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This article is a part of the “Are We Prepared? Planning for Pandemics and Natural Disasters” special section in the Aug/Sep 2010 print issue of PA TIMES.
Traci Foster, David Milen
There are numerous disasters, both manmade and natural, that have resulted in public agencies having to use alternative resources, different forms of communication, and training exercises in order to prepare for possible disasters and emergency response operations.
In an effort to prepare for disasters financial resources must be present in order to purchase equipment, radios, and other forms of communication. Economic crisis and budget constraints may influence the local and state public agencies abilities to prepare for emergency responses to disasters. Public agencies may need further assistance with grant funding opportunities that may be obtained through the federal government.
Further issues that may inhibit emergency response and coordination include inconsistency in training and overall guiding curricula for disaster preparedness. Training may vary from public agencies based on demographics and how the locations of the public agencies may differ. Some training may be consistent with disaster response and preparation for hurricanes, while other training may be developed for tornadoes in a specific part of the country. Many public agencies may not have personnel who are qualified to train the department or city in specific medical or hazardous materials response. A designated training officer may be necessary in order to fulfill the obligations of disaster preparedness for that agency.
The U.S. Department of Health and Human Services has stated there are solutions for public agencies to establish preparedness programs, communications and collaborations among responding agencies. One of the areas where public agencies may improve their capabilities to emergency preparedness and response is to foster collaboration by forming a coalition of emergency response members. The members may be stakeholders from federal, state, and local agencies who are willing to participate and take the initiative in disaster preparedness and planning. The coalition will provide a foundation for role designation, training, communication capabilities, allocation of resources and resource availability, and training with interagency participation for mass casualty events/incidents.
One of the many areas that appears to be lacking is the ability to have a consistent and dependent training and credentialing system. Recently, a credentialing system has been established called the ESAR–VHP credentialing system. This system allows hospitals, medical facilities, and alternative care sites the opportunity to use a computer to check licensure of RNs, MDs, EMTs, paramedics, and allows them access to their respective facilities for assisting in times of disaster or emergency response crisis.
The credentialing system is made available through software specially tailored for such events. In addition, the credentialing system is a form of security for those facilities affected by disasters that may have several volunteers arriving to assist, state they have credentials, but licensure may be in question or expired. The credentialing system allows a security check of the volunteers’ name, licensure, and whether the license is valid to continue practice/treatment. The system is still in infantile stages for several states, but Illinois, Indiana, Michigan, and Wisconsin appear to be collaborating for the establishment of the credentialing system state-wide to further improve response operations.
Communication and coordination efforts may be another obstacle agencies face. A different form of communication may be used by a local public agency, for example, police and fire departments may have different frequencies programmed in their radios causing a deficient means of communication and hampering emergency response. The adoption of the National Incident Management System (NIMS) and the Hospital Incident Command System (HICS) has allowed both communicability and flexibility for collaboration and disaster/emergency response.
Disaster response should provide agencies and hospitals the ability to communicate freely and have a structure in place regarding who is commanding the incident, what supplies and provisions may be needed, and when the incident should be terminated based on collaboration between the facilities. The use of similar radios and radio frequencies may provide adequate communication for the command centers and various locations for personnel assuming command in both the NIMS and HICS positions. There are several areas where public agencies, as well as hospitals located in those jurisdictions, may improve upon their overall preparedness measures in response to disasters and emergencies.
Training, evaluation, and exercise preparedness are key elements for public agencies to coordinate and practice with surrounding jurisdictions and facilities in order to further prepare for disasters. The stakeholders involved in training exercises may include the police, fire, EMS, American Red Cross, and other community resources (hospitals, faith-based organizations, etc.) in order to create realism in disaster response.
Further collaboration is required for the use of communication systems during the exercises. All stakeholders involved in the exercise should be aware of radio brand, frequencies, and capabilities for distance, channels, and issues concerning attenuation. If public agencies are able to meet with local and community leaders, more awareness has been created for developing plans concerning life safety, communications, and overall stakeholder information. Training and full– scale exercises can be part of this component.
Training, evaluation, and exercises should be tested semi-annually. After Action Reports (AAR) are an important piece of public agency preparedness and disaster planning efforts. Agencies have the opportunity to train and exercise across multi – jurisdictional boundaries, but also have access to planning strategies, issues that may have arisen during training and the drill, other supplies and transportation that may be necessary during disasters and emergencies.
The AAR will serve as a guide for future standards and changes, processes, procedures, and other trainings that will be necessary to improve upon the already established guidelines. The AAR will not only serve as an imperative piece for disaster planning, but ensure public agencies meet the requirements for ASPR funding. Disaster manuals must be kept in order not only for disaster and emergency response, but to further meet the grant funding requirements.
Disaster planning manuals offer a concentration of information regarding phone numbers, meeting locations, evacuation information, resources, and initial responses to the disaster/emergency. The disaster planning manual may serve as a reference or guide for public agencies that need immediate assistance during an emergency.
Depending on the type of public agency, maps, drawings, and surveys may be included in the appendix of the manual in order to further expedite efforts for emergency response. These drawings may include the overall outline of the buildings, some interior high profile areas, and entrance and exits for means of ingress/egress. Furthermore, the manuals serve as an educational tool in order to educate public agencies, their staff and personnel, and local jurisdictions concerning response and activation of the disaster plan.
Public agencies can better plan for mass casualty events (MCEs) by coordinating with local jurisdictions training efforts, creating a communication system that functions with all agencies and community resources that are involved in disasters and disaster preparedness, and have a folder or binder of information regarding important contacts, emails, phone numbers, pager numbers, and other information that may be needed during a disaster.
In order to further enhance the communications during training or an actual event consideration should be given to establishing HAM radio frequencies, having a listing of all the frequencies of the surrounding areas and facilities, and establish a command center where HAM radio operators will be able to establish communications should computers, other electronic devices, and handheld radios stop functioning. Public agencies may also research other existing data or case studies to further improve upon their own responses.
Case studies serve as another venue for public agencies to research best practices and lessons learned from previous disasters, emergencies, and trainings. Interoperability between local jurisdictions can be beneficial during exercises and trainings in an effort to create a report regarding lessons learned. These lessons may also serve as guidelines for other public agencies in the United States and abroad for further preparedness efforts.
A case study, for example, Hurricane Katrina, could provide valuable information, moral and ethical practices, establishment of alternative care sites, interoperability with communications and communication failures, and the use of a unified command system during disaster and emergency responses. Researching several similar case studies might provide key components to the overall planning and disaster response for public agencies to utilize and perhaps change based on their own circumstances.
Public agency preparedness in the future will rely on training, communication, real-life exercises, the establishments of coalitions with local jurisdictions and the ability to maintain and secure grant funding through ASPR in order to further prepare for disasters and emergencies. The key to the future is collaboration between agencies and jurisdictions having authority in order to respond in an organized professional manner to disasters and outside issues that may include terrorism.
Traci Foster is nursing manager at St. Margaret Mercy Hospital. Email: [email protected]
ASPA member David Milen is bioterrorism/disaster preparedness coordinator at
St. Margaret Mercy Hospital. Email: [email protected]