global economic crisis, viewed as "pandemic-light", offers a unique opportunity to practice and prepare for the actual event. It may turn out to be the best test of pandemic preparedness possible, if approached in a thoughtful and structured manner.

Pandemic Defined:

Pandemic: From Greek "pan" (all) and "demos" (people): Occurring over a wide geographic area and affecting an exceptionally high proportion of the population.1

While the current financial crisis may have diverted the attention of business leaders, continuity planners and emergency managers away from pandemic influenza planning, the risk of a possible pandemic has not diminished. In recent weeks, avian and human influenza activity in the United Kingdom, China and India have thrust the flu back into the spotlight. As of January 27, 2009, the World Health Organization (WHO) has updated its statistics and now reports 403 human cases of the avian influenza, resulting in 254 deaths worldwide. The H5N1 virus responsible for these deaths is particularly powerful, proving lethal in more than 50% of the known cases. Each new human case heightens the possibility for the virus to make the critical leap in mutating to a deadly pandemic strain.

The H5N1 virus has several significant similarities with the influenza virus that swept the globe during the Great Pandemic of 1918. Not only has the pandemic influenza threat not abated, but communities, organizations and nations may be at even greater risk if the pandemic were to emerge during such vulnerable economic times.

The current economic crisis may in fact have a potentiating affect on the pandemic risk. A standard pandemic planning assumption is that possibly 30-40% of the nation’s workforce may be offline at any one time, due to illness or death, or remaining home out of fear or to care for the ill. If an organization is forced to layoff a substantial number of employees and is already operating with a depleted workforce in a down economy, further diminishing the remaining workforce by another 30-40% during the pandemic may have a paralytic - if not fatal - affect on the organization.

The current economic downturn has resulted in a continued reduction in the Gross Domestic Product (GDP) in the United States and in other industrialized countries. The arrival of a pandemic influenza in the midst of the global financial crisis would represent a "perfect storm" scenario resulting in potentially unimaginable consequences for the global economy, as well as individuals and families, communities and organizations.

Sudden and Smoldering Crises

Sudden crises tend to produce acute stress reactions in individuals, families, communities and organizations. These events can be said to have "bookends", in that it is clear when the event began, when it ended and whether one was directly impacted. A smoldering crisis often lacks these clear markers by beginning slowly, with many of the early warning signs remaining below the radar. Once the crisis begins, it is difficult to know exactly when it will end. It can also be difficult to determine exactly how badly one is affected since they are dynamic and shifting in degrees of severity over time. Smoldering crises tend to result in chronic stress reactions. They exhaust individual, organizational and possibly national resources. A pandemic that circles the globe in two or three "waves" of illness over the course of 12 months or longer may begin with a sudden realization that the outbreak has begun, that it is real and it is bad, but would generally be considered a smoldering crisis. Likewise, the economic crisis, though beginning with the initial "subprime" calamity, reached the sudden crisis phase on one specific weekend in September 2008, but will most likely be remembered as a long, complex and smoldering crisis.


The global economic crisis may be viewed as "pandemic-light", while there is pain and psychosocial disruption, but without the body count.

The national strategy for surviving a pandemic and an economic crisis hinges on three key actions:

Stop, slow, limit spread of crisis  

Mitigate impact, suffering and permanent damage (or death)  

Sustain infrastructure/economy and functioning of society

Comparing the economic crisis to a pandemic can surface many interesting similarities that may inform pandemic preparedness efforts in both the public and private sectors. These similarities can be found in the areas of event dynamics, impact, response, planning and recovery. To demonstrate the similarities between the economic crisis and influenza pandemic useful to planners and decision-makers, the overlapping elements have been delineated in several categories.

Event Dynamics

Both the economic crisis and a potential influenza pandemic share many features, including the twenty identified below:

Global reach

Few, if any, are immune

Contributing factors identified long in advance of the onset of crisis

Small pool of experts warned of impending doom

Threat not fully recognized until reaching dramatic, irreversible levels

General public had little awareness of the risk

Highly technical/exotic factors triggered onset

Slow-moving but unstoppable once in motion

Long, complex crises

Progress in waves or cascading sequence

Disagreement among experts about best way to handle the situation

Remedy or vaccine not readily available, must be developed quickly

Initial attempts to "treat" the problem prove to be insufficient

Intensity and duration of crisis exhausts resources

Distinct social, economic and emotional consequences

Raise many ethical dilemmas

Characterized by loss

Contain aspects of both "sudden" and "smoldering" crises

Increases distrust of authorities

Create a sense of helplessness or powerlessness


The impact and response to "sudden" and "smoldering" crises differ. A sudden crisis has a definitive beginning and end and while shocking, the human impact is more easily compartmentalized because of the definitive timeline. With smoldering crises, the effects are usually more insidious and difficult to overcome because the emotional and behavioral cycles associated with the crises repeat over a sustained period of time. Recovery from a smoldering crises is often more complicated.

However, both events are characterized by loss and dread. While a loss of life is more likely in a catastrophic disease outbreak, other losses associated with the financial crisis may result in similar emotional and behavioral reactions, possibly further complicating response and recovery.

These losses include, but are not limited to the loss of:


Sense of community; belonging

Status and role





Beliefs or faith (i.e., patriotism, religious beliefs, etc.)

Future and purpose

In Time Magazine reporter Amanda Ripley’s latest book, "The Unthinkable: Who Survives When Disaster Strikes-and Why", she isolates "dread" as a significant factor influencing the human response to threatening events. She has gone as far as developing a "dread formula" to explain these dynamics. Some, if not all, of the elements in this formula are equally present in both the economic crisis and most pandemic scenarios. Ripley’s dread equation is:


+ Unfamiliarity

+ Unimaginability

+ Suffering

+ Scale of Destruction

+ Unfairness



One can assign each of the elements of the dread formula to some aspect of both the economic crisis and a pandemic. Many commentators have been liberal in their use of the terms "unimaginable" and "unthinkable" in their descriptions of the financial meltdown. It is likely that those same labels would be recycled and applied to a devastating public health crisis as well.

The impact of both events can potentially reach all corners of the globe and all spheres of our personal and professional lives. Both in the home and in the workplace, there is a foreseeable range of affects, including:

In the workplace

A great deal of time, effort and money has been spent in the U.S. and abroad over the past several years developing plans and procedures to mitigate the effects of a pandemic on the workplace. While a pandemic strain of influenza has yet to emerge, the current financial crisis has triggered many of the same workplace dynamics anticipated by pandemic planners, including:

High levels of stress and fear

Diminished or depleted workforce

Significant reduction in productivity

Loss of capital and/or access to capital

Supply chain disruption (i.e., cargo stacked up or waiting off shore at sea ports)

Drastic decline in retail, travel, entertainment, construction and many other economic sectors

Escalating unemployment

Consolidation among businesses within certain industries

□ Disruption or closure of financial markets and institutions

In the household

The 2008 American Psychological Association (APA) "Stress in America" survey revealed that 8 of 10 Americans identify money matters as a leading source of daily stress (APA, 2008). Since that study was released in mid-2008, the economic climate has darkened substantially. The Conference Board’s January 27, 2009 Consumer Confidence Index documented a steady slide into despair, with the consumer confidence level reported at an all-time low. People are feeling stressed and anxious about their financial future. Many are unsure how they will handle a recession or more economic bad news.

Both the economic crisis and a pandemic will result in the closures of many businesses, lost earnings and many other hardships. In both instances, individuals and households may suffer great financial difficulties, such as:

□ Little or no household income

□ Depletion of savings

□ Increased dependence on credit cards to replace income

□ Risk of default on loans or mortgages

□ Potential for crisis-related financial scams

□ Increase of a overall financial stress/distress


Emotional responses can range from simple distress to diagnosable mental health conditions, including:

□ Extreme fear and anxiety

□ Sadness and depression

□ Anger, blame

□ Helplessness, hopelessness

□ Increased rates of suicide

□ Traumatic stress reactions

□ Complicated grief and bereavement

Trauma and Grief

Grief has been described as our reaction to something (or someone) "good" leaving our lives, while trauma is our response to something "bad" coming into our lives. In the instance of a worker losing a job, baby boomers losing 40% or more of their retirement savings or a family losing their home, loss is loss and our minds and bodies do not necessarily distinguish between loss related to a health crisis or an economic disaster.

Behavioral reactions tied to our appraisal of the situation can lead to:

□ Increased alcohol and drug use

□ Increased irritability

□ Difficulty concentrating, problem solving and/or decision-making

□ Increased risk-taking

□ Increased emotional-eating (esp. sweet, salty and high-fat foods)

□ Social isolation, withdrawal

□ Change in sleep patterns

Many behavioral reactions affect interpersonal relationships in the home and workplace. These can be manifested as:

Increased conflict

Diminished communications

Difficulty parenting or supervising workplace subordinates

Poor spousal/partner and/or peer relations


Much can be done to reduce and/or mitigate many of the negative consequences identified above through conscientious planning in the home, workplace and community.

Planning in the Workplace

Guidance in pandemic influenza planning has focused on several areas of concern that are equally relevant in the financial crisis. These include ensuring critical processes, communications, physical and mental health issues, ability to travel to or attend work and, finally, developing organizational resilience. Successful consequence management through the economic pandemic will require attention to many of the same concerns.

In planning for a pandemic, it is important to ensure critical processes can continue with a reduction of workforce. If, during the economic crisis workforce reduction is necessary, insure the remaining workforce still retains the core skills and knowledge (corporate memory) to assure essential business functions can be accomplished, or make sure critical processes are documented so unskilled laborers can perform the required function.

"Crisis-sizing" the Workforce

"Crisis-sizing" or temporarily adjusting the size and configuration of an organization’s workforce due to economic pressures rather than illness may be a necessary part of a survival strategy in the face of this new threat. Pandemic planning guides have suggested that leaders should explore creative workforce restructuring for survival. Several businesses have recently received applause for implementing creative alternatives to layoffs, including reduced hours for all rather than lost jobs for some. Other cost-saving alternatives have included shifting some employees to working from home and job sharing to reduce their office space requirements and other fixed overhead costs. These strategies have been discussed in the context of pandemic flu planning as ways to cope with a workforce downsized by disease.

Changes in the workforce and financial health of critical vendors must also be assessed. If the organization is reliant on external resources or services, leaders should conduct business risk and impact assessments to identify critical suppliers, identify alternative sources and negotiate contract terms in advance of any potential disruption.


Immediately, organizations can provide the most value to their employees by communicating their priorities and survival strategies. In the workplace, survival is a shared responsibility. Clarity regarding roles and responsibilities during a crisis is crucial. To reduce anxiety, leaders should provide employees with two-way communication vehicles. During the financial crisis, as in pandemic preparedness, leaders should let employees know what the business is doing to mitigate risk. If there are serious concerns, it is not only much better from an ethical standpoint to openly communicate these challenges, there is a legal obligation documented in the Worker Adjustment and Retraining Notification (WARN) Act that indicates companies must provide 90 days’ notice prior to plant closure or

mass layoffs, so affected employees can be as prepared as possible for negative outcomes.

Employees may better prepare financially and emotionally for a reduction or loss of income with some degree of advanced notice rather than following a surprise or sudden reduction of work force. Warning enhances a sense of controllability and whenever possible proactive communications are recommended.

Proactive communications may also involve the development of draft "shelf-kits" by creating internal and external communication templates and having them pre-approved by corporate communications officers to help speed the delivery of timely communications for different contingencies. Establishing a "hot-line" can empower employees to ask questions and/or make suggestions to help stabilize their workplace environment.


Many organizations active in pandemic planning had initiated training programs for executives and supervisors, as well as internal crisis management and first responder teams, to raise awareness of the unique physical and mental health challenges associated with an influenza outbreak. Such programs were designed to help decision-makers predict and prepare for a pandemic using accurate information about the disease and its likely impact on society, as well as the organization. Specialized training focused on the unique challenges associated with the financial crisis may be equally important. Understanding the human factor in both a pandemic and financial crisis can give planners an advantage in recalibrating business contingency plans appropriately for the current threat environment.

Sources of Emotional Support

We have previously discussed the concepts of trauma and grief as they relate to both a pandemic and the financial crisis. It is foreseeable that there may be an increased need for psychological support programs for workers and their families. Establishing or enhancing Employee Assistance Programs (EAPs) or community outreach programs can aid and educate employees with financial planning or other related services. A lesson learned is that natural support systems, in the home, community and workplace tend to be the most helpful in other smoldering crises. Promoting peer support programs and other mechanisms for employees to both give and get emotional support may prove invaluable in a long-haul scenario.

At home

Just as it is important for leaders to communicate in the workplace, providing family members with information goes a long way toward an effective response and recovery. The emotional demands of both a pandemic and the financial crisis can erode relationships in the home during a time when the support of loved ones is most needed. Sharing information about the affects of smoldering crises on homes and families can be beneficial and may help those affected anticipate the likely emotional traps that characterize long-term stress situations.

Employers can also provide additional assistance in financial planning and household money management. Those not yet seriously impacted by the financial crisis can modify the home budget and identify ways to curtail unnecessary spending. It is helpful to enlist all family members to watch spending. Even young children can understand the concept of saving for future benefit. Planning ahead will be necessary to ensure that basic needs will be met. Prudence and pragmatism will be of equal importance in both the current financial crisis and a possible pandemic in the future.

Tracking and Benchmarking Through a Smoldering Crisis

There is very little, if any, empirical research from the "Great Influenza Pandemic" or the "Great Depression" that can be applied to predicting human behavior in a smoldering health crisis or financial crisis. So what else can be done by organizations to utilize the lessons learned from the past to address the financial pandemic at hand?

Some organizations have begun to track the impact that employee benefit or wellness programs, such as weight reduction, smoking cessation and exercise programs, have on an organization’s bottom line. It would be beneficial to also document other human factors issues (absenteeism, performance, morale, conflict, others) in the home, business and community as we move through the various phases of the financial crisis. Such tracking can help leaders gain a better understanding how prolonged adversity impacts the "worried well" (those who are still employed or not otherwise derailed by the financial crisis) to inform pandemic flu policies, plans and exercises. Organizational benchmarking of human factor issues can be invaluable in developing the type of accurate behavioral assumptions that will be necessary to sustain productivity and the bottom line during a pandemic or other smoldering crisis.


As with event, impact and response factors, the likely psychosocial challenges in the long-term recovery from both pandemic flu and the economic crisis are similar. In a typical disaster, the behavioral response cycle can quickly shift from neighbor-helps-neighbor to neighbor-fears-neighbor to neighbor-compete-with-neighbor as fear escalates. During the recovery period, the cycle gradually returns from self-preservation back toward community cohesion and support. In fact one of the lessons learned in other smoldering crises is that the natural support systems within the home, business or community become the most important and dominant source of help. Knowing this, families, businesses and communities should take every opportunity to bolster and promote cohesion in the early phases of a crisis, since it will become increasingly important as time goes on.


Personal and organizational resilience is essential to the recovery from a smoldering crisis. Resilience is often defined as the "human capacity and ability to face, overcome, be strengthened by, and even be transformed by experiences of adversity."

The potential for resilience can be and should be nurtured. Smoldering crises are best approached by applying the discipline and strategy of the marathon runner, not the sprinter. Everyone wants out of a tough situation sooner, rather than later, but both the financial crisis and a pandemic are challenges of endurance. Those who have survived and thrived through smoldering crises in the past identify three common tactics:

Face the sources of their stress directly

Learn from past experiences

Reach out for and use resources

There will be numerous challenges in the wake of the financial crisis, as there certainly will be in a pandemic. These include, but are not limited to:

Overcoming loss or guilt from having survived through the storm

Taking inventory and examining the current state of one’s personal and professional affairs

Addressing both the physical and psychological consequences of the crisis

Developing a reconstruction plans to rebuild or recoup losses

Reaching out to friends and the community to give and get support

In Conclusion

Pandemic planning should remain a priority during the financial crisis. It can be particularly useful to revisit pandemic plans to see what elements can be recalibrated or repurposed for the current financial crisis.

The authors suggest that the current financial crisis may be one of the most realistic and productive pandemic influenza planning exercises business and community leaders may have in that both events are smoldering crises with many similar human factors and economic consequences. While recognizing that a catastrophic disease outbreak could result in a tremendous loss of life, therefore becoming a disaster of a whole different magnitude, there are enough similarities to allow business continuity and emergency management planners to track, benchmark and use their observations of the financial crisis to inform pandemic planning efforts. Likewise, prior pandemic planning efforts may also inform strategy and decision-making in the current financial crisis.

Lastly, it is important to reiterate that the pandemic risk is not diminished. This threat is still lurking in the shadows while the world turns its attention to the urgent financial situation. A weakened global economy may in fact leave nations, businesses, communities and families that much more at risk to a public health disaster.


UNH/NOAA Report: Arctic Region Underprepared for Maritime Accidents [Feb 2 Washington DC]--The existing infrastructure for responding to maritime accidents in the Arctic is limited and more needs to be done to enhance emergency response capacity as Arctic sea ice declines and ship traffic in the region increases, according to new report released today by the University of New Hampshire and the National Oceanic and Atmospheric Administration.

The report details findings from a panel of experts and decision-makers from Arctic nation governments, industry and indigenous communities convened by the Coastal Response Research Center, a UNH-NOAA partnership housed at the university. The panel, which included representatives from the U.S. Coast Guard and U.S. Arctic Research Commission, assessed the potential threat of maritime accidents in the Arctic and the ability of nations in the region to respond effectively to vessels in distress, oil spills and other situations.

“The reduction of polar sea ice and the increasing worldwide demand for energy will likely result in a dramatic increase in the number of vessels that travel Arctic waters,” said Nancy Kinner, UNH co-director of the CRRC and a professor of civil and environmental engineering. “As vessel traffic increases, disaster scenarios are going to become more of a reality.”

The report’s key recommendations include:

  • Strengthening multinational plans and agreements for all types of responses
  • Improving logistical support capabilities for disaster responders
  • Updating weather data and navigational charts for the Arctic
  • Studying the behavior of oil in cold water and improving technologies for spill response in Arctic conditions
  • Designating potential ports in the Arctic where damaged vessels can be taken to safeguard them against the Arctic’s harsh environmental conditions and reduce the risk of harm to the environment

The report’s findings and recommendations are based on the panel’s examination of five potential emergency response scenarios: a grounded cruise ship whose 2,000 passengers and crew must abandon the vessel; an ice-trapped and damaged ore carrier; an explosion on a fixed drilling rig north of Alaska; a collision between a tanker and fishing vessel that results in a large oil spill; and the grounding of a tug towing a supplies barge in an environmentally sensitive area near the Bering Strait.

"Now is the time to prepare for maritime accidents and potential spills in the Arctic," said Amy Merten, NOAA co-director of the CRRC. "This report clearly indicates that international cooperation and adequate resources are key to saving lives and protecting this special region."

The complete report may be accessed online.

Scenario III from the report:

Cruise Ship Grounding on the Greenland Coast

A. Scenario

The M/V A, with 1400 passengers on board, runs aground while exiting a fjord on the
west coast of Greenland in mid September. Progressive flooding makes the ship unstable, and all must abandon ship. Some passengers and crew were injured in the grounding, requiring special medical attention. Medical concerns for some passengers, approaching darkness, and less than ideal weather outlook require this be treated as an urgent search and rescue (SAR) case. The response will consider the possibility that other cruise ships may be in a position to assist within certain timeframes. It is likely that other such vessels would be available within 24 hours or less, but poor weather might reduce their ability to respond. The vessel has greater than 25,000 bbls of intermediate fuel oil on board, as well as smaller amounts of lube oil, diesel fuel, and various hazardous materials associated with refrigeration, dry cleaning, and other ship services. The initial discharge may be relatively minor, but if the ship is not stabilized within 48 hours, heavy seas may destroy the vessel. The ship is operated by a major cruise line, but under the flag of convenience.

B. Expertise in Cruise Ship Grounding Breakout Group

- John Falkingham; Canadian Ice Service
- Lawson Brigham; US Arctic Research Commission
- Trygve Ertmann; Royal Danish Navy
- Jens Peter Holst-Andersen; Royal Danish Navy
- Nancy Kinner; Coastal Response Research Center
- John Snyder; Strategic Studies, Inc.
- Robert Parsons, Parsons Associates International

C. Assumptions Regarding Cruise Ship Incident

The group assumed that because the major cruise line operates under a flag of convenience, it is difficult to locate and enforce environmental response standards with respect to the responsible party (RP). The ship was assumed to have a crew of approximately 700 and a limited medical staff. Input from group members familiar with the Arctic cruise industry noted that it is likely that most of the cruise ship passengers are between the ages of 50 and 80, some with limited mobility, including a number of wheelchair-bound individuals. The incident is assumed to occur in a portion of Disko Bay that is 50 miles away from the nearest town of Ilulissat, and that likely passenger injuries include broken bones, strains, shock and trauma. With the on-scene weather and water temperatures, passengers would likely have a 4.3 hour functional time, which represents the time at which a person becomes incapacitated due to cold. There is a 67% percent chance of survival within this functional time. The group assumed that although some people fall into the water during the evacuation, none are lost, and
therefore the response consists of rescue operations only, with no search component. It is possible that other cruise ships are in a position to assist within 24 hours, however, poor weather could reduce their ability to respond. The incident occurs in an area that has been designated as a Convention on Wetlands of International Importance, and a World Heritage site due to the unusually fast ice stream and glacier calving rates.

D. 2008 Response to Cruise Ship Grounding

Jurisdiction for the SAR associated with the cruise ship grounding lies with Denmark and Greenland, with a Danish Naval vessel assuming the role of on-scene command upon arrival, and the Danish Maritime Rescue Coordination Center (MRCC) coordinating international involvement. While a clear SAR chain of command exists through international agreements, this incident is likely to overwhelm local resources and thus is likely to be deemed a mass rescue operation (MRO). The pollution response proceeds after victim rescue, and would likely not commence until 48 hours after the incident. The degree of environmental harm will depend primarily on measures enacted to secure the source of spilling oil by the cruise ship salvage and recovery team, and containment and removal of released oil before it impacts sensitive shorelines. If oil is spilled, a best case scenario involves containment within 48–72 hours. SAR response is funded by SAR providers (Arctic governments). The SAR system maintains financial responsibility for passengers until they reach the nearby village of Nuuk.

Environmental cleanup is provided by a cruise ship indemnity insurance company (P&I club), while the ship owners have financial responsibility for vessel salvage. The cruise ship has approximately 15 self-propelled, rigid hull lifeboats and 10 life rafts with no propulsion. The boats contain global positioning system (GPS) navigation systems, very high frequency (VHF) communication capability, as well as at least one crew member per boat. The boats must meet minimum Safety of Life at Sea (SOLAS) standards. Royal Danish Navy vessels can respond from the east coast of Denmark, and although they have SAR and communications capabilities, they cannot take on passengers. The first vessel is likely to arrive within 12 hours of the incident, and the second vessel can arrive within 24 hours. The response from Greenland is quicker, with a 25 m police cutter with a 2-hour response time from the city of Ilulissat.

However, as with the Danish vessels, they have communication and SAR capability, but cannot take on passengers. It is estimated that a second cruise ship capable of taking on passengers could arrive on scene within 24 hours, and fishing vessels in the area could respond within 2 to 3 hours. Pollution response and salvage can be provided by a U.S. Coast Guard (USCG) Strike Team, however, response time is typically 2-3 days. Salvage vessels are available from Halifax, NS or Iceland with a transit time of approximately 7 days.

There are numerous logistical challenges in this response. Due to the freezing weather and minimal protection offered on life boats, responders must attempt to rescue people from the boats and rafts as soon as reasonably possible. The first responders to arrive on scene will be local and therefore they will probably all speak Greenlandic. The magnitude of this response requires an international effort from all Arctic and nearby nations, including the United States, Canada, Iceland, England, Norway, and Denmark.

E. Gaps/Problems Identified in Response to an Arctic Cruise Ship Grounding

The group identified several gaps/problems in the current state of response and recovery. Cruise ships have a minimal capacity for self rescue, and due to their lack of propulsion, current life rafts could not reasonably transit the 50 miles from the incident location to Ilulissat. The passengers are also likely to be ill-prepared for the weather, which decreases their likelihood of survival, if they are not rescued quickly.  Vessels may elect to follow International Maritime Organization (IMO) guidelines on a  voluntary basis. Therefore, capability for self rescue will vary with the degree of adherence.

The group identified several jurisdictional problems, including the fact that although bilateral SAR agreements exist to govern responsibility for response between two adjacent nations, no agreements are currently in place to address response procedures for incidents involving multiple Arctic nations. With no agreements in place, governmental clearance may be required for some SAR operations, which could potentially slow the response. In addition, response operations could also be hampered by dated and incomplete navigational charts for the region.

SAR costs are likely to be significant. Furthermore, Arctic nations need to expend considerable funds developing the infrastructure necessary to support increasing cruise ship traffic in the region. While cruise ships use and benefit from this infrastructure, they have no financial role in its construction and maintenance. Since first responder vessels do not have the capacity to take on a large number of passengers, the only “viable” rescue vessel is a second cruise ship. A 24-hour response time for the ship is unacceptably long in this situation. Further, cruise ship crews receive minimal training for the emergency response in polar conditions.

A number of logistical challenges were identified. Ilulissat has very few hotels, and if another cruise ship cannot respond within a reasonable time frame, the food and housing needs of the rescued will quickly overwhelm such a small town. The ship and town do not have sufficient medical personnel to respond to an incident of this magnitude. As the response progresses and more international SAR resources arrive, language barriers between responders from different countries have the potential to result in an uncoordinated and inefficient response. The response will also potentially be vulnerable to political influence, as the home countries of the passengers with a vested interest in these efforts may attempt to exert control over aspects of victim/survivor management. There will also be great interest from the media and environmental organizations, which may hinder responders.

F. Recommendations for Enhancing Response to Cruise Ship Incidents in the Arctic

The group developed 17 recommendations to enhance response, recovery and restoration for this type of incident.

_ Develop preventative legislation for safe operations in the Arctic. The legislation would revise the Polar code for ship operations above 60º N, and include the development of an agency similar to International Association of Antarctic Tour Operators (IAATO) to manage ship itineraries and maintain real-time cruise ship locations. This legislation would also strengthen and support the Association of Arctic Cruise Expedition Operators (AECO) guidelines, and implement regulations for lifeboats and rafts in the Arctic. Survival craft should meet specifications for acceptable transit distances and have equipment for ample security. Special standards should be implemented for vessels transiting through the Arctic including specifications for cold weather gear.

_ Designate potential ports of refuge and develop guidelines for cruise ships in the Arctic to use them.

_ Adopt an Arctic regional SAR agreement that encompasses all Arctic nations to better manage incidents requiring a international response. The agreement should be designed to avoid delaying response for government clearance. This agreement should encourage transparency and information sharing between cruise ship lines regarding operations in the Arctic.

_ Perform regular drills and exercises to ensure readiness and compliance with regional SAR agreements.

_ Establish vessel exclusion zones within three miles of the coastline to prevent sub-standard ships from operating inside these zones. As an additional benefit, this provision may prompt insurance companies and ship classification societies to enforce compliance with safety regulations.

_ Employ standard environmental cleanup measures. Oil spill countermeasures should be deployed to reduce the impact of oil on sensitive shorelines as soon as possible, and pumps should be airlifted to the site in order to remove fuel from ruptured tanks.

_ Improve and update navigational charts for the Arctic region including cruise ship destinations.

_ Determine recovery and restoration possibilities with a post-incident assessment.

_ Develop a quasi-tariff for Arctic operations. This will provide a mechanism for the cruise ship industry to contribute financially to aid Arctic nations with SAR costs.

_ Encourage cruise ships operating in the Arctic to develop a protocol for mutual aid. The ships should carry extra immersion suits and other cold weather equipment to use when responding to an emergency on another vessel.

_ Improve/use resources for air support. Supplies can be strategically located in the Arctic and sub-Arctic to facilitate air drops for quicker access and response times.

_ Develop salvage plans that can be implemented if dedicated salvage vessels are not available. Icebreakers should be considered for performing a salvage tow.

_ Improve first responder training among ships’ crews.

_ Increase availability of emergency supplies by immediately loading and deploying aircraft from Denmark and Canada with food and water. Local Arctic response agencies and governments should increase stockpiles of emergency response equipment for SAR and spill response in the Arctic.

_ Plan for language issues during an international response. Responders should have translation services available, and fully use bilingual individuals within organizations for international incidents.

_ Conduct a workshop on Arctic SAR. The Arctic Council and the international cruise industry could partner to host this initial dialogue.

The complete report may be accessed online.




Project on National Security Reform

State/Local Issue Team Solution Set

Structure Working Group


Submitted by John F. Morton, Team Lead, 25 Nov 2008

“Where the hell is the cavalry on this one?...They keep saying we’re going to get supplies.  For God’s sake, where are they?”  Kate Hale, Director of Emergency Management, Miami-Dade County FL, Day Three Press Conference, Hurricane Andrew Response, 1992         

“[A]t some point we saw there was…nothing for the federal government to stick on to.”  Scott Wells, FEMA Deputy Federal Coordinating Officer for Hurricane Katrina in Louisiana, quoted in Hurricane Katrina: A Nation Still Unprepared, Special Report of the Committee on Homeland Security and Governmental Affairs, U.S. Senate, May 2006 

“The preparation and response to Hurricane Katrina show we are still an analog government in a digital age.”   A Failure of Initiative, The Final Report of the Select Bipartisan Committee to Investigate the Preparations for and Response to Hurricane Katrina, U.S. House of Representatives, February 15, 2006


SOLUTION 1:  The PNSR State/Local Issue Team recommends the official merging of the National Security Council (NSC) and the Homeland Security Council (HSC) to end the artificial bifurcation of national security and homeland security at the strategy, policy-development and assessment level.  Because of the non-federal constituencies with whom they interact, the Secretary of Homeland Security and the Attorney General should be made permanent members of the NSC, in part to ensure the inclusion of relevant non-federal input into decisions that have national and not just Federal implications.

SOLUTION 2:  A parallel process is required, similar to that currently used within the national security establishment, led by the Assistant to the President for Homeland Security and Counterterrorism, with the Secretary of Homeland Security as his/her executive agent, to prepare an annual assessment of homeland security risk and capabilities across the Federal government, to include state and local inputs, which measures capabilities and outcomes—not simply activities.  In consultation with Congress and to improve the efficiency of national homeland security efforts, this assessment should seek maximum consolidation of recurring  homeland security capability reporting requirements into one comprehensive, capability-based report, and it should be tied to the annual national security assessment.

SOLUTION 3:  Congress should codify the Secretary of Homeland Security’s overall Federal executive agent responsibility as the Principle Federal Official (PFO) for ensuring coordination of domestic incident management to include prevention, protection/mitigation, response and recovery actions, while respecting the inherent authority and responsibility of other cabinet and agency officials to perform the specific duties and execute inherent operational responsibilities assigned to them.   

SOLUTION 4:  Homeland and National Security budget activities should be combined into a single entity within the Office of Management and Budget (OMB).  Consistent with the review role of the Assistant to the President for National Security in the national security budget process, the Assistant to the President for Homeland Security and Counterterrorism should have similar oversight of homeland security budget submissions across all Federal departments and agencies.

SOLUTION 5:  The Department of Homeland Security should re-establish a single office, acting on behalf of the Secretary of Homeland Security, to oversee and coordinate the policies, programs and activities of the Department relating to state, tribal and local governments to ensure that the relationship between DHS and its partners is well managed and is strong.   

SOLUTION 6:  Congress should consolidate congressional oversight of DHS homeland security functions into one authorization committee and one appropriations subcommittee per chamber

SOLUTION 7:  The PNSR State/Local Issue Team recommends that Congress direct the Secretary of Homeland Security as the Principal Federal Official for domestic incident management to develop by a date-certain a comprehensive National Operational Framework (NOF) that describes how operational integration will occur across all levels of government and the private sector for the full range of prevention, protection/mitigation, response and recovery activities, succeeding the current more narrow National Response Framework. 

SOLUTION 8:  Conforming language in statute and executive order should maintain that the Secretary of Homeland Security is the Principal Federal Official (PFO) for domestic incident management of homeland security threats and events and incorporate language to clarify the chain of directive authority through the appropriate regional Federal structures. 

SOLUTION 9:  The PNSR State/Local Issue Team supports the idea of pre-designated field-level PFOs but believes that regardless of the type of event, the PFO should be the sitting FPC—by whatever title—as the regional DHS representative who can leverage his/her on-going, steady-state, stakeholder relationships in a crisis. 

SOLUTION 10:  The Executive Branch should establish at the appropriate levels formal, up-front, consistent systematic “steering committee” processes and structures for state and local government, private sector and non-governmental organization (NGO) participation to support national security and homeland security policy development for issues where those constituencies have equities.  When appropriate, these processes and structures must provide direct and regular reporting access to relevant cabinet secretaries and the White House advisors.   

SOLUTION 11:  Congress should adjust the current Federal Advisory Committee Act’s (FACA’s) time consuming requirements to facilitate better coordination needed among Federal, state, local, private sector and NGO representatives for both homeland security and national security policy development, especially under exigent circumstances.   

SOLUTION 12:  To further a structure and process for private sector and NGO participation in homeland security/NOF policy development, planning and possibly operational execution, the PNSR State/Local Issue Team encourages the Federal government to support an independent,  private sector-led national mechanism/entity to facilitate public/private collaboration and sustain “continuity of community” approaches for domestic incident management. 

SOLUTION 13:  DHS should resource the Department of Defense’s Task Force Emergency Response (TFER) initiative (or some equivalent) which leverages military planning expertise for the determination of regional capabilities and capability requirements and development and implementation of regional response/recovery plans based on community-based assessments of risk. 

SOLUTION 14:  Further to achieve cost savings and improve efficiency, the Department of Homeland Security must clearly structure and empower departmental-level acquisition, procurement, coordination and resourcing authority and oversight activities relative to its operational components.  By statute, therefore, Congress should empower the DHS Under Secretary for Management via the Chief Procurement Officer to centralize acquisition and procurement authority and acquisition offices in a direct line reporting relationship to leverage the buying power of the Department and to mandate consistent, department-wide policies to guide acquisition and procurement.

SOLUTION 15:  The annual national homeland security assessment (Solution 3 above) should inform a systematic, annual Federal homeland security grant process.  By statute, Congress should transfer from FEMA to the Secretary of Homeland Security executive agent authority for all homeland security grants, i.e., (1) to develop and publish grant goals, guidance and requirements, (2) manage the grant application, review and approval process and (3) fulfill fiduciary responsibilities associated with grant management.  Further, the DHS Secretary should engage non-federal stakeholders, relevant DHS components and other Federal departments and agencies with homeland security. 

SOLUTION 16:  Consistent with the recommendations of the White House Katrina report and Executive Order (EO) 13434, Congress must authorize and resource a professional development process for the Federal homeland security workforce, similar to that of the national security and intelligence communities, which mutually accommodates and reinforces “continuum of service” and to the degree practicable the state and local governmental levels, as well as in the private sector and NGO communities. 

SOLUTION 17:  For the purposes of better coordinating information and intelligence sharing for domestic national security, homeland security situations, the Director of National Intelligence (DNI) should have centralized authority to establish cross-cutting policy to guide the sharing of Federal national security, criminal and incident management information and intelligence with non-federal entities.  Further, the DNI should be responsible for establishing technical and cross-cutting information and intelligence sharing training standards that ensure the ability to share and integrate, when authorized and where necessary, all-source data, including those that necessarily should remain routinely independent.   Furthermore, all Federal Senior Executive Service (SES) and career personnel in positions with actual and potential domestic incident management, information sharing, law enforcement and domestic incident management command and leadership roles should have a consistent prerequisite to be certified under these training standards before being eligible to assume their positions. 

SOLUTION 18:  The PNSR State/Local Team recommends establishment of a dynamic NOF two-way data sharing system, a “platform,” to be used as an Incident Command System (ICS)-enabler, from routine incidents to complex multi-site catastrophes.   

SOLUTION 19:  Congress should provide DHS with authority over an NOF information sharing platform for resourcing and standards and should liaise with the Department to determine the appropriate governmental entity to house and administer it on behalf of the states.



The term “homeland security” entered the American lexicon on September 20, 2001, when President Bush used the term to name a new “Office of Homeland Security” established in the White House that October.  Homeland security generally means the unified national effort to prevent, protect against, respond to and recover from threats and acts of terrorism, as well as other man-made and natural hazards.  To quote from the 2007 National Strategy for Homeland Security, “This Strategy…recognizes that effective preparation for catastrophic natural disasters and man-made disasters, while not homeland security per se, can nevertheless increase the security of the Homeland.”

This national strategy seeks to apply a comprehensive approach to risk management—primarily the risk of high-end terrorist attacks or other catastrophic disasters.  The risk to America can never be reduced to a factor of zero (no more than reducing to zero the national crime rate).  However, by leveraging all national resources, the U.S. can substantially reduce risk.  It is thus crucial to understand that homeland security is far bigger than any one Federal department in Washington or more especially one level of American government.

With regard to the structure and process for homeland security, it is therefore necessary to consider homeland security in relation both to national security and emergency management.


America’s current national security model—premised on the National Security Act of 1947 and historically driven by issues of national defense—is biased toward addressing situations beyond our borders and only addresses those within our borders which are the most extreme, e.g., acts of war. 

The constitutional separation of powers with its checks and balances has historically impeded a unified national—and not simply Federal—approach to national security.  Unintentionally, these provisions exacerbate fragmentation within and between levels of government with regard to national security and homeland security policy development and operational execution.  In a truly national domestic crisis—one which by perception or fact constitutes a threat to our national security—Congress and the American people expect a level of command and control among all responsible Federal and non-federal entities. 

A high-end terrorist attack falls between a criminal act and an act of war.  Absent Federal ability to “command and control” non-federal assets, especially in ambiguous events that may or may not constitute a national security situation, the optimal political and practical goal is to have shared and agreed-upon policy, doctrine and operational capabilities among all levels of government which are not subject to multiple interpretations in the midst of a crisis forming or as it is occurring.

Given the above contradictions, the PNSR State/Local Issue Team has concluded that the current 21st century risk environment—which includes high-end acts of terrorism and catastrophic natural disasters—no longer permits the easy segregation of national security/defense and the security and safety of the homeland.  The presently ill-defined boundaries of 21st century national security and homeland security (to include emergency management) frustrate policy development and operational execution.

Note: These and the following italicized paragraphs are the wordings from the Team’s Problem Analysis. 

Viewed from the Federal perspective, the policy environment must now be seen in terms of what should be called the national and homeland security continuum.  Heretofore, the bifurcation has remained at the borders: national security has been borders-out; homeland security, borders-in.  This borders-out/borders-in bifurcation essentially worked until the nineties when asymmetric threats became a recognized priority.  In the current national security environment, this bifurcation is obsolete and must no longer be used to justify national security structure and process.


The practical effect of national security and homeland security bifurcation is the creation of parallel policy, doctrine and operational environments—sometimes intersecting, sometimes not.  Irrespective, effective management of domestic prevention, protection/mitigation, response and recovery activities requires unity of effort among all levels of government, civilian and military entities and elements of the private sector.  Multiple approaches used to address a crisis—in advance or after occurrence—hamper unity of effort and produce ambiguity about the nature of the crisis event itself, i.e., whether it is a national security or homeland security issue and correspondingly which structural mechanisms should manage it.

For homeland security, the continuum of missions runs from prevention through protection and response to recovery.  Homeland security derives from multiple disciplines which now intersect: emergency management, public health and medical, fire, civil defense, mobilization and counterterrorism.  In addition to the interagency dimension, the national response to today’s asymmetric threats involves a second intergovernmental dimension which presents constitutional complications.  


National security policy development has been historically the exclusive domain of the Federal government and has never formally engaged state and local levels.  Irrespective of the debates about the efficacy of separating homeland security and national security, even under the current environment, states have a vital and critical policy development and operational role in America’s national security.  Structures and/or processes do not harness non-federal governmental capabilities to address exigent national security situations within the borders to supplement and in certain cases perform primary missions to support Federal national security priorities.  However, national security and homeland security policies do not always define the roles, responsibilities and authorities of the Federal government, sovereign state and local governments, the private sector and non-governmental organizations (NGOs).

Generally speaking, homeland security policy development can be said to be another continuum which begins with strategic planning and runs through policy development and policy review/implementation—ultimately leading to execution.

According to Homeland Security Policy Directive-1 (HSPD-1), Organization and Operation of the Homeland Security Council, the Homeland Security Act of 2002 and other foundational documents, the Homeland Security Council (HSC) and the National Security Council (NSC) provide the President with strategic planning and policy advice.  The HSC ensures coordination of all homeland security-related activities among executive departments and agencies and promotes the effective development and implementation of all homeland security policies.  The HSC is chaired by the Assistant to the President for Homeland Security and Counterterrorism (the Homeland Security Advisor).  As does the NSC, the HSC structure includes the Deputies and Principals Committees and eleven Policy Coordination Committees (PCCs) at the assistant secretary level, as well as the Domestic Readiness Group (DRG) and the Counterterrorism Security Group (CSG).  These HSC structures have no operational responsibilities.  

The DRG, an interagency body of the HSC, co-chaired with the NSC (which has the lead), convenes on a regular basis to develop and coordinate preparedness and response policy.  This 42-member, staff-level group evaluates various policy issues of interagency import regarding domestic preparedness and incident management and makes recommendations to cabinet and agency deputies and principals for decision.  As appropriate, the HSC chair and cabinet principals present such policy issues to the President for decision.  Again, the DRG has no role regarding operational management during an actual incident.   


          As addressed in HSPD-8, National Preparedness, and the National Preparedness Guidelines (NPG), preparedness is about building capabilities to prevent, protect against, respond to and recover from threats and acts of terrorism, natural disasters and man-made accidents.  Modern preparedness can be traced back to the advent of civil defense in the early 20th century.  This concept of preparing civilians and non-military agencies for disasters began to take greater shape during the Cold War.  At that time, civil defense involved activities such as building fallout shelters and local and state government development of specialized rescue services for their communities.  Civil defense eventually gave way to the term comprehensive emergency management (CEM), when the modern model of preparedness began to take shape in the late 1970’s with the creation of the Federal Emergency Management Agency (FEMA) in 1979.

For almost twenty years, as the emergency management profession grew and matured, preparedness evolved on the premise of building capabilities to respond, recover and mitigate damage from disasters.  Indeed, shortly after FEMA’s creation, the Robert T. Stafford Disaster Relief and Emergency Assistance Act of 1984 outlined formal protocols for major disaster management, i.e., when and to a certain extent how the Federal government may provide assistance to state and local governments during a major disaster.

For nearly a decade, the vast majority of Stafford Act disasters were natural or man-made accidents.  Preparedness activities focused on responding to such incidents.  During much of this period, terrorism preparedness was barely an after-thought.  In 1993, the focus began to change with a presidential disaster declaration issued for the first terrorist bombing of the World Trade Center and later in 1995 with Presidential Decision Directive 39 (PDD-39), U.S. Policy on Counterterrorism.  PDD-39 provided recognition that the threat of terrorism as a potential major hazard was increasing, as evidenced by the first World Trade Center bombing, the Oklahoma City bombing, and the Tokyo sarin gas attack. 

In 1996, Congress authorized the Nunn-Lugar-Domenici Domestic Preparedness Program as part of the Defense Reauthorization Act.  This domestic preparedness program focused on enhancing the ability of local and state governments to respond to a weapon of mass destruction (WMD) incident, with a particular emphasis on terrorism.  Elements of the program consisted of advanced training, equipment and exercises for local first responders.  While PDD-39 assigned FEMA as the lead agency for “consequence management” in response to acts of terrorism, Nunn-Lugar did not assign that agency as the lead agency for managing the program.  Instead, Congress gave the Department of Defense (DoD) that task.  Nunn-Lugar was the immediate legacy program of the homeland security preparedness programs of today.

While the lead went to DoD, other Federal agencies also played a role in the new domestic preparedness program.  This included FEMA, the Federal Bureau of Investigation (FBI), the Department of Health and Human Services (HHS), Department of Energy (DOE) and Environmental Protection Agency (EPA).  At the time, FEMA chaired the Senior Interagency Coordination Group on Terrorism, which was established to facilitate better Federal interagency coordination on policy issues and program activities focusing on WMD response.  Eventually in the late 1990’s, the Department of Justice (DOJ) through the Assistant Attorney General for the Office of Justice Programs would manage the preparedness program through the Office for State and Local Domestic Preparedness Support, which later became the Office for Domestic Preparedness (ODP).  The National Domestic Preparedness Office (NDPO), housed in the FBI, inherited oversight of the Nunn-Lugar-Domenici “train-the-trainer” programs for states and localities.  At that time, FEMA declined the opportunity to assume the national-preparedness mission.

In 2005, DHS Secretary Michael Chertoff’s Second Stage Review (2SR) attempted to institutionalize preparedness as a structure with a DHS directorate led by an Under Secretary of Preparedness.  More recently, HHS has structured an operational shop at the assistant-secretary level which is now called Preparedness and Response (ASPR). 

Preparedness is thus more of an emergency management term, but in the context of the continuum of homeland security missions, the term contributes to confusion.  Preparedness became a political football after Hurricane Katrina.  Responding to pressure from the emergency management community, Congress seized upon the Chertoff division of preparedness and response in his 2SR.  In the Post-Katrina Emergency Management Reform Act of 2006, lawmakers conjoined the two in FEMA in an effort to empower the agency and restore some of the clout it enjoyed during the tenure of FEMA Administrator James Lee Witt in the 1990s. 

The current preparedness mission stems from the Post-Katrina legislation.  The act assigns FEMA new responsibilities to develop a National Preparedness System and lead its implementation.  The National Preparedness System defines target preparedness levels and priorities and provides for a cycle of standard-setting, training, exercise, planning, assessment, technical assistance, grant-making and reporting activities to build those capabilities.  The National Preparedness Guidelines (NPG) released in September 2007 is the foundation for accomplishing and implementing this mission.  The NPG supposedly provides the doctrine for how to achieve and sustain coordinated intergovernmental, interagency, private-sector and non-governmental organization (NGO) capabilities presumed to balance risk with resources and need.

Until the HSPD-8, National Preparedness, Annex-1, National Planning, official language had suggested a homeland security/emergency management continuum based in part on CEM which encompassed prevention, preparedness, response and recovery.  The conforming amendments of HSPD-8 Annex 1 clarified the continuum by removing “preparedness” from HSPD-5, Management of Domestic Incidents, and inserting “protection” in HSPD-8.  As cited above, the original CEM emergency management continuum had been "mitigation, preparedness, response, recovery."   The amendments are now saying for HSPD-5 and HSPD-8 that the homeland security/emergency management continuum will be "prevention, protection, response, recovery" and in HSPD-5 they speak of "preparedness and operational prevention, protection, response, recovery."  In DoD-speak, HSPD-5 thus distinguishes “readiness” from “operations.”  The former has to do with a condition; the latter, actions.  Similarly, “preparedness” and “steady-state” are not synonymous terms.  Rather "steady-state" and "crisis-state" refer to operational modes for each mission.

Indeed, in announcing the 2007 National Strategy for Homeland Security, the White House spoke of preparedness in terms of “building a culture of preparedness”—a characterization quite accurate.

The PNSR State/Local Issue Team regards the traditional emergency management term "mitigation" as a subset of “protection” which gives protection more of an all-hazards cast.  Thus, in conformity with HSPD-8 Annex 1, the Team recommends phrasing the homeland security/emergency management continuum as “prevention, protection/mitigation, response and recovery" better to visualize the scope of the all-hazards, homeland security missions.  “Preparedness" (incorporating planning) undergirds these missions and is distinct from the "operational" activities for each of the four.  Also of note, the emergency management term "consequence management" applies to response and what FEMA now characterizes as “short-term recovery,” as distinct from “long-term recovery.”

To be accurate, the framework presented by “prevention, protection/mitigation, response, recovery” is more consistent with risk management theory and provides consistency for all-hazards formulation, documentation and integration of processes and operational activities.  Preparedness and the execution of operational activities are elements which are integral to each framework component.   


In the 1940s, rapidly advancing aerospace and nuclear technologies enabled a strategic threat to the American homeland which required a policy response and the structuring of a centralized, top-down national security state replete with security classifications and command and control operational hierarchies.  However, today’s advancing technologies and strategic threats and political, economic and social realities require structures which are completely the reverse. 

First, the structure of a U.S. homeland security system has to account for the social reality imposed by the American federal system of governance.  It is fundamental.  It is intergovernmental with three layers of sovereignty—Federal, state and local.  As such, the traditional defense and national security top-down, hierarchical structures do not, will not and moreover cannot apply to homeland security.

Secondly, homeland security structures and processes must accurately reflect the management law of weighting.  The Federal government alone does not have the weight to lead a response to a catastrophe and arguably never did.  The oft-cited statistic on national critical infrastructure makes the point: the private sector owns and is responsible for 85 percent of national critical infrastructure.  The Federal government does not “own” the problem; it thus cannot own the solution.  This economic and political reality leads to one conclusion: any structure and process must have up-front buy-in—systematically and comprehensively—from state and local authorities, the private sector and NGOs.  The Federal government therefore must provide a national structure for systematic and formal state- and local-level, up-front participation in the policy development process which will include the private sector and NGOs as all-hazards, homeland security partners and stakeholders.

Homeland security begins with the sovereign people, and must be driven from the bottom-up.  Conveniently, this truth aligns with contemporary network theory. 

Four key sources support the position which the PNSR State/Local Issue Team is taking which are absolutely essential for a full understanding of its recommendations as relate to devolution of homeland security functions: 

·        Albert-Laszlo Barabasi Linked: The New Science of Networks (Cambridge: Perseus Publishing, 2002); on network theory and the ramifications of the Internet on socio-political structure

·        John Robb Brave New War: The Next Stage of Terrorism and the End of Global Civilization (John Wiley & Sons: Hoboken, NJ, 2007); on leveraging network approaches to achieve national resilience

·        Donald P. Moynihan Leveraging Collaborative Networks in Infrequent Emergency Situations (IBM Center for The Business of Government, June 2005); on the applicability of network structures for managing emergency governance

·        Donald P. Moynihan From Forest Fires to Hurricane Katrina: Case Studies of Incident Command Systems (IBM Center for The Business of Government, 2007); on the incident command system (ICS) model as a temporary hierarchical-network model for managing catastrophic events 

Network theory reflects how insights have moved from applications for the fast-paced innovations of the information technology (IT) world to theories of management and organization.  The irony of networks is that their very vulnerability makes them most resilient.  This understanding informs recognition of the need to adopt a strategy of decentralized resilience with power devolved to local government, private companies and individuals.  Structure and process for homeland security policy must reflect this understanding of 21st century socio-political reality. 

To illustrate the point, in any high-end catastrophe like a pandemic, meltdown of cyber-infrastructure, major natural disaster or WMD terrorist attack, response and short-term recovery will begin for individual Americans in the household, place of work, school or wherever they may find themselves.  From there, response and short-term recovery goes to a community level, to the local jurisdiction, state, region and nation. 

There will be no Federal cavalry.  Pandemic preparedness policy, for example, posits this truth in an acronym—YOYO—“You’re On Your Own.”

It is an uncomfortable truth which has dramatic policy implications: the Federal government will never be able to resource, command or control a Federal response or recovery.  At best, it will be able to serve as one element providing support to a state or states.  The notion of “federalizing” a response is a chimera.

Borders-in—and some would argue borders-out—the Federal government is merely a network enabler, a partner, one element, one stakeholder among several.  Its role is to resource baseline interagency and intergovernmental preparedness across all four homeland security and emergency management missions and to provide operational support for those missions to state and local authorities and communities.

Implementing this new preparedness paradigm is a difficult task.  Preparedness may have a broad constituency, but it has no specific champion.  The fundamental role of the Federal government in homeland security must be to empower a bottom-up preparedness that is all-hazards, balanced by a community’s own determination of risk across the continuum of prevention, protection/mitigation, response and recovery missions.  It must sustain a baseline preparedness capability which is all about attitude, skills and relationships.  Through education, training and exercises, it achieves this baseline capability which enables and resources a planning culture to support the four missions which have acquisition implications for a broadly-defined and encompassing, yet-to-be-determined homeland security technology and industrial base.

The nature of contemporary civil society being what it is, a homeland security policy development and operational process and structure must be horizontally comprehensive and thus move beyond the purely interagency, interdisciplinary governmental mechanisms to include sustained and institutionalized partnership with the private sector and NGO communities.  Incorporation of the private sector, however, must acknowledge differing accountabilities.  Whereas public entities are ultimately accountable to electorates, private sector entities are ultimately accountable and report to their shareholders.  Corporations weigh the public good of homeland security against their private economic goals.

Homeland security processes and structures must also be vertically comprehensive.  States have a resource problem.  Left to themselves, they will never have enough treasure, time and talent.  At best, state and local authorities can resource themselves to administer emergency management missions and to prioritize threats which their electorates say are threats—be they routine fires or big thunderstorms.  However, the average citizen is not going to support a state or local government “ante-up” for preparedness. 

By default, it has to be the responsibility of the Federal government in its partnership with the states to facilitate and resource their bottom-up preparedness which they and their local government, private sector and NGO partners can't do themselves, as well as provide capabilities which are unique to its functions.  This Federal obligation is the 21st century expression of the expectation in the Preamble to the Constitution that constituted government among other things will “insure domestic tranquility, provide for the common defense, promote the general welfare.”

Needed is a Federal commitment to fund long-term preparedness and help sustain it.  The Federal government must fund a national level of readiness—whatever level that may be—according to a standard set by interagency/intergovernmental, public/private sector entities with up-front stakeholder input.  Policy implementation would come with the understanding that states will apply that level of readiness according to the priorities their citizens set for themselves via their elected officials.  

Preparedness undergirds the Incident Command System (ICS) and the National Incident Management System (NIMS), the protocols, procedures, relationships and plans practiced on a daily, routine, steady-state basis at the state and local levels.  Should a catastrophe hit and generate surge requirements, then all stakeholders engage, and Federal support plugs into incident command along with the private sector and state-to-state support via Emergency Management Assistance Compacts (EMACs), which as the Mississippi Katrina response amply demonstrated will provide the preponderance of assistance in a major regional disaster.

As stated previously, preparedness is all about relationships, especially when hierarchical models do not apply.  Relationships and up-front buy-in go hand-in-hand.  Underpinning all then is the establishment of a homeland security culture for all disciplines and all levels—in and out of government—which have homeland security missions.

Because the Federal government is primarily in a supporting role, it is the corresponding responsibility of state and local governments and the private sector and NGOs to utilize the national mechanisms to tell it what support they require to execute their own homeland security responsibilities and authorities.  They must provide this input up-front at the strategy, policy and doctrinal development stage of the process.  Only by so doing will all parties have buy-in to the policy.

Today’s asymmetric threat in this time of rapidly advancing information and public health technologies calls forth a policy response and structuring of a devolved, decentralized  homeland security “network” which is ultimately community-based and bottom-up.   


The PNSR State/Local Issue Team takes the view that the National Response Framework (NRF)/National Incident Management System (NIMS)/Emergency Support Function (ESF) construct based on and derived from incident command system (ICS) principles will work for all-hazards incident management from the routine to events approaching the scale of a Katrina hurricane.  Exercises and execution in future incidents will generate iterative improvements.   

A structure to manage this process should draw from—but not replicate—DoD structure which separates professional, operational policymaking and policy implementation by the military from naked political interference.  DHS and other Federal departments and agencies with homeland security functions can learn from the Pentagon’s policy development and implementation structure in the Office of the Secretary of Defense (OSD) and the Joint Staff.  DoD policy development takes place in OSD where political appointees predominate.  Policy development and implementation occurs among the military professionals on the Joint Staff.  Notwithstanding the overlap, the cultures are different. 

            Such a structure and process for homeland security policy development should reflect the professional culture of the Joint Staff and require service by representatives exclusively drawn from broadly-defined homeland security, emergency management and public health professionals, i.e., from those representatives who have or have had operational line authority.

However, homeland security makes a key operational distinction between unified command and the strictly military command and control.  Unified command is a mode of operation well understood by the National Guard (in its Title 32 role), Coast Guard and Public Health Service.  These paramilitary cultures have an inherent understanding of the collaborative interagency and intergovernmental ways of doing things.  Their cultures are different than the purely military, i.e., that of the Title 10 Federal military. 

            Another consideration is the role such a policy development and implementation structure would play in execution, if any.  The Joint Staff and its masters, the Joint Chiefs of Staff (JCS) play none.  The chain of delegated presidential authority goes through the Secretary of Defense (SecDef) to the combatant commanders (CoComs).  This example would suggest that such a structure should be just for policy development and implementation.  A homeland security “joint staff,” more specifically homeland security “steering committees,” could arrive at outputs with the same results as the DoD Joint Staff because the culture would be a professional culture.  Service on the Joint Staff is preceded and followed by service in the field.  Those with Joint Staff experience are primarily accountable to their professional peers.  Such would be the model for the homeland security steering committee structure. 

To restate: the traditional military command and control model does not apply to homeland security.  A tenet of emergency management is “all disasters are local.”  Thus, in terms of unified command relationships for homeland security policy development and operational execution, advancing 21st century information technology is enabling a networked, cross-functional approach for processes and structures for steady-state and crisis management. 


The fragmented national security and homeland security structures—between and within all levels of government—fails to require and empower systematic collaboration, coordination and integration of strategy and policy development, resourcing and aligned operational execution in steady-state or crises.



  1. Resolution first involves an alignment of the interagency and intergovernmental homeland security structure. 



Symptomatic of the core problem is the ambiguity in many national security and homeland security roles and missions within the Executive Office of the President (EOP) which creates confusion and impedes clear lines of presidentially-delegated authority to lead policy development and Federal-level operational execution.

PNSR recognizes that the general approach to Federal-level interagency coordination has been to delegate presidential authority either to a lead Federal agency or to a “czar,” who functions above the cabinet level, e.g., in the Executive Office of the President (EOP) or the NSC. 

The Team notes several informed studies and recommendations for a supra-cabinet-level entity to coordinate Federal interagency homeland security functions.  In essence, these approaches have assumed or advocated the merger of the NSC and HSC, as recommended by the 9/11 Commission, which in some respects is consonant with the Team’s view that the bifurcation of national security and homeland security is artificial in the 21st century asymmetric threat environment. 

Expert opinion and numerous studies support a merger, with one exception.  Richard Clarke and Rand Beers advocate elimination of the HSC and the transfer of homeland security functions into the NSC.  Clarke and Beers would establish under the National Security Advisor three homeland security czars in the form of: (1) a Deputy National Security Advisor for Homeland Security with two special assistants, one for emergency preparedness and another for cyber security; (2) a Deputy for Homeland Security for Intelligence, Law Enforcement, Prevention and Standards-Setting; and (3) a Deputy for Homeland Security for Crisis Management for the full range of Federal support, who would also hold the chair in the situation room—an operational function—and be responsible for the national exercise program.  The two latter Deputy National Security Advisors for Homeland Security and their support staffs would also be the Federal link to state and local authorities. 

This year’s Center for Strategic and International Studies (CSIS) report on homeland security management similarly advocates the HSC/NSC merger.  CSIS calls for amending the National Security Act of 1947 by eliminating Sections 901-06 and adding language to make the Secretary of Homeland Security and the Attorney General permanent members of the NSC.  The study further recommends creation of a Deputy National Security Advisor for International Affairs and a deputy National Security Advisor for Domestic Affairs.   

Differing from Clarke and Beers, CSIS does not advocate an NSC operational role, rather continued oversight of strategy and policy development.  Its position is supported by the findings of a Stanford forum which recorded similarly informed opinion that any iteration of an HSC—merged or not—should not assume any operational role but rather should focus on policy coordination.  

The CSIS study poses two options for the President: (1) giving directive authority for unity of effort to a single cabinet secretary or (2) exercising strong leadership from the White House. 

As presently configured, the NSC and HSC are unequal in status, both culturally and statutorily.  HSC, for example, does not have statutory authority to receive appropriations.  Each council has different stakeholders which have their own lenses through which to view policy priorities and crisis management.  Multiple approaches used to address a crisis—in advance or after occurrence—hamper unity of effort and produce ambiguity about the nature of the crisis event itself, i.e., whether it is a national security or homeland security issue and correspondingly which structural mechanisms should manage it.  Threats which originate externally and internally require tracking in both the external and domestic environments.  However, separate NSC and HSC structures continue to institutionalize such approaches that have the potential to produce particular harms, e.g., for management of a domestic “loose nukes” scenario.  This scenario in the “prevention” space is precisely ambiguous and demands clear lines of presidentially-delegated authority. 

The disestablishment of the HSC with the transfer of its functions to the NSC supports the concept of a more unified national security/homeland security continuum.  It would eliminate the seam between external and homeland security policy making and oversight.  A reconfigured NSC thus would become the appropriate venue to do the strategic and policy development trade-offs across the artificial borders-out and borders-in priorities.  These priorities, however, would retain their operational expressions in various departments, e.g., DoD and State, whose foci will primarily remain borders-out, and DHS and DOJ, whose foci will be primarily borders-in.

Merger has its risks.  First, conjoining the NSC and HSC would eliminate the political purpose of communicating to the American people that the security institutions and approaches used externally and domestically are different.  Secondly, the NSC’s long institutional legacy, its historically shared policy space with DoD and State and its disproportionately large staff-size relative to HSC suggest that traditional “national security” would dominate the culture of a consolidated council, if not properly configured.  If Congress were to merge the two councils, some would argue that consolidation would risk homeland security getting lost in steady-state policy discussions.  Nevertheless, informed opinion also holds that homeland security would appropriately take the NSC center stage in a domestic, borders-in crisis. 

However, combining the councils could be one way to elevate homeland security issues to the same stature as external security concerns; however, it could also have the exact opposite of the intended effect.  Much would depend on the individual who served as the security advisor to the President.  In actual practice, PNSR has found that presidents use their formal security councils with declining frequency.  Effective decision making typically takes place elsewhere.  Moreover, the National Security Advisor or Homeland Security Advisor via his/her respective Executive Secretary typically invites any cabinet officials to meet with the President relevant to an issue, irrespective of statutory membership on the councils.  In any case, the NSC and HSC have substantial overlap.  When issues transcend the scope of one or the other council, the council staffs should be able to work to integrate the issues.  This argument, however, can also be used to support the case for one council and one integrated staff in the first place. 

Based on interviews with former HSC and NSC senior staff, the PNSR State/Local Issue Team deems that a merged NSC/HSC should have a single permanent staff.  The resultant newly-configured NSC would have two Principal-level (vice Deputy-level) advisors whose titles would be Assistant to the President for National Security Affairs and Assistant to the President for Homeland Security and Counterterrorism.  Both would have the formal authority and the gravitas to convene Principals and have direct access to the President.  Each would have an immediate policy staff.  While the national security and homeland security policy staffs would have their primary reporting requirements to their respective advisors, in instances of issue overlaps, e.g., as regard counterterrorism and the homeland security prevention mission, staffs would have a dual reporting requirement as may be warranted.  

Whatever the strength of the above observations, making by statute the Secretary of Homeland Security a permanent member of the NSC would eliminate the risk of steady-state inattention to homeland security issues and would further empower NSC domestic crisis management.  As for extending the argument to include the secretaries of Energy and Health and Human Services, for example, provision can always be made to allow them to participate in NSC deliberations, and indeed for other departmental and agency heads who would have subject-matter expertise related to a particular issue.

The PNSR State/Local Issue Team would like to note that the Project for National Security Reform (PNSR) is proposing a reform option whereby a President’s Security Council (PSC) would replace the NSC and HSC, but not the National Economic Council (NEC).  Under the concept, the President would convene the PSC “as needs dictate, inviting the cabinet officials and any other agency heads that control expertise and resources required for effective decision making.  Convening the PSC would still be a formal act, but the membership would fluctuate with the agenda, both of which would be formally specified prior to the PSC convening.”  A Director of National Security Affairs would replace the National Security Advisor and the Homeland Security Advisor and would have the authority to “recommend that the President convene the PSC to consider issues elevated by the Principals and Deputies Committees or to issue guidance that merits direct presidential involvement.”


The PNSR State/Local Issue Team recommends the official merging of the National Security Council (NSC) and the Homeland Security Council (HSC) to end the artificial bifurcation of national security and homeland security at the strategy, policy-development and assessment level.  Because of the non-federal constituencies with whom they interact, the Secretary of Homeland Security and the Attorney General should be made permanent members of the NSC, in part to ensure the inclusion of relevant non-federal input into decisions that have national and not just Federal implications.


Currently, there are no satisfactory definitions for homeland security risk, outcomes or end-state, nor objective measures of performance for operational success.

The Federal government should have the capability to develop national risk assessments and provide risk management guidance and a technical assistance program to assist states, tribes and local governments in developing their own risk management programs.  In addition, the Federal government and other levels of government must have tools to measure capability gaps and enhancements based on risks faced.

At the departmental level, DHS has not adequately developed a comprehensive risk analysis capability to produce analyses and products focusing on the threats, vulnerabilities and consequences of incidents across the nation—whether those incidents are caused by nature, accident or terrorism.  If risk is going to drive overall homeland security actions, then DHS must have a robust risk analysis capability that can assist Federal, state and local agencies in understanding the all-hazards risk environment in which they operate and which homeland security capabilities are needed to mitigate those risks.  

If Congress is expected to increase homeland security funding for Federal agencies and state and local governments, lawmakers should require that all levels of government have a set of tools to measure the effectiveness of investments made and those proposed to mitigate identified risk.  To that end, the Secretary of Homeland Security should develop tools to determine and measure (1) the level of capability to secure the homeland, based on the Target Capabilities List (TCL), and (2) the associated costs to maintain those capabilities at the Federal, state and local level.

To enhance risk and capabilities assessment, a statute or executive order should designate the Secretary of Homeland Security as the chief risk officer of the United States and primary risk advisor to the Assistant to the President for Homeland Security and Counterterrorism who will work .  The DHS Secretary will further be responsible for reporting annually to the OMB Director the Federal agency and state, local, tribal, territorial and private entity compliance with the assessment methodology.  The Secretary and his/her staff would oversee and coordinate strategic risk assessments and capability metrics, leading the entire Federal, state and local interagency process for collecting risk data and for developing tools to identify gaps in capabilities and capability enhancements related to all-hazards risk.  Although the Secretary would work primarily through existing structures, conforming language would establish his/her lead responsibility and authority to collect risk and capability information from other Federal departments and agencies.  Staff capacity would need to augment, e.g., within the Homeland Infrastructure Threat Reporting and Analysis Center (HITRAC), to serve as the empowered liaison to other Federal, state and local departments and agencies.    

Several states and localities have already begun the process of measuring capability based on their homeland security grants and other investments.  DHS must work with those states, localities and private sector and NGO stakeholders in the development of capability measurement tools to ensure their utility especially at the state and local levels.  Measuring capability cannot be simply another Federal reporting requirement such as the current State Preparedness Report.  It must effectively help decision-makers make policy and budget decisions at each level of government based on risks faced and capabilities—both those currently attained and still needed. 


A parallel process is required, similar to that currently used within the national security establishment, led by the Assistant to the President for Homeland Security and Counterterrorism, with the Secretary of Homeland Security as his/her executive agent, to prepare an annual assessment of homeland security risk and capabilities across the Federal government, to include state and local inputs, which measures capabilities and outcomes—not simply activities.  In consultation with Congress and to improve the efficiency of national homeland security efforts, this assessment should seek maximum consolidation of recurring  homeland security capability reporting requirements into one comprehensive, capability-based report, and it should be tied to the annual national security assessment. 

The PNSR State/Local Issue Team believes that DHS—in concept—should be the lead Federal agency for homeland security.  However, after five years of operation with at least two reorganizations, DHS has failed to realize that concept and is yet to live into its lead Federal agency role for homeland security.  The Team favors the lead Federal agency approach based on three main findings:   

  • Czars independent of a department have had a patchy history.  As the saying goes in Washington about czars: the serfs revolt, and the barons kill them.
  • The congressional bias against operational roles undertaken by the NSC or EOP makes for a dubious constituency, uncertain funding and eventual atrophy, as history has proven.
  • Most importantly, given the absolute necessity that homeland security requires a statutorily empowered structure to drive sustained, “systematic collaboration, coordination and integration of strategy and policy development, resourcing and aligned operational execution in steady-state or crises,” such capability best resides in a department properly configured as a 21st century government enterprise. 

By extension, strengthened DHS leadership at the secretary level would give added clout for domestic incident management and behind FEMA to coordinate Federal interagency ESF functions to plan for and execute the response and recovery missions.

With particular regard to improvements to planning and resourcing, an empowered DHS Executive Secretary (ExecSec) might include an operational board of senior leaders to do trade-off studies, as suggested by former Assistant Director of the Congressional Budget Office (CBO) Cindy Williams in a recent and most excellent study.  While this corrective and others suggested by Williams would certainly help DHS prioritize and do its internal trade-off drills, by itself it will not correct the interagency homeland security unity of effort shortfalls. 

Congress must empower the DHS Secretary to lead the national homeland security policy space.  Absent this empowerment, homeland security will not have a concomitantly empowered constituency in the NSC and thus a merger of the two councils would not serve the domestic borders-in component of national security.  The two correctives must be linked—not one without the other.

The Secretary of Homeland Security, like the Secretary of Defense and others, maintains both policy direction and operational execution responsibilities.  Effective operational coordination of Federal agencies for domestic prevention, protection/mitigation, response and recovery operations and its integration with local, state, private-sector and NGO organizations should not have to occur in the White House and detract from its role of maintaining broad strategic focus. 


Congress should codify the Secretary of Homeland Security’s overall Federal executive agent responsibility as the Principle Federal Official (PFO) for ensuring coordination of domestic incident management to include prevention, protection/mitigation, response and recovery actions, while respecting the inherent authority and responsibility of other cabinet and agency officials to perform the specific duties and execute inherent operational responsibilities assigned to them.


The currently inefficient budget process does not vest the Office of Management and Budget (OMB) with the appropriate authority to oversee and make recommendations on all Federal homeland security and national security budgets to identify and eliminate duplication of effort among and within departments and agencies.

Further to empower systematic collaboration, coordination and integration of homeland security policy development and resourcing, the PNSR State/Local Issue Team supports the Cindy Williams recommendations for Congress and the White House to transfer OMB’s homeland security branch into its National Security RMO and to create a single homeland security budget function.  Implementation of these recommendations would align with the Team’s recommendation to merge the HSC and NSC.  As Williams noted, putting the HSC into NSC would allow the creation of homeland security cells for long-term planning, risk assessments, gap analyses and trade-offs cells for the NSC staff which would conform to similar cells in the OMB to identify priorities and link to constrained budgets.

The Team also supports the CSIS recommendation for establishment of a partnership between the OMB and NSC to lead the development of integrated budget planning across the homeland security mission areas.  CSIS sees a need for a new OMB staff group to facilitate an integrated review across mission areas similar to the role of OSD’s Office of Program Analysis and Evaluation (PA&E).  It also would have an NSC Strategic Planning Directorate to oversee homeland security requirements generation across all departments and agencies.  These two entities would work together in a joint OMB/NSC budget review process whereby the OMB staff group would leverage policy and budget expertise with an NSC Strategic Planning Directorate’s budget and planning expertise.


Homeland and National Security budget activities should be combined into a single entity within the Office of Management and Budget (OMB).  Consistent with the review role of the Assistant to the President for National Security in the national security budget process, the Assistant to the President for Homeland Security and Counterterrorism should have similar oversight of homeland security budget submissions across all Federal departments and agencies.

 Congress should re-empower the DHS Office of State and Local Government Coordination.  Acting on behalf of the Secretary of Homeland Security, the Office should be headed by an Assistant Secretary or Deputy Assistant Secretary, either by presidential appointment (PA) or presidential appointment with Senate confirmation (PAS), for State and Local Government Coordination supported by approximately 25-30 personnel.  The Office of Intergovernmental Programs (the successor office to the Office of State and Local Government Coordination) would be dissolved or removed from the National Protection and Programs Directorate and made a part of the Office of the Secretary of DHS.  Presumably the Office of State and Local Government Coordination currently has authority to fulfill much of this solution through the Homeland Security Act of 2002, but reconfirming language would be needed in light of the Post-Katrina Reform Act. 

The responsibilities of the State and Local Government Coordination Office should include: (1) coordination of DHS policies, programs and activities relating to state, tribal and local governments to include direct oversight of DHS-component state and local offices, similar to the current structure used by DHS Public Affairs and the General Counsel’s office; (2) coordination and, as appropriate, consolidation of the Federal government's communications and systems of communications relating to homeland security with state, tribal and local government personnel and agencies; (3) distribution or, as appropriate, coordination of the distribution of warnings and information to state, tribal and local government personnel and agencies; (4) assessment of and advocacy for resources needed by state and local governments to implement the national strategy for homeland security  (5) provision to state and local government of regular information and research to assist state, tribal and local efforts at securing the homeland; and (6) development of a process, in coordination with the Under Secretary for Policy, to receive meaningful input from state, tribal and local governments to assist the development of national homeland security policy

The Office will also work with regional organizations on grants via its state and local programs office for managing grants, training, exercises and technical assistance.  Through it, DHS would have a single entity that looks across the entire department on all issues which have an impact on state and local governments.  At the same time, the Office would be able to coordinate interaction at the headquarters level between different directorates and components which need to engage directly with states and localities on certain issues.  Examples would include CBP on Operation Stonegarden (border security), Immigration and Customs Enforcement (ICE) on 287(g) (immigration enforcement) and the Office of Intelligence and Analysis (I&A) on fusion centers.   Having a full picture of coordinated interaction, this single DHS state/local entity would coordinate activities on behalf of the Secretary and allow agency-level operators to engage directly with the states and local on policy and other issues.


The Department of Homeland Security should re-establish a single office, acting on behalf of the Secretary of Homeland Security, to oversee and coordinate the policies, programs and activities of the Department relating to state, tribal and local governments to ensure that the relationship between DHS and its partners is well managed and is strong. 

  1. Resolution of the core problem involves alignment of congressional oversight with executive branch homeland security functions.   


Current legislative branch mechanisms (structure, processes, culture, etc.) drive further fragmentation and inefficiencies in execution of executive branch and national security and homeland security responsibilities.

Homeland security should be a separate congressional committee obligation.  Oversight over non-homeland security functions in DHS and other agencies should remain with the legacy committees.  Lawmakers with long experience with the organization and operations of such DHS legacy agencies as the Coast Guard or the Secret Service should retain jurisdiction over non-homeland security functions within those units.

Such streamlined congressional oversight will strengthen the DHS secretary-level and the department’s interagency role as coordinator of homeland security missions in other agencies and departments.  Lawmakers need to put their oversight over a strengthened DHS Secretary and senior departmental leadership above the agency level in the homeland security authorization committees and appropriations subcommittees.  These four homeland security panels will fence monies for all DHS agencies and eventually for all agencies with homeland security missions in legislation modeled on the Guard Empowerment Act which successfully fences military funding specifically for the National Guard.  By also fencing homeland security grant monies, these committees would provide Governors four points of contact for purposes of lobbying for homeland security authorization and appropriations on Capitol Hill.  Thus would these panels serve as “joint mission-driven” committees which would match the mission-driven concept of DHS and in acquisition terms would better enable a “joint mission area acquisition” strategy for homeland security. 


Congress should consolidate congressional oversight of DHS homeland security functions into one authorization committee and one appropriations subcommittee per chamber

  1. Resolution further requires clarification of the secretary of homeland security’s role in domestic incident management and proper alignment of certain departmental functions.



Ambiguity in many national security and homeland security roles and missions within the Executive Office of the President (EOP) creates confusion and impedes clear lines of presidentially-delegated authority to lead policy development and Federal-level operational execution.

The PNSR State/Local Issue Team takes the view that the National Response Framework (NRF)/National Incident Management System (NIMS)/Emergency Support Function (ESF) construct based on and derived from Incident Command System (ICS) principles will work for all-hazards incident management from the routine to events approaching the scale of a Katrina hurricane.  Exercises and execution in future incidents will generate iterative improvements. 

The NRF and ongoing efforts to develop national planning doctrine for use among all civilian agencies reflect response and recovery imperatives revealed by the 9/11 attacks and reinforced by Hurricane Katrina.  Yet the NRF constitutes an operational capability primarily targeting Stafford Act events and to a much lesser extent national security emergencies or broader coordination of domestic prevention and protection operations.  Because the national experience is limited with respect to the prevention and protection missions as well as in dealing with national security events and the needed coordination among all Federal and non-federal entities, the National Security Council and Homeland Security Council have not adequately developed shared and understood policy, doctrine and plans.  

The Post-Katrina Emergency Management Reform Act reconnected preparedness and response in the “new” FEMA.  This structural solution may have resolved the disconnect in emergency management terms, but as detailed above, it fails to incorporate the prevention and protection missions in a comprehensive homeland security framework for domestic incident management. 

Given the breadth of the homeland security mission continuum, the PNSR State/Local Issue Team believes the scope of the NRF is currently too narrow and should expand to cover more adequately the prevention and protection missions.  At a minimum, the NRF must incorporate the National Infrastructure Protection Plan (NIPP) and the protect mission in order to affect a truly comprehensive, integrated and national homeland security policy and operational framework for prevention, protection/mitigation, response and recovery.  Hence, the NRF needs to be redefined.  Team sees three options for clarification:  

(1)  Change the name of the NRF to the National Protection and Response Framework (NPRF) and incorporate language to address protection

(2)  Publish the NRF in two volumes as the National Prevention and Protection Framework (NPPF) and the National Response and Recovery Framework (NRRF)

(3)  Replace the NRF as the National Operational Framework (NOF) 

When Congress put the responsibility of national response doctrine into FEMA, what resulted was the NRF framework.  Though an improvement over the National Response Plan (NRP) and the predecessor Federal Response Plan (FRP), the NRF is heavily weighted toward response and recovery.  While it may be well articulated for emergency management, the NRF does not account for the fact that the prevention and protection missions are at the intersection between national security and homeland security. 

FEMA is not an intelligence or public safety agency.  As such, it is not suited to be the executive agent for homeland security operational doctrine across the full continuum. 

Aggregation of the homeland security/emergency management continuum can take place at one of three Federal levels.  It could build on FEMA’s ongoing NRF process which FEMA administers via its NIMS Integration Center (NIC).  It could occur at the DHS Secretary level which potentially could manage policy and resourcing trade-offs across the continuum as represented by the range of DHS agencies as well as buttress DHS efforts at interagency homeland security/emergency management coordination via the ESF process.  Thirdly, it could occur above the cabinet level via the HSC (independent or merged with the NSC), EOP or some independent Federal entity modeled on the Office of the Director of National Intelligence (ODNI).

The PNSR State/Local Issue Team believes strongly that protection and response must be conjoined above emergency management and that the appropriate executive agent is the Secretary of Homeland Security with appropriate input from the states.

In the opinion of the State/Local Issue Team, 60 percent of any combined national operational doctrine based on the current iteration of the NRF would focus on response and recovery.  Required is a major effort to incorporate prevention and protection to balance a successor document.   Just as FEMA has led the policy and doctrine effort for response and recovery, so might the DHS National Operations Center (NOC), for example, coordinate a similar effort for prevention and protection inputs. 

This new document should be called the National Operational Framework (NOF) to reflect accurately the true homeland security/emergency management continuum—prevention, protection/mitigation, response and recovery—furthering the integration of the public safety and emergency management communities which, with other homeland security stakeholder disciplines, must plan and execute ICS at the operational levels.


The PNSR State/Local Issue Team recommends that Congress direct the Secretary of Homeland Security as the Principal Federal Official for domestic incident management to develop by a date-certain a comprehensive National Operational Framework (NOF) that describes how operational integration will occur across all levels of government and the private sector for the full range of prevention, protection/mitigation, response and recovery activities, succeeding the current more narrow National Response Framework. 

The current chain of command among Federal agencies for domestic incident management involving catastrophic disasters is unwieldy and inefficient.  The roles and authorities of the Defense Coordinating Officer (DCO), who ultimately reports to the Secretary of Defense, the Senior Federal Law Enforcement Official (SFLEO), who ultimately reports to the Attorney General, Federal Coordinating Officer (FCO), who reports to the FEMA Administrator, and the Principal Federal Official (PFO) in the field, who reports directly to the Secretary of Homeland Security, among others, are less than clear. While HSPD-5, Management of Domestic Incidents, designated the DHS Secretary as the PFO for domestic incident management, the directive bestows no additional authority to the Secretary to execute that mission and does not affect existing statutory authorities vested in other cabinet secretaries, i.e., the Secretary of Defense and the Attorney General. 

The State of Florida, which arguably has the most effective statewide incident management structure in the United States, affords a model which may have a Federal applicability.  The Florida Governor often designates—pre-disaster in the case of a hurricane—directive and control authority to the State Coordinating Officer (SCO), e.g., the state emergency manager, over all state assets and personnel as well as local government personnel and assets.  Drawing on this example, the PNSR State/Local Issue Team believes the Federal government may want to consider following the Florida model and allowing the President to delegate directive and control authority to the Secretary of Homeland Security as the PFO for domestic incident management under HSPD-5 over all Federal response assets to include, but not be limited to, Federal law enforcement, public health and military personnel and assets.  

For execution, the chain of command would go from the President to the DHS Secretary and an empowered NOC, to the regional- and state-level Federal homeland security officials.  The empowered regional level would be like a domestic interagency Combatant Command.  However, unlike a military Combatant Command, the field-level PFO (by whatever name) would function via unified command vice military command and control. 

In steady-state, ongoing activities require execution for the prevent and protect missions.  This 24/7 mission set would help keep in mind the reality of the system with a life of its own as is true for the military.  The system is not one of preparedness and response: it is one of prevention and protection (which happen all the time) and response and recovery (which happen in a disaster event).  Steady-state activities must include coordination of Federal prevention and protection activities on a regional level in accordance with national strategic objectives under the oversight of the Secretary of Homeland Security.   


Conforming language in statute and executive order should maintain that the Secretary of Homeland Security is the Principal Federal Official (PFO) for domestic incident management of homeland security threats and events and incorporate language to clarify the chain of directive authority through the appropriate regional Federal structures.

As the PFO for domestic incident management of homeland security threats and events, the Secretary of Homeland Security would exercise directive authority for all homeland security operations requiring interagency integration.  Directly reporting to the President as his/her single PFO for domestic incident management, the Secretary and staff would thus direct the entire Federal interagency process and serve as the President’s singly-empowered domestic incident manager for homeland security.  Strengthening his/her role would probably require augmentation of the staff and capacity, e.g., to support the DHS National Operations Center (NOC) and serve as empowered liaison to other Federal departments and agencies.  The Secretary would work primarily through existing structures, but conforming language would make clear his/her directive authority over other departments and agencies, specifically vis-à-vis DoD and DOJ, and delegated lines of authority to Federal representatives in the field to eliminate currently confused reporting relationships and stovepiping, e.g., as presently detailed in the NRF. 

With regard to devolving Federal authorities to regional homeland security structures, DHS must avoid creating regional “fiefdoms.”  Homeland security must be mindful of the historical example of devolved authorities in the Department of Justice where at one time the positions of U.S. attorney and U.S. marshals were so regionally empowered (by judicial district) as to prioritize local objectives over national priorities.  In the DOJ experience, the national agency headquarters struggled to gain operational and policy control of U.S. attorneys and U.S. marshals.  As such, the department was squarely at odds with the Federal judiciary, impeding local information sharing and diligence in performing national objectives. 

FEMA faces similar challenges by virtue of the relationships FEMA regional administrators need to build locally.  However, FEMA has managed this potential condition well through the regionalization of multi-state operational areas (regions) such that no single state or local authority exercises too great an influence on the regional agency leadership. 

Selection of DHS regional administrators should mirror the same statutory authorities applied to the General Services Administration (GSA).  GSA regional administrators are presidential appointments which fall under the operational and administrative authority of the GSA Administrator.  The names of candidate senior regional homeland security officials, who would be serving the same geographical area should be developed and vetted through the same process used for GSA Regional Administrator nominations for Senate confirmation.  DHS regional administrators would fall under and serve as directed by the Secretary of Homeland Security.

Of note, GSA and DHS/FEMA Regions are identical, except that GSA designates a National Capital Region (NCR) and FEMA does not.  However, FEMA has an NCR Principal Federal Official in the form of an “NCR Federal Coordinator,” the only standing position of its kind.  While this example has been functionally under utilized, it is a better example of how not to develop the regional positions.  The NCR Federal Coordinator has consistently been under-budgeted and under-staffed, given the absence of a requirement for any DHS agency to augment the Coordinator’s staff or an incentive to support his/her initiatives.  A single regional PFO/FCO must have clearly defined duties, performance metrics linked to national strategies with functional alignment with regional realities, and corresponding budget and staffing authorities.

An empowered DHS Secretary would help solve the intergovernmental problem where DHS would lead in the regions and at the state level.  Federal support is but one and not necessarily the primary support element to support a state.  DHS must establish regional all-hazards prevention, protection/mitigation, response and recovery structures which build upon EMACs.  It must institutionalize partnership relationships at the regional level.  It can do so by leveraging FEMA preparedness efforts in the FEMA regions—which are, after all, Federal regions. 

FEMA regional structures atrophied when the agency transferred into DHS.  While DHS and FEMA have now embraced the concept of empowering regional Federal structures for homeland security, their emphasis thus far has been on the FEMA structure in the context of emergency management response and recovery. 

At present, the FEMA Federal Preparedness Coordinator (FPC) is the key Federal homeland security official at the regional level and is central to the regional national preparedness framework.  The focus of the FPC is on preparedness for the entire homeland security mission continuum—not just response or recovery. 

CSIS has recommended pre-designation of so-called Lead Federal Coordinators (LFCs) as composite Federal Coordinating Officials (FCOs)/Principal Federal Officials (PFOs) and the strengthening of Regional Interagency Steering Committees (RISCs) to ensure all senior Federal officials at the regional and state levels are as qualified as DoD DCOs.

The PNSR State/Local Issue Team believes strongly that DHS must build its regional capacities and capabilities not just on FEMA.  For example, Clarke and Beers have advocated regional critical infrastructure protection (CIP) offices in each FEMA region.  The CSIS report variously referred to FEMA regional administrators as DHS regional administrators.  CSIS accepts that DHS regional administrators would have no line authority over other Federal agencies except in extraordinary circumstances and that they would have no authority to direct activities within a state or states.  The report makes the domestic comparison to the military’s regional CoCom organization.

The regional hub for homeland security should not just be a FEMA entity.  It should be a component of DHS reporting to the DHS Secretary.

Since the Hurricane Katrina response, the confusion as to the roles and responsibilities of the PFO, FCO and the Secretary of Homeland Security has generated much debate and discussion. 

The White House Federal Response to Hurricane Katrina: Lessons Learned report said in Recommendation Six, “The PFO should have the authority to execute responsibilities and coordinate Federal response assets.  The PFO should have the same authority as an FCO to manage and coordinate the Federal response to a disaster.  The PFO should have the authority to make any operational decisions necessary, within the law, without having to obtain approval from headquarters.  Giving the PFO this authority could be accomplished without a change to the Stafford Act by simply designating the PFO as an FCO. Alternatively, the Secretary of Homeland Security or the FEMA Director could delegate their authority to oversee FCO to the PFO.  This action does not require demoting FCOs within a particular region to Deputy FCOs. The FCO will retain all current authorities under the Stafford Act and will report through the PFO. An incident covering multiple states will require multiple FCOs operating concurrently under the command of the PFO.”      

Although the White House wanted the FCO to report through the PFO, Congress did not ratify the recommendation in the Post-Katrina Act. 

The distinction between the Secretary of Homeland Security as the Federal coordinator for incident command and the FEMA Administrator as the principal advisor to the President and the Secretary for emergency management is still poorly defined.  Moreover, vesting and weighting authority with the Secretary would put emergency management into a broader context.

Combining the authorities and responsibilities of the PFO and FCO into one position with clear reporting responsibility is consistent with unity of command.  The FCO function as the state-level counterpart of the SCO in unified command would be covered by the Deputy FCO.  Some quarters support the idea that PFOs should be drawn from a predetermined interagency pool and assigned according to the type of the event.  PFOs, and indeed all key players in domestic incident command, should not only know the fundamentals of command and management but must be able to apply them effectively.  Should the President and DHS have the authority to predesignate a single senior Federal official for domestic incident management in each region, those individuals should be ICS-certified at the highest level (included certification from a professional development and education program) and not restricted to a DHS cadre.  Moreover, candidates should have both operational (equivalent to brigade-level command) and Washington experience.


The PNSR State/Local Issue Team supports the idea of pre-designated field-level PFOs but believes that regardless of the type of event, the PFO should be the sitting FPC—by whatever title—as the regional DHS representative who can leverage his/her on-going, steady-state, stakeholder relationships in a crisis.

  1. Resolution of the core problem requires alignment of policy development.



Despite the language of such foundational policy documents as the National Security Act of 1947, Homeland Security Act of 2002, Intelligence Reform and Terrorism Prevention Act of 2004 and others such as National Response Framework (NRF), the National Security Council (NSC) and Homeland Security Council (HSC) have no standardized process to solicit and receive state, local, private sector and NGO  input into the development of national policy.

DHS decisions project broad impact on the national fabric.  From high-level strategic planning and policy development to agency-level policy implementation, DHS decisions affect a vast array of stakeholders.  As the PNSR State/Local Issue Team recommends enhancing DHS executive authority, it is in nation’s best interest to impose certain checks and balances.  

Homeland security policy development obviously occurs throughout the Federal government in a number of departments and many agencies and at several levels.  Placing all homeland security policy making decisions into a single entity would grind policy development to a halt.  For some issues, how the Federal government should engage non-federal input at the right level and on the right topics is more about process than structure. 

For example, the FEMA Administrator’s policy on public assistance reimbursement or the Immigration and Customs Enforcement (ICE) Commissioner’s policy decisions on how to handle transfers from non-federal to Federal status represent a class of issues which require state and local input.  The primary stakeholders in such cases are the Federal, state and local operational communities.  For the most part, the process in these instances does not call for the intimate engagement of the White House (except OMB), and Capitol Hill needs only to be generally aware.  Existing structures thus work well. 

General policy promulgated by secretaries and/or their departments, e.g., in areas such as grants, critical infrastructure sector security guidelines and foreign traveler ID requirements, regularly needs external stakeholder input.  With these types of examples, the present lack of uniform and clear processes for what input is required and how to solicit it has driven individual officials and Federal entities to base ad hoc decisions from issue to issue on “how to get the input”—whether the process is internal to those entities or a Federal interagency drill.  Further complications arise from the state and local side: obviously no single voice can speak for all governors and mayors on general policy.  Where state, local, private sector and NGO perspectives are much more important than full unanimous agreement, most of the existing structures can handle input needs with process improvements.  Thus, for development of general agency and departmental homeland security policies, the Federal government must formalize consistent processes (vice structural consolidations) for up-front state, local, private sector and NGO input.

More challenging, however, is another category of policy development issues: those homeland security policies issued at the presidential level which have direct impact on states and communities.  Because such policies involve classified information and/or executive privilege, institutionalized solicitation of perspectives and inputs is problematic. 

Formalized opportunities for input should be established at the NSC/HSC level with respect to all homeland security missions with the DRG.  For example, the National Counterterrorism Center (NCTC) can provide good offices for prevention; the DHS Office of Infrastructure Protection (OIP), for protection; and FEMA, for response and recovery.  Each entity has potential for more direct and formal state and local government participation. 

Stakeholder inputs for policy development should come from three primary sources.  First, interagency staffing could come from joint duty representatives from all departments and agencies with homeland security functions.  Second, intergovernmental staffs could be assigned from a pool managed by the DHS Office of State and Local Government Coordination.  Third, private sector and NGO representatives could come from a pool managed by the DHS Private Sector Office.

The staffing thus would have interagency, intergovernmental, private sector and NGO representatives on temporary duty assignments, similar to a corporate advisory board.  Homeland security workforce development improvements (interagency and intergovernmental) would make possible such a process in line with the adoption of an expeditionary homeland security workforce culture.  With regard to the use of representatives from state and local governments and the private sector and NGO communities, adoption of these processes and structures would require revisions to the Federal Advisory Committee Act of 1972 (FACA) and the Ethics in Government Act of 1978.   

The PNSR State/Local Issue Team thus recommends permanent "NOF policy development offices" or “NOF steering committees” to set policy direction.  These steering committees would be composed of "professionals" whose appointments would be strictly based on credentials.  Their composition would be representative of all disciplines and levels of government drawn from a pool of stakeholder organizations and associations, e.g., the National Homeland Security Consortium.  Indeed, such offices would involve relatively large groups, but their mission charge should be to set one uniform direction not subject to politics and "interpretation." 

 Such entities would be called steering committees, vice advisory boards, given that the latter term has corporate connotations which complicate the public/private relationships.  This homeland security/NOF policy development steering committee process and structure for the strategic and agency levels would provide formal, up-front, systematic and comprehensive participation by state and local governments, the private sector and NGOs.  NOF steering committees would professionalize policy development and implementation.  They would convene for all homeland security missions: prevention, protection/mitigation, response and recovery.  If they include all stakeholders, i.e., from the Federal, state, local, private sector and NGO communities, they would provide the mandatory venues for up-front buy-in—whether supporting the DRG, the NOC’s Incident Management Planning Team (IMPT) or policy development entities elsewhere.  While these entities would function as interagency NOF policy development steering committees, it might be appropriate to have them be resident in the DHS Office of the Under Secretary for Policy.  In either case, the NOC or Policy Office would act on behalf of the senior Federal executive agent for homeland security, i.e., the Secretary of Homeland Security.

Such institutionalization should not be in the form of another advisory body; rather the approach could be a process solution working for the most part—where possible—through existing policy development bodies.  For example, Congress also should consider reconfigure such existing advisory councils as the DHS Homeland Security Advisory Council (HSAC) and the FEMA National Advisory Council (NAC) to serve as homeland security steering committees.  

The concept of steering committees, already widely used in an advisory role, is an excellent means of providing stakeholders a meaningful voice.  Both HSPD-7, Critical Infrastructure Identification, Prioritization and Protection, and the NIPP establish a structural framework for partnership between the private sector and government sector for protection of critical infrastructure/key resources (CI/KR).  This sector partnership structure encourages the formation of Sector Coordinating Councils (SCCs) and the Critical Infrastructure Partnership Advisory Council (CIPAC).  Building upon the advisory council concept such that these entities are charged with a steering role in policy development and agency-level policy implementation is a progressive step of enhancing partnership.

At the local level, the Metropolitan Medical Response System (MMRS) utilizes a steering committee structure for public, private and NGO stakeholders to operationalize HSPD-8, National Preparedness, target capabilities for medical incident management.  This systematic up-front effort for local planning for ESF-8 (Emergency Support Function-8, Public Health and Medical Services) is recognized and supported by HHS.  It forms the basis for regional collaboration and is another collaborative model for state- and Federal-level steering committees.

Informed by such approaches, Congress should legislate a formal process and structure for steering committees to provide venues for the Federal government to collaborate with state and local government authorities, the private sector and NGOs on homeland security matters.  Steering committees would serve as fora to develop national—as opposed to purely Federal—agendas and policy solutions.  In this process, committees would seek to strike a consensus across Federal and non-federal homeland security stakeholder representatives on issues ranging from interoperability to infrastructure protection to mitigation. i.e., any function vital to Federal homeland security missions but which escape the control and responsibility of Federal agencies.   

For strategic-level planning, a steering committee would engage “strategic thinkers” (recently retired or senior professionals) drawn from the state- and local-levels, the private sector and NGOs.  These members would represent diverse experience in disciplines of relevance.  For directive influence, non-federal members might not have a full vote, but they would have an appropriate proportional voting level. 

At the agency level, this steering committee structure would duplicate, with different experiential depth to function within the policy development arena.  However, at this level, the agency would retain policy development and might not extend directive influence to the steering committee, i.e., non-federal committee members would not have proportional voting.  Their function would be strictly advisory and would serve only as a mechanism for voicing state, local, private sector and NGO perspectives.   An excerpt from FEMA’s National Advisory Council overview statement is instructive:

“The National Advisory Council (NAC) shall advise the Administrator of the Federal Emergency Management Agency (FEMA) on all aspects of emergency management.  The National Advisory Council shall incorporate state, local and tribal government and private sector input in the development and revision of the national preparedness goal, the national preparedness system, the National Incident Management System, the National Response Plan and other related plans and strategies.”

While this FEMA NAC language above appears passive and optional, the PNSR State/Local Issue Team proposal would require an agency director/administrator to utilize the agency-specific steering committee in all homeland security/NOF policy development. 

Should Congress codify the steering committees for the strategic and agency levels, one option might have these panels play no role in operational vetting, development of standards/procedures/protocols or operational execution.  Such a change might require revising existing statutory language in Title 6 USC §451(a) and §121, as well as for those governing appropriations authorizations.  Another might have DHS incorporate national proposals and standards arising from this process in lieu of Federal standards, similar to American National Standards Institute (ANSI) standards for regulatory issues.  This approach would yield a process more akin to participatory, voluntary rule-making as opposed to governmental regulation.

Beyond reviewing proposals from DHS, steering committees would develop proposals for consideration and adoption by Federal, state and local policymaking bodies.  Steering committees could also convene in cases where sufficient advance warning permitted.  In this way, the nation would shift from a centralized approach to homeland security policy formation to a broader collaborative approach.  In essence, such a committee structure would resemble cross-functional teams: this governance process would enable representation of all key players with stakes, assets and capabilities.  Such an inclusive process is likely to generate more effective and sustainable homeland security policies, grounded in intergovernmental, public/private sector realities.   


The Executive Branch should establish at the appropriate levels formal, up-front, consistent systematic “steering committee” processes and structures for state and local government, private sector and non-governmental organization (NGO) participation to support national security and homeland security policy development for issues where those constituencies have equities.  When appropriate, these processes and structures must provide direct and regular reporting access to relevant cabinet secretaries and the White House advisors. 

Non-federal engagement in public policy development is governed by the Federal Advisory Committee Act of 1972 (FACA).  FACA was not written with the idea of homeland security and national security discussions, many of which are time sensitive and do not lend themselves to notification requirements of FACA.  In these cases, virtually no current mechanism engages state, local, private-sector and NGO perspectives in a meaningful way.  Agencies are precluded from talking about issues with their constituents, because of classification or pre-decisional deliberation requirements, and most of those are legacy issues from a time when state, local and private sector entities did not have the stake they do today. 

Congress should rewrite FACA to allow the exemption under Section 871 of the Homeland Security Act to be specific to NOF policy development issues in order to protect the secrecy of communications under executive privilege as already provided under the Act.  Congress should also rewrite the Ethics Act for civilian government service to allow state, local, private sector and NGO representatives to serve in temporary duty at a Federal-, state- or local-level government entity with a waiver on disclosure, similar to the waiver enjoyed by state Title 32 National Guardsmen/women who are assigned to temporary active duty at the National Guard Bureau (NGB) under Title 10.


Congress should adjust the current Federal Advisory Committee Act’s (FACA’s) time consuming requirements to facilitate better coordination needed among Federal, state, local, private sector and NGO representatives for both homeland security and national security policy development, especially under exigent circumstances. 

The Federal government generally must make particular provision for broader implementation and sustainment of the private sector and NGOs in homeland security/NOF policy development, planning, exercises and operations.  It is necessary, however, to distinguish carefully private sector and NGO participation in steering committees, which may deal with technical issues, and deliberate planning, which is a tricky challenge.  The problem is the public/private operational interface.  Engaging the private sector and NGOs for the response mission in particular requires a mechanism for systematic integration starting at the state level. 

The private sector has led several initiatives to form a national-level entity to encourage and facilitate state/local-level entities nationwide and provide integration points for business with government at all levels.  The structural component would be an independent entity that develops and nurtures public/private partnerships and recommend procedures to facilitate tactical information sharing and response activities.  Programs and recommendation of such an entity must be consistent with emergency management doctrine, i.e., codified in the NOF.           

Including the private sector and NGOs in exercises and planning through multi-level partnership structures would allow assimilation of private sector/NGO knowledge, skill and input into overall policy development as well as into development of specific protocols for the prevention, protection/mitigation, response and recovery continuum.            

A national framework would provide guidance for national and regional businesses and NGOs and would recommend a common approach for consistent execution at the state and local levels.  This commonality would allow for national companies and organizations to participate anywhere with greater efficiency, thus minimizing costs at the jurisdiction level.      

Such an entity would require some kind of national governing board with both public and private participation to ensure the appropriate checks and balances.  In the event of a disaster (with or without a presidential declaration), it could facilitate activities to allow seamless scalability of the response efforts.  A board of representatives from the constituent population would govern such an entity.          

The field-level entity would facilitate resource acquisition, not just procurement, in disaster response.  One approach would be to have essentially a private sector and NGO ESF within the Joint Field Office (JFO), i.e., where the Federal government establishes unified command in the field, and/or the state EOC, i.e., the locus of state-level coordination.  Alternately, it could operate as a component of the logistics section of the EOC.  Either way such an entity would encourage horizontal integration of practical operational insights to inform the development of plans and strategies for the private sector and NGOs.   

The concept of “continuity of community” should serve as a foundational element in strategy and policy development as well as for procedural execution to maximize efficiency and effectiveness in all homeland security/emergency management missions.  This concept holds that the private sector and NGOs, as members of the community and dependent upon the community, will act in the community’s best interest to restore it to normal functioning as quickly as possible after a disaster event.

To ensure scalability and minimize process conflicts, private sector and NGO participation must integrate with ICS and other Federally-mandated protocols.  At the state and local levels, those participants representing the private sector and NGOs would participate in exercises and other activities.  They would have input and review privileges into policy development, although they would not necessarily need to be a discrete part of policy development.             

This kind of proposal underscores the importance of legislative language to provide for liability protection for businesses which put themselves on the line during a response effort as well as for relaxation of some regulations to enable them to participate fully.  It may also require revisions to the Stafford Act to allow businesses to receive public support under certain circumstances. 

Already widely accepted is the FEMA-supported Aidmatrix Network as the standard tool for donations management.  FEMA partnered with the Aidmatrix Foundation to enable state-based, interoperable portals which form a national network for matching private sector resources to specific points of need.  Aidmatix portals plug into the ESF structure in a JFO or EOC.  In the past 18 months, 30 states have activated Aidmatrix, covering more than 80 percent of the U.S. population.  While FEMA’s core Aidmatrix tool currently applies to in-kind donations of products or services, several states are already working with Aidmatrix to expand its application to reimbursable and procured resources, as well.  Additional capability exists also for cash donations and volunteer management.  

            Most recently in November 2008, a public benefit coalition of 30 representatives from the homeland security stakeholder community released for comment a proposal to strengthen public/private collaboration titled “Building a Resilient America.”  The coalition proposal puts forth a concept for an entity to facilitate and sustain partnerships for “ensuring continuity of community—and by extension, a resilient nation.”  According to the coalition document, “The nation’s preparedness and response policies must be informed by the realities of life in local communities, as well as by the Federal perspective.” This coalition sees its proposed entity as independent, i.e., operating outside of DHS and other Federal agencies.  Further, it argues that any such public/private effort should not have legal authority to mandate nor to regulate state and local partnerships but would rather engender standards.  “Collaboration cannot be mandated by government, but rather is grounded in trusted, tested relationships and common purpose—often more easily established at the local level.”  Partnerships must have the flexibility and authority to self-govern and to reflect the economies, culture and priorities of their respective regions.  Public/private collaboration must come in a manner consistent with Federal doctrine, e.g., NIMS, without top-down regulation from Washington.

This proposed nationally-recognized, independent public benefit organization would draw on such models as the National Academies and the Corporation for Public Broadcasting.  This concept does not call for an operational entity, however.  “The not-for-profit corporation will serve as a trusted venue for sharing information, best practices, mistakes and lessons learned.  It will be a national repository of subject matter expertise, innovative programming, illustrative partnership models and business plans, resources for resilience education and information on related technology solutions.”  As yet, the legal/organizational construct and funding model for this proposal is yet to be determined but may result in an entity which would be Federally charted, independent, not-for-profit or public benefit.  It may or may not involve government money, or it might receive only Federal start-up money as was the case for the Presidio following the 1995 Base Realignment and Closure (BRAC).


To further a structure and process for private sector and NGO participation in homeland security/NOF policy development, planning and possibly operational execution, the PNSR State/Local Issue Team encourages the Federal government to support an independent,  private sector-led national mechanism/entity to facilitate public/private collaboration and sustain “continuity of community” approaches for domestic incident management. 


Implementation of comprehensive national security and homeland security planning at the state and local levels is uneven. 

On the DoD side, U.S. Northern Command (NORTHCOM) has achieved some concepts of operations (CONOPS), including those for chemical, biological, radiological, nuclear and explosive (CBRNE) consequence management (CBRNE CM) and defense support to civil authorities (DSCA) for the 15 National Planning Scenarios.  However, one Pentagon official with well over a decade’s experience in DSCA-type relationships is skeptical of their worth.  In his view, while DoD may say it is able to execute Concept Plan 3501 (CONPLAN 3501, NORTHCOM’s DSCA plan), he is assured that NORTHCOM lacks sufficient knowledge of the ESF structure.  In reality, he says, NORTHCOM won’t be able to execute CONPLAN 3501.  In other words, at an operational level DoD will not know how to plug into a state or local ICS structure. 

DoD is developing a planning capability in its Task Force Emergency Response (TFER), an initiative launched by the Office of the Assistant Secretary of Defense for Homeland Defense and Americas Security Affairs (HD/ASA).  The TFER approach is based on the 15 National Planning Scenarios, whereas state and local planning is not usually scenario-based but rather is more often functionally-based to identify common tasks to be performed under all-hazards planning.  However, the approach does have merit because of its proximity to the regional and state levels and leveraging of military planning expertise. 

A TFER is a regional DCO’s responsibility which falls under his/her J-5 (deliberate planning support).  The DCO will liaise with regional adjutants general (TAGs) to use the TFER to backfill states’ planning capabilities if needed.  While the capabilities of states with large- and medium-sized metropolitan areas may be robust, rural states with smaller populations need help.  The DCO reports his/her TFER findings to the NORTHCOM J-5.  TFERs are now piloting in 12 states.  

Whereas DHS is wrestling with how to incentivize states to engage in the Integrated Planning System (IPS) by using FEMA grants as the whip, DoD is proactively covering the costs of the TFERs.  Since no congressional authority requires states to do a gap analysis study, NORTHCOM sees the DoD-funded TFER initiative as means to determine individual state capability requirements where FEMA efforts to do so have been unsuccessful. 

TFERs and IPS are planning attempts to address but one symptom of the failure of the cross-cutting, interagency structure for national security and homeland security resourcing to translate effectively and efficiently capability requirements into budgeting and programming.  It is oft noted that civilian departments and agencies do not have a planning culture as DoD understands it.  The charge applies even to the DHS legacy agencies with law enforcement missions.  Theirs is a tactical culture.  As such, a trend is underway to task military planners for homeland security planning, specifically deliberate planning, i.e., “the structured development of operational plans”—not a field where civilian Federal agencies and state and local governments have much experience.  As CSIS observes, preparedness would benefit from cross-fertilization of military planners and ICS emergency management planners.

Such is already happening.  As referenced above, two years ago DHS created the Incident Management Planning Team (IMPT) as a planning element in the NOC which can augment with an “on-call” staff.  The IMPT, which includes a number of military personnel, works on national planning system CONPLAN development in a process which includes a DRG review.  In 2007, FEMA launched its Operational Planning Unit (OPU) with some 12-15 planners, who were mostly former members of the military.  The IMPT focuses on long-term planning at the strategic level and is more of a deliberate planning entity.  The Operational Planning Branch (OPB, as the OPU is currently known) functions from the FEMA Disaster Operations Directorate and focuses on near-term planning (under six months out) as would a military staff J-35 (future operations). 

Implementation and resourcing of a planning continuum is primarily a Federal responsibility.  Yet credible homeland security planning should (1) reflect bottom-up, community-based assessments of risks which may require Federal-level entities to backfill, (2) orient to the regional level leveraging EMAC processes/structures and (3) engage military planning expertise.  The TFER, perhaps refocused more on regional planning scenarios vice the 15 National Planning Scenarios, would appear to be a good model for comprehensive, integrated Federal, state and local response/recovery planning. 


DHS should resource the Department of Defense’s  Task Force Emergency Response (TFER) initiative (or some equivalent) which leverages military planning expertise for the determination of regional capabilities and capability requirements and development and implementation of regional response/recovery plans based on community-based assessments of risk.                                                                                                                             

  1. Homeland security resourcing must be properly structured.

DHS does not have centralized acquisition and procurement authority.  The Secretary of Homeland Security and the Under Secretary for Management currently have sufficient authority to make it so, and the Government Accountability Office (GAO) and DHS Inspector General have both recommended such.  However, objections from DHS agencies and components and congressional supporters have stalled implementation.  Needed is statutory language to affect it. 

Under the current structure, DHS has nine separate procurement policy shops, nine separate procurement automation shops and nine separate procurement training organizations—all within a 15 minutes drive of one another.  Centralization would make these nine component procurement offices report directly to the DHS Chief Procurement Officer, enabling the department to unify its acquisition program, increase opportunities for program success and eliminate waste.  This change would allow DHS to obligate nearly 15 billion dollars of its budget through the acquisition process in a more unified manner thereby assuring greater program and mission success.  By not implementing this recommendation, DHS would require some additional 500 procurement staff.  Implementation, however, would enable it to provide a higher level of service with no additional staffing and without eliminating structure.  Agency and component procurement offices would merely report directly to the Chief Procurement Officer and enable him/her to align staffing and resource around department-wide needs in addition to component specific programs.


Further to achieve cost savings and improve efficiency, the Department of Homeland Security must clearly structure and empower departmental-level acquisition, procurement, coordination and resourcing authority and oversight activities relative to its operational components.  By statute, therefore, Congress should empower the DHS Under Secretary for Management via the Chief Procurement Officer to centralize acquisition and procurement authority and acquisition offices in a direct line reporting relationship to leverage the buying power of the Department and to mandate consistent, department-wide policies to guide acquisition and procurement.


Homeland security grant mechanisms work against collaboration, fragment state and local planning and reinforce Federal stovepipes. 

The PNSR State/Local Issue Team has studied the current homeland security grant system, primarily based on individual programs, and sees merit in moving toward a state-based structure where states determine their own homeland security priorities.  At the same time, DHS needs more authority to direct the grant process to state and local authorities.

Structuring grants for individual programs like the Public Safety Interoperable Communications (PSIC) grant program (notwithstanding its positive attributes) is not a good model because individual grant programs with equipment procurements tend to favor legacy solutions articulated by contractors

Grant criteria and funding must henceforth drive integration and planning as well as interoperability.  On the up-side, PSIC grants, as well as the Urban Area Security Initiative (UASI) grants, recognize integration.  UASI in particular, which followed the efforts of the Nunn-Lugar-Domenici “train-the-trainer” program of the late 1990s, supports integrated planning.  Grants must also support planning at all levels, including the regional level for a regional planning and the NOF framework—intra-state and multi-state.

The CSIS report supports empowering FEMA regional offices to be the “front line” of the grants process.  CSIS wants grant guidance for all major DHS grant programs to “focus proposed state investment in the target capabilities.”  To that end, it recommends revising the DHS Target Capabilities List (TCL) to set an agreed basis for assessing capability development.  According to CSIS, “A baseline survey of state capabilities, followed by the development of a database to track state capabilities, would facilitate operational planning at all levels.”  Evidently confident that previous grant programs have brought state efforts to a level sufficient for building incident management, it would shift the risk-based strategies for grants toward sustaining capabilities.  CSIS also is recommending that “the National Exercise Program should be designed explicitly to verify Federal, state, and local acquisition of target capabilities.”  

Too many grant programs with too many requirements overwhelm state and local authorities which do not have the infrastructure to handle them.  While some grant programs, specifically the UASI grant program, have actually encouraged multi-jurisdictional coordination, others have mechanisms which have worked against collaboration, fragmented state and local planning and reinforced Federal stovepipes.  The grants structure and process must be streamlined.


The annual national homeland security assessment (Solution 3 above) should inform a systematic, annual Federal homeland security grant process.  By statute, Congress should transfer from FEMA to the Secretary of Homeland Security executive agent authority for all homeland security grants, i.e., (1) to develop and publish grant goals, guidance and requirements, (2) manage the grant application, review and approval process and (3) fulfill fiduciary responsibilities associated with grant management.  Further, the DHS Secretary should engage non-Federal stakeholders, relevant DHS components and other Federal departments and agencies with homeland security

  1. Human Capital:  A homeland security workforce culture, as a subset of a national security workforce culture, must be institutionalized.



Strong workforce cultures in each department, agency and intra-DHS stovepipe have prevented full institutionalization of a homeland security culture.  With respect to DHS, no organizational entity above the DHS agencies—whether in the mission or back offices—effectively drives a common culture.

The time has come for institutionalization of a homeland security culture, fostered by a broad-based, interagency, intergovernmental workforce professional development program.  This claim rests on a number of recent governmental findings and initiatives.

In 2006, the White House Federal Response to Hurricane Katrina: Lessons Learned report called for a professional development and education program for homeland security personnel.  According to the report, “Over the long term, our professional development and education programs must break down interagency barriers to build a unified team across the Federal government.  Just as the Department of Defense succeeded in building a joint leadership cadre, so the rest of the Federal government must make familiarity with other departments and agencies a requirement for career advancement.  Where practicable, interagency and intergovernmental assignments for Federal personnel must build trust and familiarity among diverse homeland security professionals.”

The report charged DHS specifically with the responsibility to “develop a comprehensive program for the professional development and education of the nation’s homeland security personnel, including Federal, state and local employees as well as emergency management persons within the private sector, non-governmental organizations, as well as faith-based and community groups.  This program should foster a ‘joint’ Federal interagency, state, local, and civilian team.”

Similarly, the May 17, 2007, Executive Order (EO) 13434, National Security Professional Development, called for establishment of a national security professional development program, a plan for interagency and intergovernmental assignments and fellowship opportunities and professional development guidelines for career advancement.  It tasked the DHS Secretary to develop a program for Federal, state, local and tribal government officials to receive education in disaster preparedness/response/recovery plans and authorities and training in crisis decision-making skills.

            Earlier, the 2003 National Commission on the Public Service (Volcker Commission) more generally observed that the senior executive service (SES) had never developed into a corps of experienced managers which would move across agencies, deploying skills and bringing the benefit of experience to a broad array of management venues.  It recommended dividing the SES into a professional and technical corps (PTC) and a executive management corps (EMC), where “mobility across agencies should characterize service in the EMC,” i.e., in conformity to the principle that interdisciplinary experience is a positive value toward building a top-down, public service culture.

It took the Goldwater-Nichols Act of 1986 to mandate for DoD the so-called “joint duty requirement” for professional advancement in the military officer corps.  Similarly, Congress must authorize and resource by statute a structure to implement the recommendations of the White House Katrina report and EO 13434.  The homeland security workforce professional development program is all about training and exercising to develop collaborative skill sets and build relationships which will lead to a national NOF culture built on familiarity with ICS protocols and processes.  The end state should be a homeland security workforce professional development structure for a joint culture and NOF career path which is horizontal across disciplines/agencies and vertical concerning Federal/state/local governmental service. 

The PNSR State/Local Issue Team further recognizes the career succession challenge of maintaining a talented, trained and capable workforce.  In today’s world, if the government identifies high-flying public sector employees and incentivizes them, they will not stay in government for 20 years.  As the saying goes in state government, "You have to leave to get a raise."  To attract and retain qualified individuals, the government needs creative compensation packages and incentives, e.g., student-loan forgiveness for years of service, merit-based bonuses, career paths accommodating promotions and salary increases, etc.  Such inducements are hard to structure.

One paradigm which holds promise is the concept of “continuum of service,” articulated by the Punaro Commission on the National Guard and Reserves and based on a 2004 report by the Office of the Assistant Secretary of Defense for Reserve Affairs titled Rebalancing Forces: Easing the Stress on Guard and Reserve.  As applied to the active and reserve components of the military, continuum of service would institutionally support “a pool of individuals who may participate in varying levels of service throughout their careers, moving along as circumstances in their lives change or as the needs of [DoD] evolve.”  Under continuum of service, public sector employees can leave government, work in the private sector and return to public service at a higher pay grade reflecting their time, experience and performance as private sector employees.

Continuum of service plans, for example, could be facilitated by a public/private partnership via memoranda of agreement (MoAs) whereby private sector employers would get incentives coming from some kind of contract similar to the 8A status or tax credit for those firms with a vendor or contractor relationship with government.  Such continuum of service arrangements should apply to homeland security professionals, and indeed should be institutionalized as a fundamental element of a workforce career path.


Consistent with the recommendations of the White House Katrina report and Executive Order (EO) 13434, Congress must authorize and resource a professional development process for the Federal homeland security workforce, similar to that of the national security and intelligence communities, which mutually accommodates and reinforces “continuum of service” and to the degree practicable the state and local governmental levels, as well as in the private sector and NGO communities.

  1. Knowledge Management:  A system of systems for information sharing must be institutionalized.


DHS, the Department of Justice, DoD, ODNI, the HSC and other Federal entities with homeland security mission responsibilities—along with their state and local partners—have failed to institutionalize a responsibility-to-provide information sharing culture and a comprehensive and workable information sharing structure. 

Agencies at all three levels of government need to have clarity as to who grants the authority to declassify information for sharing.  Resolving the bifurcation of national security and homeland security should lead to resolution of the security clearance standards issue, at least as far as the law enforcement communities are concerned.  Clear standards for information sharing with respect to non-law enforcement public officials and the private sector will require further work, but are equally mandatory.

The Robb-Silverman Commission on U.S. intelligence capabilities addressed standards for ODNI classification.  Its report recommended the establishment of a Chief Information Management Officer (CIMO) who, reporting directly to the DNI, would be responsible for information sharing for Federal agencies.  The charge to the CIMO should extend to include standards setting for all levels of government as well as the private sector.

The DNI should be able to set and enforce standards, procedures and training protocols and exercise administrative oversight of training for information sharing and classification standards from Sensitive But Unclassified (SBU) to Top Secret (TS)/compartmented.  In addition to Federal-level information sharing, oversight must account for sharing necessary information with state and local levels and the private sector and NGOs to improve effectiveness in prevention of and preparedness for threats and allow the private sector and NGOs to work more effectively with the various law enforcement agencies.  Further, the focus of the Information Sharing Environment (ISE) should not be restricted to counterterrorism information but rather should include all intelligence information as per the Robb-Silverman Commission. 


For the purposes of better coordinating information and intelligence sharing for domestic national security, homeland security situations, the Director of National Intelligence (DNI) should have centralized authority to establish cross-cutting policy to guide the sharing of Federal national security, criminal and incident management information and intelligence with non-federal entities.  Further, the DNI should be responsible for establishing technical and cross-cutting information and intelligence sharing training standards that ensure the ability to share and integrate, when authorized and where necessary, all-source data, including those that necessarily should remain routinely independent.   Furthermore, all Federal Senior Executive Service (SES) and career personnel in positions with actual and potential domestic incident management, information sharing, law enforcement and domestic incident management command and leadership roles should have a consistent prerequisite to be certified under these training standards before being eligible to assume their positions.

Operational requirements should give direction for technology development and deployment of interoperable situational awareness and communications systems, which in turn would facilitate operational information sharing.  At present, they are not, and they must.  

For the incident commander and the EOC, the “Holy Grail” of situational awareness and communications interoperability is vertical and horizontal voice, data, video and geographic information system (GIS) integration. 

Despite such efforts as the PSIC grant program, the Federal government has not provided sufficient direction in terms of standards and requirements.  With some 100 contractors operating in the space, all proffering communications solutions, jurisdictions struggle with various bridging technologies (e.g., the ACU-1000) and 800 MHz to make their current systems work. 

The problem is not entirely Federal.  All government entities (local, state, tribal and Federal) still cling to legacy systems and are not focusing on advancing technologies and their capabilities for broadly integrated information sharing. 

The Federal government, specifically DHS, has the responsibility to establish standards for a national information sharing system for situational awareness and communications interoperability and to program for it.  It must do so with a Federal-level policy directive on funding which requires states to submit plans detailing how they will use the money to construct communications systems that must work together and integrate.  Further, the directive should condition funding on whether that plan meets Federal standards for a national situational awareness and interoperable communications system. 

Some form of NOF information sharing “platform” should work off routine information, e.g., transportation information.  As a flexible system-of-systems, akin to the Web, it must be technologically neutral, i.e., data neutral, and serve steady-state information sharing as a platform which personnel will use on a daily basis.  Daily use is a critical success factor.  From it, personnel develop competence and the faith to use the platform in crisis mode.  Finally, the system must be the platform for EOC staff training as well as for enhanced planning and private sector use for critical infrastructure/key resource (CI/KR) protection, business continuity and response.

States do not want an information sharing process and platform which push information from above and produce information overload at the incident command level.  The system must frame, prioritize and direct information to the different sections of the incident command, which as per ICS are operations, planning, logistics and finance.  At the same time, the process and platform must also provide some capability to expose all parties to relevant information when its relevancy is not understood in the stovepipe and can only be ascertained by those to whom it might apply. 

As a technologically neutral platform, it will have to employ data brokering.  It will inevitably have data entry challenges, e.g., those involving out-of-state access, health information and privacy, credentialing/privileging/access, planning, training, integration with the intelligence community and the sharing of critical infrastructure protection (CIP) data.

Rather than phrase information sharing in terms of a Federal/state issue or protection of state/local/Federal/private sector interests, it is less politically charged to express sharing in terms of “data owners” and “data customers.”  This approach conforms to key elements in the DNI’s recently released Vision 2015 for what he calls “a net-centric information enterprise” and mostly particularly with respect to his expectations for “customer-driven intelligence.”

The process would involve three layers.  The data layer would consist of all-source data produced by owners.  The integrated layer would be where integration by ESF function would occur.  Finally, a presentation layer would generate integrated data, a common operating picture (COP), et al to customers using the Web, 511, secure portals, paging, etc.  In the end, the system would be more or less a closed loop where the customers in fact would overlap with the data owners.  The information flow needs to be across jurisdictions (local-state-Federal) and across disciplines (police-fire-EMS-transportation-health, etc.) from "the field" (i.e., at the scene) to the various centers’ EOCs—traffic management centers, fusion centers, Health Industry Distributors Association (HIDA) data centers, etc. 

These interfaces have ramifications for the networks used, i.e., wireless, in order to transmit voice, data, video and GIS to create situational awareness and a COP.  All operations or fusion centers must publish into the neutral platform with different security protocols for each data “bucket.”  Protocol and process are technology agnostic.  Above the data sets at the integrated data layer, the data set standards will allow data to aggregate across state lines.  Utilizing a technology equivalent to the intelligence community’s “Intelipedia,” the platform would serve to deconstruct the stovepipes for analysis. 


The PNSR State/Local Team recommends establishment of a dynamic NOF two-way data sharing system, a “platform,” to be used as an Incident Command System (ICS)-enabler, from routine incidents to complex multi-site catastrophes. 

While the Federal government has had the primary responsibility for national security, in the 21st century threat environment, it no longer has (if it ever had) the exclusive responsibility to execute it.

Information sharing must be seen in terms of an intergovernmental and public/private partnership with shared responsibilities for managing and resourcing.  With regard to the intergovernmental piece, precedents include shared intergovernmental responsibilities for transportation and medical entitlement programs and the example of Federal Title 10 funding to the National Guard for preparedness and state funding to the Guard for Title 32 execution.  The virtue of an intergovernmental partnership for such a national program is clear when compared to a Federally-mandated program like Real ID, notwithstanding the Federal funding.  Such a program without state buy-in runs the risk of Governors opting out.  

In principle, the NOF platform should be an initiative driven by the states—coming together with a common need—to leverage up to the Federal level and the intelligence community for information sharing. 

Congress gives the authorization on information sharing policy.  As it relates to the information sharing process, the Federal responsibility should be to define standards which should be used by all potential information sources to ensure that data can be combined in a common data base or data warehouse and to facilitate common analysis of different data.  The technology layer could be the ability to link a variety of data sources in a virtual fashion rather than require that data be moved to a common warehouse.  Wherever the Federal responsibility is housed, it should not have a bias toward who is using the data or how they are using it.  Again, its responsibility is rather to define standards and facilitate a common infrastructure.  The Federal government (possibly with some level of state resourcing) would have the responsibility to fund the data layer and publishing.  The presentation layer could be use-funded, i.e., by the private sector.  Ten percent of the states are proceeding in this manner.

With respect to issues of Protected Critical Infrastructure Information (PCII) accreditation—the uneven PCII adoption by the states and corresponding private sector concerns—it is important to put the platform in play and then worry about security.  “If we build it, they will come.”  However, the private sector will need a statement protecting liability concerning information sharing and proprietary information.  Participation must be voluntary, and the data owner should establish the security level of what he/she provides.  It will be information sharing only for those with need-to-know.      

At first blush, it would seem that the Federal government should own the platform, have the aggregation responsibility and standardize protocols.  Wherever this platform resides at the Federal level, the administering entity should have state representation drawn from a pool of state homeland security advisors and state emergency management directors and their deputies, designated by Governors.      

It may be that the platform and these representatives would be physically resident in the DHS National Operations Center (NOC).  While for training and exercises all such representatives would rotate into the NOC, the crisis itself would determine the state(s) which would detail their representatives.  All other state issues would resolve via the EMAC structure.  DHS might also undertake administration via the State, Local, Tribal, and Territorial Government Coordinating Council (SLTTGCC) structure or each CI/KR sector’s Government Coordinating Council (GCC) and private Sector Coordinating Council (SCC) system.  However, this approach might be too stovepiped.  Other options would be to house the aggregation capability in ODNI, DoD or the FBI, although each has its obvious drawbacks, particularly with regard to state perceptions that the orientation would be too national security oriented, too Federal.      

Another alternative would be to house portions of the platform by ESF leads.  Absent the Team’s suggested consolidation of congressional committees around the NOF missions, this option would give a number of congressional committees oversight and authorization responsibilities for portions of the platform which could yield uneven results.  On the up-side, however, housing by ESF lead would give each lead a stake in the game.  This option would still require a framework-of-a-framework over the 15 Federal ESFs, i.e., some supra-cabinet-level interagency body, e.g., the HSC or NSC, as the case may be, or an EOP entity like the White House Office of Intergovernmental Operations which would have to include state, local, private-sector and NGO communities and would serve as a one-stop shop for the governors to call.                 

In sum, the PNSR State/Local Issue Team recommends consideration of the following specific options:  a White House function resident in the HSC/NSC or EOP; a GAO-type body; a department or agency; an equivalent to an independent agency like the Federal Reserve or the Securities Exchange Commission (SEC); or as a function under the National Guard Bureau (NGB).  While the NGB operates with Federal Title 10 funds, it could create a state-funded Title 32 entity which Federal Title 10 funds could support all or in part.  In that regard, the states would have some ownership.       


Congress should provide DHS with authority over an NOF information sharing platform for resourcing and standards and should liaise with the Department to determine the appropriate governmental entity to house and administer it on behalf of the states.




Emergency Management Survey Report - November 2008
Access Alerts Project

Marcia Brooks, Trisha O’Connell

WGBH Carl and Ruth Shapiro Family National Center for Accessible Media


The WGBH National Center for Accessible Media (NCAM) conducted a national, web-based survey during two weeks in late June/early July 2008, for its "Access to Emergency Alerts for People with Disabilities" grant project (Access Alerts), funded by the U.S. Department of Commerce’s Technology Opportunities Program.1

The survey was designed to identify existing and planned practices to make emergency notifications accessible to people with sensory disabilities (PWSD - consumers who are deaf, hard of hearing, blind, visually impaired, or deaf-blind).

Of note: the survey was completed just prior to back-to-back Hurricanes Gustav and Ike; After Action Reports for those events will likely bring to light additional information on this topic.

The Survey and its Respondents

The Emergency Management Survey queried diverse stakeholders about challenges and opportunities in policies, roles and practices for accessible message development and dissemination. The 22-question survey was developed with input from the Access Alerts national working group and was widely distributed to national emergency management professional associations, as well as national, state and municipal government offices of emergency management. People who either work directly in emergency management or who have involvement with accessibility initiatives related to emergency notification practices were invited to participate.

Within a two-week period, the survey attracted participation across public and private sectors, in nearly every facet of the emergency notification arena and beyond. The survey attracted over 200 respondents but not all respondents answered all questions. While the majority of respondents represented 911 call centers and emergency operations centers, there was significant representation from state, county and local offices of emergency management. Others included: state and municipal governors and mayors offices; first responders; consumer advocacy agencies and non-profit organizations; college and university emergency management representatives; public health agencies; vendor hardware representatives; and emergency management analysts and consultants.

Results convey a broad sampling of the state of accessible notification, and indicate opportunities to fill in known gaps and identify effective practices. Where possible, answers have been parsed for relevance to different disability groups.

Delivery Methods for Notifications to People with Sensory Disabilities (PWSD)

By far, television and radio are still the most predominant ways of getting emergency warning messages directly to people at risk, followed by the NOAA/National Weather Service emergency warning systems and the Emergency Alert System (EAS).

Question: What systems are used in your jurisdiction for getting emergency warnings directly to people at risk? (Check all that apply.)

When asked which methods are used for getting emergency warnings to people with disabilities, approximately a third of respondents listed family and friends and approximately 16% listed co-workers, indicating that senders of emergency alerts depend on interpersonal communications to take care of part of the notification process.2 Other person-to-person methods cited by respondents included caregivers and door-to-door canvas by local fire departments or other local emergency personnel.

Question: How are most people who are deaf, hard-of-hearing, blind or have low vision alerted to emergencies in your jurisdiction? (Check all that apply.)

Alerting people who are deaf or hard of hearing

More than a third of respondents do not know how most adults who are deaf or hard of hearing are alerted to emergencies in their jurisdiction. Of those who knew, over half of respondents listed captioned television, and approximately a quarter listed TTY. A smaller percentage of respondents cited the use of video relay and relay services and indicated their notification equipment/service has speech-to-text capability.

Alerting people who are blind or who have low vision

More than a third of respondents do not know how most adults who are blind or who have low vision are alerted to emergencies in their jurisdiction. Of those who knew, nearly half listed radio, more than a third listed television, and approximately a quarter listed landline telephone.

A smaller percentage of respondents cited the use of cell phones, and indicated their notification equipment/service has text-to-speech capability. Several listed voluntary consumer registries, sirens and public address systems.

Awareness of accessibility features or requirements

More than a third of respondents do not know if their agency/organization uses notification equipment or services that offer accessibility features, and more than half of those who responded to this question do not know if they require vendors to offer these capabilities.

Question: Does your agency/organization require vendors of notification equipment/services to provide specific accessibility features? (Check all that apply.)

Message Content Development

County/local offices of emergency management, and emergency operations centers/911 call centers led the list of entities cited as responsible for compiling emergency messages. Other entities charged with compiling emergency message content include: public safety departments; public information officers; communications department; campus emergency personnel; police/fire/incident commanders; and a local speech and hearing agency.

Nearly half of respondents said alert messages instructed consumers to check their local TV or radio station for more information, followed by websites, hotlines, and other phone numbers.

A quarter of respondents do not know if their jurisdiction’s emergency messages advise consumers to check other sources for more information. More than a third of respondents do not know if other organizations or persons add more information to the original message but those who did know cited localized information about shelter locations, instructions, evacuation routes, and sources for more information as additional message components.

Question: What kind of localized or enhanced information is provided in your jurisdiction? (Check all that apply.)

Nearly three-quarters of respondents do not know if specific content for PWSD is provided in messages sent within their jurisdiction. The inclusion of TTY numbers was cited most frequently by those who are aware of specific content included in emergency messages.

Question: Tell us if any content has been added to emergency alert messages in your jurisdiction that is specifically relevant to people who have hearing and/or vision loss. (Check all that apply.)

Policies and Procedures

Nearly 40% of respondents do not know if there are specific provisions for PWSD in their jurisdiction’s Emergency Operations Plan or Standard Operating Procedures. About 30% of respondents said there were specific provisions included in their plan. About 30% of respondents said there were none.

Almost half of respondents do not know if a specific person/entity is responsible for compliance with federal mandates, statutes, and laws on emergency information access. A third said there is a person/entity responsible. Several listed ADA staff while others cited varied emergency management offices and other state/ local government agencies. More than a third of respondents do not know of programs or initiatives in their jurisdiction to provide accessible information. Only a small sampling of respondents know of their organizations’ participation in disability-focused private sector efforts for accessible notification, or whether their jurisdiction has participated in disability-focused government-sponsored training programs.

Specific Practices and Programs

A number of respondents reported ongoing efforts to educate first responders to needs of PWSD and to coordinate with local media. A number of respondents mentioned the work of the National Weather Service and the CEPIN project. One respondent mentioned a CERT curriculum specifically developed to train people of all disabilities. A handful of respondents reported working with local media to address the need for varied messages in different formats to reach consumers with disabilities. Similarly, a few respondents cited work underway to define shelter needs for vulnerable populations or to develop special needs transportation plans. Other existing programs and practices cited include:

  • Use of sign language during emergency telecasts
  • Reverse 9-1-1
  • Email alerts
  • Mass notification telephone systems
  • TTY training
  • Brailled emergency preparation materials
  • 211 Service
  • Evacuation registry
  • Buddy system
  • Providing equipment recommendations and discounts
  • Providing first responders with accessible support materials
  • Meeting with/involving people with disabilities in emergency drills

• Developing voluntary special needs registries for people to receive customized information (though a smaller amount have actually used them, others plan to use them).

When asked about programs or services respondents would like to replicate, initiatives in a number of states (Ohio, South Carolina, Oklahoma, Los Angeles County, Illinois, New York, Florida, Washington and Texas) were cited. Respondents’ recommendations include:

  • A robust email, text, PDA, cell, landline alerting system at a reasonable cost that allows self registration for varied messages of the receiver’s choice (i.e., NYAlert, OK-WARN and Kent County CityWatch) were among the systems mentioned that offer some of these options.
  • Special pagers that receive alerts based on geographic locations, i.e., weather alerts based on where the pager is instead of a statewide broadcast
  • A vision/hearing directory and outreach program
  • Evacuation registry
  • Televised and Web-based ASL alerts and video instructions
  • Brailled emergency information distributed to support groups and public libraries
  • Car visor cards for people with disabilities to alert responders of their special needs.
  • Alpha-Numeric Flip Charts to communicate with deaf consumers.
  • Map services such as the Map-Your-Neighborhood (MYN) in Washington State
  • Tactile maps for emergency notification and evacuation guidance for the blind.

Challenges Related to Creating Programs for Accessible Information

When asked to list challenges related to serving PWSD, the majority of respondents listed insufficient funding, staff resources, system capabilities and training.

Question: Identify challenges in your jurisdiction to creating or maintaining a program that provides accessible emergency information to people who are blind, low-vision, deaf, hard-of-hearing, or deaf-blind. (Check all that apply.)

Comments included:

There is never enough funding to provide equipment to those with disabilities and to give adaptive equipment to first responders.

Currently we do not have any type of emergency alert information systems for disabled or anyone in our county to be notified or where to go or what to do in an emergency situation. I would say it needs to be mandated as the improvement [is] needed in our

community. As far as I am aware there are no funding sources for this. With current lack of funding, we find it extremely difficult to support present operations, never mind expanding where we want to go. Lack of funding has resulted in using traditional methods such as television text and TTY.

We would like to hear of an affordable system solution that covers all mixes of vulnerable populations. System costs range annually from $10K to $120K per year which are very cost prohibitive for smaller counties.

There is little funding. All of the initiatives thus far have been from the Office of Emergency Preparedness staff and donated studio time from Cox Communications and persons from the deaf action center.

We have a limited capability to reach such people in an emergency, however, we [are] constantly trying to improve and expand the City's capacity to serve people with all forms of disabilities. The primary constraint is directly related to budget, which impacts staffing and the number of programs we can manage and sustain.

More than a third noted lack of sufficient knowledge about the need, or how to implement such a program. Others noted insufficient access to ASL interpreters, lack of cooperation from related agencies, and insufficient access to demographics. Several noted challenges in developing voluntary registries including low participation and low prioritization.

Going Forward

The broad range of respondents and their willing participation in the survey indicates a national awareness of the importance of accessible notification. Findings indicate significant differences and gaps in messaging and delivery practices, training and funding, all of which support the need for shared criteria and consistent implementation of universal design considerations within emergency alert systems. Respondents noted greater opportunities for accessible alerting in integrated emergency information systems.

It would be great if the various communities affected by disabilities would combine with organizations and leaders who want integrated emergency information systems. There are common solutions, but they are not being pursued. I.e. the registration of an attribute for routing messages or invoking special IT treatment could be "deaf" or it could be "hazmat". The use is very different, the underlying plumbing is the same.

A number of respondents also indicated that the survey itself will influence their work.

…. this survey has led me to seriously think about our position in this regard and do some further investigation into who might have a plan in place that we could duplicate.

This survey has spurred interest in checking our policy and procedures and also our equipment capabilities that deal with such notifications.

Our agency is hoping to purchase a notification system for emergencies and community notifications. The process has not started yet and with these questions, it has brought many more questions for the RFP to mind. Thank you.


NCAM wishes to thank Elizabeth Davis and Rebecca Hansen of EAD & Associates for contributing their time, insight and resources for the web-based survey development, hosting and gathering of responses.

NCAM also wishes to thank the Access Alerts Working Group for contributing to the survey’s content, and for enabling its national distribution.

For more information and additional reports, we encourage you to visit the Access Alerts Web site at http://ncam.wgbh.org/alerts 



Editor's note: The complete report is a must-read. Hopefully, these selections will inspire you to explore this well-written, extensively researched and beautifully laid-out report. Information on where you can access the complete report is in the left-hand column.

Be well. Practice big medicine.



Selections from:


Southern California Wildfires After Action Report

September 2008

by June Isaacson Kailes


prepared in partnership with the Access to Readiness Coalition, The California Foundation for Independent Living Centers, and The Center for Disability Issues and the Health
Professions at Western University of Health Sciences


Executive Summary


This After Action Report (AAR) highlights many disaster response and recovery areas of specific and significant concern to the diverse disabilities communities in California. It documents the experiences of people with disabilities and individuals with access and functional needs. The areas covered include:

• cross cutting issues,
• communication access,
• mass care and shelter,
• evacuation and transportation,
• role nongovernmental provider and advocacy
organizations in disaster response,
• long term care facilities,
• training and exercise programs.

Many of the local government AARs are silent on these issues or only vaguely mention them.


This AAR offers 71 specific recommendations for strengthening and improving preparedness, response actions and recovery efforts that are inclusive of people with disabilities and activity limitations. Many of the recommendations reinforce a variety of continuing emergency concerns that existed before the 2007 fires and continues today.


Information for this AAR was collected through: key informant interviews, stories collected via California Foundation for Independent Living Centers’ Access to Readiness Coalition review of hundreds of emails generated during and after the fires by NGOs staff and government employees who worked as responders, review of public hearing testimony, review of prior California disaster reports focused on how people with disabilities fared, and review of presentations and discussions from forums focused on the fires.

The intended audience includes the state, regional and local governments policy makers and emergency planners, non government organizations), long term care facilities and older adults and disability advocates.

Major cross cutting issues discussed include:

• Most disaster response systems are designed for people who can: walk, run, see, drive, read, hear, speak and quickly understand and respond to instructions and alerts.

• Narrow definitions of disability do not work in disaster planning and response because there are large segments of the population that have functional needs.

• The term “special needs” does not work because it does not provide guidance to operationalize needed planning tasks. A better way to think about the needs of people with disabilities and activity limitations is to use an orientation that considers major
functional needs: communication, medical, maintaining functional independence, supervision, and transportation.


• Preparing to accommodate people with functional needs often translates into emergency response systems being better equipped to serve diverse and sometimes vulnerable groups.

• Good practice involves networking, building and strengthening relationships that foster ongoing communication, coordination, cooperation and collaboration between at risk communities and emergency managers.

• Involving qualified representatives from these communities helps planners understand and think through issues from disability, functional needs and aging perspectives and can help prevent making mistakes.

• Separate “special needs population” planning and separate “special needs population”
annexes are not effective. Segregating and isolating the needs of significant numbers of the population does not make sense. It is inefficient with regard to budgeting, procurement and resource allocation. Planning is not a two stage process comprised of “the critical plan” and then “the special plan.” Separate planning often means the planning is never is done.

• If the value that everyone should be included is not infused into planning, then not everyone will be included.

• Except for the Office of Emergency Services Office of Access and Functional Needs, the state devotes few fiscal resources to identifying and addressing barriers to help ensure the safety of all people, regardless of their functional needs.

• State and local government emergency policy makers should allocate a percentage of annual funding to strengthen and improve preparedness, response actions and recovery
efforts that include people with functional needs.


4. Cross Cutting Issues


4.1 Narrow Definitions of Disability Do Not Work in Disaster Planning and Response


It is common for emergency planners to be unclear regarding who is included in the “people with disabilities and activity limitations.” Some planners, for example, when asked who makes up the special need populations, respond narrowly: “people with mobility disabilities,” “deaf people,” “blind people,” and “hospital patients.”

Many people need assistance, including those who do and those who do not identify as having a disability or activity limitation. Many need assistance, but have conditions that are not apparent. Others have obvious disabilities and limitations but do not need
assistance. Activity limitation can be temporary resulting from, but not limited to, surgery, accidents and injuries (sprains, broken bones), pregnancy, etc. as well as permanent conditions. Some activity limitations result from the disaster itself, and leave individuals more vulnerable.

The challenge is that most disaster response systems are designed for people who can: walk, run, see, drive, read, hear, speak and quickly understand and respond to instructions and alerts. Preparing to accommodate people with disabilities (diverse
functional needs) often translates into being better equipped to serve diverse and sometimes vulnerable groups. Many people cannot safely or comfortably use standard
response and recovery services, information or equipment. If the value that everyone should be included is not infused into planning, then not everyone will be included.

There are many more people who have disabilities and activity imitations than is commonly recognized. Traditional narrow definitions of disability do not work. Therefore, a function based orientation should be integrated into disaster planning and response.

When the Federal Emergency Management Administration’s (FEMA) and the Centers for
Disease Control’s (CDC) definitions of people with special needs are used, people with limited or no English proficiency, older people, minority groups, children, people with serious mental illness, people without vehicles, people with specific dietary needs and, pregnant women are also included.

This adds up to 50 percent of the population when the most typical groups of “special needs” populations: people with disabilities, serious mental illness, people who do not speak English or do not speak English well, people 65 years old and over and children, age 15 and under, are counted. By adding the entire institutionalized population, about
4 million people (Census 2000, Summary File 1, Table PCT16) the percentage of individuals in the special needs category increases to 51.44%. See Table 2 below for detail.


Some emergency managers question, “Why focus on such a small, insignificant group, when there are so many other priorities?” Given the size of the populations, people with disabilities and activity limitations should not be thought of as the unfortunate special few. Functional limitations are common characteristics of the human experience. This is a very large group!

Many of these groups have little in common beyond the fact that their margin of resiliency may be narrower and their vulnerability may be higher when compared to people without disabilities and activity limitations and that they are often left out of programs, services and emergency planning.

Accommodating this large group often translates into being better equipped to serve all people. Disasters and terrorism instantly escalate the number of people with new disabilities and functional limitations.

While these population categories add up to 50%, not everyone in these categories is likely to be effected in every emergency. Depending on the type of event, the time it occurs, its duration, and the length of pre-event notice, different groups will be affected. For example, an event with no notice that occurs during the middle of a school day will leave many more children away from home and more vulnerable than they would be if the event happened when they were home with their parents. People over 65 are not always at risk, some may actually be leading and/or playing active roles in the response and management effort. The same is true of people with disabilities.


Depending on functional needs, and availability of regular support systems, many will need no assistance. Individuals who are immersed in a community where they do not need to speak English, will rely on friends and neighbors who can translate emergency messages to address their communication needs. However, again depending on the event, some subgroups, functionally defined, may need to be considered as a whole. For
example, in the event of potential toxic exposures, all pregnant women will be vulnerable, whether or not they speak English or have a disability. A midday event that triggers a large-scale evacuation will place individuals who rode public transit to their job that day in a “transportation disadvantaged” situation. Even though they may have a car at home or parked in a commuter parking lot, functionally, they are “carless” to respond to the event.

Even if all people in all categories that make up this 50% demographic are affected by an event, it does not necessarily mean that they all need assistance during any or all phases of response and recovery. However, unless planners use a function based approach to assess and address unmet needs, there is no way to know which individuals will need additional consideration, and which will cope adequately on their own.


4.2 Moving Emergency Planning from “Special Needs” to “Functional Needs”


Many lessons document, reinforce and underscore that it is long past time to disaggregate the term “special need populations.” The term “special needs” does not work because it does not provide guidance to operationalize needed planning tasks. A better way to think about the needs of people with disabilities and activity limitations is to use a function based orientation that considers major functional needs: communication, medical, maintaining functional independence, supervision, and transportation. Although everyone has functional needs, the consequences of people with disabilities and activity limitations not receiving needed support, can be much more severe and much less forgiving.


Experience with disaster should raise the bar by incorporating learning, but this often has not been the case with functional needs issues. People continue to lose their health, independence and sometimes their lives because information transfer and lessons documented over the last 30 years have not been sufficiently learned and applied.

Disaster preparation and emergency response processes, procedures, and systems can be made more effective for people with disabilities, as well as for the population as a whole. An essential element of building appropriate levels of capacity, specific planning, and response success is to move beyond focus on special needs. A functional based
approach is a more accurate and flexible planning and response framework. It is a framework based on essential, sometimes overlapping, functional needs: communication, medical, maintaining functional independence, supervision, and transportation. A function-based definition reflects the capabilities of the individual, not the condition or

Individuals in need of additional response assistance may include those who have disabilities; who live in institutionalized settings; who are elderly; who are children; who are from diverse cultures; who have limited English proficiency; or who are non-English speaking; or who are transportation disadvantaged.

This definition seeks to establish a flexible framework that addresses a broad set of common function-based needs irrespective of specific diagnosis, statuses, or labels (e.g., children, the elderly, transportation disadvantaged). The definition focuses on the following function-based aspects:


Maintaining Independence – Individuals requiring support to be independent in daily
activities may lose this support during an emergency or a disaster. This support may
include consumable medical supplies (diapers, formula, bandages, ostomy supplies, etc.),
durable medical equipment (wheelchairs, walkers, scooters, etc.), service animals, and/or attendants or caregivers. Supplying needed support to these individuals will enable them to maintain their pre-disaster level of independence.

Communication – Individuals who have limitations that interfere with the receipt of and
response to information will need that information provided in methods they can understand and use. They may not be able to hear verbal announcements, see directional signs, or understand how to get assistance due to hearing, vision, speech, cognitive, or
intellectual limitations, and/or limited English proficiency.


Transportation – Individuals who cannot drive or who do not have a vehicle may require transportation support for successful evacuation. This support may include accessible vehicles (e.g., lift-equipped or vehicles suitable for transporting individuals who use oxygen) or information about how and where to access mass transportation during an evacuation.

Supervision – Before, during, and after an emergency individuals may lose the support of caregivers, family, or friends or may be unable to cope in a new environment (particularly if they have dementia, Alzheimer’s or psychiatric conditions such as schizophrenia or intense anxiety). If separated from their caregivers, young children may be unable to identify themselves; and when in danger, they may lack the cognitive ability to assess the situation and react appropriately.

Medical Care – Individuals who are not self-sufficient or who do not have adequate support from caregivers, family, or friends may need assistance with: managing unstable, terminal or contagious conditions that require observation and ongoing treatment; managing intravenous therapy, tube feeding, and vital signs; receiving dialysis, oxygen, and suction administration; managing wounds; and operating power-dependent equipment to sustain life. These individuals require support of trained medical professionals.

Separate “special needs population” planning and separate “special needs population” annexes are not effective. Segregating and isolating the needs of significant numbers of the population does not make sense. It is inefficient with regard to budgeting, procurement and resource allocation.

Planning is not a two stage process comprised of “the critical plan” and then “the special plan.” Separate planning often means planning is never is done.

People with disabilities and activity limitations are diverse and should not be sidelined or
compartmentalized into a special needs box. The current general population is one that is diverse, aging, and focused on maintaining independence as long as possible. The popularity of living situations that provide an “as needed” level of care in the least restrictive manner is becoming the norm. Consideration must be given to people who
may be able to function independently under normal situations, but who may need assistance in an emergency.

Special implies difference and isolation and that the individuals needs are different from others. Among disability advocates, the special label is often used for segregated programs. Programs and services continue to miss the mark when people are seen and served as people having special needs instead of people who are a part of every segment of the general population. As long as disability and other special needs groups are viewed as unique or special, the system’s existing inefficiencies will continue.



1. State and local government emergency planners should use a “functional needs” framework. Using a more effective, accurate and flexible framework built on an essential functional based orientation addresses the needs of more people, more efficiently and effectively in ways that:

• build appropriate levels of capacity for disaster preparation, emergency response processes, procedures and systems;
• adopt guidelines and protocols for appropriate resource management;
• strengthen service delivery and training;
• prevent health complications and reduce institutionalization and the inappropriate use of scarce, expensive and intensive emergency medical services;
• allow disaster services to incorporate the value that everyone should have the chance to survive;
• translate documented lessons into knowledge and application; and
• improve overall response successes

Many underestimate the advanced planning and coordination time needed to make the transition to a function based approach that is necessary to effectively integrate and accommodate people with disabilities and activity limitations. Good practice involves networking, building and strengthening relationships that foster ongoing communication,
coordination, cooperation and collaboration between disability communities and emergency managers. Involving qualified representatives from these communities helps planners understand and think through issues from disability, functional needs and aging perspectives and can help prevent making mistakes.

Qualified representatives, include those who, in terms of recruiting people for advising, planning, staffing and contracting work:

• Identify as people with disabilities and / or activity limitations;
• Have a user’s perspective;
• Have personal experience with disability and disability advocacy;
• Can speak broadly on disability issues as opposed to only addressing their own needs;
• Are knowledgeable about cross-disability access issues (hearing, vision, mobility, speech, and cognitive limitations);
• Are knowledgeable about a variety of physical, communication, and program access issues.

Qualified people should:

• Be connected to and involved with segments of national, state or local constituencies of the disability community, such as active involvement in broad-based disability organizations (of and for blind, deaf, hard of hearing, learning disability, developmental disability, independent living, multiple chemical sensitivities, etc).

• Have in place and use communication arteries to facilitate two-way communication with the segments of the disability community they are representing.

In addition, other types of experience may be needed. For example, qualified advisors, trainers, contractors and consultants with disabilities may need to have:

• Disaster-related technical expertise.

• Advocacy experience, management experience,
and training skills.

SB 1451 sponsored by Senator Christine Kehoe (D-San Diego) and developed with input from the California Council for the Blind, and other disability community groups, requires The Governor’s Office of Emergency Services (OES) to integrate members of the diverse disability community into all pertinent Standardized Emergency Management Systems (SEMS) committees. This enables qualified individuals with disabilities, through this state level planning to address communication, evacuation/transportation, shelter and recovery issues.


2. As the state emergency planners transition from the SEMS planning committee
structure to a structure that reflects the state’s revised emergency functions (in the soon to be updated State Emergency Plan) the state should continue to ensure input and integration of diverse qualified disability representatives in these new planning committees.

3. State emergency planners should develop and offer guidance to local government regarding how to actively recruit qualified people with a variety of disabilities (i.e., mobility, vision, hearing, cognitive, psychiatric, and other disabilities), and how to involve organizations with expertise on disability issues in all phases of emergency management planning.

4.3 Grants and Funding

In 2007, Senator Kehoe introduced SB 426, sponsored by the California Foundation for
Independent Living Centers (CFILC), intended to create the position of Deputy Director for Access and Functional Needs Coordination within the OES. Although the bill did not pass the legislative process, it did emphasize the importance of this office. CFILC’s Access to Readiness Coalition continued its advocacy efforts immediately following the wildfires and as a result, in early 2008 the OES Director established the Office of Access and Functional Needs.

This office is identifying and addressing barriers to help ensure the safety of all individuals regardless of their functional needs. This office will oversee and ensure adequate planning that incorporates the diverse needs of people with disabilities and functional limitations in all preparedness, response, recovery, and mitigation activities. This includes minimizing adverse impacts by building capacity so that emergency programs and services are accessible to, accommodate and are inclusive of these populations.


4. The state should make the Office of Access and Functional Needs permanent and the lead position equivalent to a deputy director / assistant secretary. This office must have the authority, responsibility and resources to carry out its critical objectives.

Except for the Office of Access and Functional Needs, the state devotes few fiscal resources to identifying and addressing barriers to help ensure the safety of all people, regardless of their functional needs.


5. State and local government emergency policy makers should allocate a percentage
of annual funding for the purpose on strengthening and improving preparedness, response actions and recovery efforts that include of people with disabilities and activity limitations
. This AAR provides specific recommendations for critical projects to fund.

6. State and local government emergency policy makers and planners should integrate into emergency grants and contracts proposal selection criteria (rating score criteria) specific indicators for evaluating proposals that include people with disabilities and activity limitations. For example, as appropriate to the proposal’s focus, these indicators should specifically detail and show evidence of how applicants will include function based service issues and physical, communication, and program access, such as:

• Meeting the communication, evacuation, transportation, physical access, and health
needs of diverse functional needs populations,

• Contracting with and employing qualified people with disabilities and activity limitations,

• Forming partnerships among first responders, emergency planners and organizations representing diverse functional needs populations, to ensure accurate training information and development of usable services and response,

• Appointing qualified representatives from diverse functional needs populations to
emergency planning efforts as staff, advisors, trainers, contractors, and consultants,

• Promoting Community Emergency Response Teams (CERT) that recruit and accommodate people with disabilities and activity limitations.

4.4 Emergency Registries

Emergency registries, as used in this AAR, refer to government efforts to collect information about people with disabilities for use by emergency and/or health and human service personnel. This information consists of a database of individuals who voluntarily sign up and meet the eligibility requirements for receiving emergency response services based on a need. Although some registries exist in San Diego, they were not used during the 2007 fires. There are documented reports from California regarding serious problems in keeping registries current as well as easily and quickly retrieving the data and responding when needed.

California emergency responders commenting on the use of registries stated:

“The act of creating a registry does not increase response capacity, but focusing on integrating community stakeholders in response does.”

“Lists are only as good as the public being able to provide information or wanting to provide information. The lists are also very time consuming and require a large amount of staff time to maintain.”

“There is also a public expectation that being on a “registry” means that the appropriate response will occur - during disasters there are usually not enough resources to respond to each registered person.”

Some emergency planners mistakenly view disability-focused registries as relatively easy and simple solutions. However, this is not the case, registries have diverse and complex elements that include funding, administration, focus, recruitment of potential users, enrollment, disclaimers, education efforts, data management (information collected, privacy, refreshing-maintenance, storage and retrieval), and response force commitments.

Unfortunately, there is scarce and piecemeal research on registries and how to operationalize and sustain them. There is a lack of guidance regarding accepted good practice when entities are contemplating creating and maintaining a registry. The research is silent with regard to acknowledging the ongoing significant time and labor costs and there is little documentation regarding successful outcomes.

Acceptance of the use of these registries by the populations they are intended to assist varies from appreciation to grave concern and condemnation. Some disability advocates state it is “a lot about us without us,” meaning the intended users are not included in the planning for or managing the effort. Some question the rigor applied to the critical effort of keeping data current and accurate given the short self-life and perishable nature of registry data. Many object to the inherent registry bias that most people with disabilities are easy to locate because they are “homebound.” That is, registries do not acknowledge that this diverse population, just like everyone else, works, volunteers, plays, prays, shops, eats and travels.

Some claim registries are inadequate approaches authorized by emergency managers who do not comprehend the complexity of disability-related emergency services. Some worry that registries give people a false sense of security, even when they come with educational efforts and very clear disclaimers. Some complain that registries are often undertaken as a “reflex response” and a misguided and “easy planning fix” to the disability “problem.” Some question what happens to the many who do not register. Do only people who register get preferential service and what about visitors?

California’s Emergency Services Act promises to develop model guidelines for local government agencies and community-based organizations planning to develop a disaster registry, but to date these guidelines do not exist.


7. State and local government emergency planners should proceed cautiously and carefully with regard to endorsing the use of emergency registries for people with disabilities and activity limitations.

8. State emergency planners should review existing registry requirements in the California Emergency Services Act and develop realistic recommendations that lead to integrating disability-focused services and qualified representatives into emergency planning and management systems.

New report calls for inclusive disaster planning

POMONA, Calif. – Sept. 26, 2008 – The Southern California wildfires in October 2007 reinforced the need for modifications to emergency preparedness to be inclusive of people with disabilities and activity limitations.

The Southern California Wildfires After Action Report (2008) by June Isaacson Kailes, Associate Director, Center for Disability Issues and the Health Professions, Western University of Health Sciences, documents the experiences of people with disabilities and individuals with access and functional needs during the wildfires.

“An After Action report is created to capture what happened - what worked, what didn’t work, and what needs work,” Kailes said. “This report is dedicated to the many people with disabilities and activity limitations who lost their independence or their lives because information transfer and the lessons learned and documented over the last 30 years are not yet uniformly applied.”

The report was prepared in collaboration with California Foundation for Independent Living Centers, the Access to Readiness Coalition and the Center for Disability Issues and the Health Professions at Western University of Health Sciences.

Findings include:

Most disaster response systems are designed for people who can: walk, run, see, drive, read, hear, speak and quickly understand and respond to instructions and alerts.

Except for the Office of Access and Functional Needs, the state devotes few fiscal resources to identifying and addressing barriers to help ensure the safety of all people, regardless of their functional needs.

Significant numbers of people rely on essential medications, consumable medical supplies and durable medical equipment.

Significant numbers of people do not have access to evacuation transportation because they cannot drive due to disability, age, poverty, addictions and legal restrictions, or they just do not own a car.

Many of the local government After Action Reports are silent on these issues or only vaguely mention them, according to Kailes. This report offers 71 specific recommendations for strengthening and improving preparedness, response actions and recovery efforts that are inclusive of people with disabilities and activity limitations.


Many of the recommendations reinforce a variety of continuing emergency concerns that existed before the 2007 fires and continues today.

The intended audience for this report includes state, regional and local government policy makers and emergency planners, non-government organizations, long-term care facilities and older adults and disability advocates.

This report covers cross cutting issues, communication access, mass care and shelter, evacuation and transportation, the roles of nongovernmental providers and advocacy organizations in disaster response, long-term care facilities and training and exercise programs.

Among the recommendations:

A better way to think about the needs of people with disabilities and activity limitations is to use a function-based orientation that considers major functional needs: communication, medical, maintaining functional independence, supervision and transportation.

State and local government emergency policy makers and planners should integrate into emergency grants and contracts proposal selection criteria (rating score criteria) specific indicators for evaluating proposals that include people with disabilities and activity limitations.

State and local government emergency planners should ensure a speedy mechanism and flexibility of the Standardized Emergency Management System process to meet the requests for medications, durable medical equipment and consumable medical supplies.

State and local government emergency policy makers should develop standards for integrating accessible transportation providers into local governments’ evacuation plans.


The complete report may be accessed online.


June Isaacson Kailes is a consultant and a disability rights advocate. Respected and recognized nationally and internationally, she is one of the original national leaders in the Independent Living Movement. June is an Adjunct Associate Professor and the Associate Director of the Center for Disability Issues and the Health Professions at Western University of Health Sciences, Pomona, California.

June has operated a consulting practice since 1978. She works locally, nationally and internationally as a consultant, writer and trainer. She consults for and trains businesses, universities, state associations, government entities, centers for independent living and other not-for-profit organizations. She has delivered hundreds of keynote addresses, workshops and seminars.



The Past as the Future of
Emergency Preparedness and Management



Murray Turoff

Starr Roxanne Hiltz

Connie White

Linda Plotnick

Art Hendela

Xiang Yao


Information Systems Department

New Jersey Institute of Technology



It is our intent in this paper to provide an overview of Emergency Preparedness and Management that is based upon our prior work in this area.  To start with, we first summarize the findings of a major U.S. government study on Disaster Preparedness because they are very relevant to the motivation of our work (Turoff et al 2004a, 2004b) and the observations and recommendations that follow.  The purpose of this report was to identify the key areas needing improvement throughout the U.S. for improving Emergency Preparedness and Management.  We will first itemize these concerns in terms of words taken directly form the initial summary of findings study (pages 3 to 6): 

Planning is essential for any region or community likely to be affected by a disaster, in order to determine what preventive and protective measures can and should be taken before and at the time of a disaster.  Planning requires cooperation from all levels of government... To be confident that disaster planning is preparing government officials, volunteers, and the public to cope better with disasters, such plans must be exercised and evaluated.

Vulnerability analysis is a prerequisite to effective disaster preparedness.  The variety in types and frequency of natural disasters and the differences in effect and damage make it clear that an assessment of vulnerability must be made for each community as a first step in formulating regulations, plans, and programs to reduce hazards and prepare for disasters. 

The reduction of hazards and preparedness for disasters are government responsibilities as well as the concerns of every citizen.  For this purpose there must be ... appropriate disaster legislation for all levels of government.   

Public awareness of the threats posed by the various natural disasters is essential to preparing for them and reducing their destructive effects.

The value of past investment in prediction and warning capabilities is clearly demonstrable.  Despite the increasing property losses, there has been a notable decline in lives lost when such capabilities have been established and used.

The objective of mitigation is to find ways to reduce the vulnerability of people and property to damaging effects. ... there is a need for a national program involving Federal, State, and local jurisdictions in avoiding the mistakes of the past and in gaining fuller consideration of natural hazards in regulating land use and construction. 

The main focus of emergency response to major disasters should be: (1) to expand routine emergency services, such as police, firefighting and sanitation; (2) to provide those things which the individual citizen takes care of by himself in normal times but which have been interrupted by the disaster, such as food, housing, and personal welfare; and (3) to make special provisions for medical care. ... There is a favorable benefit-cost ratio in taking early measures when a disaster is imminent.

Research on the causes and characteristics of natural disasters and for the protection of people and property holds great promise and is a national imperative.  The most immediate need is to apply the scientific and technological knowledge already existing.  The sheer number and variety of disaster related research activities in the government and private sectors now make it difficult to coordinate and integrate these activities. 

This report to the US Congress, titled Disaster Preparedness, was published by the Office of Emergency Preparedness (OEP) in the Executive Office of the President in January 1972.  This extensive report was inspired by General George A. Lincoln who was director of OEP, an executive office agency which was scheduled for elimination in 1973 along with the Office of Science and Technology.  The final quote included is a few words from the director's letter to the U.S. Congress. 

The main thrust of this report points to the need for improvement in disaster preparedness at all levels. ... Disaster preparedness is a task never completed.  It represents an unbroken chain stretching from the prevention though ultimate recovery and requires continuous effort at all levels of government.

The words of this report, with the inclusion of man-made disasters as well as natural ones, appear to be just as true today as they were in 1972. Within the context of the above requirements the authors are going to review some of the recent work that addresses these concerns, roughly following the topics in the report as summarized above. We will review the continuous planning cycle for emergency response, including the applicability of “muddling through” as a management philosophy for this field. Then we will discuss a scaling method that we have devised that can be helpful for assessing vulnerability. After briefly reviewing disaster legislation in the U.S., which provides the context for the current disjointed situation, we discuss the need for public awareness and community involvement in mitigation and other phases of the planning process. Our emphasis in moving to information systems for emergency response is on providing collaboration tools for communities of practice.


This is the foundation on which everything rests and it involves integration of the plans across all the ongoing objectives of planning or what is loosely termed the phases of emergency management.  What is not clear to all is that these objectives of planning are part of a continuous process:

Planning (for all the objectives below)

            Mitigation (long term reduction of risk or vulnerabilities)

            Training (for all actions)

            Detection and Warning (for all disaster types)

            Preparedness (pre disaster event readiness)

                        Responders, volunteers, community, organizations, press, etc.

            Response (to a disaster event usually short term, but not always)

            Recovery (restoring what was normal)

            Evaluation and Process improvement

                        What went wrong and how to correct it for the future?

Good planning requires good communications and good information.  Both today are a problem.  Disasters or emergencies cross political, geographical, or organizational boundaries.  The fragmentation of participation by existing human-determined boundaries and the presumption that these divisions are appropriate for planning and dealing with an emergency have been principal reasons why we have not seen major improvements in many of these areas since 1972. 

  • Lack of commonality with respect to interface design, visualization, and decision support, making it difficult for practitioners to master a range of very different systems necessary to their concerns (Carver and Turoff, 2007).
  • The separation of threats by source (terrorism, natural disasters, and man made disasters) with very different priorities for different phases and dissimilar activities.
  • Lack of major integration requirements across organizations.

The above properties result from a web of deeper problems that tend to prevent the actions and developments that are needed.  For example the common perception is that the response phase of an emergency will only last a week or two.  However, this was not the case with the Anthrax emergency in the US and clearly the response phase of hurricane Katrina was far in excess of what usually occurs in urban areas.  If we ever encounter a true pandemic, the response phase will last years.  Fundamental issues of this sort greatly impact the design of information systems to deal with all the phases that can occur in any of these events.   

In this paper we raise a number of such issues that need to be more explicitly exposed, investigated, and treated to make sure information systems can deal with likely future occurrences as well as past ones.  We also suggest associated future R&D objectives.  The characteristics that have changed considerably since 1972 are those associated with the evolution of the Web and the opportunities, applications, and problems that it now makes possible. (See Chapter 16 in Van de Walle, Turoff and Hiltz, 2009, for more details).  These issues include:

  • Lack of an integrated structure and ethical policy for dealing consistently with all types of disasters, at least in the U.S.

  • The problem of information overload for emergency management professionals

  • The critical processes of Cooperation, Coordination, and Collaboration on a wide area and national basis

  • Recognition of the planning, policy analysis, and decision process of “muddling through”

  • Social Computing, Community Involvement, and Citizen Participation as the future road to successful emergency preparedness and management.

Muddling Through

Trying to plan also presumes one is aware of how decisions are made in any of the disaster phases.  Recent writings have argued that High Reliability Theory (HRT) and Sensemaking are the foundations of what should underlie good decision making practices (Weick and Sutcliffe, 2001).  HRT has evolved from organizations dealing with physical systems such as nuclear power plants and does make a lot of sense; however, it turns out there is an earlier theory that does not require the existence of any physical systems.  This is commonly known as mudding through and also as a form of incrementalism.  This was originally proposed as the way in which important government policy decisions should be made.  In 1959 Lindblom wrote a classic paper about the concept of making decisions by "the science of muddling through" rather than by a "scientific" process of setting goals and deducing logical resulting actions.  The following summarizes and contrasts the two views of decision making discussed:

  1. Scientific deductive decision making with complete knowledge of all relevant variables and values from which an optimization can be made by use of resulting obvious criteria for the decisions.

  2. The subjective comparison of a limited number of alternatives relying heavily on experts and their past experience and expertise, where they are focusing on a judgment based upon a few of the most important values

This might be an over-simplification of a superb paper proposing a different form of decision making for governmental decisions at all levels. However, it strikes us that in the context of the unexpected such as occurs in disasters and emergencies, "The Science of Muddling Through" should be required reading for practitioners, designers, and researchers concerned with Emergency Preparedness and Management. Furthermore it is a foundation for the approach to collaborative decision processes that we have taken in most of our writings in this area, producing a ‘collective intelligence’ where the group will produce a better outcome than any individual member of the group would have (French and Turoff, 2007).

Ill structured, wicked events call for flexibility in decision-making as well as improvisation with the available assets to best accommodate a situation to lessen the chances for the worst outcome and increase chances of the best. Traditional management styles of one or two people in charge of making all the decisions must be replaced by the expertise of the group and defer to that expertise during the response efforts. As the magnitude of an event grows, so too does the group of people to manage. It has been suggested that implementing an incident command system as a hierarchical network is the best solution for managing a large and unknown situation, allowing for flexibility for those in charge (Moynihan 2007). We differ very much with this view and offer the challenge of how to turn a large scale team of professionals into an instant HRO (High Reliability Organization, Weick and Sutcliffe, 2001), networking even when they have never worked together before.

In 1979 Lindblom published a follow-up paper restating the concepts of muddling through in a comparative analysis of different types of "incrementalism." In that paper he listed the stratagems for muddling through that could also be termed as "disjointed incrementalism." What is startling for our purposes is how much they seem like the concepts underlying High Reliability Organizations and concepts of "sense making" which are increasingly popular in Emergency Management operations (Van de Walle and Turoff, 2008). Quoting Lindblom from his 1979 paper:

  1. A greater analytical preoccupation with ills to be remedied than positive goals to be sought;

  2. A sequence of trials, errors, and revised trials;

  3. Analysis that explores only some, not all, of the important possible consequences of a considered alternative;

  4. Fragmentation of analytical work to many (partisan) participants in policy making (e.g. stakeholder analysis and community participation).

Determining what went wrong and getting that corrected for the future by changes to the process was top priority for "muddling through" and later for HRT (High Reliability Theory). This incremental series of changes based upon understanding the past is a critical human process in making improvements to any situation. In terms of policies, plans and practices, Lindblom, (1979) also observed:

"A fast-moving sequence of small changes can more speedily accomplish a drastic alternation of the status quo than can an only infrequent major policy change." (page 520)

The above seems to be the way practitioners have to actually plan and execute responses and recovery in this field.  It also seems that emergencies or disasters are the time when changes can be more easily made in local, state, or federal government agencies; the term emergency in Korean also means "opportunity."  It should also be a time to uncover mistakes and take action to eliminate them from any of the phases in the future.  Today we have too many fears and inhibitions about allowing these errors to be exposed and corrected. In addition, there are the following weaknesses in the current process, in the U.S.:

  • We don't create the working team until the emergency occurs.
  • We don't really integrate volunteer organizations or community groups into the command and control structure.
  • The command structure does not allow integration across levels of government, organizations, and various man made boundaries (Chen et al, 2009).
  • We isolate the public and the press and really do not always offer an accurate picture of what is taking place.
  • The people who do the planning are not the people who have to execute the plans, making them difficult to communicate and lacking detail on local conditions (Byrne, 2008).
  • Unprotected organizations are reluctant to expose errors because of liability and public reaction (Lee et al, 2006).
  • Too many sources are trying to be the official source for materials critical to locals for dealing with emergencies and the result is information overload.

The technology available today offers solutions for many of these problems and will be discussed later in this paper when we deal with collaboration and community involvement.

Vulnerability and Risk Analysis

A Risk Analysis done by the method of cost benefit studies has two prime fallacies. A risk study is an examination of relative truths in the sense that it compares various risks and tries to determine their relative importance. Therefore the process follows the Kantian philosophy of science (Mitroff and Turoff, 1975). However, cost benefit studies translate everything to dollars which linearizes the relationships between the causes of risks and the consequences of them. However many risk situations are non linear in their relationships and the comparison of risks really needs to be done based upon the physical parameters/variables in the real world (deaths, buildings destroyed, number of accidents, etc.) underlying their occurrences and consequences.

The second related fallacy is the application of discounting (applying time dependent discount factors to measures of performance or costs) in the cost benefit model. This assumes there is no memory of consequences in the model as to when (in what year in the future) a value or cost would be gained and they are independent in any year (Linstone, 1972). For example, if there is a slow leak in a nuclear reactor which would not accumulate a deadly level in the surrounding area for over 100 years, the typical cost benefit study would show that available money should be spent on other threats more likely to produce deaths next year. Even a 2% discount rate would bring the costs a hundred years from now down to almost nothing. Essentially, discounting destroys any impact of a variable change in one year propagated or compounded into other years. 

A recent action by the Environmental Protection Agency (CBS News, Washington, July 10, 2008) reduced the value of a human life by one million dollars. This has the impact of making increased regulations to reduce deaths in the future far more costly to implement than the value of the lives saved. The current wisdom is the ratio must be greater than one to implement stiffer regulations. When decisions of this sort are reduced to thresholds based upon arbitrary modeling decisions, games can always be played. In emergency management the reality of this is the growing age of our infrastructure as the decrease in maintenance or replacements of bridges, sewers, water systems, etc is seen by politicians as a way to reduce budgets; but eventually, “tomorrow” comes and the bridges fail.

The older term used in 1972 of "Vulnerability Analysis" of specific situations and locations was much more clearly understood as referring to studies of the physical variables that characterize the risk rather than financial abstractions.  In Emergency Preparedness it is not the financial damage that is important before the event or immediately after.  It is measures like the expected causalities, injuries, and requirements for shelter, food, water, power, transportation, etc. 

Students in a recent graduate course in Emergency Management Information Systems were asked to use the Delphi Method (Linstone and Turoff, 1975) to determine the relative importance of different dimensions for measuring the impact of a disaster before and during the event, to aid the Emergency Management function (Plotnick, Gomez, White, and Turoff, 2007).  The lowest values for informative purposes were the two that are most often reported (financial loss and recovery costs).  What citizens who might be involved in the disaster want to know are the other variables in the Thurstone's scale shown in Table 2 that was derived as a group result from the individual preference rating.  Note the top rated dimensions of Causalities and Fatalities is 2000 to 1 more important, as rated by the class, than the last which is Financial Recovery Costs.  Clearly the latter may become more significant after the disaster is over.

Many of these variables are better estimated by local citizens with experience in prior similar disasters or local experts familiar with things like local building codes and practices.  Using national estimates does not give informative estimates when the threat is on the way nor does it aid the management processes of insuring the availability of current resources.  One needs local estimates of each variable on this scale.  That local estimate and measurement will change dynamically from the initial detection of the threat, through the occurrence and response, and into the recovery.

Each of the dimensions below can have a local scale of the degree of damage estimated by the local community "experts" on a continuous basis from the earliest detection of the current threat right up to its actual occurrence, and then afterwards as actual damage assessment occurs.  This estimation process also points out the difference in understanding of the situation when one is looking at the status of each of these dimensions or just the total of potential financial loss as one would do in a cost-benefit study.



Disaster Damage Dimensions


Disaster Damage Dimensions



Casualties and Fatalities










Utilities Impact











Potential to Spread

Ability of local response adequacy







Loss of Command and Control

Infrastructure Damage




Resources for Aid or Containment

Time needed for response



Duration of Disaster





Public Reaction





Geographic Impact










Time to Return to Normal










Chance of imminent reoccurrence




















Financial Loss















Financial Recovery Costs



Table 2:  A Thurstone scale for the relative importance of measures of disaster impact (Plotnick et al, 2007)

If we are going to take many types of extreme events seriously we need to do much more about meaningful citizen involvement, as they are the true first responders (Palen, Hiltz, and Liu 2007).  The area that has the greatest payoff for handling extreme events is the more complete involvement of the communities and their citizenry in all phases of disaster preparedness and response.  This should be our first line of defense.

Disaster Legislation at all Levels of Government

A real difficulty that planners have today is that there is no commonly understood ethic of what any level of government feels is its explicit responsibility for responding to the needs of communities and citizens.  U.S. citizens cannot say what the local, state, or federal government will take responsibility for in the case of a disaster.  Once upon a time (until the mid 1970s) there was a federal ethic that expressed the philosophy behind most of the disaster legislation passed by congress:

Insofar as possible citizens and business should be restored to the state they were in prior to the disaster; however, no one should profit from a disaster. 

This had its problems since one could not spend federal funds to build a better bridge if the bridge went out in a flood.  Rarely did local communities or states add money to build a better bridge.  However, the lack of explicit knowledge on just what different government agencies will do in a given situation leaves the planner in emergency management in a rather difficult situation.  How do the local planners plan either response or recovery when they don't know what the state and federal governments provide?  There needs to be more transparency for the public and associated organizations.

Public Awareness and Community Involvement

Even in classical management we have seen the evolution of concepts such as Stakeholder Analysis to overcome the shortcomings of the typical monetary approach to Risk Analysis.  A formal approach to Stakeholder Analysis is more useful for integrating the large spectrum of concerned planners, responders, and decision makers.  This would mix the key people in different levels of government (federal, state, local) and other national or even international organizations concerned with any of the disaster phases.  There are also in various communities severe problems in communications because non governmental groups are not regular members of the command and control system used during disasters.  For example in many urban areas there is no active linkage between community organizations providing emergency health services and the general social support system in that community (Turoff and Hiltz, 2008).  As a result, someone coming out of a hospital care situation after a disaster is not in any database that would interface to the community organizations that might help them further with such basic problems as shelter, food, and other forms of help.

In any case, what is clear is the following needs for emergency preparedness based risk analysis (Hendela et al, 2006; Turoff et al, 2002, 2004a, 2004b, 2008; White et al, 2007a, 2007b, 2008, Yao and Turoff, 2007):

1. Determining what has worked and what has not worked in past experience.
2. The participation collaboratively of a large multidisciplinary community of practice with members who are familiar with the local area and its vulnerabilities.
3. An information based knowledge structure able to accept, organize, and provide a community and organizational memory for experiences, plans, resources, and other critical items for Emergency Preparedness and Response.
4. The ability for the community citizens and professionals to continually and dynamically contribute their knowledge and wisdom and to be able to evaluate and expose problems and disagreements for discussion and resolution.

This would be in essence a community recommender system for the community decision makers in local government, private companies, non profits, and other community organizations.

Mitigation and Improved Emergency Response

The community as a whole should provide the opportunity for participation in building and maintaining a community disaster plan.  Today most plans come down as templates from the federal government and are not highly tailored to the local community.  The usual government members are not made up of the professionals who have the background knowledge to be able to assess details such as engineering vulnerabilities in the infrastructure.  The CERTs (Civilian Emergency Response Teams) are a positive concept but really limited to civilian training for only the response phase and do not encourage contributors to any of the other critical phases such as planning and mitigation.  Also there is no easy way for leadership in the community to be actively involved except for an occasional table top exercise.  This might happen once every six to twelve months, never get to a professional level of detail, be conducted face to face only, and rarely have a detailed result except for some top level insights by the leadership, who may not come back to a second exercise.

Local severity and probability risk assessment could well serve as a first motivational tool.  This should be generated and compiled on an asynchronous basis much as in an online Dynamic Delphi, allowing continuous input and discussion by members of the community as well as collective ratings of risks.  The results of such an approach could well serve as a collaborative process for the community and leadership to determine the important planning details and preparation for having the necessary resources and equipment. 

A new variant of Wikipedia http://www.wikimapia.org allows people to link information to specific points or areas on a map, which can utilize detailed maps of a given area as the knowledge structure.  This means a lot of community information and viewpoints can be linked to the potential location of a risk, problem, resource, etc.  The Wikimapia system is available online and is accessible anywhere there is Internet connectivity and a browser. 

There have been other recent calls for the use of modern web technology to create a 911 system that would integrate all the community activities in emergency management at the local, regional, state, and federal level.  It would cut across all the different physical devices available to community members (Shneiderman and Preece, 2007)The name suggested has been “911.gov” in the United States and it would provide a variety of applications tied to any phase of emergency preparedness and it would provide for open access to all citizens. 

Involving the public and other organizations in the planning process as well as the other aspects will lead to many important benefits for all the phases of emergency preparedness and management.  Once the public feels it is getting reliable information from all levels of government, efforts to improve mitigation of future disasters or emergencies will be a lot easier to accomplish.  Carrying out emergency response will be much easier when virtual representations of response plans and especially evacuation processes can be viewed and understood by any concerned citizen.

Collaboration and Collective Intelligence

When disasters cross political boundaries, emergency response teams are often partially or fully distributed virtual teams.  Virtual teams have been an area that has seen a great deal of prior work at NJIT, with teams involved on such tasks as software development and project management (Hiltz, Fjermestad, Ocker, and Turoff, 2006).  A partially distributed virtual team is a hybrid team whereby there are some individuals collocated in subgroups, and the subgroups are distributed from one another (Huang and Ocker, 2006).  In an emergency, people from each organization that is involved in the response may form such distributed collocated subgroups.  The challenge is for the subgroups to form an effective team.  A communication/ information system must enable the teams to overcome the inherent difficulties of working in such teams.  For example, collocated members may tend to have “collocation blindness” (Bos, Olsen, Nan, Shami, Hoch, and Johnston, 2006) whereby they will resist reaching out to distributed members even when the best expertise lies outside of the collocated group.  Deferring to Expertise (HRO theory) is something too often lacking in extreme events.

Lindblom in his book, The Intelligence of Democracy, (1965) put it in very clear terms: "that people can coordinate with each other without anyone's coordinating them (Lindblom, 1965, p. 3)."  In disaster planning and response it is full scale collaboration that is needed and we would extend the above quote to encompass coordination, cooperation, and collaboration.

Elements of a Dynamic Response Information System

Real-time, effective decisions are required of experts collaborating on management and response.  Without effective response, outcomes can be catastrophic, with more dire consequences than expected or experienced previously.  Errors in management and decision making can exacerbate the situation and result in greater injury, loss of life, or a disastrous financial toll.  Lessons learned from past experiences include the need for a feedback mechanism in a support system so that the processes of an event can be critiqued and further utilized to promote learning from failures.  Characteristics or values of success need to be identified and integrated into the information system.  Expecting the unexpected and managing disasters effectively calls for a system with dynamic features conducive to support group collaboration on a large scale.

Thurstone’s Law of Comparative Judgment helps to reflect best a group’s opinion by breaking complex situations down to a manageable set of characteristics (Thurstone, 1927a, 1927b, 1928; Torgerson, 1858).  We have made a major theoretical modification to Thurstone’s method that allows complete dynamic voting and the introduction of new items with a fluctuating number of contributing voters possible on any subset of preference items in the list (White, Turoff, and Van de Walle 2007a; White, Plotnick, Turoff, and Hiltz 2007b).  The critical contribution is a new measure of uncertainty that provides a separate Thurstone scale that shows the greatest possible uncertainty condition that results from some items having only a few votes and others having a lot more.  This results in a second Thurstone’s scale that can be lined up with the first scale to show the potentially large variations that can occur for items that are new and/or have currently only a small number of evaluations. 

The approach provides two separate visualizations based upon the interval scales generated by the Thurstone method.  If two alternatives are at the same point this means that half of the individuals who are voting on that comparison prefer A to B and the other half prefer B to A.  The linear distance between the two is the current vote.  Thus, P(A>B) = P(B>A) = .5 is the zero difference point between the two options.  In the second scale those not voting but who indicate they are likely to vote at some point are assumed to be able to drive the vote back in the opposite direction and this gives a new version of the scale that measures the uncertainty when compared to the original scale.  The first votes cast are meant to expose any disagreements so they can be brought out and discussed by everyone focusing on the particular problem, quickly bypassing areas of agreement and saving precious time.  With this method anyone can change their vote at any time based upon the discussion that has occurred about what appears to be meaningful disagreements.  The interval scale provides a visual measure of the degree of agreement on the relative preference of any two items.  With this feedback, and the visual information provided by the second scale that shows the uncertainty as previously mentioned, experts have a more complete understanding of the level of agreement and status of opinions for decision making.  People may choose to vote via “paired comparisons,” rank order, “yes,” “no," “no judgment,” or “no judgment at this time,” the latter showing other participants their intention to vote in the future.  The feedback mechanisms of the voting scheme allow participants to see just how many vote changes have occurred for any one item in the list.  We are adapting the standard Delphi design practice of only encouraging those who are confident in their judgment to express a preference (Linstone and Turoff, 1975).

Thus, this new method allows for providing a group reflection of individual experts to vote, revote, or not vote at all on a given situation, depending upon the relevance of the decision to the experts’ domain of knowledge. These subsets of experts can then work more effectively given the dynamic nature of the event, and with the aid of Internet technology, from anywhere, anytime, and asynchronously. Prior research supports implementing the following list of characteristics into a distributed group support system to aid the decision making process so that better solutions are produced (Linstone and Turoff, 1975, Turoff 2002, White, Turoff, and Van de Walle 2007):

• Anytime, anywhere participation in decision processes
• Ability to vote on an issue, not vote, wait for more information to vote, or change a vote based on the changes in merit from evolving information input
• Visual feedback on real time vote status
• Anonymous voting
• Total vote changes on any item and histogram of recent vote changes over time
• Contribution to any part of the decision process by any team member

Anyone can participate in any part of the process at any time; this is crucial as the experts can change their minds, change a vote on a given decision based on the changes in merit of the arguments. Discussion is stimulated by disagreements made salient to the participants by a visual voting feedback system. This discussion amongst experts furthers understanding of a given situation and lessens ambiguity. In many cases the individuals converging on a specific problem will have different professional backgrounds and represent different viewpoints. In such situations the quick recognition of differences in meaning (ambiguity) is critical to reaching the stage where the more difficult issue of uncertainties can be dealt with.

Thus, expertise is used when it is most needed.  Teams of experts should be in a standby mode ready to respond anytime when disaster strikes.  However, the system must be used by the contributors in the interim because having a history of using the system regularly will promote ease of use.  Waiting until a disaster to use a system impedes making full use of its capabilities.  Only when a system is used on a day to day basis will the experts and teams be able to interact efficiently and effectively use it as a means to communicate and solve problems.  This means that the thousands of people involved, who come from a great many different organizations and affiliations, must have access to the system between emergencies.  This is for the purpose of replacing the need for a physical system as the basis for an HRO (e.g. nuclear power plant, aircraft carrier) with a virtual command and control system which can be fine tuned and used for training on a continuous basis (Turoff, Chumer, and Hiltz 2006).  They can become part time participants in a virtual organization (Mowshowitz, 2002) where they can also develop the social relationships and other factors necessary to evolving a team and developing trust in each others’ capabilities necessary to allow for the sharing of roles and responsibilities in any event with an unknown duration.

This approach allows those who feel confident through experience and/or expertise to self choose the problems to which they believe they can contribute.  The shared motivation to reduce or mitigate the harm occurring in an emergency or crisis and the trust that only those that feel qualified to contribute are enough to eliminate the problems we usually fear in group collaboration due to Arrow's paradox.  What we hope can be accomplished in this type of collaborative process is "collective intelligence" (Hiltz and Turoff, 1978, 1993) where the group result is better than any one member would have reached working alone and where decision making can occur as quickly as a single individual seeking to collect and consider carefully all the available information that might influence the process. 

Accessibility to an easy to use management system can also create a bank of experts in which subsets can dynamically come together and handle unforeseen situations with the best outcome given the set of events.  Such dynamically formed groups of experts need a system to support making fast decisions based on merit.  No one can predict the composition of the perfect teams needed for problems that cannot be predicted ahead of time.  What is needed is a system that is open to all the participants and provides the necessary information and alerts for individuals to find the problems they feel they can contribute to at any given moment or place in the response activity.

A Dynamic Emergency Response Management Information System (DERMIS) has been proposed by Turoff et al. (2004a, 2004b, 2006) which will provide for supporting dynamically changing teams of experts as they respond to or plan for extreme events.  By focusing on roles, changes in personnel assigned to those roles can occur seamlessly and not adversely impact the effectiveness of the team.  Each individual needs to have access to information that is relevant for an effective response.  Flexibility, robustness and a dynamic nature are keys to effective handling of such emergencies.  It is proposed (White, Plotnick, Adams-Moring, Turoff, and Hiltz, 2008) that a dynamic voting Delphi-like process can further increase effectiveness and ameliorate some of the problems that are inherent in rapidly changing, critical environments.

Other benefits of consistent use of a system are that users will meet one another and have a means of building trust within a virtual social network (Turoff et al., 2004a).  On the other hand, during large scale or unexpected events, numerous participants in the command, control and analysis process may not have interacted before or have a plan that fits the circumstances.  The secret for planning in emergencies is have a process that works and known resources that can be commanded, not in designing decisions ahead of time.  Trust may need to develop quickly as swift trust, and/or have challenges not present in more static, well-defined situations (Iacono and Weisband, 1997; Coppola, Hiltz, and Rotter, 2004).  A person in a decision role may be reluctant to hand over that role to someone they do not know well enough to trust to carry out the role as well as they do.  This is what leads to individuals working until exhaustion becomes a problem where it concerns making reliable decisions.  Roles have to function on a 24 hour, 7 day basis.  This also requires systems that track accurately the status of any response so that those taking over roles can have all the information dealing with an open response event.  Familiarity with a system is a critical factor, especially when the participants in a crisis are further challenged with duress from psychophysical symptoms (Turoff et al, 2004a) such as the Threat-Rigidity Syndrome.  Even during down times, it is important for participants to stay abreast of the situation so that when they come back on shift, they are aware of any drastic changes and can seamlessly continue the teamwork as an effective member.

Alleviating Information Overload in Communities of Practice

When experts work collaboratively with a goal of learning from one another about a common interest, a Community of Practice (Wenger, McDermott, and Snyder 2002) can emerge; this strengthens the likelihood of good performance in situations of great stress.  If the system has been used previously and is well understood, attention can be focused on the emergency and not diverted to issues of system use.

The history of the U.S. federal government in Emergency preparedness and management has resulted in numerous and diverse sources of information for communities of practice.  There is no single source of collaboration among all those involved including the state and local governments and no single source for the collection and dissemination of plans and best practices for any or all of the many phases of the emergency preparedness process.  Instead, there are numerous fragmented sources in specific areas, where some organizations or agencies have many more resources than others.  The result for the practitioners is a proliferation of diverse documents that is not handled in any systematic approach and which has lead to practitioners in all areas and phases of emergency preparedness and management being overwhelmed with information they cannot adequately find, filter, or utilize (Turoff and Hiltz, 2008).

While there are significant efforts in the medical emergency area to overcome this information overload problem, even there the primary current emphasis from an information science viewpoint is on classical information retrieval utilizing largely academic sources of literature.  There are no systematic attempts to collect best practices, working plans, case studies, and other sources of what is commonly called the “gray literature.”  A search on the web for “emergency management” or “emergency preparedness” turns up about nine million hits.  A recent study of the behavior of practitioners in this area clearly identifies the conviction of practitioners that they all feel the problem of information overload.  Just joining a few of the relevant message lists produces hundreds of new documents every week.  Many emergency practitioners feel these documents might have something useful, but they have no time to skim anywhere near that number of documents.  Their feeling that something is there that might improve their performance but which they have not seen is very real (Turoff and Hiltz, 2008).  There is no library type organization that takes the role of integrating all this material into an integrated index relevant to all the different concerns, in the U.S. or internationally.

The resulting design for the emergency response community to attempt to solve their information overload problem involves interpreting their requirements to create a new type of information recommender system controlled by the practitioners themselves. Such a system would have to allow vetted practitioners in Emergency Preparedness and Management to:

1. Nominate documents to be included
2. Retrieve and skim or read these documents
3. Comment on the usefulness of a given document.
4. Vote on the usefulness if they are vetted professionals in a specific area.
5. Be able to view very useful documents rated as such by others who are in the same specific areas of EP&M as themselves.
6. Provide visualizations of document clusters on an interval scale such as provided by Thurstone’s law of comparative judgment.
7. Allow them to change their vote or viewpoint based upon the information provided by others.
8. Allow for collaborative tagging to let the community keep the indexing tags for documents current and evolving with the latest changes in knowledge.
9. Provide vote summaries broken down by the types of professionals that voted on any particular document (medical, fire, hazards, etc).

This would represent a system supporting a “community of practice” to accumulate and acquire their own knowledge base of what they consider the most current and useful material for their field of endeavor (White, Plotnick, Turoff and Hiltz, 2007; White, Plotnick, Adams-Moring, Hiltz and Turoff, 2008; White, Hiltz, and Turoff, 2008).  But all the above is somewhat foreign to the classic approach to information retrieval and would bypass the current journal industry.  Essentially a recommender system for a community of practice would take the control of the literature out of the hands of journals, reviewers, and the publication industry, reduce costs greatly, and allow total control of the process by the actual users themselves.  It would be the ultimate “open access” system (Poynder, 2008).  It would still require vetting the contributors to insure they are active and knowledgeable professionals in some particular aspect of Emergency Preparedness and Management.  Also, there would still be a need for editors in specific areas to look for anomalies of strong disagreements among professionals that should be investigated.  Even Wikis today now have roles for editors for given pages to assess changes and conflicts.

Final Observations

Currently the process of bringing bottled water to a disaster site by the federal government is a very complex one which requires going up a significant number of governmental layers and engaging in outsourcing to a contractor that will actually acquire and supply the bottled water (Byrne, 2008), no doubt at a higher cost than one would expect. Local authorities and clearances between local emergency managers in a region and sources of bottled water from local established stores would require very few agreements and a few phone calls to have such deliveries made to a point of need within hours, if in fact we had the right sort of agreements and command and control structure integrating all the local or regional parties involved.

The fragmentation of participation by existing human- determined boundaries and the presumption that these divisions are appropriate for planning and dealing with an emergency has been a principal reason why we have not seen major improvements in many of these areas since 1972. 

  • Lack of commonality with respect to interface design, visualization, and decision support, making it difficult for practitioners to master a range of very different systems necessary to their concerns.
  • The separation of threats by source (terrorism, natural disasters, and man made disasters) with very different priorities for different phases and dissimilar activities.
  • Lack of major integration requirements across organizations.

The above properties result from a web of deeper problems that tend to prevent the actions and developments that are needed.  For example the common perception is that the response phase of an emergency will only last a week or two.  However, this was not the case with the Anthrax emergency in the US and clearly the response phase of hurricane Katrina was far in excess of what usually occurs in urban areas.  If we ever encounter a true pandemic, the response phase will last years.  Fundamental issues of this sort greatly impact the design of information systems to deal with all the phases that can occur in any of these events. 

There is a very dedicated community of professionals in emergency management in the US and elsewhere in the world.  They have often faced terrible examples of mismanagement and lack of influence in the processes associated with many recent disasters.  They need to be better integrated with those developing and implementing the systems needed to address the problems they face.  They need to be part of a continuous community of practice that integrates across all local organizations and has the resources to involve all the local community, agencies, organizations, and individuals that want to participate in any phase of the Emergency Preparedness process.  There is a significant element of truth in the unofficial motto they have expressed in the IAEM (International Association of Emergency Managers) message list in recent years:

“We, the willing, led by the incompetent to do the impossible for the ungrateful, have done so much for so long with so little, we are now capable of doing practically anything with nothing."


Bos, N., Olsen, J.S., Nan, N., Shami, N.S., Hoch, S., and Johnston, E. (2006) ‘Collocation Blindness’ in Partially Distributed Groups: Is there a Downside to Being Collocated?  Proceedings of the CHI 2006, Montreal, Quebec, 2006.

Byrne, Michael,  And Not a Drop to Drink, Water: an Alternative Test for Emergency Managers,” Homeland Security Affairs IV, no. 2 (June 2008), http://www.hsaj.org/?article=4.2.2

Carver, L., and M. Turoff (2007) Human Computer Interaction: The Human and Computer as a Team in Emergency Management Information Systems Communications of the ACM, March 2007, 33-38.

Chen, R., Sharman, R., Rao, H.R., Upadhyaya, S.J., and Cook-Cottone, C.P. (in press) Coordination of Emergency Response: An Examination of the Roles of People, Process, and Information Technology, in Information Systems for Emergency Management, (Van de Walle, B., Turoff, M., and Hiltz S.R. eds) in the Advances in Management Information Systems monograph series (Zwass, V. editor-in-chief), Armonk, NY: M.E. Sharpe Inc.  Anticipated 2009.

Coppola, N., Hiltz, S. R., and Rotter, N.(2004) Building Trust in Virtual Teams.  IEEE Transactions on Professional Communication, 47, 2, 95-104.

French, S., and Turoff, M. (2007)  Decision Support Systems, Communications of the ACM, 50, 3, 39-40.

Hendela, A., Yao, X., Turoff, M., Hiltz, S. R., and Chumer, M. (2006)  Virtual Emergency Preparedness Gaming:  A follow up study, Proceedings of ISCRAM 06, May 14-17, NJIT, Newark NJ, ISBN 90-9020601-9

Hiltz, S.R., Fjermestad, J., Ocker, R. and Turoff, M. (2006) Asynchronous Virtual Teams: Can Software Tools and Structuring of Social Processes Enhance Performance?  In Volume II: Human-Computer Interaction in Management Information Systems: Applications, Dennis Galletta and Ping Zhang, editors, Armonk, NY: M. E. Sharpe, Inc., 119- 142.

Hiltz, S. R., and Turoff, M., (1993) The Network Nation: Human Communication via Computer, 1978 Addison Wesley, MIT Press.

Huang, H., and Ocker, R. (2006) Preliminary Insights into the In-Group/Out-Group Effect in Partially Distributed Teams: An Analysis of Participant Reflections, Proceedings of SIGMIS-CPR ’06, Claremont, California.

Iacono, C. S., and Weisband, S. (1997) Developing Trust in Virtual Teams, Proceedings 30th Hawaii International Conference on System Sciences (HICSS) Volume 2: Information Systems Track-Collaboration Systems and Technology.  Washington DC: IEEE Computer Society.

Lee, J. S., Lee, S. L., Damon, S. A., Geller, R., Janus, E. R., Ottoson, C., and Scott, M. J. (2006) Risk Communication needs in a chemical event, Journal of Emergency Management, 4, 2, 37-43, full report http://www.wetp.org/wetp/public/has1_get_blob.cfm?ID=1051

Lindblom, C., (1959), The Science of Muddling Through, Public Administration Review, 79-88.

Lindblom, C., (1979), Still muddling, not yet through, Public Administration Review, November/December,  517-526.

Lindblom, C, (1965) The Intelligence of Democracy, Free Press.

Linstone, H. A., On discounting the future, Technological Forecasting and Social Change, volume 4, (1973), pp. 335-38.

Linstone, H. and Turoff, M. (1975) The Delphi Method: Techniques and Applications, Addison Wesley Advanced Book Program, 1975 (available online at http://is.njit.edu/turoff).  Available at http://is.njit.edu/turoff, last access 18 August 2007.

Mitroff, Ian, & Turoff, Murray, (1973), Technological Forecasting and Assessment: Science and/or Mythology?, Journal of Technological Forecasting and Social Change, Volume 5, 13-134.

Mowshowitz, A. (2002) Virtual Organizations, Quorum Books.

Moynihan, D. (2006) From forest fires to Hurricane Katrina: Case Studies of Incident Command Systems, Networks and Partnerships Series, IBM Center for The business of Government.

Palen, L. Hiltz, S.R. and Liu, S. (2007) Citizen Participation in Emergency Preparedness and Response, Communications of the ACM, special issue, 50, 3, 54-58.

Plotnick, L., Gomez, E. A., and White, C., (2007) Furthering Development of a Unified Emergency Scale Using Thurstone's Law of comparative Judgment: A progress Report, Proceedings of ISCRAM 2007, 4th International Conference on Information Systems for Crisis Response and Management, Delft, the Netherlands, May 13-16, Brussels University Press.

Poynder, Richard (2008), Open Access: Doing the Numbers http://poynder.blogspot.com/2008/06/open-access-doing-numbers.html, Open and Shut Blog, Wednesday, 11 June 2008.

Thurstone, L.L., (1927a), A Law of Comparative Judgment, Psychological
, 34, 273-287.

Thurstone, L.L., (1927b). The Method of Paired Comparisons for Social Values. Journal of Abnormal and Social Psychology, 21, 384:400.

Thurstone, L.L., (1928), Attitudes Can Be Measured, The American Journal of Sociology, Vol XXXIII, No. 4, pp 529-554.

Torgerson, W.S. (1958). Theory and Methods of Scaling, John Wiley & Sons, Inc.

Turoff, M, (2002) Past and Future Emergency Response Information Systems.  Communications of the ACM, 45, 4, 29-33.

Turoff, M., Chumer, M., and Hiltz, S. R., (2006) Emergency Planning as a Continuous Game.  Proceedings of the 3rd International ISCRAM Conference, Newark, NJ.

Turoff, M., Chumer M., Hiltz, R., Klashner, R., Alles, M., Vararheyi, M., and Kogan, A., (2004b)   Assuring Homeland Security: Continuous Monitoring, Control & Assurance of Emergency Preparedness, Journal of Information Technology Theory and Application, (JITTA), 6, 3, 1-24.

Turoff, M., Chumer, M., Van de Walle, B., and Yao, X., (2004a) The Design of a Dynamic Emergency Response Management Information System (DERMIS).  Journal of Information Technology Theory and Application, (JITTA), 5:4, 1-35.

Turoff, M., and Hiltz, S. R., (2008)  Information Seeking Behavior and Viewpoints of Emergency Preparedness and Management Professionals Concerned with Health and Medicine, Report to the National Library of Medicine, February, 2008.  (Will be Web accessible)

Turoff, M., Hiltz, S. R., Cho, H-K, Li, Z., and Wang, Y. (2002) Social Decision Support Systems.  Proceedings of the 35th Hawaii International Conference of System Sciences.

Van de Walle, B. and Turoff, M. (2008) Decision Support for Emergency Situations,  In F. Burstein and C. Holsapple, Eds., Handbook on Decision Support Systems, International Handbook on Information Systems Series, Springer-Verlag, (This chapter will be open on the Web).

Van de Walle, B., Turoff, M. and Hiltz, S.R. (expected 2009).  Information Systems for Emergency Management.  In the Advances in Management Information Systems monograph series (Editor-in-Chief: Vladimir Zwass). Armonk, NY: M.E. Sharpe Inc., in press.   

Wenger, E., McDermott, R., and Snyder, W. (2002) Cultivating communities of practice: a guide to managing knowledge, Harvard Business School Press, Boston, Mass.

Weick, K. and Sutcliffe, K. (2001) Managing the Unexpected: Assuring High Performance in an Age of Complexity, Jossey-Bass Publishers.

White, C., Plotnick, L., Turoff, M., and Hiltz, S.R. (2007b) A Dynamic Voting Wiki, Proceedings of 13th Americas Conference on Information Systems.

White, C., Plotnick, L., Aadams-Moring, R., Turoff, M. and Hiltz, S.R. (2008) Leveraging a Wiki to Enhance Virtual Collaboration in the Emergency Domain, Proceedings of the 41st HICSS.

White, C., Turoff, M. and Van de Walle, B (2007a).  A Dynamic Delphi Process Utilizing a Modified Thurstone Scaling Method: Collaborative Judgment in Emergency Response.  Proceedings of 4th Information Systems on Crisis Response Management.

Yao, X., and Turoff, M., (2007) Using Task Structure to Improve Collaborative Scenario Creation, Proceedings of ISCRAM 2007, 4th International Conference on Information Systems for Crisis Response and Management, Delft, the Netherlands, May 13-16, Brussels University Press



Those who rush when alarm sounds

by Jimmy Breslin


September 13, 2001

YESTERDAY, the city belonged to those who do real work.

Steve Casey, a firefighter out of Montgomery County, Md., was working in a long line of men handing out rubble. He came up here with two others. There were people like him all over downtown. The Steve Casey people know exactly what to do when the alarm goes off. They put on their work boots and head for the scene. Here was Casey, age 20, with short black hair. He was from Maryland, and there were cops from Sayreville, N.J., and dump truck drivers from Hartford, Conn., and carpenters from Allentown, Pa. And they were all here because they knew they owed it to New York, and everybody depends upon New York for a living and the life of their times.

Steve Casey worked with firefighters' gloves and he picked at the rubble by hand. The long lines of workers who passed the debris out could use neither shovels nor machines. They prayed that there were bodies in there somewhere. And uncovering them required gentleness in a brutish place. They hoped that there were people alive there someplace, never mind the word bodies.

Somewhere, in the jagged metal and pulverized concrete, there was a sound, a shifting. Steve Casey's 20-year-old hands picked at the rubble right over it. Picked at it, picked at it, picked at it. He got a handful of debris and handed it to the guy behind him, who handed it to the one behind him and on down the line of 100 or so, and into trucks.

Now Steve Casey heard more sounds. They were coming from maybe two feet down in the rubble. This time, as he passed the debris behind him, he said. "EMS."

The guy behind him said to the next, "EMS."

And that guy, in turn, said "EMS," and this spread thrillingly down the long line. EMS. A man is alive.

Casey scooped two feet of debris up and here was a New York City firefighter alive and on his back. And Steve Casey's hand and those of all the others started to lift the guy, he gave them a nod and a small wave of a hand. The EMS workers took him away.

"He was going to make it," Casey was saying. "Then we kept going. We found a deceased woman about an hour later. Then we found a few more deceased women."

"Nobody else is alive?" he was asked.

"Oh no, I know there are people in there still alive. I'll show you. I'll find them," Casey said.

He put his head back onto a blanket roll that served as a pillow and stretched out on the sidewalk. He was down the street from the Trade Center. He closed his eyes for a short time. He would be back. There were thousands of bodies in the rubble, and maybe somebody was alive.

When the plane went in under them, everything below in One World Trade Center was in flames, at least some office workers in the investment firm of Cantor Fitzgerald gathered in a conference room and prayed. Then they called families. One was speaking to a wife in Montclair, N.J. Another called his brother and implored his brother to find a way to help him.

Down in the lobby at this time, three senior Fire Department officers were with Father Mychal Judge, the Fire Department Chaplain. He is a Franciscan priest at St. Francis of Assisi on West 31st Street in Manhattan, and a city legend.

Also in the lobby were six members of a firehouse on West 77th Street who got into an elevator for a ride up high to fight flames.

And then the building blew. Everybody in the Cantor Fitzgerald conference room apparently is gone. About 850 others are unaccounted for. This is just the start of the counting of casualties. People whispered the number 20,000.

In the lobby, the three chiefs and [N.Y.F.D. Chaplain] Father Judge were killed.

And the six firefighters from West 77th Street were gone in the elevator.

In the firehouse on Amsterdam Avenue and 66th Street, 11 men were listed as missing. Three young women, wives or fiancees, sat in gloom and nervousness inside as the firefighters milled around.

Another, a young woman with long white hair and tears in eyes that were set in a heartbreaking face, leaned against a small tree in front of the firehouse.

One of the people bringing clothes and food to the firehouse said softly, "I wish I could make it better for you."

"Thank you," she said, dully.

Across Amsterdam Avenue was the beauty of the city, a magnificent crowd that was gathered on the steps of the Red Cross building to donate blood. There were so many that they could not be processed by night. Young people sat on the ledge in front of the building and filled in forms and looked like a beautiful class taking an exam.

And up on West 77th Street, George McGann, the old captain retired but back for the tragedy, stood in his firehouse and pointed to a board on the wall that listed the names of the ones missing after getting on the elevator, and at this point, missing means gone.

The names are:

Lt. Glen Perry.

Robert Minara.

Kenneth Kunkel.

Matt Barnes.

Joe Rivelli.

Paul Ruback.

John Collins.

"How many kids among?" McGann was asked.

"Barnes had three boys. What are they? They come to the Christmas party. Seven, eight, 10? Minara has two boys, and, Oh, I can't remember anything now. They all have children."

And here was Tim Janis, who wore sunglasses against air filled with pebbles. He was tired after a shift on the line at the explosion site. He is a doorman at the Plaza Hotel. He heard his man, Howard Stern, say on the radio that everybody should go downtown and pitch in. Janis did. He wound up on a crew of guys from Iron Workers Local 40. They regarded any heavy metal they lifted as being nothing more than a small sack of feathers. They began to saw and slash at metal. Janis stood in there and gave it a shot. Howard Stern would have been proud of him. But there was no way Janis could keep up with anybody from Iron Workers Local 40. He is a wise man who knows his limitations. So here he was on the street pondering his future in the great city emergency. "I've got to find another way to help, but one I can do," he said.

In the late afternoon, the spot on the sidewalk where Steve Casey had been resting was empty. Somebody said he had gone back to work on the line.



A perspective on hazard vulnerability analysis by hospitals [Part 1]


by Ric Skinner, GISP, Healthcare Preparedness Consultant, Sturbridge MA


[Jul 31 08]

Part I of this article will address the current process typically employed in Hospital[1] Hazard Vulnerability Analysis. Part 2 will present a proposal for process improvements.

The Real Estate industry and the Disaster Preparedness & Response sector have three things in common:


When looking for my current house, I wanted one located in a woodsy setting with a brook or pond within view. When analyzing hazard events that a hospital might be exposed to, one should consider the hospital’s location with respect to weather patterns, hazardous storage facilities, transportation routes, population demographics, etc. For example, in a hazards analysis it should be obvious that a hospital located in a FEMA Q3 Flood Zone should consider and prepare for an external flooding event much differently than a nearby patient care facility on higher ground. Perhaps less obvious, a hospital located a half mile downwind from an industrial storage tank containing 10,000 gals. of anhydrous ammonia should give the hazard a higher priority in its disaster analysis than a patient care facility would located a half mile upwind from the same storage tank.

Identifying risks from hazards and assessing a hospital’s vulnerabilities to those risks is fundamentally about having the right information, and in many cases spatial information. The Joint Commission (JC) recognizes the importance of all-hazards vulnerabilities and requires that hospitals it accredits conduct an annual Hazard Vulnerability Analysis (HVA) in a formal, documented process.

An HVA is the process which identifies the internal and external risks of “all-hazards” disasters (natural, technological, human related and hazardous materials related) most likely to affect facilities and the probable severity of impacts if they were to occur. By understanding risk exposure the facility should be better able to develop adequate mitigation, preparedness, response, and recovery actions for those risks, thus reducing vulnerability and impact to the organization making it more resilient.

A hospital’s disaster preparedness and its ability to respond and recover from disasters depends on how well it has identified and prepared for the historically real and most likely hazards to which it could be exposed, and how well it has estimated the frequency and severity of impact of those hazards on people (i.e., patients, employees, visitors), facilities, and operations.

While no particular HVA method is prescribed by JC, it cites a manual scoring method originally developed by Kaiser-Permanente (KP HVA tool) and which is used by most hospitals in one variation or another. Using this tool a hospital can rank events based on their qualitative probabilities and determine where to focus preparedness and mitigation efforts. However, the KP HVA tool is essentially a blank form. No probabilities based on regional or local information are included. It is no easy task to research, identify, and quantify event probabilities and severities, therefore, making an assessment of the impacts of regional and local events upon facilities is left up to the evaluator’s  – or often a group of evaluators’ – personal knowledge, recollections, and consensus regarding each event. This approach is consistent with results from a recent survey conducted by this author where half of healthcare facilities responding indicated their HVAs were completed by “group decision”, “mostly subjective” and may include “some factual or experienced-based information”. Consequently, the resulting assessment is essentially subjective since few fact-based probabilities and severities are researched and factored into the tool. From a hospital administrator’s perspective this has probably been justified as a reasonable use of limited staff time. This statement is supported by another recent survey conducted by this author and others which revealed that over half of 1500 responding facilities had 1 or less than 1 FTE assigned the responsibilities for emergency management/disaster preparedness.

A confounder in hospital HVAs is that many hospitals often have multiple buildings in various locations in a city or region that fall under their single JC accreditation. The majority of these hospitals manually complete a KP HVA tool type process in a time consuming consensus-driven manner to provide a composite assessment across all facilities covered by the single accreditation. However, JC is now emphasizing that location is a factor that should be considered in an HVA as remotely located facilities may warrant separate HVAs.

In JC’s new Emergency Management chapter, which will become effective in January 2009, EM Standard 01.01.01 of the Hospital Accreditation Program requires that:

“The [organization] engages in planning activities prior to developing its written Emergency Operations Plan.”

These activities include identifying risks, prioritizing likely emergencies, attempting to mitigate them when possible, and considering potential emergencies in developing strategies for preparedness, response and recovery. 

In the Elements of Performance for this requirement JC states:

“The hospital conducts a hazard vulnerability analysis (HVA) to identify potential emergencies that could affect demand for the hospital’s services or its ability to provide those services, the likelihood of those events occurring, and the consequences of those events.”   

An added time and resources consuming requirement is for the hospital to work with community partners to make sure its HVA meshes with similar efforts by the community.

Then, here is where JC recognizes “location” in a clarifying note:

“Hospitals have flexibility in creating either a single HVA that accurately reflects all sites of the hospital, or multiple HVAs.  Some remote sites may be significantly different from the main site (for example, in terms of hazards, location, and population served); in such situations a separate HVA is appropriate.” 

While the term ‘remote’ is not defined by JC, in my view this could mean patient care facilities under the same JC accreditation distantly located elsewhere in a county, or proximally located in different sections of the city. Separation of only a few blocks could result in significantly different risk exposure by certain hazards.  

Worth interjecting here is that in a recent study the National Academy of Sciences concluded that location information, and tools for analyzing that information spatially, should be an essential part of all emergency management aspects -- from events planning, through response and recovery, to the mitigation of future events (“Successful Response Starts with a Map: Improving Geospatial Support for Disaster Management). This would apply to an HVA conducted for any (not just healthcare) facility. 

It has been the practice of many hospitals to carry out a single HVA regardless of the number and location of facilities covered by the JC Accreditation. The survey referenced above revealed that more than 46% of facilities do a composite HVA.  However, from a preparedness and response standpoint, and the rationale that an HVA should lead to a relevant and appropriate disaster preparedness and response plan, the composite HVA can result in some very important facility-specific risks being averaged out to a lower priority. 

The process and KP HVA tool approach in its current format would be very time consuming to apply to each building, especially where regional or local information should be included in the evaluation. The KP HVA tool does not support a composite score for multiple individually rated facilities because it does not recognize an individual facility’s location-based risk factors in the overall assessment.  

The importance of the facility’s geographic location in estimating the probability of an event affecting a facility, along with the risk itself, historical data, proximity to local/regional high-risk locations (e.g., a chemical manufacturer, nuclear plant, “tornado alley”, coast line, etc.), and discussions with local emergency managers should all be factored into a facility’s HVA. Population (i.e., density and location) is another important risk factor applied in the context of the community population as well as a facility’s occupancy (e.g., employees, patients, visitors). 

Therefore, the level of vulnerability to which hospital facilities and operations may be exposed due to impacts of a hazard event, or combination of events, can be summarized as a function of: 

  • Specifics of the potential or real hazard event (e.g., flood, fire, pandemic)
  • Facility attributes (e.g., structural design, age, location)
  • Operational attributes (e.g., staffing, operational modes, facility purpose)
  • Likelihood of the occurrence of the hazard event (e.g., local or regional history)
  • Consequence severity of possible impacts (e.g., death, injury, disruption of services)
  • Mitigation and preparedness plans and resources (e.g., evacuation routes, inventoried supplies, reserve staff, Memorandums of Understanding and/or Mutual Aid Agreements).

I believe there needs to be an objective (as opposed to subjective) standardized process, a format for capturing the inputs and relating them to location-based factors, and a scientifically based assessment methodology so that those hazards that can be quantified in terms of risk can be, and those that are more qualitative or lack historical or design attributes can be addressed to the extent feasible. And above all this must all be easy, relatively simple, time efficient and able to be archived from one year to the next so that only those aspects that have changed since the previous year need be revised. That will be the subject of Part 2 of this article. 

Note: A draft of this article was reviewed by emergency management professionals at healthcare organizations in Florida and Oregon. 

Comments, corrections or suggestions are encouraged and should be sent directly to the author at ric.skinner@gmail.com.

[1] While this article discusses HVA as required by JC for hospitals, it is also applicable to other JC accredited healthcare facilities.



July 15, 2008
The Honorable Bennie G. Thompson
Committee on Homeland Security
U.S. House of Representatives
Subject: Emergency Management: GAO Responses to Post-hearing Questions for the Record
Dear Mr. Chairman:
On June 11, 2008, I testified before the Subcommittee on Management, Investigations, and Oversight on the Department of Homeland Security’s (DHS) Preparedness for Catastrophic Disasters. Members of the Committee requested that GAO provide additional comments to a number of post-hearing questions. The questions and our answers are provided in the enclosure. The responses are generally based on work associated with previously issued GAO products, which were conducted in accordance with generally accepted government auditing standards. Because the responses are based on prior work, we did not obtain comments from DHS...

The entire letter may be accessed online.


1. Based on your years of work, is there a time when FEMA was more successful at working within the interagency? If so, when was it and what do you think was different then?

While Federal Emergency Management Agency (FEMA) has always faced challenges in managing interagency working relationships with other federal organizations, we reported favorably on FEMA’s inter-governmental efforts as the lead federal agency responsible for consequence management in 2001 prior to 9/11 and FEMA’s incorporation into DHS.2 Specifically, we reviewed FEMA’s efforts to enhance preparedness for a terrorist attack and concluded that, in policy and practice, FEMA had generally addressed the key lessons learned from its experience in coordinating federal consequence management activities after the Oklahoma City bombing in April 1995. As we reported, in analyzing the lessons learned after the bombing, FEMA updated the Federal Response Plan to address how federal agencies, states, and localities would work together to respond to an act of terrorism.

In May 2001, as one approach to achieving a more integrated federal terrorism preparedness response, the President created an Office of National Preparedness within FEMA to coordinate all federal programs that support state and local preparedness. In our September 2001 testimony after the events of 9/11, we recommended a move beyond coordination—program consolidation.3 We believed that consolidation of assistance programs would best eliminate overlapping assistance programs and provide a single federal liaison for state and local officials. The need for consolidation of preparedness and response assistance efforts had been similarly expressed in the Gilmore Commission’s reports on assessing domestic response capabilities for terrorism involving weapons of mass destruction. Likewise, the Post-Katrina Emergency Management Reform Act of 2006 (Post-Katrina Act) restored FEMA’s preparedness functions, which DHS had transferred to another component in July 2005, thereby consolidating within FEMA the spectrum of emergency management functions from preparedness to response and recovery.4


2. Do you agree that a basic “roles and responsibilities” document like the NRF is important? If so, why? And do you think it would have been useful in the days immediately before and after Katrina?

A basic “roles and responsibilities” document like the National Response Framework (NRF) is an important guiding document for national response. It is important because many stakeholders can and do have unique and potentially overlapping responsibilities, depending on the scale of the incident and the response required. Such a document has been in place since April 1992 when FEMA issued the Federal Response Plan which outlined how the federal government would implement the Stafford Act.5 The Homeland Security Act of 20026 required DHS to consolidate existing federal government emergency response plans, such as the Federal Response Plan, into a single, coordinated national response plan. In December 2004, DHS responded with the 2004 National Response Plan. Thus, a basic “roles and responsibilities” document was in place and was useful in the days immediately before and after Katrina and provided basic doctrine for the federal response. However, Katrina revealed unresolved issues in the National Response Plan regarding lines of authority with respect to the Secretary of Homeland Security and the FEMA Administrator, as well as the key officials reporting to them, the Principal Federal Officer (PFO) to the secretary, and the Federal Coordinating Officer (FCO) to the FEMA Administrator. For example, in response to Katrina, the Secretary of Homeland Security initially designated the FEMA Administrator as the PFO, who appointed separate FCOs for Alabama, Louisiana, and Mississippi. It was not, however, clear who was responsible for coordinating the overall federal effort at a strategic level. Our fieldwork indicated that this lack of clarity in leadership roles and responsibilities resulted in disjointed efforts of many federal agencies involved in the response, a myriad of approaches and processes for requesting and providing assistance, and confusion about who should be advised of requests and what resources would be provided within specific time frames. Because of confusion concerning the key leadership roles of the secretary, the administrator, the PFO and the FCO, we recommended in March 2006 that DHS clarify these roles7 and test, train and exercise its clarification of them.8

On October 4, 2006, Congress enacted the Post-Katrina Act. The act designated the FEMA Administrator—the new title of the official who leads FEMA—as the principal advisor to the President, the Homeland Security Council, and the Secretary for all matters relating to emergency management. In January 2008, DHS issued the final NRF that generally describes the doctrine that guides national response actions and the roles and responsibilities of officials and entities involved in response efforts.
However, the NRF is not an operational document so it is important that it be supplemented by documents that provide more detail on the operational implementation of the roles and responsibilities it describes. Accordingly, the NRF also includes Emergency Support and Incident Annexes that provide additional detail on the roles and responsibilities and functions for specific emergency support functions, such as mass care and shelter, and for catastrophic incidents (although, the catastrophic incident annex has not yet been revised to reflect the changes in the NRF). In addition, FEMA plans to include four partner guides to the NRF that describe key roles and actions for local, tribal, state, federal and private sector entities involved in response activities. These supplemental planning documents should enhance the usefulness of the NRF by providing needed clarification and specificity, but FEMA has set no firm date for their completion.

3. What is the impact on state, local, and tribal governments when interagency disputes break out during disaster preparedness and response?

Interagency disputes during disaster preparedness and response can impair partnership and coordination and, thereby, the speed and effectiveness of the overall response and recovery effort. After Hurricane Katrina, many states sent supplies, first responders, National Guard personnel, and other resources to assist the areas hardest hit by the disasters. But coordinating the implementation of the assistance was faulty and the timeliness of needed resources and assistance was affected. As events unfolded in the immediate aftermath and ensuing days after Hurricane Katrina’s final landfall, responders at all levels of government—many victims themselves—encountered significant breakdowns in vital areas such as emergency communications as well as obtaining and deploying essential supplies and equipment.

4. Mr. Jenkins, in your testimony you talked about DHS and FEMA working together to develop the Integrated Planning System. From what you’ve seen, are DHS and FEMA coordinating well in this area, or have you seen problems?

We have not identified any problems with DHS and FEMA coordination in developing the new integrated system, based on our discussions with FEMA and DHS officials. Officials from FEMA’s National Preparedness Directorate, in coordination with the Disaster Operations Directorate and DHS’s Office of Operations Coordination, said they have begun to develop a common federal planning process that will support a family of related planning documents; these related planning documents are to include strategic guidance statements, strategic plans, concept plans, operations plans, and tactical plans. They said the outline of the system is currently undergoing final review prior to approval. The effectiveness of DHS’s and FEMA’s coordination efforts will be reflected, in my view, in the timeliness and quality of the system that is developed and implemented.


5. Would you please elaborate on how direct line authority with respect to DHS operations centers would strengthen not just departmental coordination but also interagency coordination efforts?

While GAO has not recommended that the Operations Directorate have direct line authority for all DHS operations centers, we have reported that the Directorate, established in November 2005 to improve operational efficiency and coordination, does provide DHS with an opportunity to more fully implement the key practices that are important to enhancing and sustaining collaboration at its multi-agency operations centers. Although the Operations Directorate does not possess administrative, budgetary, or operational control over the other component’s operations centers, guidance from the Operations Directorate could help the other components responsible for multi-agency operations centers make key advances in each collaborative practice. To provide a setting for enhanced collaboration among the staff at each operations center, we recommended in October 2006 that the Director of the Operations Directorate provide guidance and help ensure the component agencies of the multi-agency operations centers take the following actions: define common goals and joint strategies; clarify the roles and responsibilities for watchstanders;9 apply standards, policies, and procedures for using DHS’s information network; conduct staffing needs assessments; prepare mechanisms to monitor, evaluate, and report on the results of collaborative efforts; and address collaborative efforts at the four multi-agency operations centers in plans and reports.10

As we reported last month, integration of operations centers is essential for effective planning and response capabilities.11 We noted that DHS has taken the first of three steps toward integrating its operations centers responsible for planning for, monitoring, and responding to disruptions to the communications infrastructure, including voice and data networks, and the security of data and applications that use these networks. Specifically, in November 2007, DHS moved the operations center for communications infrastructure to office space adjacent to the center for data and applications. This close proximity allows the approximately 41 coordination center and 95 readiness team analysts to, among other things, readily collaborate on planned and ongoing activities. We reported that a key factor contributing to DHS’s lack of progress in implementing the latter two steps is that completing the integration has not been a top DHS priority. Ultimately, the better DHS coordinates its own operations (and operations centers), the better equipped it will be to coordinate with other departments and agencies.


6. Based on your review, do you believe the current coordination among departmental operations centers is sufficient to avoid unnecessary duplication or confusion in response to a catastrophic incident?

In conducting the most recent assessment of DHS’s management of its operations centers in June 2008, as discussed above, we concluded that until DHS completes the integration of the two centers, it risks being unable to efficiently plan for and respond to disruptions to communications infrastructure, and the data and applications that travel on this infrastructure, increasing the probability that communications will be unavailable or limited in times of need.12 The objective of our October 2006 was to assess the collaboration among the 4 operations centers that employed staff from multiple DHS organizations, rather than the effectiveness of their response capabilities.13 Nonetheless, we found that the centers lack joint strategies for collaboration and staffing needs assessments, and also lacked standards and procedures for using DHS’s primary information-sharing network. GAO’s previous work has shown that such practices are effective in enhancing and sustaining collaboration among federal agencies. These practices could also help DHS avoid unnecessary duplication or confusion in response to a catastrophic incident.


7. According to your work reviewing DHS, in which areas do you believe the department has been most effective in leading national preparedness efforts? Has the department been more effective in leading preparedness efforts at the federal level as opposed to the state or local level?


In comprehensively assessing DHS’s progress in implementing its mission and management functions in August 2007, we concluded that DHS had made limited progress in its emergency preparedness and response efforts. 14 DHS and FEMA have had mixed success at both the federal and state and local levels. Among the successes are the development of pre-scripted mission assignments for federal agencies that can be activated as needed following a disaster. However, DHS and FEMA are still developing operational plans to guide other federal agencies’ response efforts and metrics for assessing federal capabilities. Two essential supplements to the new National Response Framework—response guides for federal partners and an integrated planning system—are still under development and federal agencies must develop also operational plans to reflect the roles and responsibilities described in the NRF, these partner guides, and the more detailed functional and incident annexes that accompany the NRF. At the most fundamental level, DHS has not yet developed a means of measuring the nation’s overall preparedness—at federal, state, and local levels—based on a list of targeted capabilities and has not yet completed an inventory of all federal response capabilities required by the Post-Katrina Act.


8. In what areas of needed capabilities are we as a nation most prepared for a catastrophic disaster and why? In what areas are we least prepared and why?

One of the key concerns that our work has identified is that DHS, as the federal organization with primary responsibility for assessing and reporting on the status of national capabilities, cannot with any certainty answer that question. As I testified in March 2008,15 DHS’s and FEMA’s current efforts do not provide information on the effectiveness of homeland security funds in improving the nation’s capabilities or reducing risk. According to FEMA officials, DHS leadership has identified this issue as a high priority and is trying to develop a more quantitative approach to accomplish the goal of capturing and using information for the more strategic purpose of monitoring the achievement of program goals.

Following Katrina, we reported that there were major capability problems in several key areas, including: (1) situational assessment and awareness; (2) emergency communications; (3) evacuations, particularly for those who do not have transportation or otherwise have mobility limitations; (4) search and rescue; (5) logistics; and (6) mass care and sheltering.16 These areas continue to present challenges, although DHS and FEMA have taken actions to address the problems that surfaced in Katrina. Our recent discussions with DHS and FEMA officials indicate that FEMA has initiated a Catastrophic Disaster Response Planning Initiative to ensure that FEMA and its federal, tribal, state and local partners are well prepared to affect an appropriate, timely, and efficient response to such a catastrophic disaster. According to DHS, the Disaster Operations Directorate is continuing venue-specific catastrophic planning and disaster readiness initiatives focused on four specific areas – Southeast Louisiana, New Madrid Seismic Zone, the State of Florida, and the State of California.


Key areas of potential concern regarding national preparedness for catastrophic events include pandemic influenza and response to nuclear attack:

• In reporting on the issue of pandemic influenza preparation in 2007, we noted that federal government leadership roles and responsibilities for preparing for and responding to a pandemic continue to evolve, and will require further clarification and testing before the relationships of the many leadership positions are well understood.17 Although the Department of Health and Human Services’ (HHS) Secretary is to lead the public health and medical response and the DHS Secretary is to lead overall nonmedical support and response actions, the National Strategy for Pandemic Influenza Implementation Plan (Plan) does not clearly address how these roles and responsibilities are to work together or simultaneously, particularly over an extended period and at multiple locations across the country. We reported that important gaps exist that could hinder the ability of key stakeholders to effectively execute their responsibilities. State and local jurisdictions that will play crucial roles in preparing for and responding to a pandemic were not directly involved in developing the Plan, relationships and priorities among actions were not clearly described, performance measures focused on activities that are not always linked to results, insufficient information is provided about how the documents are integrated with other key related plans, and no process is provided for monitoring and reporting on progress.


• Regarding the nation’s preparedness for a nuclear incident, we reported in June 2008 that, while DHS and other agencies have taken steps to improve homeland defense, local first responders do not have tools to accurately and immediately identify what, when, where, and how much chemical, biological, radiological, or nuclear (CBRN) materials are released in U.S. urban areas, either accidentally or by terrorists.18 We reported that DHS’s Domestic Nuclear Detection Office (DNDO) is responsible for acquiring and supporting the deployment of radiation detection equipment. However, this DNDO has primarily emphasized developing and deploying radiation detection equipment to secure cargo container shipments at U.S. ports of entry to prevent smuggling radioactive material into the United States. DNDO’s Chief of Staff told us that it does not consider its mission to include the development of radiological detection equipment for local first responders to use in identifying the release of radiological materials in the atmosphere. It does not evaluate radiological detection equipment for first responder use in consequence management. Among other things, we recommended that the Secretary of Homeland Security reach agreement with other agencies on which agency should have the mission and responsibility to develop, test, and certify detection equipment that first responders use to detect hazardous material releases in the atmosphere. DHS concurred with our recommendations but stated that GAO should consider other scenarios as alternative ways of looking at the present national capabilities for CBRN response and the current status of testing and certification of detection equipment.

9. Do you believe that DHS is prepared for the 2008 Hurricane season?

Planning and exercising of capabilities at the federal, state, and local levels is essential for developing and assessing national response capabilities. Because FEMA has not yet issued its plans or the results of its recent hurricane preparedness exercises, there is no way to objectively determine whether DHS is prepared for the 2008 Hurricane season.


  • Planning: According to FEMA officials, the agency is coordinating closely with its federal interagency partners to develop the 2008 National Hurricane Season Contingency Plan. However, we are already into the hurricane season, and have found no evidence of an approved plan.

  • Exercising: The Department of Homeland Security's National Exercise Program (NEP), the nation's overarching homeland security exercise program, conducted a combined exercise in May 2008 to test hurricane preparedness planning, assess federal interagency Continuity of Operations procedures, exercise a response to terrorist attacks in Washington State and test Defense Support of Civil Authorities. These linked exercises were referred to as National Level Exercise 2-08. The exercise took place May 1 to 8 with a wide range of participants from federal and state departments and agencies. The evaluation of this exercise with regard to hurricane preparedness has not yet been released.

10. What is your assessment of the roles and responsibilities of the Principal Federal Office (PFO) and Federal Coordinating Office (FCO)? Do you believe these roles have been sufficiently clarified? Do you think DHS is taking the necessary steps to ensure that state and local responders and emergency management personnel are aware of the distinctions?

The experience of Hurricane Katrina revealed problems with the National Response Plan (NRP), identifying uncertainty and confusion regarding the roles, responsibilities and lines of authority with respect to the DHS Secretary and the FEMA Administrator as well as the key officials reporting to them, the PFO to the Secretary and the FCO to the Administrator. In our March 8, 2006 testimony, we recommended that DHS clarify these key leadership roles consistent with the provisions of the Stafford Act and the Homeland Security Act of 2002.19 Shortly after our testimony, in May 2006, DHS issued revisions to the NRP that addressed the PFO and FCO roles, pending a more comprehensive review of the NRP. In light of the persistent confusion regarding key leadership roles, we recommended in our September 2006 report on catastrophic disasters that DHS should rigorously re-test, train, and exercise its recent clarification of roles, responsibilities and lines of authority in the NRP and implement changes to remedy any identified coordination problems.20

In October 2006, Congress enacted the Post-Katrina Act, which, among other things, addressed the PFO’s relationship with the FCO and other federal and state officials. Specifically, the Post-Katrina Act provided that the PFO shall not direct or replace the incident command structure established at the incident or have directive authority over the FCO or other federal and state officials.21 The enactment of the Post-Katrina Act coincided with the start of DHS’s comprehensive review of the NRP, which culminated with the issuance of the NRF in January 2008. The NRF repeats the Post-Katrina Act’s prohibition that the PFO shall not direct or replace the incident command structure or have directive authority over the FCO or other federal and state officials. The NRF also generally distinguishes between the PFO and the FCO. For example, the NRF describes the PFO as representing the Secretary of Homeland Security in the field to provide a primary point of contact and situational awareness for the secretary. The PFO’s duties include promoting federal interagency collaboration and conflict resolution where possible, presenting to the secretary any policy issues that require resolution, and acting as the primary federal spokesperson for coordinated media and public communications. The FCO, on the other hand, represents the FEMA Administrator in the field to coordinate Stafford Act support to state, local and tribal governments. The FCO’s duties include the commitment of FEMA resources and the issuance of mission assignments to other federal departments or agencies. The FCO is the primary federal representative with whom the State Coordinating Officer and other state, tribal and local response officials interact to determine most urgent needs and to set objectives for meeting them.

Whether the NRF revisions will be effective in promoting a common understanding of the PFO and FCO roles remains to be seen. As I discussed in response to Question 2, the NRF is not an operational document, so it is important that it be supplemented by documents that provide more detail on the operational implementation of the roles and responsibilities it describes—operational roles and responsibilities that must be tested and evaluated in realistic exercises. Unlike the NRP, the NRF is to include four partner guides that will supplement the core NRF document and further describe key roles for local, tribal, state, federal and private sector entities involved in response activities. These supplemental planning documents should enhance the usefulness of the NRF by providing needed clarification and specificity, but FEMA has set no firm date for their completion. In addition to the need for supplemental planning documents, FEMA also needs to engage in rigorous testing, training and exercising of the recently issued NRF, just as we recommended following the May 2006 revisions to the NRP. Without testing, training and exercising, it is a matter of speculation as to whether state and local responders and emergency management personnel have a common understanding of the revised PFO and FCO roles and responsibilities, or whether further refinements need to be made to remedy any identified coordination issues.

We have ongoing work that will assess actions FEMA and DHS have taken to define the roles and responsibilities of key governmental and nongovernmental stakeholders to promote a more consistent national response and the extent to which related issues have surfaced in national preparedness exercises. The results of this work should provide more information for evaluating the extent to which the roles and responsibilities of the PFO and FCO are clearly understood at the federal, state, and local levels.


11. What do you believe are DHS’s greatest challenges in effectively preparing for and responding to catastrophic disasters?

Effective federal preparation for and response to a catastrophic event requires planning, coordination, cooperation, and leadership within DHS and between DHS and other federal agencies—both civilian and military— as well as state and local governments, and the private and nonprofit sectors that have resources and capabilities needed for the response. The single biggest challenge is getting all those who have major responsibilities for responding to a major or catastrophic disaster to work together to identify the capabilities each participant needs for effective response, then to develop, test, and maintain those capabilities. DHS must provide leadership across a broad spectrum of stakeholders including federal agencies and departments, and DHS’s own components; state, local and tribal governments, their emergency management agencies and other state agencies; sector-specific businesses and industry; voluntary organizations; and academia. It is an enormous challenge and responsibility. In leading national preparedness efforts, DHS through FEMA is responsible for developing national-level policies and doctrine to guide the efforts of these stakeholders to establish operational plans to carry out their roles and responsibilities and to build, measure, and sustain their ability to do so effectively. However, DHS’s efforts to develop operational plans to guide other federal agencies’ response efforts and metrics for assessing federal capabilities are incomplete. In addition, DHS is still establishing a process to measure the nation’s overall preparedness and has not yet developed a complete inventory of all federal response capabilities. These are significant challenges, not likely to be easily or quickly resolved.

12. What are you views on the role of detection canines in responding to catastrophes?

The 28 Urban Search and Rescue teams have detection canines (primarily to detect people in rubble). However, we have not examined the prevention (e.g., explosive detection) and response requirements for which canine teams would be needed nor have we evaluated the performance of canine teams, whether for weapon(s) of mass destruction (WMD) detection or search and rescue operations. Consequently, we have no basis on which to assess whether DHS has the appropriate number of canine teams.

However, GAO currently has a review underway of the Transportation Security Administration's (TSA) National Explosives Detection Canine Team Program whose explosives detection canine teams (each of which consist of a dog and a handler) are trained, certified, and deployed to airports and mass transit systems nationwide. Section 1307 of the Implementing Recommendations of the 9/11 Commission Act of 200722 requires increases in the number of TSA-certified canine teams over the next 3 years. The Act also requires GAO to report on the use of these teams and the capacity of TSA's canine program. Our objective is to determine if TSA has a plan to increase its number of teams as required by statute and, if so, to evaluate the extent to which TSA has the capacity to do so and is on track with its plan. We plan to report on the results of this review later this year.


13. Do you believe we have enough canine teams for the homeland security mission? If not, how many should DHS acquire?

See the response to Question 12.

14. Based on your experience, what recommendations do you have to develop training and certification standards for detection canines?

See the response to Question 12.



1 GAO Emergency Management: Observations on DHS’s Preparedness for Catastrophic Disasters, GAO-08-868T (Washington, D.C., June 11, 2008).

2 GAO, Combating Terrorism: FEMA Continues to Make Progress in Coordinating Preparedness and Response, GAO-01-15 (Washington, D.C.: Mar. 20, 2001).
3 GAO, Homeland Security: A Framework for Addressing the Nation’s Issues, GAO-01-1158T (Washington, D.C.: Sept. 21, 2001).
4 Pub. L. No. 109-295, 120 Stat. 1355 (2006). Section 611 of the Post-Katrina Act (6 U.S.C. 315) gave FEMA all its responsibilities and programs as constituted on June 1, 2006, as well as those of the Preparedness Directorate, with certain exceptions.

5 The Robert T. Stafford Disaster Relief and Emergency Assistance Act (Stafford Act), 42 U.S.C. §§ 5121-5206.
6 Pub. L. No. 107-296, 115 Stat. 2135 (2002).
7 GAO, Hurricane Katrina: GAO's Preliminary Observations Regarding Preparedness, Response, and Recovery, GAO-06-442T (Washington, D.C.: Mar. 8, 2006).
8 GAO, Catastrophic Disasters: Enhanced Leadership, Capabilities, and Accountability Controls Will Improve the Effectiveness of the Nation's Preparedness, Response, and Recovery System, GAO-06-618 (Washington, D.C.: Sept. 6, 2006).

9 The term “watchstander” refers to an individual required to work full-time on a rotating 24-hour schedule, 7 days per week, to maintain situational awareness, conduct information assessment and threat monitoring to deter, detect, and prevent terrorist incidents. A watchstander may also act as a liaison between his agency and other agency representatives at the center, and may manage response to critical threats and incidents.
10 GAO, Homeland Security: Opportunities Exist to Enhance Collaboration at 24/7 Operations Centers Staffed by Multiple DHS Agencies, GAO-07-89 (Washington, D.C.: Oct. 20, 2006).
11 GAO, Critical Infrastructure Protection: Further Efforts Needed to Integrate Planning for and Response to Disruptions on Converged Voice and Data Networks, GAO-08-607 (Washington, D.C.: June 26, 2008).

12 GAO-08-607.
13 GAO-07-89.
14 GAO, Department of Homeland Security: Progress Report on Implementation of Mission and Management Functions, GAO-07-454 (Washington, D.C.: Aug. 17, 2007).
15 GAO, Homeland Security: DHS Improved its Risk-Based Grant Programs’ Allocation and Management Methods, But Measuring Programs’ Impact on National Capabilities Remains a Challenge, GAO-08-488T (Washington, D.C., Mar. 15, 2008).

16 GAO-06-618.
17 GAO, Influenza Pandemic: Further Efforts Are Needed to Ensure Clearer Federal Leadership Roles and an Effective National Strategy, GAO-07-781 (Washington, D.C.: Aug. 14, 2007).

18 GAO, Homeland Security: First Responders' Ability to Detect and Model Hazardous Releases in Urban Areas Is Significantly Limited, GAO-08-180 (Washington, D.C.: June 27, 2008).

19 GAO, Hurricane Katrina: GAO's Preliminary Observations Regarding Preparedness, Response, and Recovery, GAO-06-442T (Washington, D.C.: March 8, 2006).
20 GAO, Catastrophic Disasters: Enhanced Leadership, Capabilities, and Accountability Controls Will Improve the Effectiveness of the Nation's Preparedness, Response, and Recovery System, GAO-06-618 (Washington, D.C.: Sept. 6, 2006)
21 6 U.S.C. § 319(c)(2).

22 Pub. L. No. 110-53, 121 Stat. 266 (2007).



Rush's Tiers of Healthcare Integration


by Jim Rush

[Jun 24 08]

It is important to note that the information presented here has not been coordinated with HHS or DHS nor approved by any governmental agency, and reflects only the views of the author.

Recently we had a discussion on the IAEM List about Network contributors and takers. If this document helps save lives through others developing a highly integrated healthcare response, I’ll be delighted and will be both a contributor and a taker. I contributed my experience in developing an integrated public health and medical integrated response and will take away the knowledge that I may have made a difference. That’s a really good deal.  Jim Rush

Developing a Robust Healthcare Disaster Readiness System by using the 6-Tiered response approach.

• Management of Individual Healthcare (Tier 1): A well-defined Emergency Management Program (EMP) to prepare, mitigate, respond and recover from “All Hazard” events, both man-made and naturally occurring.  Robust processes must be applicable both to traditional hospital participants and to other healthcare organizations like physician practices, optometrists, occupational and physical therapy clinic staffs and Public Health practitioners who may provide “hands on” patient care in an emergency. Thus, each hospital and medical center must have a robust emergency management program in place to prepare for integration with other hospitals and medical centers at Tier 2 and with higher management tiers.

Individual Hospital - No coalition of other hospitals, but integrated with healthcare providers and Public Health practitioners in the immediate area.

Hospital is likely Tier 1 Compliant if it has: 

     Developed a comprehensive Emergency Management Program (EMP) based on the Community Hazard Vulnerability Assessment (HVA).

     Developed an estimated casualty estimate for each planning scenario outlined in the community HVA.

     Instituted a Hospital Incident Command System (HICS)-National Incident Command System (NIMS) compliant.

     Provided Personal Protective Equipment for all first receivers

     Provided decontamination and treatment for at least one (1) chemically biologically or radiologically contaminated patient.

     Developed a robust EMP; implemented and tested (exercised) using the Hospital Incident Command System (HICS) during all Joint Commission required drills and exercises.

     Coordinated with Emergency Management Services (EMS) organizations regarding ongoing casualty care capabilities

     Coordinated with jurisdiction’s SNS coordinator and hospital’s suppliers for supply and equipment support after normal supplier sources have run out of products.

     Contracted with emergency generator maintenance and fuel supply providers for continuous power capabilities when city power is unavailable

     Ensured Materials Management Department preparation of plans for procurement of all goods and services required during planned scenarios.

     Fatality Management plan with the EMA coordination and formal agreements with mortuary companies for temporary morgues and cadaver preparation and burial.

     Developed a patient evacuation plan as a “Last Resort” for when “defend in place/shelter in place” efforts have proven insufficient to continue healthcare services at the hospital/medical center.

• Management of a Healthcare Coalition (Tier 2): Tier 2 is characterized by cooperatives and coalitions among area hospitals and medical centers including local healthcare and Public Health entities.  Coalition building is critical to providing adequate and consistent healthcare across an affected jurisdiction. The healthcare coalition provides a central integration mechanism for information sharing and management coordination among healthcare assets, and also establishes an effective and balanced approach to integrating medical assets into the jurisdiction’s Emergency Management Program. 

You are likely Tier 2 Compliant if you and other coalition Healthcare Organizations have: 

     Built a robust Healthcare/Public Health coalition via the local jurisdictional Emergency Management Agency’s disaster/emergency planning committee

     Reviewed the jurisdiction Hazard Vulnerability Assessment/Analysis and the disasters most likely to occur in the jurisdiction-“planned scenarios”

     Developed a casualty and fatality planning committee to estimate the number of casualties that would result from each of the planned scenarios

     Developed resource sharing plans via formal MOU/MOA with other area healthcare organizations (hospitals, health systems, nursing and rehabilitation hospitals etc) and all EMS organizations for the movement, management and treatment of casualties identified in each planning scenario.

     Developed a “Fatality Management Plan.” This may be accomplished via coordination with the EMA and possibly with mortuary companies on temporary morgues and cadaver preparation and burial.

     Developed a patient evacuation plan as a “Last Resort” for when “defend in place/shelter in place” efforts have proven insufficient to continue healthcare services at the hospital/medical center.

• Jurisdiction Incident Management (Tier 3): Normally, a Tier 3 integrated healthcare/Public Health response system is associated with a sub-state entity (city, town, borough, state region etc.). The jurisdiction’s Emergency Management Agency’s Incident Command System (ICS) integrates the jurisdiction’s healthcare assets with other response disciplines to provide the structure and support needed to maximize MSCC. In certain events, the jurisdictional ICS promotes a unified incident management approach that allows multiple response entities, including health and medicine, to assume significant management responsibility.

You are likely Tier 3 Compliant if you have:

     Integrated healthcare organizations and the Public Health Department into the disaster planning and Incident Command System across a local sub-state jurisdiction. This may include a city, county, borough or other “sub-state” entity.

     Reviewed the jurisdiction Hazard Vulnerability Assessment/Analysis and the disasters most likely to occur in the jurisdiction-“planned scenarios”

     Developed a casualty planning committee to estimate the number of casualties that would result from each of the planned scenarios

     Developed MOU/MOA with other area healthcare organizations and all EMS organizations for the movement, management and treatment of casualties identified in each planning scenario.

     Developed redundant communication systems, i.e. Voice over IP, Cell phones, satellite phones, Ham radios with volunteer operators for each hospital, walkie-talkies, couriers

     Contracted with waste removal companies on automated pick-ups during emergency operations

     Contracted with mortuary companies on temporary morgues and cadaver preparation and burial.

     With EMA, developed a patient evacuation plan as a “Last Resort” for when “defend in place/shelter in place” efforts have proven insufficient to continue healthcare services at the hospital/medical center.


     Coordinated with law enforcement to ensure security and control of ingress routes for supplies and egress routes for patient evacuation to referral hospitals outside the disaster jurisdiction when patient care capabilities have been reached.

     Coordinated with Fire and Rescue organizations for services appropriate to each planned scenario

     Developed jurisdiction-wide Emergency Management Services (EMS) agreements regarding ongoing casualty evacuation, movement and referrals to healthcare organizations within and outside the jurisdiction.

     Coordinated with jurisdiction SNS coordinator for long term sustainment support for medical supplies and equipment after normal supplier sources have run out of product

     Conducted emergency power requirements review for all healthcare treatment facilities …..( life support equipment, surgery, ER, HVAC, water and sewage pumps etc.)

     Contracted with emergency generator maintenance and fuel supply providers for continuous power capabilities when city power is unavailable

• Management of State Response (Tier 4): State Governments participate in a “Statewide” medical incident response across a range of capacities, depending on the specific event. The State may be the lead incident management authority, it may primarily provide support to incidents managed at the jurisdictional (Tier 3) level, or it may coordinate multijurisdictional incident response. Important concepts are delineated to accomplish all of these missions, ensuring that the full range of State health and medical resources is brought to bear to maximize MSCC.

You are Tier 4 Compliant if you have:

     Developed State plans to link all State emergency functions with the State Emergency Management Agency.

     Developed robust, automated and back-up manual, redundant communications systems linked with all state regional emergency response agencies and healthcare entities.

     Joined together via a State disaster/emergency planning committee which reviews all local jurisdictional casualty planning and management documents.

     Reviewed the jurisdiction Hazard Vulnerability Assessment/Analysis and the disasters most likely to occur in the jurisdiction-“planned scenarios”

     Developed a casualty planning committee to estimate the number of casualties that would result from each of the planned scenarios

     Developed MOU/MOA with other area healthcare organizations and all EMS organizations for the movement, management and treatment of casualties identified in each planning scenario.

     Developed redundant communication systems, i.e. Voice over IP, Cell phones, satellite phones, Ham radios with volunteer operators for each hospital, walkie-talkies, couriers

     Contracted with waste removal companies on automated pick-ups during emergency operations

     Contracted with mortuary companies on temporary morgues and cadaver preparation and burial.


     Coordinated with State and Federal law enforcement to ensure security and control of ingress routes for supplies and egress routes for patient evacuation to referral hospitals outside the disaster jurisdiction when patient care capabilities have been reached.

     Coordinated with State and Federal Disaster Team  assets for services appropriate to each planned scenario

     Developed jurisdiction-wide Emergency Management Services (EMS) agreements regarding ongoing casualty evacuation, movement and referrals to healthcare organizations within and outside the jurisdiction.

     Coordinated with jurisdiction SNS coordinator for long term sustainment support for medical supplies and equipment after normal supplier sources have run out of product

     Conducted emergency power requirements review for all healthcare treatment facilities …..( life support equipment, surgery, ER, HVAC, water and sewage pumps etc.)

     Contracted with emergency generator maintenance and fuel supply providers for continuous power capabilities when city power is unavailable

• Interstate Regional Management Coordination (Tier 5):  This “Regional Response” system includes effective mechanisms to promote incident management coordination between affected States. This ensures consistency in regional response through coordinated incident planning, enhanced information exchange between interstate jurisdictions, and maximized Medical Surge Capacities and Capabilities through formalized interstate mutual aid and other support. Tier 5 incorporates existing legal instruments, such as the Emergency Management Assistance Compact (EMAC), and describes established incident management and mutual aid concepts to address these critical needs.

You may be 5th Tier compliant if your healthcare organization is included in Regional plans, exercises and response efforts to man-made and natural disasters in a manner that allows horizontal and vertical communication. Your organization is also a part of a regional integrated logistical support system for supply, equipment and services needed to sustain healthcare organizations during man-made and natural disasters and enable continuity of operations until recovery is complete.

• Federal Support to State and Jurisdiction Management (Tier 6):

Tier-6 capabilities include a robust National Disaster Medical System (NDMS) with the capability to sustain Healthcare Organizations across America with all the staff, special response teams, supplies, equipment, and services required to manage casualties in the affected jurisdiction (s) and/or to transport patients to specialty centers across America and internationally.


Selected excerpts from a report on:


Information Seeking Behavior and Viewpoints of Emergency Preparedness and Management Professionals Concerned with Health and Medicine


Prepared for the National Library of Medicine


Murray Turoff, turoff@njit.edu  http://is.njit.edu/turoff 

Starr Roxanne Hiltz, hiltz@njit.edu  http://is.njit.edu/turoff


A study for the National Library of Medicine (NLM) was conducted to assess the information requirements for health-related issues in emergency preparedness and response. The overall goal of the study was to identify the views of potential users about the most significant knowledge, information, and services they are seeking, some of which might be incorporated into the development of the Disaster Information Management Research Center (DIMRC) planned by the National Library of Medicine or into other related efforts. The emphasis of the study was on determining the current information seeking behavior, existing preferred sources of information, and unmet information needs of professionals involved with the medical and public health aspects of emergency planning, preparedness, and response. The report summarizes responses to questions around the following topics: current sources, desired sources, organizing the information, examples of important materials and missing materials on the Web, librarian roles, information needs in extreme events, methods for dealing with information overload and organizing information, international issues, and level of experience with NLM resources. Detailed appendices include examples of grass roots efforts to mitigate information overload, a copy of the self report guide, a complete compilation of responses organized by type of respondent, and a list of international websites compiled by one of the respondents.

The study results address a full range of information needs, including the formal published literature, comprehensive databases for the management of specific types of disasters, practice-based documents that are typical of the gray literature, aids to developing and maintaining practitioner documents, and improved methods of organizing information of all types. Roles for librarians as well as disaster community experts were identified for enhancing access to important information at the time it is needed.

Findings and Observations

Currently used sources:

Respondents reported use of a diverse range of sources that they consider highly useful and important information for health-related emergency preparedness or response, with the diversity due partly to the varied specializations in particular types of emergencies. Current sources included primarily websites and journals, but other types of print resources were also identified. With the journal literature, there is a tremendous scattering of the literature over many different sources. Hundreds of web sites were mentioned, with little overlap. The most frequently mentioned was the CDC's http://emergency.cdc.gov/ site, with eleven mentions. The next most frequently cited was the Department of Homeland Security general site or its Lessons Learned Information Sharing (LLIS) site, followed by Relief Web. The FEMA and Radiation Event Medical Management (REMM) sites were next, with three mentions each.

What's missing?

Users were also asked about desired resources that are currently lacking or are difficult to use. The practitioners were especially dissatisfied with their ability to get the current information they need, when they need it, and with the ability to know which resources are authoritative. In addition, practitioners, medical professionals, and academic researchers alike expressed the need for more practical, easy to understand information – "useful, real data on real-life emergency situations." Examples included the need for more logistics and management information and for implementation information such as Standard Operating Guidelines and equipment lists. There were also requests for more websites similar to REMM, an 'Event Type Information Portal' for radiation events, extended to other types of threats, for best practices summaries to inform about the best way to handle an event, for disaster related assessment instruments, protocols and intervention plans, and for disaster drill data. Other suggestions included more disaster planning and recovery information in the Go Local component of NLM‘s MedlinePlus service, an all-hazard core Emergency Operations Plan (EOP) template for public health, and a coherent journal pulling together selected articles that focus on emergency preparedness and response.

Other needed resources deal with the "gray" literature that is not formally published and can exist in either print or web-based form, or both. Many respondents believe this type of literature often contains the most up-to-date and most relevant content. Examples include forms, procedures reports or assessments, operations plans, databases of personnel and other resources, and 'best practices' and case reports. With respect to what is lacking in Web resources, again the responses were diverse, but there was a general feeling that there should be less guidance-related information and more information related to hands on assistance. There were several mentions of the need to use 'new media' typical of Web 2.0 and use of cell phones to reach isolated, deep field populations. Needed materials included online training materials and courses; specific compilations of local best practices; actual plans for organizations such as hospitals and community service organizations, schools, and local agencies; and access to information on local response efforts, such as a list of shelters and first responders (with a role for GoLocal mentioned).

In actual emergency situations, participants provided examples of information that was needed but was difficult to obtain. One example dealt with displaced persons standing around the emergency room and not knowing where to go, illustrating the need for up to date information and action advice for a specific emergency and locale. The development of online templates that could be used in any specific disaster to facilitate compilation of such information was suggested. Another example addressed people wading through inches of ash with no information about toxicity and use of safety equipment such as respirators. In another case, physicians caring for people outside their areas of specialty not only needed access to medical and prescription records, but also to quality information health care information, including from previously unauthorized sites.

In extreme emergencies and crisis situations, the need for focused background information in advance of disasters was mentioned in terms of minimizing mortality and morbidity. This information includes baseline health indices, disease prevalence and vaccination coverage, ethnographic data on populations at risk, information on in-country NGOs and UN agencies, the country's disaster plan, logistics information, and in-country capacity for food, drugs, and supplies. Due to the unpredictability of emergency situations, respondents also reported that systems need to be flexible to the needs of rapid specialized information delivery, and the physical communications infrastructure for delivery of this fast breaking information must be considered.

Organization of information:

Regarding the issue of organization of information and methods used to find useful material, respondents emphasized the need to be able to obtain information that is relevant among an abundance of diverse and scattered resources. There is a general feeling that there is better information out there that they have not accessed, information that would enable them to do better plans, improve training, and maker better decisions. A range of tactics to find useful, relevant material were reported, including restriction of inputs to limited sources with good filters; using material that has been vetted by trusted sources; relying on individual contacts; developing classification structures; and seeking specific types of information such as after action reports, reports of best practices, and specific plans. Trust in sources and lack of cooperation or collaboration between different organizations or levels of government were reported as underlying problems. Many different sources are attempting to become the one source that everyone should go to for disaster information, and some respondents felt that this was not a worthy goal given the diversity of topics and problems that are involved.

Regarding ways to better organize resources to reduce the time needed to find useful new material, suggestions included having information specialists retrieve and synthesize relevant information, establishing integrative portals to quality sites for each type of disaster, expanded indexing, and classification systems with expert input, and community-based approaches to organizing material, including use of social tagging to create taxonomies.

Respondents were also asked about what they would like to see represented in an index or ontology of disaster preparedness and response. Ideas about various approaches to organization were offered, but the emphasis was less on the specific content, and more on the need for input from experts (including experienced emergency management practitioners) and for dynamic systems that can evolve to meet changing knowledge and needs.

Library roles:


When asked about current or potential roles of libraries, librarians, and information specialists, there was considerable support for the idea that librarians must become an integral part of the nation's emergency preparedness and response team. Among the suggestions for librarian roles were:

  • creating and maintaining taxonomies with expert input;

  • serving as a clearinghouse of knowledge concerning the different aspects of disasters;

  • equipping libraries to access real-time emergency telemedicine networks;

  • working with specialists to identify high-quality information;

  • developing easy-to-use methods of delivering specific content;

  • producing annotated bibliographies and syntheses;

  • participating in call centers taking questions from the public;

  • developing FAQs for local emergency preparedness and response and making them easy to locate;

  • assisting in text and data mining, aggregating and compiling information to support public health decision-making; and

  • sharing expertise with those in developing countries through an international network of librarians and archivists.

International issues:

Study participants were also asked about international considerations relevant for NLM. Cultural and language diversity were cited in the context of not relying solely on high tech solutions and the need for culturally appropriate information. Creating an international network that allowed librarians and archivists in developed countries to
share expertise with those in developing countries was also suggested. The need for a central point of decision support information was cited, much of which is currently obtained in an ad hoc fashion from various international organizations when a disaster strikes. Examples of ways in which such a resource could facilitate international disaster relief included more targeted intervention; effective stockpiling; geographical pre-positioning; better strategic decision making by senior managers, and improved targeting of rapid health assessments.


Regarding contributions that other countries could make to NLM, respondents reported an abundance of information such as local contingency plans, lessons learned, case studies, and best practices, but noted it is difficult to access, as many of these documents are either not in digital form or are held locally. By providing an example of open document collection, it was observed that NLM could work with other institutions in these countries to encourage and help them to share more widely, thus building recognition for their contributions. Additional specific suggestions included analysis of UN data on medical and public health impacts of disasters, and providing expertise on how to respond when high tech solutions involving use of internet and advanced medical technology fail due to emergency conditions.


Experience with NLM Resources:

Respondents were also asked about their prior experience with MEDLINE/PubMed or other NLM systems (e.g. WISER, REMM, TOXNET) to find information related to emergency preparedness or management. Many had praise for NLM's current services, yet others had limited experience, especially among the emergency practitioners. One reason suggested for their more limited use was the lack of information for immediate practical use in emergency response. The contributions and importance of NLM were acknowledged by one respondent in this way: “It would be wonderful if the NLM were to be asked to join DHS as a full partner in preparing America for future disasters.”


Cooperation, Coordination, Integration:

In addition to the structured questions, respondents were given the opportunity to provide additional information or comments not addressed by the study instrument. Responses primarily dealt with major process issues that, at least indirectly, lead to problems in the information functions that are necessary to carry out various phases of emergency preparedness and management. These include lack of communication and information exchange between the medical and the community service operations; unclear roles and responsibilities of the federal, state, and local agencies with respect to degree of aid and recovery of the public; the need for improved cooperation and coordination among the various agencies; and more explicit treatment of ethical issues. Though the focus of this needs assessment was in the areas of emergency medical response and public health, the investigators also emphasize that the health and medical areas integrate with a great many other aspects of a disaster, making it difficult to consider issues in isolation from other concerns like infrastructure, living necessities, transportation, and logistics. At least half of the 34 respondents were involved in other areas of emergency preparedness and management.


4. Summary of Responses by Question

Question 2: Current Sources of Information

The question asked was: 2. What sources do you currently consider as highly useful and important for emergency preparedness or response missions with medical or public health implications (e.g. including journals, organizations, websites, books, reports, plans, training materials, services, etc)?

The diversity of sources listed is very great, with some respondents sending us lists or links to hundreds of sources. The only sources that are mentioned by a substantial number of respondents are web sites. Figure 1 profiles the leading three websites, mentioned by at least four of the respondents. The CDC website is by far the most frequently mentioned (11 times, explicitly). This is followed by five mentions of LLIS or a generic 'Dept. of Homeland Security' websites. The third most frequently mentioned, especially by international professionals, is Relief Web. Interestingly, FEMA does not make the top three; it is 'tied' with REMM, with three mentions (Radiation Event Medical Management- http://www.remm.nlm.gov/.


Figure 1


Description of the Three Leading/ Most Frequently Mentioned Websites Related to (Health/ Medical) Emergency Preparedness and Response

1. CDC http://emergency.cdc.gov/ This is part of the CDC site devoted to all kinds of emergency medicine information, as shown below in the main page.


2. Lessons Learned Information Sharing System www.llis.gov


LLIS.gov is a national on-line network of lessons learned and best practices designed to help emergency response providers and homeland security officials prevent, prepare for, respond to, and recover from all hazards, including terrorism. The central component of LLIS.gov is a collection of hundreds of peer-validated lessons learned and best practices.


It also serves as a central repository of relevant government homeland security documents and events. The system is frequently updated with new reports and publications intended for homeland security personnel.


3. ReliefWeb www.reliefweb.int  This is the global hub for time-critical humanitarian information on Complex Emergencies and Natural Disasters. It is indexed by country/ location of current emergencies.


Question 3: Desired Sources

The first part of this question asked was about general needs:

3.a. For emergency preparedness or response missions with medical or public health implications: What useful resources, services, or types of information are now missing or difficult to access or use, that you would like to see more readily accessible to all concerned? (Either for a specific type of medical disaster such as a pandemic flu, and/or for general health aspects of emergencies; i.e., disease outbreaks after hurricanes or earthquakes).


The practitioners were especially dissatisfied with their ability to get the current information they need, when they need it. As one emergency management professional put it: 'I think the problem is not resources, it is finding the right ones and then knowing which resources are authoritative. A web search on any given topic will likely turn up multiple resources.' Another emergency manager described specifics related to this as 'Easily accessible lists of potential contractors sorted by actual (rather than professed), proven areas of expertise; coherent journal pulling together selected articles that focus on emergency preparedness and response from a wealth of sources (e.g., public health-related journals) in which those articles may be buried.'


A third noted that an unmet need is 'Information about what other organizations are doing. What supplies, equipment, medications and personnel are 'in the pipeline' on route to a disaster scene. Unfortunately, we are still depending on traditional (read: antiquated) means of communication.' A fourth wants more 'Disaster 'After Action Reports‘, especially where lessons were NOT learned and the same deficiencies were present over time.' This need for the 'nitty gritty' details are also expressed by a fifth practitioner: 'What FEMA planning course calls 'implementing information' Standard Operating Guidelines (SOGs), equipment lists, job action sheets, MOUs (Memorandum of Understanding). There is a lot of clinical information, much of which is redundant, and not enough logistics and management info (by comparison).'


The phrase 'easily accessible' includes the need for medically related information in a form comprehensible by the layperson. A practitioner dealing with radiation and nuclear related emergencies noted, 'Rad/nuc info is difficult to aggregate and find. Needs to be made intellectually accessible to those without radiation expertise. Using multimedia helps as this area is very technical.' The themes raised by medical professionals are quite similar in that they focus on 'practical,' easy to understand and use information and resources. For instance, one notes:


"I think that websites such as REMM that are vetted by experts and provide rapid access to what you need to know in order to manage a certain event are terrific. It would be ideal if there were similar one-stop-shopping sites for other threats. They would need a point person or two to communicate with experts to update the latest information and delete outdated recommendations."


A second medical professional wants 'best practices with summaries if I wanted to know what the best way to handle an event is.' Another medical professional wants:


A database with Disaster related instruments: Pre Disaster HVA (Hazard Vulnerability Assessments) instruments. Psychosocial Assessment tools. Post Disaster Response Assessment instruments.

A database with National/State/City protocols and intervention plans.

A data repository with National/State/City disaster drill data

A centralized data repository with raw data published or research in progress.


A variation on this theme of need for practical information is contributed by a librarian, who says, 'I would like to see more disaster planning and recovery information in Go Local. NLM could input national resources and local projects could input regional data.' An academic researcher states, 'An all-hazard core Emergency Operations Plan (EOP) template for public health is missing.' Another researcher states, 'The main problem for me is finding useful, real data on real-life emergency situations.'


In other words, the kinds of resources needed but not available now deal not with published literature, but with information, particularly about procedures and tools to support these procedures, that must be contributed, gathered, and vetted by peers who are actually on the 'front lines' of emergencies, rather than by medical researchers. An international participant refers to this as 'how to access the 'grey' (unpublished) literature. It often contains the most up-to date and most relevant content.' If one uses 'literature' to include the forms and procedures reports, the operations plans, the databases of personnel and other resources, and the 'best practices' and case reports mentioned above, 'grey literature' summarizes what is missing now.


Specific examples were then requested as follows:

3.b. Can you give one or two specific examples of emergency situations or preparedness phases in which information was needed but was difficult to obtain?


Two practitioners referred to missing information after 9-11. One described people who had been evacuated from their apartments hanging around hospital emergency rooms, because they did not know where else to go, and the personnel at the emergency rooms had no suggestions for them: 'The need that I know of for health services professionals to understand the needs of the patient for broader help, for human services… what if they are being discharged and they have no home to go to?" He also stated that more generally, 'every disaster large and small needs a complete and accurate guide as to where you, in this disaster, can get help and information you need,' specific to that disaster and that location. Online templates and related information could be provided to help to put together that information for any specific disaster. The second referred to wading through inches of ash two days later and thinking it was probably toxic, that people should have respirators on, but nobody had issued bulletins about this.


A librarian who worked with Katrina victims noted, 'Following evacuation of New Orleans after Hurricane Katrina, health professionals and first responders in shelters in Houston had a great need for health information immediately. Pediatricians were caring for senior citizens; psychiatrists were caring for gynecology patients. No one had their medical records, or prescription records with them. Access to quality information at a previously unauthorized site (Astrodome, George R. Brown Convention Center) was needed immediately.


'In other words, what is missing in specific situations is up to date information and action advice about that specific emergency and locale. One practitioner states, ―In the early phases of an event when one is totally dependent on media reports, the situation is so fluid that any information is either wrong, or out-of-date by the time you get it. Need to improve rapid assessment of needs (data for decision making, actionable threat awareness).' An expert in biological terrorism echoes this sentiment: 'A confirmed biological event at any major transportation facility requires access to real time information in order to assess the public health risk and start the recovery process.'


Question 4: Organizing Information, Knowledge or Wisdom
4.a. What sort of methods or methodologies (e.g. specific search engines, trusted sites, organizations, other peer recommendations, email lists, filters, indexes, etc) do you use now to find useful material and/or to avoid information overload?


Clearly information overload is a problem faced by just about everyone in this field. As one international contributor puts it, 'Just as it is important to be able to obtain information; [it] must be relevant. This emphasizes the need for …"peer-reviewed materials that do not necessarily have to be present in a journal form (peer-reviewed web sites may do fine e.g.)"


This results in an extreme range of tactics for coping:


Restrict inputs to only a few sources.


Stick to only material which has been vetted by others that are trusted in the area of emergency preparedness and management.


Seek push type sources with good filters on what is sent out.


Seek contact with individuals based upon their experience and background in the area


Rely on grass roots (free) type sources, people in the same area acting as individual "gatekeepers" or as a "team."


Providing Web based information or as active participants in useful message list servers.


Seeking process model structures as a way to get organized and well classified information (single index items inadequate)


Attempts to develop morphological structures to classify data by the underlying fundamental dimensions.


Seeking up-to-date information that is clearly defined in that manner


Seeking specifics such as after action reports, reports of best practices, specific plans


We have drawn a number of examples in Appendix A of this report that include some grassroots examples. While there have been some of these efforts in existence since 9/11 it seems to have mushroomed since Katrina and some of the major international disasters.


While many are coping with the problem and have established a workable approach for their situation, it is clear they are suffering the stress produced by the "opportunity costs" they are encountering. There is a general feeling that there is better information out there but they are not aware of where the specific things they need or should need are or what they are and how they can find them when their responsibilities and duties leave them little extra time. Can one do better plans, improve training, and choose better actions or decisions based upon some information or wisdom that is somewhere but which they have not accessed?


Trust in sources and things like the lack of cooperation or collaboration between different organizations or levels of government is also an underlying problem. When organizations do not feel, for whatever reason, they can expose their mistakes and seek to eliminate them through integrated efforts then there is no way the improvements can be made to create an HRO (High Reliability Organization) among all the diverse groups that must be involved in the integrated planning, training, responsiveness, or recovery processes of an emergency or disaster situation.


A lot of different sources are attempting to become the one source that everyone should go to for disaster information, and this is not a worthy goal given the diversity of topics and problems that are involved. What it is doing is making it more difficult for many people to solve their information overload problem and/or raising opportunity costs to them personally and emotionally.


4.b. Are there ways or methods you would like to see material in this area organized, indexed, clustered, processed, and/or filtered that would make it easier for you or others to recognize that something new might be of use to you or others in this area? Or, what would you like to see done to cut down the time to find useful new material?


These two quotes summarize it well for the practitioner:


"Unfortunately I have found that it takes somebody knowledgeable (me) to go through all the various resources and pull out what is useful. I also am a generalist in terms of interest in all things medical/public health, with a strong interest in everything else available in the homeland security field. Many, many, many organizations are trying to be the 'be all and end all' of an information source and none are really succeeding at this point.

"Using the SNS (Strategic National Stockpile of medical resources) list serve as an example, there are so many submissions that it is tempting to read none. Somehow they need to be categorized, and it needs to be possible to unsubscribe to portions of a list serve or to filter in what you would like to receive."


It is clear they feel the need for experts that are devoted to the information classification problem that goes beyond the abilities of a general reference librarian. It would seem to say that librarians need to develop systems where the expert-users can make recommendations on the quality and content of the items be covered if in fact one is going into the gray literature. Clearly a lot of what actual practitioners want is the gray literature. Even the professional vetted journal literature differs considerably in the relevance to a particular situation and this is important to many of those in positions of management or practitioner experts. Clearly there is no time to hunt down needed materials in the actual disaster phase.


"Basically, a "documentalist" who will retrieve only the relevant information on behalf of the users. Will also need an expert such as an epidemiologist to consolidate data from a variety of sources, formats etc... and most importantly to synthesize information."


There seems to be a feeling that in some ways too much guidance on what to do and not enough focused help is being generated on how to do it.


"Yes. Universities, Institutes and the Federal Government need to provide consulting services (often referred to as technical assistance) to Grant Awardees and other governmental and Private Sector Healthcare entities. We need less guidance and much more hands on assistance."


There are repeated assertions elsewhere that the official documents often have no common internal framework relevant to the emergency community and this makes it difficult in dealing even with the official material. Considering the wide range of agencies and contractors involved this has a ring of truth to it. However, in some areas, like dealing with emergencies like pandemics, we have not had much experience with it might be too soon to try to impose such standards.


Setting up a separate integrative portal for each type of disaster was suggested and might be a worthy goal if it truly allowed cooperation and collaboration among different vetted professionals and organizations in compiling and judging the quality of the material. Note that users seem to want a much more hands on collaboration for contributing and evaluating material.


"I would like to see more community-based approaches to material, particularly using social tagging to create a more grounded taxonomy – the one we currently have is heavily predefined by the Cluster system. An aggregator of academic publications that might be useful in disaster response, from a range of journals in different topic areas, would be very useful in helping the humanitarian community to access this expertise – at the moment; it‘s just too difficult and costly for us to stay up on current research."


"You may wish to consider Google‘s approach and/or folksonomies or tagging. There‘s a couple of really fascinating videos on YouTube that talk about Web 2.0 and organizing information. One on the Information Revolution and the other on Web 2.0; both are by Michael Wesch. If you haven‘t seen them, you should. Unfortunately, our IT security people have deemed both YouTube and Facebook to have no valid business purposes, so I can‘t simply send you the URL."


From the examples we have collected via our participants it is clear the users are anxious to help one another as a community of practice and in the emergency field this trend is going to continue unless they are brought in as an active part of the formal systems that seek to support them. Once again, a lot of the examples in Section 5 and Appendix A are free and based upon efforts of unpaid volunteers.


Question 5: Current outstanding examples or missing materials on the Web

5.a. Are there any other specific medical, health care, public health disaster plans or training materials or web based resources that you consider outstanding examples of such material?


There is a 'grab bag' of suggestions in this section, but many simply repeat sources already mentioned in question 3, such as CDC and REMM. However, there are several mentions of the need to use 'new media' typical of Web 2.0, e.g.: 'Internet 2.0, Wiki, Blog, Forums, Social Networking, shared work spaces like Groove, use of cell phones to reach isolated, deep field populations (everyone on planet earth has a cell phone). Voxiva has taken the lead in the area of "Phones for Health" initiative with the Global GSM Alliance.' Two experts mention how good Wikipedia is. Online training materials and courses are mentioned, as well as Wikipedia, as being very useful for volunteers (fire departments and other community service organizations) and for local communities that do not have the funds (or access) for more costly sources of material.


Question 5.b. asks: What material not currently available on the Web would you like to see there?


The diversity of responses is similar to that for the first part of question 5. Some specifics that seem notable include:

Vital baseline health data (e.g., potential health risks in countries) and other focused background information in advance of disasters (e.g., large scale population movements, forced migration) to minimize mortality and morbidity from preventable causes such as measles and diarrhea diseases. This will require the identification of potential risk areas around the world for disasters, vulnerable populations, mass population movements, and to target these countries for contingency planning and advance health information gathering.


Easy to find medical management for Chemical terrorism.


Specific compilations of local "best practices," actual plans for organizations such as hospitals and community service organizations, schools, local agencies so that practitioners can compare and evolve improvements in these areas relevant to their localities.


More online training for health related problems in disasters, aimed at potential first responders and others likely to be on site.


A librarian would like 'Local response efforts (list of shelters, first responders, etc.) in the event of a major or even minor disaster. This is where I see a major role for Go Local.'

Question 6: Roles of Libraries, Librarians, and Information Specialists

Question: What are the current or potential roles and/or services for Libraries, Librarians, and/or Information Specialists in any phase of the Emergency Preparedness and Response process? Are there other particular services a local or specialized library should or could provide? Among the suggestions are:

Creating and maintaining a taxonomy for my field would be a welcome contribution from the Library Sciences, so that as the body of knowledge and literature grows, it is usefully archived.  

A major activity would be to serve as a local, State, regional, national and international clearinghouse of knowledge concerning all of these different aspects of disasters.  

Foster the transfer of knowledge among the different stakeholders, and policy makers in order to improve society's resilience to disasters and other emergencies.  

Libraries must be equipped with real-time Emergency Telemedicine Networks. Sweden is the first country in the world to have a national infrastructure for Telemedicine. Librarians must become an integral part of the Nation‘s Emergency Preparedness and Response Team.

A crucial need its just to keep track of plans and supporting documentation

Continuing to work with specialists to identify high-quality information and developing easy-to-use methods of delivering specific content.

Produce something like the National Center for PTSD (Post Traumatic Stress Disorder) newsletters in which a particular topic is explored and an annotated bibliography is provided. It‘s very helpful for busy clinicians and others to get a quick overview.

Participation in call centers taking questions from public – helping shape responses into understandable FAQs and making sure people can find them.

They could be requested to assist in mining, aggregating and compiling information so that existing information can be easily analyzed by public health decision-makers and provide context for their decisions.

It would be very useful to create an international network that allowed librarians and archivists in developed countries (where most of the resources are located) to share expertise with those in developing countries.

Question 7: Extreme Events

Question: If you had to consider an "extreme" but possible event (e.g. a pandemic, another Katrina, or a large earthquake) would this add additional information requirements relevant to any of the other questions on this survey?

One emergency practitioner gave a very complete set of special requirements for such crisis situations, including:

Particularly, "human generated" events (Chemical, blast, technological, transportation, radiological, nuclear emergencies etc) would require very specialized information requirements… including baseline health indices, diseases, in-country capacity such as the following:

a. Health data such as: -epidemic risks -incidence and prevalence of communicable diseases and vaccination coverage -nutritional status -country health profiles and other public health information such as status of local health facilities and the availability of other material resources

b. Basic ethnographic data on populations at risk of adverse health consequences from disasters. This could include some medical anthropology data so that health programs and interventions could be made more culturally acceptable.

c. Database of in-country NGOs, UN agencies, and their resources (this may include many development organizations, but many of these may also have emergency relief capabilities). Ideally, this would include list of key individuals and points of contact information but such information may change too often to be readily kept up to date.

d. Description of the country's disaster plan, if any. Specifically, this would include what ministries, etc. are responsible for preparing for and responding to emergencies.

e. Organization of health professional training in the country of origin.

f. Logistics: warehouse capacity, availability/price of gas/diesel, air/road access, telecommunications (e.g., availability of landline phones, mobile phone cells, electricity), etc.

g. Local and regional laboratory capabilities for identification of causative organisms and antibiotic sensitivity testing, drug resistance (e.g., to chloroquine) and nearest reference labs for cholera, shigella, etc. If not available in-country, should note guidelines for transport.

h. In-country production capacity for and availability of drugs, jerry cans, cooking kits, etc. i. In-country availability of food stocks

This type of information simply is not available now. Much of it is not 'medical' per se but all of it relates to public health issues after a massive disaster. There are systems design implications of the fact that many large scale events, especially those that may be caused by terrorists, are not only unpredictable, but often 'unimaginable' ahead of time. Thus, as another emergency practitioner notes, 'I think it is important to recognize that the future is uncertain and hard to predict and that systems need to build that are flexible to the needs of rapid specialized information delivery.' In addition, the physical communications infrastructure for delivery of this fast breaking information must be thought about: 'What level of web traffic can the best, trusted sites handle? If they can‘t handle the load, where do they redirect? If we lose Internet, how to disseminate information? If schools are closed, librarians with families are not available to fulfill their roles, unless library planning incorporates school planning. Is there hazard pay for staying in an area deemed at risk?'

Question 8: Your critical topic areas

In terms of creating an index (general ontology) out of a sample document database that can then be used to automatically classify new information as it occurs, what would you want included in such a database and what specific topic areas would you want to see in the resulting index or ontology?

This is a question that may be very difficult to answer based upon cognitive differences. Those who are able to deal with abstraction usually have a better chance of conceptualizing a more complete specification of terms as opposed to those who deal better with data specifics and are very oriented to specifics. Both types of problem solving processes are represented.

We had a wide range of responses from one single term to thirty eight terms in a two level hierarchy. A significant variety of types of emergencies are represented. There is recognition that the dimension of terrorism introduces the possibility of risks that create medical problems that are the common ones that medical and health care professionals may be familiar with in a given locality. Hence the need, as expressed, elsewhere for very selective retrieval capabilities. The need for great precision in finding material is quite clear in an emergency situation. Here is an example of one of the more detailed lists suggested as one respondent‘s areas of concern:

1. General Concepts

a. Basic physics of disasters

b. Triage

c. Pediatric considerations

d. Infectious diseases

e. Pharmaceuticals

f. Critical Incident Stress

g. Complex Humanitarian Emergencies

2. Disaster Response Planning and Coordination

a. Disaster planning

b. EMS in disasters

c. Public health in disasters

d. Urban Search and Rescue

e. Federal Disaster agencies and response (CDC, DMAT, DHS, VA etc..)

f. State and local disaster agencies and response

g. Communication and information technology Tools

h. Managing disasters in austere environments (including Wilderness EMS)

i. International level response, planning & coordination

j. Incident Command System

k. Disaster Drills

3. Natural Disasters

a. General information

4. Infectious disease epidemics / pandemics

a. General info

b. Planning / response / coordination

c. Local / state / federal level

5. Industrial, Technologic and Transportation Disasters

a. Radiation accidents

b. Hazmat-related disasters

c. Mass gatherings

d. Maritime disasters

e. Air crash disasters

f. Fires and mass burn care

g. Internal hospital-related disasters

6. Conflict-Related Disasters

a. Conventional terrorist bombings

b. Nuclear detonations

c. Intentional chemical disasters

d. Biologic weapon agents – including vaccination information

e. Tactical EMS

f. Mass Shooting

7. Education, Training, and Research

a. Education and training

b. Research

8. Personal accounts from deployments

9. Disaster Medicine Resources / References

Over time changes have occurred and every large scale disaster introduces new problems we did not think about before, with Katrina and 911 being prime examples. The emergency of the pandemic as a new risk requires not only new terms to represent new problems to be addressed but also the necessity of integration of other dimensions of concern over extended periods of time. All the supporting infrastructure and logistic maintenance of normal consumable resources cannot be separated from the medical situation. This is evident for a short time scale of weeks in Katrina but in a tr