|What is Emergency Management? To some, it is a disciple, to others, a process. I look at emergency management as a process, under the elected leadership, where communities manage complex emergencies and disasters. It is that ability to manage these events that separates emergency management from respond organizations. Fire, Law Enforcement, EMS, even Public Works are the subject matter experts in their fields. But they rarely work daily as teams in dealing with complex events. Nor do they generally work with the elected leadership of a community in their daily responses.
Emergency Management (EM) is based on the concept of local disaster management supported by higher levels of Government to include State and Federal assistance when needed. EM recognizes that disasters are cyclic through phases. Those phases include preparing for disasters through training, exercises, planning, and public education to name a few preparedness activities. If disaster occurs, responding to the event and managing the immediate effects on the community. After the emergency phase has passed, often even during, recovery begins, the task of returning a community to the pre-disaster state that may take years. Reducing or eliminating impacts of hazards is a constant goal of EM though mitigation programs. A new phase of prevention has taken a more prominent role in the U.S. after September 11, 2001. From terrorism to disease outbreaks, prevention can involve intelligence, surveillance and detection, and even vaccinations.
The job of Emergency Management is to improve the outcome of a disaster. These outcomes can be measured in lives saved, fewer injuries, reduced damages, decreased disruptions, shorter recovery time, to name a few. If we do not improve the outcome of a disaster, then we have failed.
- the event must be detected.
- the decision to warn the public must be made.
- the public must receive and understand the warning.
- the public must have somewhere safe to go to or action to take
- the public must act.
Unless we improve the outcome of an event, the system has failed
Sometimes the obvious is the best response, over the years, these truths have kept me focused on the mission. With everything that can go wrong going wrong, usually at the same time, it helps to remember what's important and what's not.
- Meet the needs of the disaster survivors
- Take care of the responders
- See rule 1.
There is always much more that needs to be done, but these standing orders make sure you get started on the basics.
- Reestablish Communication with Areas Impacted
- 2.Initiate Search and Rescue /Security
- 3.Meet Basic Human Needs
- 5.Emergency Fuel
- 6.Ice is a distant sixth (Unless its really hot)
- 4.Restore Critical Infrastructure
- 5.Open Schools / Local Businesses
- 6.Begin the Recovery
While this seems an over simplification of a disaster, it helps when everything is needed yesterday and you have run out of options. There is also a big difference between needs and wants. Many times we get wrapped up over the public wants (money, ice, etc) and needs (shelter, water, basic medical care, etc.)
- Protective Action Required
If you order an evacuation, start planning for the re-entry. What conditions will be required for the return of the residents.
- Free of mistakes
Disaster Operating Environment
- New Players in Unfamiliar Roles
- Heavy Information Demands
- Politically Sensitive Issues
- Changing Requirements
- Rapid Decisions
- Degraded Communications
- Unforeseen Consequences
- Public Affairs Priorities
Then there is always the question of what is a disaster...
How to Tell a Disaster From an Emergency
Use a Sledgehammer
It rarely pays to be subtle.
It’s better to have too much than
Push resources into the affected
area. Don’t wait for requests.
A quick and overwhelming response
is better than a well-planned and well thought out response.
If you wait until you have all the
facts, it becomes harder to change the outcome.
The public has a right to knowledge - so that they can
make an informed choice - on how to respond to
threats to their community.
From Jim Shultz, Director, DEEP Center (Center for Disaster and Extreme Event Preparedness), University of Miami
Key Points on Disaster Behavioral Health
for Emergency Management Professionals
Disaster behavioral health deals with optimal health human functioning within family, community, and occupational roles during extreme events (Shultz et al., 2003).
Psychosocial Consequences of Disasters (Shultz et al., 2006):
1) Widespread. The psychological “footprint” of disaster is much larger than the medical “footprint.” Translation: More people are impacted psychologically than are harmed physically.
2) Spectrum of severity. Fear and distress is common among persons exposed to disasters but most regain function rapidly without need for intervention. This is good news—resilience is the most likely outcome. However, a subset of survivors are distressed to the point of changing behavior such as surging on hospitals and points of distribution. A smaller percentage develop psychiatric disorders including PTSD, depression, and anxiety disorders.
3) Range of duration. Some survivors will experience psychological impact long after the disaster event is over. This is because the “forces of harm” that provoke psychological reactions include not only exposure to hazards (usually brief), and also loss and change (usually long-lasting).
4) Related to the nature of the disaster. Generally, across all types of disasters, the degree of psychological impact is directly related to the magnitude, intensity, duration, and geographic scope of the disaster. As one key finding, human-generated intentional disasters such as terrorism produce severe psychiatric outcomes in a higher proportion of exposed persons than do natural disasters (Norris et al., 2002).
Effective Emergency Management is also effective behavioral health support and intervention.
Strong scientific evidence exists for the psychological benefits of interventions that create or restore safety, calming, connectedness, self-efficacy, and hope for disaster survivors (Hobfall, et al., in press). Effective emergency management includes (Fugate, 2006):
1) Establish communications
2) Secure the area (first 12 hours) and establish a “presence”
4) Stabilize and restore basic needs (first 72 hours)
5) Reestablish infrastructure and “normal” operations
These actions are directed toward the disaster-affected community at large (not usually delivered one-on-one). These actions rapidly and efficiently reestablish safety, security, presence, basic needs, and critical services—with powerful psychological benefit. Also, these actions are outcomes-driven.
Predictors of Serious Psychological Impact
Pre-Disaster Risk Factors
Lack of personal and family preparedness
Poverty and lack of financial resources
Lack of social support (lack of family and friendship resources)
Previous traumatic exposure (abuse, combat, assault, severe accident, life-threatening illness)
Previous psychiatric or substance abuse diagnosis
Lifespan risks (young children, single parent status, frail elderly)
Special needs and disabilities that may limit ability to respond to warnings, evacuate, engage in self-care
Disaster Event Phase Exposures
Personal experience of threat of death or severe bodily harm
Witnessing harm to others or death
Physical harm to self
Physical harm or death of loved one, close friend, or co-worker/teammate/buddy--bereavement
Exposure to grotesque scenes
Exposure to noxious agents
Post-Disaster Risk Factors
Disruption of basic needs and services
Multiple losses (home, work, children’s schools)
Stress Signs--Common Fear and Distress Reactions in Disasters
Physical: Fight-or-flight response (increased heart rate, respirations, BP, adrenalin “rush”)
Emotional: Fear, terror, anger, irritability, overwhelm, hopelessness, helplessness
Cognitive: Decreased concentration, decision-making & problem-solving ability, memory problems
Behavioral: Changes in sleep and diet, decline in performance, increased substance use
Social: Withdrawal, isolation, difficulty giving or receiving support, hostility
Spiritual: Increased reliance on faith or crisis of faith, cynicism
Evidence-based Early Psychosocial Intervention
Psychological First Aid (PFA) represents the current cutting edge. Use national PFA models developed by experts in the field (National Center for PTSD/National Center for Child Traumatic Stress model is becoming the standard). The NCPTSD PFA Operations Guide is available at www.ncptsd.va.gov)
PFA is not only an individual level intervention. A great deal of PFA is provided during mass response activities conducted by survivors themselves and by arriving teams of first responders. DEEP Center-defined outcomes that can be measured (systems approach to PFA) (Shultz et al., 2006):
- · Restore SAFETY (remove from harm’s way, bring to safe place, provide basic needs)
- · Reestablish FUNCTION (calm survivors, connect survivors to loved ones and support personnel)
- · Empower ACTION (provide information for action, restore infrastructure, guide first steps)
Use behavioral triage to distinguish persons needing referral for psychiatric evaluation.
Psychological debriefing is generally not appropriate for survivors and may be harmful in some circumstances. Excellent guidance on early interventions is contained in: “Mental-Health Intervention for Disasters: A National Center for PTSD Fact Sheet” available at http://www.ncptsd.va.gov/facts/disasters/fs_treatment_disaster.html.
Resilience is the default
Resilience is “mastery against adversity” (Reissman, 2006). Most people regain effective function. Many survivors experience “post-traumatic growth”, becoming stronger through the disaster experience.
The focus of community-level and individual-level response is to make sure that a disaster does not “throw off” the natural tendency toward resilience. Since the default is having persons function in life as well, healthy persons, the trick is to not let the traumatic event move survivors away from resilience. Keys to resilience are the same as keys to emergency management:
1) Be prepared
2) Decrease stressors
3) Increase supports
4) Engage in healthy lifestyle behaviors
5) Build preparedness and response systems that promote items 1-4
In the post-impact phase, increase the focus on minimizing stressors and restoring resources.
Disaster Response Professionals
Disaster response professionals experience stress reactions and may have considerable impact from witnessing and responding to disaster events. Excellent guidance for response professionals in contained in: “Disaster Rescue and Response Workers: A National Center for PTSD Fact Sheet” available at http://www.ncptsd.va.gov/facts/disasters/fs_rescue_workers.html.