Preparedness and Response

Briefly Noted - Everyday Preparedness

2011-09-30T06:00:00.000-07:00

I came across this post on Stepcase Lifehack a little while back and wanted to pass it on before National Preparedness Month ended. The opening paragraphs sum the article up nicely.

People create emergency kits for car problems and bad weather, but few create kits to deal with more common but less urgent situations. In particular, misplacing a wallet or forgetting a work laptop at home can play havoc with a person’s workday.

With a little bit of planning, you can create emergency kits that will let you deal with these types of situations in a calm and productive manner.

The whole article is HERE and I highly recommend checking it out. I think it's a great way to close out preparedness month.

This is a great concept that I'm retitling "everyday preparedness". Between the examples the author gives and one from the comments (the clothing etc that are in a gym bag/locker) you've got some great ideas for managing day-to-day incidents. I used to keep a couple of changes of clothes in my office when I worked in Baltimore and I've just never gotten around to bringing the extras in to the office now that I've moved. And I've been here three years. Reading this may be enough to get me motivated.

What I hope to get to this week

2011-09-26T08:08:00.000-07:00

This week will probably be busy in the office for a number of reasons but there are also a couple of larger topics I want to spend some time on here. Specifically:

National Disaster Recovery Framework - I was planning to write on this before I saw it mentioned by William Cumming on his blog and Claire Rubin on hers. I've had various drafts of this kicking around my desk for a while now and want to take a day or so to look through it before I say anything, but it is out there.
Department of Homeland Security Authorization Act of 2011 (S.1546) - If you haven't seen this one it just means you're not an obsessive Congress-watcher. This is the authorization bill for DHS submitted by Sen. Lieberman. It is also the first of these in a long while, which makes it significant. There is a lot to digest here, especially in light of PPD-8 (something else I'd like to get to someday, since I've been heavily involved in implementation work locally) related to preparedness and response issues at the Federal level, disaster funding (obviously a hot topic), and a specific pet peeve of mine - the role of DHS Office of Health Affairs.

Briefly Noted - 2011 State-by-State Update on Laboratory Capabilities and Response Readiness Planning

2011-09-22T06:00:00.000-07:00

So the title may be longer than the post...and that's only half in-jest. I don't have a whole lot to say on this one. I picked up the 2010 version of this report at the 2011 Public Health Preparedness Summit (note - the 2012 Summit is open now, I have my reservations made, do you?) and was impressed with the amount of information the authors were able to stuff into the relatively small document. Remember, I am used to things that come out of DHS so small is relative.

The report includes great information on national preparedness, state-by-state reporting, and some appendices that explain how the different metrics were pulled together. It can be accessed from the CDC Office of Public Health Preparedness and Response website. The write up from the site is below:

Public Health Preparedness: 2011 State-by-State Update on Laboratory Capabilities and Response Readiness Planning

A report on CDC-funded preparedness and response activities in 50 states and 4 cities

Tuesday, September 20, 2011

Public Health Preparedness: 2011 State- by-State Update on Laboratory Capabilities and Response Readiness Planning is CDC's fourth preparedness report. It presents available data that demonstrate trends and document progress in two important preparedness activities occurring at state and local health departments across the nation. The report features national data as well as individual fact sheets with data on activities occurring from 2007 to 2010 in the 50 states and four directly funded localities (Chicago, the District of Columbia, Los Angeles County and New York City) supported by CDC's Public Health Emergency Preparedness (PHEP) Cooperative Agreement. All CDC preparedness reports are an important part of CDC's overall focus on demonstrating results, driving program improvements, and increasing accountability for the nation's investment in public health preparedness
The complete report and individual sections of the report are available for downloading as separate pdf files.

FEMA launching "Ready Indian Country"

2011-09-21T06:00:00.000-07:00

This is the latest product/concept from the Ready.gov team, and is targeted to the Tribal Nations. Following in the footsteps of Ready (aimed at families and individuals in general), Ready Business, Ready Kids, and Ready Responder, the Ready Indian Country is a sub-site under the Ready.gov umbrella with information targeted to Tribal members and Alaska Natives.

In addition to some general information on readiness planning that applies to most Tribal Nations members there are specific regional pages for Alaska, the Northwest, Southwest, Northern Plains, Southern Plains, Northeast, and Southeast. The regional pages include region-specific hazards and planning information, audio public service announcements, and contact information for the local FEMA Regional Office by state.

The press release on the Ready Indian Country program is below.

FEMA to Launch Ready Indian Country Preparedness Campaign

National Preparedness Month Launch is Part of Larger Efforts to Partner With Tribal Nations as They Prepare for Disasters

Release Date: September 19, 2011 Release Number: HQ-11-198

WASHINGTON, D.C. -- The Federal Emergency Management Agency (FEMA) today announced the launch of the Ready Indian Country campaign as a part of its ongoing National Preparedness Month outreach. The new campaign will provide disaster preparedness information resources for the 565 federally-recognized tribal nations and communities across the country.

The goal of Ready Indian Country is to partner with tribal leaders in asking individuals and families in Indian Country to take basic steps to prepare themselves for emergencies.

"Our tribal nations and organizations are a key member of our nation's emergency management team and this campaign will help us build on the already strong partnership we have developed," said FEMA Administrator Craig Fugate. "By strengthening these communities' ability to be better prepared in the face of emergencies and disasters, together we can save lives and bolster our resiliency against all hazards."

Ready Indian Country is designed to promote preparedness within tribal communities through education and outreach. It is intended to serve as a resource for Tribes to prepare their citizens and provide support in developing and implementing pre-disaster policies and procedures.

"The National Congress of American Indians supports the efforts by FEMA to include Indian Country. Tribal governments are continually striving to develop, improve, and enhance their emergency preparedness capabilities in order to better ensure the safety of their citizens. Staying proactive and creating lasting partnerships will help tribes achieve this goal and will build sustainable and resilient tribal communities in the process. NCAI appreciates this opportunity to work with FEMA and the Ready.gov program," said Jefferson Keel, President, National Congress of American Indians.

Ready Indian Country's resources include existing Ready Campaign messaging and builds on existing capacity with specific tools customized for Indian Country. These include:

Brochures, posters and billboards customized by geographical region to reflect diverse local conditions and American Indian and Alaska Native cultures.
Radio Public Service Announcements (PSAs) in :60, :30 and :15 second formats; and,
Tribal Leader Resources to help guide community emergency and disaster planning efforts

Ready Indian Country resources can be found at www.ready.gov/IndianCountry.
For more information on the Ready Campaign visit Ready.gov and follow Ready online at www.twitter.com/readydotgov.

FEMA's mission is to support our citizens and first responders to ensure that as a nation we work together to build, sustain, and improve our capability to prepare for, protect against, respond to, recover from, and mitigate all hazards.

Last Modified: Tuesday, 20-Sep-2011 07:55:08

FEMA webinar on preparedness for aging Americans - TODAY

2011-09-20T08:10:00.001-07:00

I'm still catching up from too many weeks on the road but wanted to get this out, since the webinar is coming up in a couple of hours. Info below...

Preparedness Considerations for Aging Americans

Click on this link to log in tomorrow September 20, 2011 at 1:50 pm EST!

No registration is required. Please log in tomorrow as a guest.

In this webinar, you will learn about specific preparedness steps for Aging Americans. Hear from FEMA officials and leaders at the forefront of Aging American Preparedness and have your questions answered:

What can I do to bring preparedness to my community?
What are the free resources available to me?
How do I connect with my state emergency management?

If you know or care for someone that is aging, you'll want to join.

Getting Real II - Promising Practices in Inclusive Emergency Management for the Whole Community

2011-09-12T06:00:00.000-07:00

I'm still traveling so I'm still running behind with getting things from my email and Twitter feeds to post. Below is information about a workshop and webcast being hosted this week on integrating whole community practices. I was able to watch parts of last year's webcast (this year I'll be in training or on a plane so I'll miss the live version) and the discussions were outstanding. If you have time to log on for even a few of the sessions I highly recommend it.

----------------------------------------------------------------------------------------------------------------

The Office of Disability Integration and Coordination ODIC at the Federal Emergency Management Agency and our co-sponsors, the National Council on Disability NCD and the National Institute on Disability and Rehabilitation Research NIDRR and our partners the Interagency Coordinating Council on Emergency Preparedness and People with Disabilities ICC and the Emergency Management Institute EMI are hosting Getting Real II - Promising Practices in Inclusive Emergency Management for the Whole Community, September 12-14, 2011 in Arlington, VA.

This year, we’re particularly excited to have a webcast generously supported by the National Council on Disability available for people who cannot join us in person. This webcast will include many of the Promising Practices presentations (and all will be videotaped for “on demand” viewing after the conference). Click on the link provided to register for the webcast Getting Real II

Thank you!

IMPORTANT DATES & TIMES:

September 12, 2011

7pm – 10pm: Opening Plenary

September 13, 2011

9:00am – 10:15 am: Morning Plenary

10:30am – 12:40pm: Promising Practices

12:40pm – 1:30pm: Lunch

1:30pm – 5pm: Promising Practices

September 14, 2011

8:30am – 9:30am: Morning Plenary with Administrator Fugate

9:45am – 12pm: Promising Practices

12pm – 1pm: Lunch

1pm – 3:15pm: Promising Practices

3:30pm – 5pm: Team Reports and Closing Discussion

Please plan to join the Office of Disability Integration and Coordination and the National Council on Disability by webcast on Sept 12-14 for “Getting Real II- Promising Practices in Inclusive Emergency Management for the Whole Community” http://GettingReal-II.WebCastOn.TV

NIMS Guideline for the Credentialing of Personne

2011-09-09T06:00:00.000-07:00

I'm in the midst of three weeks of straight travel. As interesting things show up on my radar I'm putting them up, in some cases with minimal comment. Apologies for the lazy blogging.

Early last week I received an email update informing me that the "NIMS Guideline for the Credentialing of Personnel" was available. It included the following paragraph:

The NIMS Guideline for the Credentialing of Personnel (Guideline) is now final and available for use. The Guideline provides guidance on credentialing for Federal, State, Tribal and Local Personnel, as well as for persons affiliated with Critical Infrastructure and Key Resources, voluntary and not-for-profit response organizations. This Guideline was developed with the participation of stakeholders from key sectors of our society, and builds on the doctrine established in NIMS Guide 0002 NATIONAL CREDENTIALING DEFINITION AND CRITERIA dated March 27, 2007. The Guideline addresses the full range of responders who may be called upon and need to establish their legitimacy through proof of Identity, Qualification/Affiliation and Authorization to deploy.

I haven't had the opportunity to review the Guideline so I can't say much about it. I do plan to take a look soon. Links below:

The Guideline and the NIMS Guide 0002 can be found at the NIMS Resource Center at the following URLs:

The Guideline - http://www.fema.gov/emergency/nims/ResourceMngmnt.shtm#item3

The NIMS Guide 0002 - http://www.fema.gov/pdf/emergency/nims/ng_0002.pdf
For more information on NIMS visit: www.fema.gov/emergency/nims

All questions can be directed to the NIC via e-mail: FEMA-NIMS@dhs.gov or via telephone: 202.646.3850.

National Preparedness Month

2011-09-07T06:00:00.001-07:00

I'm in the midst of three weeks of straight travel. As interesting things show up on my radar I'm putting them up, in some cases with minimal comment. Apologies for the lazy blogging.

Due to all of the travel I've been dealing with lately I haven't been able to spend as much time (read: any) paying attention to National Preparedness Month (NPM, because I am that lazy/pressed for time) events. One that I do normally try to track is the registration of coalition members. See below for details, from an informational email sent by FEMA's automatic system on 1 Sept, the first day of NPM:

The devastating impact of Hurricane Irene, the east coast earthquake, and this year's tornadoes in Tuscaloosa and Joplin have all been critical reminders about the importance of preparedness.

With the 10 year anniversary of 9/11, we do not want to miss this historic opportunity to demonstrate the private sector’s leadership and commitment to emergency preparedness. It’s time to take action.

Register now it only takes 97 seconds. Just 97 seconds to be part of the team, and part of the solution.

As a coalition member, you will be armed with content, customizable materials, creative ideas, resources, and much, much more to assist you in taking simple steps prepare your business, your employees, your families and your community.

Simple keys:

· Even if you have signed up last year, you need to sign up again.

· Click on

· Then get someone else to sign up too.

Please be a change agent. Please make a difference. Not the time to stand on the sidelines. 97 Seconds. You just may save a life.

Because of work, I end up registered without having to do anything and I encourage anyone reading this to register themselves.

National Preparedness Month webinars

2011-09-05T11:39:00.000-07:00

I'm in the midst of three weeks of straight travel. As interesting things show up on my radar I'm putting them up, in some cases with minimal comment. Apologies for the lazy blogging.

I'll have more to say on National Preparedness Month, but since the first of these webinars is Tuesday I wanted to get this posted. The following information came from a FEMA email and lists a series of webinars that are being held throughout September (National Preparedness Month).

National Preparedness Month Webinars Prepare Businesses, Children, Schools,

Pet Owners and Aging Americans

Click Here for National Preparedness Month Webinar Login Information

September Webinars for National Preparedness Month

National Preparedness Month (NPM) presents the perfect opportunity for everyone to get involved and learn more about disaster preparedness. In the wake of recent events such as Hurricane Irene, the East Coast earthquake, and the Joplin and Tuscaloosa tornadoes, now is a critical time to promote preparedness education.

Join us for these upcoming informative webinar sessions aimed at educating individuals, communities and organizations about the various aspects of preparing for a disaster in today’s ever-changing world:
September 6^th: Implementing a Youth Preparedness Program as you Kick-Off the New School Year - This webinar was previously scheduled for August 23^rd; however due to the East Coast earthquake, is rescheduled to September 6^th.

This webinar provides you with resources for implementing an effective youth preparedness program including:

Implementing and funding a youth program
Choosing from currently available curriculum
Evaluating and sustaining a program

Hear from those who have effectively developed and delivered some of the most successful youth preparedness programs across the country and learn more about engaging today’s youth in disaster preparedness!

September 8^th: Extension Disaster Education Network (EDEN): Improving Disaster Preparedness Through Education - Help with education in all disaster functions may be closer than you think. Since 1994, the Extension Disaster Education Network (EDEN) has focused on providing disaster education at the local level through each state’s land-grant university. Learn more about:

EDEN’s role in preparedness education
Various preparedness education resources EDEN provides
How to engage with EDEN

September 13^th: Available Resources to Prepare Schools - This webinar will answer many of your questions about getting schools prepared for a disaster of any kind. If you are a school administrator, principal, teacher or concerned parent, you won’t want to miss this integral discussion. Some of the questions to be discussed include:

How was Joplin successful in preparing for and recovering from a disaster? How can other schools learn from their experience?
Where can schools find additional funding and resources in today’s budget climate? How does the DHS grant process work?
What free preparedness trainings are available for schools and school administrators, both online and in person?
What preparedness resources are available to schools at little or no cost?

September 15^th: Preparedness for the Pets in our Homes and in our Hearts - Whether it is a cat, dog, turtle, fish, horse, cow or llama – animals are a very important part of our lives; however when it comes to preparing for disasters, they can pose some unique challenges. Join us to learn from pet and livestock emergency preparedness experts about:

The considerations and trends emerging in household pet and livestock readiness strategies
Disaster preparedness resources available to those with animals in their lives

September 22^nd: Preparedness Considerations for Aging Americans – Log in and learn about specific preparedness steps for Aging Americans. Hear from FEMA officials and leaders at the forefront of Aging American Preparedness and have your questions answered:

What can I do to bring preparedness to my community?
What are the free resources available to me?
How do I connect with my state emergency management?

If you know or care for someone that is aging, you’ll want to join.

September 27^th: Earthquakes can happen anywhere. Are you Ready? – You only have seconds. Do you know exactly what to do the moment the ground starts shaking? If it involves a doorway, a triangle, or running – these are not quake-safe actions. Participants on this webinar will learn:

How to get your organization involved in ShakeOut – the largest earthquake drill in the country
Actions to take during an earthquake, taught by experts from ShakeOut and FEMA
Where to register so you can practice updated quake safety and learn more about quake preparedness

Be sure to sign up as a National Preparedness Month Coalition member! In as little as two minutes, you will have access to preparedness events taking shape across the country, templates, new ideas, and tools to promote your preparedness activities. We are dedicated to forming a coalition that is large and diverse; so America’s communities can become better educated through the people they know. Let’s work together to find new partners and bring preparedness to the forefront year round.

Thank you for your participation!

Presidential Policy Directive 8: National Preparedness Goal

2011-08-30T06:00:00.000-07:00

The following is the text of an email regarding PPD-8 that came out from FEMA as part of the public outreach campaign:

Presidential Policy Directive 8 (PPD-8), signed by President Obama in March 2011, calls on all levels of government, the private and nonprofit sectors, and individual citizens to play a more active and well-defined role in strengthening the Nation’s security and resiliency.
This forum provides an opportunity to comment on some foundational concepts that apply to all PPD-8 requirements. In addition, we are also separately seeking input for the first draft of the National Preparedness Goal (NPG) on www.fema.gov/ppd8. Both will help FEMA to achieve the requirements of PPD-8.

For this forum, we would like your input and ideas on any or all foundational concepts by focus area (e.g., Prevention, Protection, Response, Recovery, and Mitigation) and for preparedness overall. We welcome your thoughts, questions, or ideas about a secure and resilient nation, including whether the narratives provide an adequate description of the focus areas, the capabilities needed to achieve success in the focus areas, and what role the community should play in these focus areas. Please visit http://fema.ideascale.com and click on the “Presidential Policy Directive: National Preparedness Goal” link under Campaigns to provide us with your feedback.

Background Information: The first two requirements of the Directive are to develop a National Preparedness Goal and the National Preparedness System. For more information on these requirements, visit www.fema.gov/pdd8.

FEMA and Hurricane Irene

2011-08-28T15:03:00.000-07:00

The following is the text of an email received from FEMA on Hurricane Irene efforts and preparedness:

Dear Partner,

As Hurricane Irene threatens much of the East Coast, we are seeking your assistance to cross-promote various preparedness resources on your websites and in social media.

FEMA offers hurricane preparedness information here: http://www.ready.gov/america/beinformed/hurricanes.html

In addition, please follow / amplify the @fema, @CraigatFEMA, @readydotgov, @DHSJournal, and any state/local emergency management agencies that are posting updates. We’ve also created a list of Twitter accounts posting updates, so feel free to promote that as well: http://twitter.com/fema/irene.

Key messages/potential social media posts for Saturday August 27^th:

Aug 27: #Irene may cause flooding or flash flooding – avoid flooded areas & roads. Turn around, don’t drown. cc: @fema

If you may be affected by #Irene, follow the direction of local officials & avoid flooded areas. Safety tips on your phone: http://m.fema.gov

Aug 27: For severe weather watches/warnings in your area -http://www.weather.gov or on your phone at http://mobile.weather.gov #Irene

Receive text msg updates f/ @Twitter accounts posting #Irene updates. Text follow + their acct name to 40404 (@Twitter’s number)

Aug 27: Bookmark useful mobile sites- #hurricane safety tips http://m.fema.gov. Your local forecast http://mobile.weather.gov #Irene

What has been consuming my time - THIRA part 1

2011-04-19T09:25:00.000-07:00

I've been meaning to blog about this for a while but have been so consumed by the project that I haven't had time. For the last month or so we've been prepping to present a proposal on a Threat Hazard Identification Risk Analysis (THIRA) model to senior leadership for a green-light, and as of yesterday afternoon (after I think four reschedulings) we got it. I'm going to outline the project here and in future posts will update with progress.

One of the major components of my current assignment is a comprehensive risk assessment of our area of responsibility. The only complication, and I'm not even sure I consider it a complication really, is that there isn't any specific or required method to follow in carrying out the assessment. So my boss and I have been working on our own formula, based on other standards we've tracked down.

Most preparedness/emergency management oriented folks are probably familiar with the HIRA concept in one form or another, if not under that name at least the risk analysis concept and the:

Risk = Probability x Vulnerability x Consequence

formula. We started there but expanded slightly and added a "threat" category which we're using to cover the man-made issues, whether terrorist, "technical hazards" (a good example of that is the Fukushima power plant situation currently unfolding in Japan), or other events of that sort. That got us to the basic components that we wanted to cover but the more we looked into it the more we found that nobody really agrees on exactly how to get to the "Probability", "Vulnerability", and "Consequence" pieces.

There were a few other things we wanted to be able to take into account, modifiers if you will:

Warning time - Some hazards modify their own Risk, reducing it, by their very nature. What I mean is that any hazard that you can see coming hours or even days away gives even the most un-prepared person time to take some action. Given that, we wanted to find a way to recognize that "notice" events should have a slightly lessened Risk than "no-notice" events.
Preparedness - We wanted to acknowledge that many jurisdictions that were actively preparing for specific hazards, either by reviewing/updating plans, conducting exercises, or even by having recently responding to a similar event. By virtue of those activities, if taken recently enough, they would reduce the potential impact of the hazard. They wouldn't necessarily reduce the Risk, which is based on the PxVxC formula, but the would mitigate some of the impact of the incident overall.
Leadership priorities - The last modifier that we wanted to include was a way for leadership to look over the list of threats and hazards that we had selected, the categories that we were analyzing, and identify the ones they felt were the most important for us to focus on. This was really an acknowledgement of the political reality - we may have data that tells us that certain hazards are the most likely to happen but there are others that are more politically sensitive, making them higher priorities for us to act on.

All of this boils into the THIRA model that we put together, which ends up looking something like this:

Risk = Probability x Vulnerability x Consequence = R

Risk can be modified (reduced) by warning time = R1

R1 is modified by Preparedness (P) and Priorities (Pr) = R1 x P x Pr = THIRA

The last component is that we have a weighting factor added in to the THIRA formula. Each of the three component (R1, P, Pr) are weighted by a factor determined by leadership, from ten total points. This is to allow one last opportunity for leadership to provide their input to the model, to indicate which component they feel is the most important. It also allows us an opportunity to demonstrate how far we have to skew the model if a particular low-risk event is identified as a high priority item.

In future posts I will explain the formulas we're looking at for each of the components (P/V/C) as well as some of the data sets we've identified. And that second point brings me to a question for readers - if you have recommendations for data sets please let me know, either in comments or email. We are looking for as much data as possible to populate to initial model and the more the better.

Reunification

2011-02-23T07:31:00.000-08:00

I was listening to a recent episode of LeShow, Harry Shearer's comedy/news radio program and he went into one of his regular topics - the situation in New Orleans. For those who don't know, Shearer is a part-time resident of New Orleans, so the Katrina situation impacted him more personally than many of the celebrities who made noise in the initial days and have since gone quiet.

(On a related, important, but tangential note to this post - if you're in a place to catch his film "The Big Uneasy" check it out. I'm looking forward to catching it in Sacramento in March. If you aren't aware, the film looks into issues around the failure of the levees and other flood-protection mechanisms, and the role of the Army Corps of Engineers in creating the disaster. After I've seen it I'll be in more of a position to comment.)

Anyway - what I wanted to talk about is the issue of reunification. On the show, Shearer was commenting on the recently released information from the census and the impact the unplanned evacuation during Katrina had on the population of the city. It's an issue he's spoken about before, the problem of there being thousands, if not tens of thousands, of residents who were evacuated to various miscellaneous locations without much effort to track them, and there now being little or no way to find them.

What this always brings up for me is - who should take the primary role in reunification? What I'm thinking about here is the role that a community, in this case the very vibrant community that makes New Orleans the great city it is, could play in reunification. Using the governmental systems in the initial stages makes perfect sense, but when it's clear that they're not cutting it, which is the case based on Shearer's comments, is it time for the community to take over? There may be websites or other ways to communicate that community members are aware of and non-community members wouldn't know. Additionally, community members would have a much better idea how many people are missing, including if there are any specific groups that need outreach (faith communities, ethnic groups, etc) and other specialized details that "officials" just don't have.

In a lot of ways it reminds me of a project one of my professors in grad school was working on, looking at ways to connect faith communities and local governments for emergency response and preparedness. His idea is that the faith communities know their members and their needs, and the local governments have the resources to help in disasters - by getting together the local governments can help the faith communities when they have members who need assistance that goes beyond what the community can meet.

In the case of reunification, the community could be the group to design the information, and the government (depending on the size of the event, local, state, or Federal) could be the mechanism for getting that information out.

It's just my thoughts, and I haven't done a lot of work or research on the subject so any thoughts or comments would be great.

Public Health Preparedness Summit

2011-02-17T13:26:00.000-08:00

I've been lax with posting, relying more on re-tweeting than anything else, but I wanted to shoot out a quick note to let folks know I'll be down in Atlanta next week for the Public Health Preparedness Summit. I've been off and on and it's a great meeting.

"Get a Kit"

2011-01-26T14:03:00.000-08:00

Last week I wrote about some of the things in Ready.gov's "Resolve to be Ready". Today I want to look a little more at one of the specific areas of personal preparedness, which carries over into professional preparedness - having a kit.

There are actually two different types of kits, one is the home/personal preparedness kit referred to in Step 1: Get A Kit at Ready. gov. From the site:

You may need to survive on your own after an emergency. This means having your own food, water, and other supplies in sufficient quantity to last for at least three days. Local officials and relief workers will be on the scene after a disaster, but they cannot reach everyone immediately. You could get help in hours, or it might take days. In addition, basic services such as electricity, gas, water, sewage treatment, and telephones may be cut off for days, or even a week or longer.

So this is pretty straightforward - to take care of yourself (and your family, pets, etc as appropriate) you need the right stuff. In a recent interview he gave with Wired Magazine, Craig Fugate spoke about this, and the whole "you're on your own for 72 hours" paradigm from a slightly different angle than I've heard it spun before. Rather than stressing the idea that it will take that long for government services to be back up and running, the point the FEMA Administrator made was that if you are able to prepare and don't you're getting in line, potentially in front of people who aren't able to take those same steps. Additionally, he said, you're putting an added stress on the limited services available in the initial hours after an incident when the focus needs to be on USAR and life-saving.

The other type of kit is the evacuation kit, commonly referred to as a "Bug Out Bag" or BOB. The idea here is similar, you want a kit that carries the items you need to take care of you and your household, but it needs to be mobile. That might mean breaking the kit down into smaller, more portable containers, keeping some heavier and more stable items in the car all the time (swapping out like batteries in fire alarms, at time changes), or other similar ways to overcome having to haul what could be a 32 gallon trashcan worth of gear.

There are too many good sources for BOB information online, but one great article that I will recommend is from Mike Coston's "Avian Flu Diary from a while back. The post is here.

Better late than never

2011-01-19T06:00:00.000-08:00

I meant to get to this a while back, and it's a good three weeks out dated now, but like I said, better late than never. If you don't follow the goings-on at Ready.gov, the FEMA Individual and Community Preparedness website (and let's face it, there probably aren't too many of you who really follow it), you may have missed the "Resolve to be Ready" campaign they were pushing around the new year. From the site:

As the New Year approaches, the Federal Emergency Management Agency's Ready Campaign is once again reminding people to Resolve to be Ready in 2011. Americans who make New Year’s resolutions are 11 times more likely to report continued success in achieving a goal than individuals who have not made a resolution, according to the Journal of Clinical Psychology. The Ready Campaign would like to make an emergency preparedness resolution easy to keep by providing the tools and resources needed to take the three important steps: get a kit, make a plan and be informed about the different types of emergencies that can happen in your area and their appropriate responses. We hope you will join the Ready Campaign this Holiday Season in promoting Resolve to be Ready.

The site (both the Resolve subsite and the larger Ready site) have a lot of good resources supporting the "Get a kit, Make a plan, Be informed" message of the site and the Ready campaign. In future posts I'll revisit the campaign, focusing on some of the other targeted subsites (Ready America, Ready Business, Ready Kids, Ready Responder) and look at the different materials each has.

At the end of the day, the general site theme is the important thing, and the idea behind it is what I'm going to be returning to for the next little while. One of the big areas of focus for FEMA as an agency in this fiscal year, and for the length of Administrator Fugate's tenure, will be raising the level of preparedness of the general community (the "whole of community" which I'll write about soon) with the point being that the Federal government, and even State, Territorial, Tribal, and Local governments, don't have the resources to respond to a truly catastrophic incident unless the general public is ready and able to pitch in. This links to the idea that survivors want to help out and are actually a fantastic resource that we have tended to under utilize in the US in disaster response in the past.

But like I said, I'll get to that in future posts.

Returning in 2011

2011-01-02T10:37:00.000-08:00

So I've been away for far longer than I thought likely. Work expanded due to some personnel shuffling which meant that I didn't have much energy left at the end of the day to be thinking and/or writing about emergency preparedness topics and on top of that I've had some family issues that took up what little time was left.

Sometime in the next month or so I'll be moving to a different assignment and one that will involve a lot more policy review and analysis as part of my day-to-day. That being the case, I plan to reactivate the blog and write again. My plan is for weekly posts and with a new Congress coming into DC I expect there will be plenty of new proposals and policies to analyze and pick apart.

I don't know how many people are still subscribed, and hopefully more will come back as I get back to posting regularly. Thank you for your patience.

Briefly noted - National Disaster Recovery Framework

2010-02-22T19:54:00.001-08:00

The following is the full text of an email I received today. Since the deadline for comments is Friday I wanted to pass this on as is.

PUBLIC COMMENT PERIOD REMAINS OPEN UNTIL FRIDAY FOR DRAFT NATIONAL DISASTER RECOVERY FRAMEWORK

Individuals and other stakeholders who still wish to submit comments on the draft National Disaster Recovery Framework have until Friday, February 26, 2010 to do so. The framework – focused on engaging state, local and tribal governments, nonprofit partners, the private sector, and the public to enhance the nation’s ability to recover from disasters – is available to read online at DisasterRecoveryWorkingGroup.gov. All comments must be submitted at www.regulations.gov in Docket FEMA-2010-0004.

The comment period is part of an extensive stakeholder outreach effort undertaken by the interagency Long Term Disaster Recovery Working Group. The draft framework was developed based on input from all levels of government, the private sector, academic and emergency management communities, voluntary and non-profit organizations, and a wide array of associations and organizations—collected through meetings and briefings across the country; online engagement; and a series of video teleconferences and stakeholder forums in five key cities.

For more information about the Recovery Framework, visit http://www.fema.gov/recoveryframework. Information about the Long Term Disaster Recovery Working Group is available at http://disasterrecoveryworkinggroup.gov.

You are subscribed to email updates from the FEMA Private Sector Division/Office of External Affairs. Contact the Private Sector Division at: FEMA-Private-Sector@dhs.gov or visit us at www.fema.gov/privatesector, Facebook, Twitter, and Youtube.

Unified Command

2010-01-27T08:16:00.000-08:00

This is going to be a dashed-off piece, triggered by a new story I saw a couple of days back.

One of the core tenets of the Incident Command System (ICS), as pushed by the US through the National Incident Management System (NIMS) is unified command. Briefly stated this is the idea that all people with authority for an incident are "at the table" and making decisions collectively. In Federally managed event (i.e., when FEMA is involved) this is done through the Unified Coordination Group (UCG). Most UCGs will include:

Federal Coordinating Officer (FCO) - the individual named by the President in the Stafford Act declaration to oversee all Federal personnel
Governor or Governor's Authorized Representative (GAR)
Defense Coordinating Officer (DCO) - liaison from DoD to FEMA
State National Guard
Local leadership

This group meets regularly, based on the operational period, to outline the objectives for the next operational period. Operations and Planning personnel take those objectives and develop the Incident Action Plan, which outlines the tactics that will be employed.

An example of this working very well is the recent Federal response to the American Samoa earthquake and tsunami in October 2009. The FCO and DCO assigned are based in Hawaii, and the Governor of American Samoa was visiting Hawaii at the time the event occurred which allowed the three of them to get together before assets had begun flowing to discuss priorities and begin coordination.

Moving to the current disaster, I saw this article from the Guardian a couple of days ago:

The Haitian prime minister, Jean-Max Bellerive, told the Montreal conference that his government needed to rely strongly on its partners but said Haiti was able to lead the rebuilding effort.
"Haitians continue to work in precarious conditions but it is in the position to assume the leadership expected of it by its people in order to relaunch the country on the path to reconstruction," he said. However, Bellerive admitted the government was facing serious legitimacy issues as people question whether it exists at all. The destruction of key government buildings has hampered the work of what was already a weak and inefficient state.

In short, the article outlines the Haitian Prime Minister speaking to a conference of supporting countries and explaining that Haiti is ready to take the lead in the response effort. This is where things can get messy, if the impacted nation is truly ready to take leadership they should be able to but many of the responding agencies are acting under their own authorities and might not acknowledge a foreign nation's right to direct their actions. In this case it is even more messy than a normal response (domestic or with a US territory or protectorate) because if we don't cooperate appropriately the Haitian government might find itself having to ask our personnel to leave, even with the massive negative impacts.

That being said, implementing a unified command and making sure there is full participation from all involved can lessen or remove this obstacle. Having the Haitian government in the UCG allows them to set the priorities and objectives, but doing it collaboratively allows the other nations and agencies (I'm thinking primarily of US DoD) to remain in their chain of command. It also will assist the Haitian government in reasserting itself and demonstrating that it is ready to lead the nation again, while having the full resources of the international response community backing it up. The most important thing to avoid, for the sake of the Haitian people, is the international community setting up in one place and the Haitian government setting up in another.

He [Prime Minister Bellerive] said Haiti's government had set up six groups to deal with issues such as humanitarian aid, housing and security. He said each group was being led by a minister as well as an international party. But the Italian government official who led the country's response to the L'Aquila earthquake condemned the relief efforts in Haiti as a disorganised "vanity parade". Guido Bertolaso, the head of Italy's civil protection service, said there had been a fundamental lack of leadership thus far in foreign aid missions to Haiti

It's not a perfect system, but it does work.

Quick note - HHS Haitit resources

2010-01-21T13:56:00.000-08:00

I've been slammed at work and not able to get back into a rhythm posting yet. I did want to take a moment to draw attention to a handy little widget that HHS has built (code here) to link to all of their resources for the response to the earthquake in Haiti. I'll keep the widget up until the site it links to is no longer valid, and encourage other folks, especially on the public health side of things, to add it to their sites aw well.

HT - Homeland Security Digital Library

An apology

2009-12-14T16:49:00.000-08:00

When I started my series on reporting I had intended it to run weekly for a month. I'm well into the second month and haven't written the final piece yet. The short reason is that as I was drafting it a number of new products caught my eye (including the very newly announced Virtual USA) and I'm holding off until I have a chance to look at some of them. I will be back on a weekly schedule after the holidays.

Reporting - Three of Four: Operations

2009-12-02T16:27:00.000-08:00

In the two preceding posts I spoke about "reporting" and how it currently relates to preparedness activities like grant monitoring . Today I want to look at reporting during operations. I will draw on two specific experiences for this: involvement in weekly and then daily data calls for H1N1; and operations in support of a declared disaster.

One of the constructs the Federal government has come up with to manage a pandemic is the Regional Coordination Teams (RCT). These individuals serve as strategic-level managers sitting over two FEMA Regions and provide a link between the Sec. of Homeland Security and the Regions. A large part of their role in the fall H1N1 outbreak has been linked to situational awareness. Initially, the RCT were reporting on a weekly basis while the FEMA Regional offices, usually through a Watch, were reporting daily. Those reports were then combined so that there was a single RCT report being filed daily. These reports are submitted in a few different ways, including secure sites like the Homeland Security Information Network (HSIN) and email. From the beginning this has struck me as an inefficient system, where an existing model (a single daily report, whether or not there is anything to report) is being forced to meet a need (accurate and timely information) that it really doesn't fit. More on that in a bit.

My other recent involvement in the operational reporting chain was working at the Regional-level in support of teams deployed to two different events at once. Again, the reports were flowing two-way with field responders sending information up on a specific calendar so that reports could be completed to send up at a specific time. This fell apart almost instantly each day because the various conference calls and data needs both internally and from us to others (HQ) often took place at different times based on events. Again, trying to use a fixed schedule sounds like it would provide stability to the response by giving a set time to follow, but all it really does is lead to having to repeat drafting reports documentation because you have to prepare something with incomplete data and then update as you go.

These two very different events (one developing on a very slow pace and the other moving very rapidly) illustrate the same problem with operational reporting: we are still greatly mired in older models where information is collected and vetted centrally before being distributed, often back to the same people who provided the information in the first place. Instead of this we need to move to a system where the data is accessible from multiple locations at the same time, allowing people to develop the reports that they need without waiting for a single, centralized report. If there is a concern about data being shared prematurely it can be marked appropriately as Not For Distribution. This would remove many of the burdens that are currently placed on field responders and planners to provide information at a moment's notice in response to a request from higher in the food chain. It would also allow different agencies operating with the bulk of their personnel in a different location (such as a department operations center) to have easy access to the same information as their colleagues in the EOC (this is the way the system was set up when I was working at the local level).

Next week I will wrap up this set of posts with a description of what I feel would be a better reporting system, one that would be useful for preparedness and operational needs.

Reporting - Two of Four: Preparedness

2009-11-16T07:34:00.000-08:00

Today I want to discuss what I'm calling "preparedness" reporting: the information collected, primarily at the Federal level, either as part of a grant application or grant monitoring process, or to otherwise assess "compliance" with specific requirements (e.g., NIMSCAST). In my professional career I have been on both sides of grant monitoring - preparing documents and data for a site visit while at a local health department and reading submissions at the Federal level - and in both cases have felt that the system as it stands is unnecessarily burdensome.

At the local level I worked to support our Director while she prepared for a Cities Readiness Initiative (CRI) review, which involved filling the Executive Conference Room with binders and files on any program that had any possible relationship with the CRI program and then sitting through two days of evaluation and discussion with a team from the CDC and the state CRI coordinator. During that time almost all other work in the office ceased since there were only four of us and all were needed to compile all of the information required. While there were undoubtedly some inefficiencies in the way we prepared because the Director was new to her position, the review was so all-encompassing that even an experienced person would have needed the better part of a week to get ready. The reviewers weren't looking for knowledge of the program but specific documentation, so being well-versed in the preparations wouldn't have been enough. The only way to be more prepared would be to base your filing system around the information requirements so that re-sorting wouldn't be needed.

Until the next program came by for a site visit and you had to start all over based on their requirements.

On the other side of things, I've been involved in reviewing monitoring information on a couple of different grant programs, and will use the Regional Catastrophic Preparedness Grant Program (RCPGP) as an example. Details on the RCPGP are available at the link, but it is essentially a program where FEMA gives money to urban areas for regional planning, similar to the UASI program but all-hazards. The RCPGP has a complex monitoring process, which includes quarterly site visits and an on-going program plan (most of the ones I have seen are Microsoft Project charts) which is reviewed on the programmatic and fiscal side at the Regional office, with HQ having the final say on compliance. Our Region has three RCPGP sites (of 11 nationally), all of which submit their materials on the same deadline, and all of which have to be reviewed by our one programmatic person in a week and forwarded on. Each of the three monitoring packets was a folder about three inches thick, and at least one of the sites was far behind where they should be, necessitating extensive documentation of the efforts that have been made to pull them back on track.

And this is one of probably 10 different projects this particular person is responsible for.

Both of these illustrate a common problem; as long as we look at reporting as a discrete event, something that happens once a quarter or once a year, then there will always be a lot of catch up for both the submitter and the recipient. If, instead, we shift the paradigm and make better use of collaborative tools such as SharePoint and Adobe Connect then we can create a system where information is always available for review, where feedback comes realtime, and we can avoid projects getting greatly off track.

Next week I will address similar problems with information collection during an active response, and the following week I'll outline a proposal for a system that would incorporate both sets of reporting.

Reporting - One of Four

2009-11-04T16:54:00.000-08:00

I mentioned on Monday that I would be discussing reporting as my first long-form topic. Today I will lay out what I mean by "reporting". Over the next couple of weeks I'll follow with targeted discussions on types of reporting and a proposal for how they can be made more useful for all involved.

Emergency management reporting falls into two separate but related categories: preparedness and response.

Preparedness reporting includes information required for grant monitoring, tracking training and exercise participation, and the dozens of other requirements laid down, primarily by DHS/FEMA, to determine if a given entity is meeting the requirements for accreditation (e.g., NIMSCAST).
Response reporting refers to the information collected during operations, from field elements to the command element and vice-versa, that is used during the response to assess the effectiveness of a particular strategy and following the response for the After Action Review (AAR) process.

These two types of reports require different sets of data and are collected under different circumstances but there is a clear link between them, or at least there should be. The data collected as part of grant monitoring and accreditation should be linked to operational capabilities; and the data collected during a response should be linked to future grant applications and training/exercise programs. However, the current system of collecting data and preparing reports does not lend itself readily to this sort of cross-purposing. Data is collected in static forms, more often than not using Word templates. That information is then pulled from one static form and plugged into another (e.g., individual comment/evaluation forms are pooled into an AAR) that is distributed as a locked Word file or pdf.

What we need is a system that allows for searching and cross-referencing of data, covering both preparedness activities (e.g., projects funded with grant money) and response activities (e.g., daily situation reports from a command post at a wildfire) so that it is possible to identify the links between the two. With this sort of linked system it would be possible to, let's say, evaluate the effectiveness of a jurisdiction's use of FEMA's Assistance to Firefighters grant program by evaluating the performance in the response of the assets funded by the grant, and not based solely on the information in the grant monitoring paperwork. It is possible to do this sort of cross-referenced evaluation now, but it requires an investment of human capital to review:

Grant monitoring paperwork - both fiscal and programmatic;
Operations logs to determine when the assets funded through the grant were activated;
Situation reports to determine the types of missions those assets were used for;
AAR (if they exist) to determine the effectiveness of those assets.

Since each of the above listed reports will be in different formats, including what may be hand-written operational logs, and none of them are likely to be context-searchable, tracking a single asset from purchase with grant funding to deployment and evaluation will require one or more persons to hunt through piles of reports looking for some kind of specific identifier. Once the asset of interest has been found it might be possible to track it through all of the different reports, but only if it is listed in the same way in all of them.

Over the next two weeks I will look more closely at the two identified types of reporting, and I will then end the month with a specific proposal to link them. I look forward to what I hope will be an active discussion of this issue, which I know greatly impacts emergency managers at all levels.

Returning

2009-11-02T09:56:00.000-08:00

I've been away from this for far longer than I thought I would when I wrote my last post. I won't go in to details, suffice to say that work got a little more crazy than I expected. Either way, I plan to start writing again and wanted to take this opportunity to talk a little about how I see the blog shifting focus.

When I first started writing it was primarily out of frustration. I was working for a local health department and was very pigeon-holed. All I was working on was pandemic preparedness, and despite numerous other opportunities and projects that needed doing, my assignment never wavered. That was a management decision and even a change of supervisor didn't change my workload. So I started the blog to explore other areas of preparedness/response that I was interested in. Then I changed jobs, moved across the country, and shifted from local government to Federal/regional work in general emergency management. I shifted to try and rotate through topic areas to cover local, state, and Federal issues. To be honest, after a while it felt forced, and that was when I suspended writing.

I've decided to shift focus a little, back to one of my original idea, and use this space to explore areas of the field that I want to delve into a little more. I will be posting only a one or two times a week, and hopefully the posts will be deeper than before.

The first area I will be looking at is information collection and dissemination within an organization. Not crisis communications, but how reporting does and should flow. This will be drawn from my experiences working in the Regional office during the early days of a dual deployment of field personnel, as well as the on-going H1N1 incident.

My hope is to use the blog to develop these topics and potentially identify areas for writing more complete white papers or policy suggestions, and look forward to discussion on them after posting.

Thanks for your patience through the months of silence.

Hiatus

2009-06-23T21:28:00.000-07:00

I will be taking a (hopefully) short hiatus from writing this blog. I've hit a point where most political debate, which is at the heart of many of the issues I like to discuss here, has me tearing out my hair. I'm going to take a little bit of time away from these issues (well, except for work where I don't have a choice) and see if I can get over the annoyance. Keep watching the feed, and I'll be back at it as soon as I can.

Joel

Pandemic - What now? (Public Health)

2009-06-15T19:21:00.000-07:00

Yesterday I threw out a sampling of the stories I've read in the last day or so about the WHO decision to declare a pandemic. Today I will be more editorial and get into what it means, from my point of view.

In a post a couple of weeks back I gave my thoughts on some of the controversy the WHO was dealing with at the time, the "will they or won't they" declare the H1N1 outbreak officially a pandemic. At the time the main problem the WHO was faced with was the fact that they had crafted a pandemic alert system that was based solely on the spread of illness. Their system didn't take severity into account. My take was that the people developing the system had done so either consciously or subconsciously based on H5N1, with its high case fatality ratio. The pieces I have read that are critical of the decision to declare a pandemic have focused in on this point. They have pointed to the 145 deaths and argued that we can't be in a pandemic because pandemics come with so many dead and dying that the social order will break down.

This is a beast of our own making.

I have been in public health, working on pandemic preparedness, so I know just how hard it was to get people who weren't epidemiologists or other public health professionals to take the potential impact of a pandemic seriously. I also know how much easier it is to make the point that preparedness is important by focusing on the worst case scenarios - not only in pandemics but in everything (the category 5 hurricane, the 9.5 earthquake). Add these two together and you have the common impression that a PANDEMIC (the catastrophic type we talked about as opposed to the textbook definition) is an illness on such a massive scale that society itself will fall apart.

Now that we're facing a pandemic that doesn't meet that criteria the skeptics are proven right. Or at least, so they will argue.

As is often the case, if you prepared for the disaster that hits you, your preparations look wasted. The easiest time to judge preparedness efforts is when they fail. If done right, proper preparation can leave you wondering if you overestimated the threat in the first place. Personally, I think that we have mostly done the right things when it comes to pandemic preparedness:

Education - While this could have been done better, the publicity over pandemic preparedness efforts, the risk, the chaos in the streets stories on the nightly news all served to make the public aware of what a pandemic could be. I doubt that it motivated many to actually prepare their own households to shelter in place, but at least the basic, Pandemic 101 part of things was done before the first outbreak.
Planning - The Federal government and agencies, states, and localities all have plans in place. Many of them are draft, many have unwarranted assumptions, and most have holes that you could drive an SNS delivery truck through, but they exist. People at all levels have thought about some of the tough questions and while they may not have answered them at least they are aware the questions exist.

Was declaring a pandemic the fear-mongering that some have claimed? a political action to justify the money (and there's been a lot of it) invested? I don't believe so. I would argue that many of the people involved would probably be happier if the declaration hadn't been made. We have no higher level to go to, there is no 11 on this amplifier. But the system is what it is, and changing it now would just continue to elicit complaints from other people that the lack of a declaration was politically motivated to avoid embarrassment or other reasons.

So what now? We continue on as we have, monitoring the situation. If it stays as mild as it has been then in a few months time when the WHO determines that the pandemic has passed we sit down and rewrite the guidance to include some sort of severity scale along with the geographic one. If it doesn't remain mild, if it kicks into high gear as the cool weather returns to the northern hemisphere, we batten down the hatches and ride it out.

Either way, there will undoubtedly be plenty of material for reviewing and investigating when it's all said and done.

Pandemic (Public Health)

2009-06-15T18:58:00.000-07:00

I was away from last Thursday until Sunday, and without internet access. I wasn't off the grid, just visiting my brother and his wife, but I didn't feel like going through the hassle of tracking down their router key to get online. Sunday night and Monday morning were my first exposure to the pile of "IT'S A PANDEMIC" news. Rather than rehash, since most readers who are interested in pandemic news have already seen it, I figured I'd link to the more compelling stories I encountered when I got back online. If nothing else this post will serve to illustrate some of the places I look for information. Due to the number of links I'm just copying titles and attaching the link to them. Also, these are in the order I found them, which may or may not be related to the initial publication.

Now keep in mind, those are only the ones that dealt mostly with reporting on the declaration (as opposed to fallout, next steps, or editorializing - if I'd included those we'd be here all week). For better or for worse, this is BIG NEWS. Tomorrow I'll add some of my personal thoughts on what this means.

Reccommended article (Public Health)

2009-05-27T09:00:00.000-07:00

Effect Measure is a fantastic blog for people interested in all aspects of public health. This piece is an excellent, easy to follow explanation of the process that we are currently in for developing a vaccine for H1N1. I recommend that anyone interested in the vaccine development process, or that just wonders how it all happens, head over and check it out.

Swine flu: why does it take so long to make a vaccine?

WHO, Pandemic Alerts, and Severity (Public Health)

2009-05-27T06:00:00.000-07:00

I'm a little late to the game on this topic, but it is something I want to speak on for a number of reasons. After quickly raising the H1N1 to the penultimate Pandemic Phase, the World Health Organization started to hesitate on following on to the final one. We are now, still, at Phase 5 of 6, defined as (link to pdf) "The same virus has caused sustained community level outbreaks in two or more countries on one WHO region". I'm not going to second guess the rapid change or the hesitation to push the button an call the outbreak a pandemic. That has been done by others far more ably than I could. Instead, I'm going to discuss the problem from my experiences as a local health department pandemic planner and now a Federal preparedness employee tangentially (to my job) involved in developing an internal pandemic response plan.

Is WHO redefining pandemic, as some have suggested? In my opinion, no. WHO is looking at altering its pandemic alert phases, and changing when it issues certain recommendations. A pandemic is an epidemiologically defined event, and as such is not really something WHO can redefine. However, the alert phases for a pandemic event are defined by WHO, and everyone else (see below) and as such, are open to redefinition. The current Phases were developed "after three years of consultations and drafting, were drawn up while the WHO and the influenza experts who advise it were nervously watching the H5N1 avian flu virus". They weren't based on a pandemic-level outbreak and clearly were written (as were many of the existing plans) based on a single virus (H5N1). That being the case, I think a better question than "is WHO bowing to political pressure to redefine pandemic?" is "isn't it sound science to modify your hypothesis when you get more data?"

Should we include virulence, or some other measure, in the pandemic Phase? Dr. Racaniello argues that no, virulence has no place is determining if an outbreak is pandemic, and he has far more epidemiology than I do. As he makes clear in his post "pandemic" is all about spread, not severity. I will argue, however, that in the definition of a pandemic alert Phase, virulence is key. An outbreak with a low severity clearly requires a different response than one with a high severity, and the system that planners use to trigger actions needs to reflect this. You have the WHO Phases, the US Government Stages, DHS (yes, last time I checked they were part of the US Government but that didn't stop them from developing their own) Pandemic Response Phases. In addition to these, the US government has also adopted a Pandemic Severity Index. All of these together are enough to make planners pull out their hair.

I've been involved in drafting two plans. One, the Federal one, is tied to the USG Stages - we had multiple agency personnel involved in that planning effort and the USG Stages were the most apolitical set to go with. The H1N1 outbreak brought some problems with that plan to light, namely the fact that the USG Stage didn't change, but the area covered by the plan was in a part of the country that was significantly impacted. Had the outbreak been more virulent we would have been caught in a "steady state" mode. The other, a local health department (and foundation for the city) plan used the USG Stages, but more directly referenced a set of geographic triggers (clusters of cases at specific geographic distances from the city triggered a move to a higher level of activation). The H1N1 outbreak justified this approach, because it requires a certain concentration of cases at a specific distance away before activation. There were some cases, but not a sufficient quantity in any one location. The problem with this sort of approach for WHO is that it's awful tough to pick which location you're going to use as the center of your geographic triggers when you're making global recommendations.

Is WHO holding off declaring Phase 6 (Pandemic) for political/PR reasons? I've seen this discussed in a number of places, highlighting the resistance of certain UN member nations to calling the H1N1 outbreak a pandemic. I also think about the public health people, especially on the preparedness beat, that I've worked with. I think, less than political, there is concern at WHO that if they pull the pandemic card out now, for a currently low-severity outbreak they're going to have nothing left if it ramps up (as many fear it will) in the northern hemisphere come fall. The problem is that the system they have more or less requires them to call it a pandemic now, and that's why they're trying to rewrite on the fly.

I don't see an easy way out of this for WHO. They built a system of alerts based around a certain outbreak, if only subconsciously, and then got hit with a different one. I can see two ways forward. One is to simply follow the US model and add a severity index to the existing alert. That would allow them to call the H1N1 a pandemic, which it is, and then identify it with a severity of 1 or 2 and allow that to modify the response recommendations. The other is to try and develop a single system that includes both the geographic nature of the outbreak (the current system) and some factor of its virulence, which seems to be the way they are leaning. I fear that will only lead to confusion and further dissatisfaction given that they will continue to be seen as trying to dodge the "pandemic" label for H1N1, for whatever reason.

References:

Effect Measure - Swine flu: WHO and its pandemic phases
NYTimes - WHO to rewrite its pandemic rules
H5N1 - Branswell: WHO under pressure to redefine "pandemic"
Avian Flu Diary - WHO to change citeria for declaring a pandemic
Virology Blog - WHO will redefine pandemic

Briefly - Hurricane Preparedness Week (Federal)

2009-05-25T23:28:00.000-07:00

This may not truly be a "Federal" post, probably better as a "Personal Preparedness" but if I follow my own schedule that would have it going out on Thursday, and what's the good in drawing attention to a "week" one day from the end? As I discovered yesterday, this is "Hurricane Preparedness Week". This comes at an extremely convenient time, as I am on the road for the next two weeks for a major hurricane exercise. This week is workshops (training) and a tabletop, next week is a three-day functional.

Rather than rehash, I'll send you out to the fantastic Avian Flu Diary for Michael Coston's lengthy and detailed post on the week and hurricane preparedness. Also, here is the FEMA official page for the week, which includes a nice list of items for a hurricane preparedness kit.

On the road again

2009-05-24T19:04:00.000-07:00

For the next two weeks I'll be on the road to conduct a series of exercises. Hopefully I'll be able to get some pieces posted since there's a lot going on.

H1N1 (Public Health)

2009-05-20T06:00:00.000-07:00

Continuing in the same line as the last two days, I want to talk about a few specific areas of the public health response. As I see it, there were three things that the public health community was primarily responsible for in this event. They are:

Crisis communication
Distribution of SNS and other medical assets
Surveillance (in this case I mean it very broadly to cover everything from initial detection to case confirmation

I will take each one in a little more depth below, especially the last.

1) Crisis communications: I've already said some of my thoughts on this topic, and Jimmy Jazz has an excellent post on it. In short, public health (at all levels, but especially the Feds from HHS and CDC) should have been the go-to people for messages about the outbreak, how serious it really was, and what actions people should take. Our media being what it is, things didn't always work out that way. The Feds tried to stay in front of the story, with daily CDC calls, daily DHS, HHS press conferences, and other similar activities, but a lot of that was knocked down by a Vice President with a chronic case of leap-before-you-look.

2) Distribution of SNS: One of the biggest actions that HHS took was a deployment of 25% of the 66% of the flu items in the SNS to impacted states. Let me try and make that a little more clear - of the pandemic supplies in the SNS 66% was purchased by the federal government, and 33% was purchased by the states; as the H1N1 outbreak was ramping up, HHS made the decision to deploy 25% of the Federal portion (the 66%) to states without their having to request it. This is the medical equivalent of pre-positioning food/water stockpiles before a hurricane hits the Gulf Coast. It's too early to get a good read on how much of that deployment was necessary, but even so it proved an invaluable test of the system itself. Now, instead of looking at the main SNS deployment numbers, which are "within 48 hours from the time a request is approved" and which are based on a single community or area needing assets, HHS can look at the time it actually took to activate a nationwide deployment. Additionally, states and locals have a chance to evaluate their Receipt, Staging, and Storage (RSS) plans and the rest of their distribution system.

3) Surveillance: As I said, I'm using this far more broadly that is probably legitimate, but there are a couple of related issues that I'd rather talk about together. On the one hand, we have what seems to be a failure of the US surveillance system to pick up the worrying cases in Mexico until after Canadian authorities. On the other, we have the time delay in getting specimens processed and confirmed as H1N1 by the CDC labs. (NOTE - this is based primarily on a daily brief I was receiving at work that included information on the attempts to get more testing kits out into the wild and the fact that there were jumps in cases whenever the labs got new kits - I don't have a link to verify with.) Both of these point to problems with the lab system, and I am in no position to identify the best solution. One suggestion that is sure to surface is to pump more resources (read: money) into the CDC, NIH, or other arm of HHS to allow them to increase their capability. The flip side of that coin is to pump those same resources (read: even more money) out to the states to increase their capabilities. At least one private company is suggesting that, at least for early detection, their data-crawling program is the way to go.

Like I said, I don't have the answer, but I'm willing to make some predictions: Over the next year there will be a lot of Federal money allocated to laboratory programs (either state, Federal, or both) to increase capacity; this increase will allow labs to add personnel, purchase fancy new equipment, and increase the use of programs like BioWatch, BioSense, etc (which have a fantastic track record); NONE of this funding will be added to the budget of the agency (HHS) but will all be emergency funding or some other kind of appropriation; in a year or two, when some new monster of the week rolls around the funding will go away and the labs will be left underfunded and will have to cut back to the levels of personnel, equipment, and systems they have now leaving us no better protected from the next outbreak.

My take-away from all of this? We really need to develop a sustainable model for improving our public health lab capabilities. This includes getting more funding to allow states and locals to hire more personnel and it also means getting those personnel to identify a data-sharing system that works and focus efforts on expanding it to where every public health lab in the country is using it. As for the other areas (communications, SNS), I think we need a full and thorough after action review (as I've pushed in other posts this week) to drill down to the core good/bad performances and identify the ways to make necessary improvements before this happens again.

H1N1 (State)

2009-05-19T06:00:00.000-07:00

The news today included a lot of information about H1N1 continuing to spread, but I am going to continue my critique of the initial response. Even if the spread continues, in the US we have settled down from the initial emergency response and are getting geared up for a longer term response, making this a good time to look at how things went.

The main thing I wanted to say about states also relates to HHS and CDC. Specifically, a hope that states that received and at least partially distributed SNS assets (which is the majority at this point) are granted an exception from the grant requirements that they run a pandemic-related exercise. Instead, they should be required to complete the same analysis and corrective action development program that is normally followed after an exercise to study and improve their performance in receiving and distributing the assets. After all, which is better - an exercise where everyone tries to act like its real, or an actual event?

Trust me on this, my day job is organizing and analyzing state and Federal emergency response exercises, no matter how hard you try the simple fact is there are too many artificialities in exercises for them to really feel like the real thing.

We have a majority of states that have had to implement at least segments of their public health emergency operations plans (EOPs) and either their pandemic- or SNS-specific plans. As I mentioned in my last post, this gives us a potentially unique opportunity to evaluate some of these pandemic plans based on an actual activation, but one that was brief enough that the resources weren't stressed to the breaking point. Instead, the plans and departments were tested enough to find the holes, and now we have a chance to plug them.

H1N1 (Federal)

2009-05-18T06:00:00.000-07:00

This week I'm going to focus on my own H1N1 post-mortem, as Jimmy Jazz at the excellent In Case of Emergency blog referred to it. Today I want to talk about the general Federal response, as opposed to the health-related response, which I'll get to on Wednesday.

The main thing I wanted to talk about regarding the Federal response was the face that was put on H1N1 - DHS Sec. Napolitano. There are a few things that may have led to this:

Under the National Response Framework and Emergency Support Function Annexes to it, DHS (through FEMA) is the "general emergency manager" for all significant emergencies, even medical ones (in the Fed plans HHS is tagged as the medical lead, with FEMA responsible for coordinating the Federal response)
Under those same documents, DHS is the lead agency for ESF-15 - External Affairs, which includes (but is in no way limited to) public affairs
At the time of the initial Federal actions on H1N1 there was no confirmed Secretary for Health and Human Services, once their was Sec. Sebelius began co-hosting all of the daily briefings

So, taking those into account, I still feel that Sec. Napoitano was not the right person. The daily press conferences/briefings should have been led by the Assistant Secretary for Preparedness and Response (ASPR), and the Director of the Centers for Disease Control and Prevention. Here's why:

The government wanted to send a specific message: "This is a serious event and we're concerned, but it isn't an emergency and nobody should panic." The Secretary of DHS doesn't send that message, by virtue of her office the message she sends is more along the lines of: "This is a threat to every man, woman, and child in the US."
ASPR is responsible for HHS preparedness and response actions, hence the job title. The emergency personnel at the Regional level report directly to the ASPR, meaning that he (in this case) is connected to the ground truth of the HHS actions in a way that Sec. Napolitano wouldn't be unless and until Principle Federal Officials (PFOs) were activated and dispatched to impacted areas.
CDC is the nation's brain trust for understanding, preventing, and controlling exactly this sort of an outbreak. The general public expects to hear from the CDC when they hear of a disease outbreak. They don't expect to hear from DHS.
Having Sec. Napolitano lead the briefings made it too easy for them to drift rapidly off-topic into everyone's favorite question : "Why haven't we sealed the borders?" If the main personnel at the podium had been medical/scientific rather than homeland security, that question would not have gotten repeated almost every day.

I hope that we will see a robust after action process come of this. For those unfamiliar with the term, after action reports (AAR) are prepared following an "action" and are used to evaluate the actions taken and identify both "lessons learned" (ie - things you did well) and "areas for improvement" (ie - things you did not so well) and also the specific tasks that will be taken to make improvements. We have an opportunity to take a look at our pandemic preparedness, not based on exercises or drill but on a real life activation, and I sincerely hope that we learn from it in time to make a difference.

What I'm working on

2009-05-06T16:54:00.000-07:00

Whether I intended it or not, it looks like I'll be shifting to an every-other-week format for a little while. My workload has increased to the point where I just don't have the mental energy left at the end of the day to write posts that hit the level I want them to.

My plan for next week is for a series of posts looking at the initial H1N1 response and what we should learn from it. The outbreak is not over or contained, but I think the first two weeks have presented a number of excellent object lessons that need to be capitalized on. In the emergency management exercise world we talk about After Action Reports and Improvement Plans, and my posts next week will be some of my observations for feeding into an AAR. They will include things that went well and things that should have gone better.

Cutting off the nose to spite the face (Federal/Editorial)

2009-05-01T15:30:00.001-07:00

An out-of-order post, mainly so it won't be an out-of-date one. Apparently Sen. David Vitter (R-LA) has decided to put a hold on W. Craig Fugate's nomination to be the next FEMA Administrator. The reason? Sen. Vitter has some unanswered questions about decisions made by the previous FEMA Administrators.

"I have a hold on the FEMA nomination because I sent a list of hurricane recovery questions and projects to FEMA, many of which have not been adequately addressed," Vitter said in a statement. "I'm eager to get full responses and meet with the nominee immediately."

I recognize that the Senator has a responsibility to his constituents to get answers to his questions, but is stranding FEMA without an Administrator in the midst of a potentially-significant infectious disease outbreak and one month before the next hurricane season really the way to go about getting those answers? As of now, FEMA is operating with an Acting Administrator - Nancy Ward. She should be back home in her Region (IX - CA, NV, AZ, HI, American Samoa, Guam, CNMI, FSM, RMI) which is one of the parts of the country dealing with the H1N1 outbreak. As soon as Mr. Fugate gets a vote (all indications seem to be that he will be approved) she will be. Stunts like this one from Sen. Vitter do nothing more than put all of us at risk.

Vitter's fellow Louisiana senator, Democrat Mary Landrieu, backs Fugate. She said, however, that she understands Vitter's concerns, which apparently relate to FEMA's maps of controversial "high-velocity flood zones," a designation related to coastal areas that are at high risk in a hurricane or an area that faces significant risk in the event of a flood. Federal regulations currently prohibit FEMA from funding new construction in such zones, and Louisiana officials want more flexibility.

So the problem seems to be that areas were classified as bad places to build. I'd think that Hurricane Katrina demonstrated the need to be a little more restrictive about some of the construction. This is an issue that is as old as FEMA (older, I imagine since the flood insurance program predates FEMA as an official agency) which comes down to when the Federal government (and really, the taxpayers) should make the tough call and refuse to fund construction do to the high level of risk. Do the models used not make sense? Is there conflict over the science or disagreement about how legitimate the damage estimates are? If so, the regulations should reflect that, have more of a focus on mitigation efforts and the like. If, on the other hand, there are reasonable and reliable models and there is not conflict over the findings, the regulations should reflect that and restrict the use of Federal funds in those areas.

If the regulations are changed and new construction (using Federal/FEMA dollars) is allowed to go through, the next time a major storm hits the area there will be all sorts of Congressional hearings to determine why we let it happen again.

A few, semi-connected rants

2009-05-01T06:00:00.000-07:00

I normally use Friday for my opinion pieces, and today I have a couple of related items that I want to make short points about.

Masks - Thursday morning I saw my first H1N1 mask, on a guy exiting the BART station while I was entering. I am a little surprised that it's taken this long for me to start seeing masks, but the point I have here is that he wasn't wearing it correctly. I can't wear a standard N95 - I broke my nose as a kid and the resulting beak breaks the seal (that's why you're supposed to fit-test the masks before relying on them). This guy wasn't even trying. He had the top strap on, and it looked tight, but the bottom strap was swinging free under his chin. I guess that made it easier for him to use his cell phone. I've also seen (during the news coverage of the daily Secretaries' press conference) people in masks with their noses uncovered, to make it easier to breathe no doubt. To me, incorrectly using the mask is the equivalent of the people who go crying to their doctor to get "antibiotics" for every sniffle, and then don't take them as prescribed. If you're going to do a thing, do it right.

Jumping the gun? - No, not the Pandemic Alert Level, but rather some things I've been doing. One of the things I find myself doing right now is looking over the pandemic plan I was recently involved in developing (one that was put into a holding pattern as a "pre-decisional draft" [if you're not familiar with Federal terminology, that means that it's a draft that has not been reviewed by the responsible senior leaders] for fairly legitimate reasons) and finding little things that we should change based on the way things have played out so far with H1N1. I can't decide if this is warranted - reviewing and updating an otherwise solid plan based on changing ground-truth, or busy work - jumping into perfecting the draft because there isn't much else I can do right now.

Weird place - We're in a weird place, as I have to keep explaining to coworkers. We got a little too-focused on a pandemic that would percolate (like it's doing now) in Asia, and then sweep across the globe at us. Not many people were talking about a pandemic that did its percolation (my highly-technical term for the period between emergence as a new illness and beefing up to pandemic-level infectiousness) here in the US. This had rendered a lot of our planning confusing, since things like the US Government Pandemic Stages don't really apply. I fully congratulate the senior leadership of DHS and HHS for being able to walk the line and set what I think has been the right tone of "wait and see" mixed with "caution and concern". I also recognize that there are heaps of people who think we should be doing more/less than we are.

Joe Biden - Can always be counted on to use the wrong words to express a legitimate sentiment.

H1N1 publicity (Public Health)

2009-04-29T06:00:00.000-07:00

Post updated 4/30 9:00 PDT

The more I've thought about writing a public health-oriented post on H1N1 the more I decided that it's being done, and better than I would have done, elsewhere. Most of the public health blogs in the list at the right are following the issue and I recommend H5N1 (recently re-subtitled to reflect coverage of H1N1), Avian Flu Diary, and A Pandemic Chronicle for timely and well-written posts. I decided instead to say a little something about the semi-hysteria in the news.

This was inspired when I found myself getting angry and refuting the claims of an on-air personality from one of the cable news networks. The individual was bouncing back and forth between talking about "probable" cases (when he should have been talking about suspected cases) in a number of states, and the fact that we were somehow giving up national sovereignty by not sealing the borders immediately. Although it must be said, the faux-outrage on this particular network over the way the outbreak has been handled is nothing compared to how loudly they'd be screaming if the more-authoritarian practices they are seemingly calling for were to be put into effect with no more evidence than what we currently have.

Add to the cable news-driven need to sensationalize everything the echo chamber that is Twitter and you have the potential for a lot of disinformation. Now, I think there may be a place for Twitter in sharing valuable information, but as these two stories make clear, that only works if you have a trusted source. More often, and I think this is what we're seeing now, people choose to "follow" others with similar interests, leading to the echo chamber I mentioned earlier - where a similar set of thoughts and opinions keep getting repeated and amplified.

Instead, we need more things like this, from H5N1:

Resources for journalists

Many thanks to Heather McCall of the Canadian Journalism Project for the link to Covering Health Crises: resources for hard-pressed reporters. I haven't had a chance to explore it, but it should be valuable for everyone.

Or, like this, from Social Government:

During Swine Flu Outbreak, CDC Once Again Impresses

By Ethan Klapper on April 27th, 2009

Once again, the Centers for Disease Control and Prevention’s social media use impresses us.

As the agency plays a key role in the latest public health issue, the Swine Flue outbreak, one can find updated information from the Atlanta-based agency on Twitter, at @CDCemergency. For hashtags, #swine and #swineflu have yielded lots of information.

They’ve also been using PandemicFlu.gov, a favorite Web site of ours, to disseminate information.

The CDC even put out a Swine Flu video podcast.

This agency really knows how to get its message out! Be sure to heed their warnings and advice, and please stay safe!

I want to make clear that I think there are great places to get information, more than most people are ready for. The blogs mentioned above, PandemicFlu.gov, other sites like CIDRAP, all have great information. The key is to find places that do a good job of vetting the material they put up, and a big one for me is finding places where the authors are good about updating posts with new information. This is opposed to what you get, at least on the cable news, where the personalities tend to continue shouting the same few talking points until the next batch comes out.

A final note - I will be sticking to what the Secs of DHS and Ag have said, and start using H1N1 to refer to the outbreak, rather than Swine Flu.

UPDATE:

I wanted to add another article on this topic that I came across this morning. It's from a site (ThreatsWatch.org) that many visitors here might not read because it has a defense (as in Department of) focus. It often has issues that relate, if only tangentially, to preparedness, and this article is a great example of that. From ThreatsWatch:

Diagnosing the Swine Flu Infodemic

By Adam Elkus | April 30, 2009

No matter the product involved, the hype cycle is always the same. First comes excessive adulation and praise, then mass buy-in, and finally critical backlash. Just like a once-hip New York indie rock band, Twitter is suffering the slings and arrows of outrageous fortune. Mainstream media critics, alarmed by the online panic over the swine flu, are attacking Twitter as a breeding ground for irrational hysteria.

Foreign Policy's techblogger Evgeny Morozov has written the most trenchant Twitter critique, pointing to a horror show of tweets ranging from conspiracist speculations about germ warfare to fallacious "simple cures" for swine flu sufferers.

Don't believe the hype. Mass panics are as old as human civilization and Twitter is neither a cauldron of hysterical ignorance nor a completely neutral technology. Twitter and other social media tools are only one part of a complex and imperfect information ecosystem that nevertheless possesses the potential for positive collaboration.

This is an excellent point, and one I should have made a little more clearly in my initial piece - Twitter (and other social media) does not create the echo chamber I was writing about. It makes it easier to get into, and larger. This same inclusiveness makes these powerful tools for getting correct information out, and it's up to those of us with access to good info to push it out, loud and often, and hopefully we can keep up.

Sources:

CNN.com - Swine flu creates controversy on Twitter
Schneier on Security - Fake Facts on Twitter
H5N1 - Resources for journalists
Social Government - During Swine Flu Outbreak, CDC Once Again Impresses
ThreatsWatch.org - Diagnosing the swine flu infodemic

Swine flu - the lighter side

2009-04-28T18:55:00.000-07:00

From the always on-point xkcd

Welcome to the Jungle? (Public Health)

2009-04-28T16:17:00.000-07:00

Saw this story a moment ago:

Senate Confirms Sebelius as Health Secretary

By Robert Pear

The Senate confirmed with a vote of 65-31 the nomination of Kathleen Sebelius as secretary of health and human services on Tuesday, filling the last vacancy in President Obama’s cabinet with a seasoned politician who will take charge of the fight against swine flu.

It will be good to have a confirmed HHS Secretary as the H1N1 outbreak continues. Not that the DHS and Ag Secs haven't been doing a fine job, but at the end of the day this is a health issue.

IOM releases free electronic book on Swine Flu (Public Health)

2009-04-28T09:08:00.000-07:00

A short while ago the IOM President released a free electronic copy of the book The Swine Flu Affair, either to read online or download. From the site:

In 1976, a small group of soldiers at Fort Dix were infected with a swine flu virus that was deemed similar to the virus responsible for the great 1918-19 world-wide flu pandemic. The U.S. government initiated an unprecedented effort to immunize every American against the disease. While a qualified success in terms of numbers reached-more than 40 million Americans received the vaccine-the disease never reappeared. The program was marked by controversy, delay, administrative troubles, legal complications, unforeseen side effects and a progressive loss of credibility for public health authorities. In the waning days of the flu season, the incoming Secretary of what was then the Department of Health, Education and Welfare, Joseph Califano, asked Richard Neustadt and Harvey Fineberg to examine what happened and to extract lessons to help cope with similar situations in the future. The result was their report, The Swine Flu Affair: Decision-Making on a Slippery Disease.
In response to the recent outbreak of swine flu in North America, Dr. Fineberg has released a new electronic edition of this report, The Swine Flu Affair, dedicated to the memory of Richard Neustadt, and available for download by the public. Dr. Fineberg is president of the Institute of Medicine of the National Academies.

I think this is an excellent resource for people interested in pandemic preparedness, and a good chance to review what can go wrong if we over-react.

Swine Flu - State Responses (State)

2009-04-28T06:00:00.000-07:00

This is going to be a short post, without a lot of sourcing. I wanted to say something about the way different states have responded to the current H1N1 (Swine Flu) outbreak, something that reinforces the bottom-up emergency response system we try to have in the US.

First, a little theory. In theory, we run a bottom-up emergency management scheme, whereby incidents are handled at the "lowest possible level". This is evident if you look at small, every day disasters like house fires. Most of the time a house fire is handled by one local engine company. If it gets too big, they call others for help. If it gets larger still (think Oakland Hills fire) they start calling for state assets, and through EMAC, out-of-state assets. If it still cannot be handled (think Katrina) they call in the Feds. (Note - this is the idealized way the system works, not an attempt to claim that the Feds in any way saved the day in Katrina). (Second note: I've covered a lot of this before).

Enough theory. I have the (dis?) advantage of watching the Federal response to the H1N1 outbreak from inside, and have noticed something interesting. To some degree, the system is working. HHS has rolled out a portion of the stockpile, first to impacted states and then offered to all states. Some states have activated their emergency operations centers, and in support some FEMA Regions are activating portions of the Regional Response Coordinating Centers (the FEMA Region equivalent of an EOC). Other places that aren't impacted to the same extent aren't taking these steps and instead they are working on situational awareness and coordinating their plans so that if they do need to activate, they're ready to go.

Some examples of state responses:

CA - the "Governor's latest video" link on the homepage takes you here. The video requires Silverlight, which I don't have on this computer, but the transcript is here. Unfortunately there is no clear link to other information from CA, but a search for "swine flu" gets this page from the California Department of Public Health.
NY (state) - again, nothing obvious on the homepage, but the search for swine flu gets you this page from NY State Department of Health.
NY (city) - decided to check NYC because of the cluster of cases (and because Mayor Bloomberg is so focused on public health, including donating to my alma mater). Unlike the state pages, there are a couple of stories about swine flu front and center. First is video of a press conference with the Mayor, and second is a page on NYC responses.

I picked those three because of the clusters of cases. In the next few days (for Thursday) I will put together a more complete summary and initial analysis of the governmental responses to H1N1.

Briefly - Swine flu

2009-04-27T13:27:00.000-07:00

I mentioned this morning that I will be working on something on the Swine Flu outbreaks for a post later in the week. I wanted to take a moment and explain why I'm waiting. Unlike many of the people who write on these issues I am 1) currently employed by a responsible agency and 2) identified by my name on my blog. Through my work I have been exposed to a lot of For Official Use Only and other types of draft/not for distribution material. I need to take a little time to review what I know and make sure to avoid publishing anything inappropriate. At best it would confuse the issue, at worst it would cost me a job I do really enjoy. Thanks for your patience.

The Fugate hearing (Federal)

2009-04-27T06:00:00.000-07:00

Yes, the big news (ahem, BIG NEWS) in preparedness right now is the H1N1 Swine Flu out of Mexico. I need to do some better research before I write about that, but I will recommend that you check out H5N1 or Avian Flu Diary for good posts, both original material and collected from many other sources. In the absence of being prepared to write about the swine flu, I'll get back to my schedule and focus on Federal matters, and the biggest (other) Federal news is the Fugate hearing.

Last week FEMA Administrator nominee Craig Fugate went before the Senate Committee on Homeland Security and Governmental Affairs as part of his confirmation process. From everything I've seen he was as well-received as was expected. From McClatchy:

"Judging FEMA's future success on the basis of whether it is 'better than Katrina' is not viable," Fugate said. "This standard does not, in my opinion, meet our sworn commitment to the American people. . . . I will hold FEMA's future response and recovery missions to a much higher standard of success."

For those who are interested, this link will take you to the C-SPAN video of the hearing. Once you get past the self-congratulatory opening statements from the committee heads (I don't find it something to feel so happy about that the "five years of experience" requirement for the job of FEMA Administrator took something as massive as the Katrina debacle to be put in place, especially given that requirements like that exist for almost every other position in the Agency) and other political statements, you actually get to Mr. Fugate's testimony (about 22 minutes in.)

I recommend the hearing to anyone interested in Federal emergency management issues.

Sources:

McClatchy Newspapers: FEMA nominee pledges higher standard for disaster response
C-SPAN: W. Craig Fugate hearing

Unintentional hiatus

2009-04-20T12:12:00.001-07:00

Between back-to-back weeks of travel for work and spending the last few weekends trying to reclaim my yard from overgrowth and help out my recuperating mom I just haven't had time to write. Hopefully things will slow down soon and I'll be back at it.

Planning with my mom (Personal preparedness)

2009-04-09T06:00:00.000-07:00

Last week I was staying with my mom while she recovered from surgery. One of the things we did while I was there was talk about preparedness kits. She lives in California, which means earthquake country, and while she is aware of what to do in smaller earthquakes she doesn't have much in the way of actual preparedness "stuff".

Since she's not a preparedness buff (like me) we decided that the best thing to do was to look at some commercial products and find one that met her needs. We also decided to add any other gear, specific to her needs, after picking a kit. This was made easy because some of the vendors that I saw when I was at the Public Health Preparedness Summit deal in those sorts of kits.

For some people a pre-fab kit will do the job, for others these kits will be undersupplied, it all depends on where you live and the type of incidents you have to prepare for. The kits we looked at generally contained the same types of gear, including:

Food/water packs (one person, 3 days)
Emergency blanket
Glow stick/flashlight
First aid kit
Tissues/TP/moist towelettes
"Sanitation liners"

Those are the basics, with other things like multi-tools, duct tape, ponchos, work gloves, and dust masks showing up as extra cost options. In fact, most of those are things we will probably be adding to my mom's kit, but my feeling is that you're better off getting most of those extras on their own, both for the cost and quality.

The other things we will be adding to her kit are:

Clothing - jeans, long-sleeved shirts, and others
Multi-tool or pocket knife - she has one floating around and I'll be checking it out to make sure it's a good one
TP - if the kit we order for her doesn't come with sufficient supplies
Duct tape - always good to have
Work gloves, dust masks, safety glasses - as with the duct tape, these are always good to have around, especially in earthquake country where dust and glass could be an issue

Once we've put the full kit together I'll write up what we got and post some pictures.

Alternate power (Personal preparedness)

2009-04-02T06:00:00.000-07:00

I do a lot of camping and cycling, so I tend to keep my eyes out for various ways to recharge my electronics while on the road. This is more an issue on bike tours, since I don't take many of my toys with me when I camp. I realized the other day that some of this information is also useful for preparedness, especially in some of the larger disasters where power is out for many days. I will say that I haven't used any of these products, but I will be picking some of them up soon and will do full reviews when I do.

I've seen a couple of different types compact rechargers, wind and solar. The wind devices seem like they're better suited to something active like cycling, and in fact one of them (the HYmini) comes with an attachment for bike handlebars. The other wind device (the Orange Wind Generator) looks much more like a mini windmill, but unfortunately it is not currently comically available. The solar chargers, including the Solio, miniSOLAR (from HYmini), and Battech Solar iPower, are fairly similar - a device with solar panels and some sort of adapter.

Both types of devices are marketed as phone/PDA/camera rechargers as opposed to larger devices (like laptops). Most of the chargers have internal batteries and can be plugged into wall current for charging. This makes them as much reserve power packs (like these that recharge cell phones from AA batteries) as solar/wind generators. Having an off-the-grid way to recharge the internal battery in the units does make them more useful for disaster use, especially since they don't require additional batteries.

The main preparedness use I can think of for these would be cell phone recharging. Since so many households, especially in the under-30 set, are cell-only (no land-lines) having a way to recharge a cell phone reliably is invaluable. As I said, I haven't personally used any of these (although apparently Pres. Obama is a fan of the Solio), but if I do pick any of them up I'll include a full review.

Sources:

Solio
HYmini
IntoMobile - iPower Charges Every Phone Under the Sun
GotWind.org - Orange Wind Generator

Institute of Medicing Preparedness Forum (Public Health)

2009-04-01T06:00:00.000-07:00

This is a very delayed post, and my apologies for how long it has taken me to get to it.

In late January I was contacted about a project from the Institute of Medicine, the Forum on Medical and Public Health Preparedness for Catastrophic Events. From the Forum website:

The Institute of Medicine’s Forum on Medical and Public Health Preparedness for Catastrophic Events serves to foster dialogue among stakeholders and provide ongoing opportunities to discuss and confront issues of mutual interest and concern. The Forum provides a neutral venue for broad ranging policy discussions that serve to facilitate coordination and cooperation among the public and private stakeholders in developing and enhancing the nation’s medical and public health preparedness. More specifically, the Forum: provides a catalyst for voluntary public/private collaboration on topics where there is synergy among potential partners; helps define the scope of the field and thus sets the stage for future policy action; brings ongoing attention and visibility to important preparedness issues; explores new approaches for resolving problem areas; and elevates the general understanding and visibility of medical and public health preparedness in the broader research, public policy, and other appropriate communities.

An interesting aspect of the Forum is that it is self-governing - the membership determines the areas of focus as opposed to there being specific direction from outside policymakers. The current areas the Forum has chosen to focus on are:

Medical Surge Capacity
Disaster Preparedness Training
Communication and Distribution
Psychological and Community Resilience
Research and Evaluation

More detail on the Forum can be downloaded here.

I was contacted specifically about some upcoming (thankfully still upcoming, despite my lateness) regional workshops. Between March 12 and May 8, 2009 the Forum is hosting a Regional Workshop Series on Standards of Care during a Mass Casualty Event. From the workshop page:

The purpose of the "Standards of Care" regional workshop series is to illuminate the progress and successes of efforts underway to establish local, state, and regional standards of care protocols. In addition, the planning committee is hoping the workshops will help to improve regional efforts by facilitating a dialog and acoordination between neighboring jurisdictions.

Standards of care, which will have to shift in a major disaster, are a topic that many people in public health are concerned about discussing so this sort of workshop series is fantastic. When I was working at a local health department the issue came up during discussions with the local hospital preparedness group. The hospital group was looking to the health department to provide guidance, and personnel within the health department felt that the hospitals had the expertise to make those decisions. The potential liability that could be laid at the feet of whoever does propose altered care guidelines is enormous, so I'm not surprised that there is hesitation. The closest thing to proposed standards that I've seen was the discussion and papers that came out of the Task Force for Mass Critical Care, which I wrote about here and here.

If you are near one of the cities where the workshops will be held (Orlando FL, New York NY, Chicago IL) and have an interest and background that might put you in a position to contribute, head over to the link for your town and register. Those same links also provide access to the agendas for the workshops.

Interactive agencies (Federal)

2009-03-30T06:00:00.000-07:00

For a few weeks I've been meaning to write a post about Federal agencies' use of so-called Web 2.0 tools - interactive electronic media - and have put it off for one reason or another. Partially, I was pushing it back because I hadn't collected all of the information I wanted. Well, my delay led to me getting beaten to the punch. Michael Coston, aka Fla_Medic, author of the excellent Avian Flu Diary, recently did a post on the same subject, entitled Fed Agencies Embracing 'New Media'. Rather than rehash the issue, check out Michael's post. Below are some of my thoughts on the issue.

I follow a few Federal agency blogs, specifically various FEMA feeds, the DHS "Leadership Journal", and when it was active Sec. Leavitt's blog. Additionally, I receive a lot of email updates from Federal agencies. Are these really Web 2.0? That all depends on how you look at it. What I see are a number of Federal agencies, involved to a greater or lesser extent with preparedness activities, experimenting with new media including blogs, Twitter, and YouTube. In some cases, like the Pandemic Leadership Blog from 2007, the agencies reach out to the community to ensure there is community participation. In others, like the DHS Leadership Journal, especially under the former administration, are used more as an alternate way to get the internal message distributed. HHS has taken a different tact and has launched an entire new media website. Currently it is very sparse, but the idea is that the site will collect all of the new media tools (a list of them is available here) in one place making it easy for people to follow news from HHS.

While the HHS new media site is actively soliciting feedback, there doesn't seem to be wider interest in using new media as social media by other agencies. There is a difference between allowing comments, the way the Leadership Journal does, and encouraging citizen input and using it to shape policy. Hopefully there will be a trend in the direction being set by HHS, but it's too early to say.

If you are interested in this topic area check out the Social Government blog, which discusses efforts from government agencies to adapt to the Web 2.0 world.

Sources:

Avian Flu Diary - Fed Agencies Embracing 'New Media'
Avian Flu Diary - HHS Unveils New Media Website
Social Government homepage
DHS Leadership Journal
HHS - Pandemic Leadership Forum (archive)
HHS - New Media Website
Sunlight Foundation - The Feds and Social Media II

Getting your home ready (Personal preparedness)

2009-03-26T06:00:00.000-07:00

A little while back I mentioned some financial issues I'd had. Specifically, someone got a hold of one of my bank account numbers and pulled some money out in various ways. The bank caught it, but it did get me thinking about personal preparedness in a whole different way.

Home inventories may not be at the top of the list when it comes to personal preparedness topics, but I've come to think that they should be. Knowing people who got hit pretty hard by Ike, and working with people who've done time processing Individual Assistance claims it seems that the more people know about their own assets the better off they are. I don't mean "assets" in the strictly financial sense, but in a more broad everything of value you own sense. Should something major happen, having a written record of your property, along with approximate values is going to make it a lot easier to file either an insurance claim or state/Federal claim. One important thing - if you have items that are specifically valuable you should probably get a legitimate assessment of the value and some sort of certificate that can be presented as proof of value. For more on running a home inventory check out this post from Lifehack.

After you've done the inventory, you need to make sure you keep the records in a safe place. This article, from University Credit Union, discusses some options for protecting vital records. Another option is one I discussed last month, using a secure USB drive. Other possibilities include things like mailing copies to out-of-area relatives or bank safety deposit boxes. An important thing to keep in mind here is that where ever you keep your records of the inventory (and other important paperwork) you need to keep it up to date. It does no good to have an inventory if it's months or years out of date. Additionally, make sure you keep your homeowner's or renter's insurance policy up to date and reflecting the value you have on the inventory.

Hopefully you'll never need to use the inventory for a claim, but having it is the important thing. Especially if you live in earthquake, wildfire, hurricane, or tornado country where the bad things can come from nowhere and wipe out everything you own in the blink of an eye.

Rita lessons and Ike (State/Local)

2009-03-24T06:00:00.000-07:00

A recent report from Rice University looks at some of the "lessons" from Hurricane Rita and how well they were applied in Ike. The short version is that many of those lessons were not learned, or at least weren't put into action. From Terra Daily:

"Essentially, this study shows that people didn't learn from Hurricane Rita," said the report's co-author Robert Stein, the Lena Gohlman Fox Professor of Political Science at Rice. "Had Hurricane Ike been a severe storm - a Category 3 or 4 - more people would have evacuated, and we would have experienced roadway gridlock."

A little background on the study itself (which is available as a pdf of a PowerPoint presentation here), which is mainly aimed at people who know survey design:

Both surveys were conducted in Harris County, TX
Post-Rita information collection was over a few days (29 September - 3 October, 2005), via random digit dial, and included 405 adults
Post-Ike collection was over a longer period (23 September - 24 October, 2008), via random digit dial, and included 1503 adults

The questions asked were:

What was the response of Harris county residents to Hurricanes Rita and Ike? Who evacuated, when did they evacuate and who stayed?
What factors shaped, influenced and determined Harris county residents’ response to Hurricanes Rita and Ike?
What actions did Harris County residents take in preparation for Hurricane Ike?
What will Harris County residents do in the future when faced with a Category 4 hurricane?

The researchers broke the population down into four groups: Real Evacuees, Shadow Evacuees, Stayed Correctly, Stayed Incorrectly. They then analyzed the data based on those four categories.

One of the most important findings is related to evacuations, to whit:

Almost 70% of those who stayed correctly during Hurricane Ike reported that they would evacuate for a Category 4 hurricane, which would significantly add to the number of shadow evacuees.

As is stated elsewhere in the report, there was already difficulty in getting out of Houston because of the number of evacuees on the roads. If the numbers who responded that they would evacuate in a Cat 4 (2.9 million) did, there would be no way for any of them to go anywhere.

One take-away from this is that emergency management personnel need to work much harder to refine their messages for the public, to make sure that the people who need to evacuate in these situations are the only ones who go. I've seen this same problem discussed in other contexts, such as improvised nuclear devices. In an IND situation, as with a catastrophic storm, the gut reaction of most people is going to be to run, even if there is no real reason that they need to.

It is vital that local emergency management build the necessary rapport with their communities so that when they tell people to stay or go, they will. Failing that, people will go with their guts and we'll have this, all over again:

Sources:

Terra Daily - Lessons From Hurricane Rita Not Practiced During Ike
Photo from AllNurses.com - Ike prepares to lay the smack down on Texas

Cleaning house (update)

2009-03-23T10:56:00.000-07:00

This week I'm working from home, helping my mom after a hospitalization. Next week I'm on the road for work. That being the case, I'm going to take some time this week to go through the dozens of articles, websites, and emails I have logged for writing about and try and get caught up. If everything goes according to plan I should build up a good slate of posts that will be semi-timeless (discussions of reports and the like) that I can use when my schedule gets wonky like this in the future.

Pandemic Preparedness (Public Health)

2009-03-18T06:00:00.000-07:00

GAO reports are a good way to see inside Federal programs, from a fairly unbiased perspective. On 26 February the GAO put out a report entitled "Influenza Pandemic: Sustaining Focus on the Nation's Planning and Preparedness Efforts". An interesting thing about this particular GAO report is that it isn't anything new, literally. It's a discussion of the status of previous recommendations related to pandemic preparedness.

From the highlights page:

GAO has conducted a body of work over the past several years to help the nation better prepare for, respond to, and recover from a possible influenza pandemic, which could result from a novel strain of influenza virus for which there is little resistance and which therefore is highly transmissible among humans. GAO's work has pointed out that while the previous administration had taken a number of actions to plan for a pandemic, including developing a national strategy and implementation plan, much more needs to be done. However, national priorities are shifting as a pandemic has yet to occur, and other national issues have become more immediate and pressing. Nevertheless, an influenza pandemic remains a real threat to our nation and the world. For this report, GAO synthesized the results of 11 reports and two testimonies issued over the past 3 years using six key thematic areas: (1) leadership, authority, and coordination; (2) detecting threats and managing risks; (3) planning, training, and exercising; (4) capacity to respond and recover; (5) information sharing and communication; and (6) performance and accountability. GAO also updated the status of recommendations in these reports.

Coming on the heels of the Assessment of States' Operating Plans to Combat Pandemic Influenza, this report completes the picture of government preparedness efforts. Unfortunately, that picture isn't a very pretty one. The report contains ten "open recommendations" - suggested actions that have not been taken or have not been completed. Hopefully, this collection of suggested actions will make it easier for the new administration to take a deep look at pandemic preparedness and begin resolving some of the existing gaps.

Fugate at FEMA (Federal)

2009-03-16T06:00:00.000-07:00

One of the biggest questions that will be posed to Craig Fugate when he goes before the Senate for confirmation is about the future of the agency he has been nominated to lead. Almost as long as it has been part of DHS there have been members of Congress (and members other organizations like IAEM and NEMA) who have called for it to be pulled out. Others have argued that keeping FEMA in DHS is the best move. My personal take is along the same lines as the DHS IG report from a couple weeks back (FEMA: In or Out?), in other words that agency leadership is more important than chain of command issues.

Apparently, Fugate agrees:

On a brewing congressional debate over whether to make FEMA a stand-alone, cabinet level agency instead of a component of the Homeland Security Department, Fugate in the past has said he agreed with his future boss, Homeland Security Secretary Janet Napolitano, saying he was more concerned with ensuring that FEMA operates successfully than where it fits in the government's organizational chart.

I know very little about Fugate, other than what has been written about him recently. What I have seen (primarily his work history) makes me confident that President Obama has named someone who understands the Emergency Management part of FEMA. Specifically:

Fugate has directed the Florida Division of Emergency Management since 2001, leading hurricane responses in the nation's fourth most populous state. A former volunteer firefighter and paramedic who spent 10 years as emergency manager for Alachua County, Fla., Fugate has presided over 23 declared state emergencies and 11 disasters declared by presidents, including four hurricanes that struck the state in 2004 and 2005.

Judging by his background, Fugate has undoubtedly seen emergencies of all sizes. That means he has an operator's understanding of the differences in what local, state, and Federal responders' role are, and what each should be able to do. That knowledge and experience will be key in continuing rebuilding FEMA over the next few years.

For a more complete listing of Fugate's background, check out the press release from the White House on his nomination.

Sources:

The White House - President Obama Announces his Intent to Nominate Craig Fugate as FEMA Administrator
The Washington Post - Obama to Nominate Florida's Craig Fugate to Lead FEMA

Problems

2009-03-09T19:49:00.001-07:00

The weekend was rough and the week isn't looking any better. Between a parent in the hospital, someone yanking close to $3000 from my bank account, and a doubling of work due to a colleague getting called to DC for a different project I just don't have the time to write. If I had more time my posts would be:

Federal - obviously the big news in Federal preparedness is the naming of Craig Fugate to be the next FEMA Administrator
State/Local - I would probably run another post on Fugate, looking at his time in Florida
Public Health - Last week (6 March) GAO put out a report (link is to pdf) summing up the various recommendations they've had on pandemic preparedness that have not been implemented - a good read if you're interested in pandemic planning
Personal Preparedness - given the recent bank account hijacking, my interest right now is how to avoid that sort of thing
Editorial - continuing the good idea/bad execution, I want to take a look at HSEEP

So there it is, my weekly postings in a few minutes. Most of those will probably show up next week, if not later this week.

Oh, if the GAO report link fails go to http://www.gao.gov/ and look for "Sustaining Focus on the Nation's Planning and Preparedness Efforts"

Target Capabilities (Editorial)

2009-03-06T06:00:00.000-08:00

Last week I mentioned that I planned to use my Friday editorials to call attention to some programs that strike me as good ideas poorly executed. Being honest, this is a series that can probably keep me going until I'm so burned out on blogging I'll never write again. Either way, I may not do it every week, but I do have one for today.

The Target Capabilities List is a Good Idea Gone Bad. Initially announced as part of the National Preparedness Guidelines, the TCL is a set of

37 capabilities that states and communities and the private sector should collectively develop in order to respond effectively to disasters.

The TCL was developed so that responders at all levels would be able to set a preparedness goal, analyze their current capability, and determine what steps should be taken to fill the gap between the two, with everyone working from a single set of criteria. This is clearly valuable, especially as we try to move towards greater interoperability. When the TCL was published there was so much information included that the document was 588 pages long.

It included detailed information on numerous ways that each of the 37 Capabilities could be demonstrated, but was applicable almost exclusively to state governments only. Because of the level of sophistication required to meet many of the goals laid out in the TCL, only very large jurisdictions (i.e. Los Angeles County) or states were able to use them effectively. When smaller communities and even state-level responders other than homeland security/emergency management (i.e. state public health) tried to use the TCL the result was a mess.

Recently there has been action to retool the TCL and make it more jurisdictionally-friendly. Unfortunately, it sounds like the way that is going to be done is by adding subcategories to each of the 37 Capabilities to provide jurisdictions with an appropriate level to meet for each, greatly increasing the complexity of the TCL. It seems to me that a better way to make the TCL more user-friendly is to simply provide it to users in a form other than pdf or printed (currently 588 pages) - specifically, through an interactive web portal.

Using an interactive portal instead of a static document would allow users to tailor their view of the TCL to their jurisdiction. A set of introductory questions would be needed to allow users to classify their jurisdiction, and once that information had been entered into an account users would login to the account and see their personalized version of the TCL. Some possible benefits:

Communities in California would have Capabilities related to preparedness/response to threats like earthquakes and wildfires visible, while similar Capabilities related to lower-likelihood threats like hurricanes would be downplayed
Communities with nuclear power plants close-by would have that presence reflected in their recommended Capabilities, while communities far from any nuclear plants would not
Communities that identify themselves as lacking certain response capabilities would not have to sort through pages of information related to those capabilities until they indicate that they exist.

These are a few examples that come to mind. Additionally, this portal could (should?) be linked to the exercise portal (HSEEP) which would then "know" the capabilities of a community, which would be used in developing exercises. Additionally, it could be linked to Grants.gov and provide a means for simplyfying the application process for DHS and other TCL-linked grants.

Unfortunately, I expect that we will see an even larger TCL, available as a pdf or printed volume, and not in an interactive form, limiting the utility for everyone.

Locators (Personal Preparedness)

2009-03-05T06:00:00.000-08:00

Today I came across two different stories that both point at the need for more people to think about bring locators of some kind when going out into the wilderness. Before getting to the stories a few notes on locators:

There are "Personal Locator Beacons" (PLBs) which operate on specific frequencies and are licensed by the FCC for that purpose, they broadcast GPS and other data that help rescuers locate lost persons;
There are other devices that are inappropriately marketed as some variation of those terms;
There are devices used by backcountry skiers, avalanche beacons, which communicate with other beacons of the same type and are used to quickly locate persons trapped by avalanches;
I am not an expert on any of these, but feel strongly that if you do backcountry activities you should probably have one, as the following tragic stories will illustrate.

First, we have the ongoing saga of the football players capsizing off of Florida:

The four men left Clearwater Pass on a fishing trip early on Saturday in calm weather, but heavy winds picked up through the day and the seas strengthened, with waves of seven feet and higher, peaking at 15 feet on Sunday. The Coast Guard added it had not received a distress signal.

The other story I saw involves skiers caught in a whiteout:

A young British entrepreneur has died while snowboarding in the Swiss Alps despite a mountain rescue operation played out live on the social networking site Twitter.

While these people had phone connections that led to the rescue of one man, the other was not found until it was too late.

Please understand that I do not want in any way malign any of these individuals, only to hopefully avoid stories like this in the future. PLBs are valuable tools, and it is likely that the boaters, if not the skiers, would have been quickly rescued had they had beacons. None of this will lessen the tragedy, but I can only hope that in the news coverage here in the US about the boaters and in Europe about the skiers there will be mentions and recommendations that people purchase and use appropriate locators.

If you are interested in learning about PLBs I recommend Doug Ritter's "Equipped.org Blog". He often writes about PLBs, including information on new technologies and debunking devices that inaccurately claim to be PLBs.

HHS Secretary, take 2 (Public Health)

2009-03-04T06:00:00.000-08:00

We now have a new HHS Secretary nominee, Kansas Governor Kathleen Sebelius. Additionally, President Obama named Nancy-Anne DeParle to head the White House Office for Health Reform. Initially, Tom Daschle was going to hold both of these positions. While I can't speak authoritatively on what it means that the positions are separated, I can speculate.

First, this strikes me as a good thing for HHS as a department and for the health reform effort President Obama plans to launch. Running a Cabinet-level agency doesn't seem like the sort of thing that would leave a lot of time for a major undertaking like health reform. With a single individual heading up both, it was likely that one would have suffered.

Next, Gov. Sebelius is, well, a governor. This is opposed to Sen. Daschle who was, well, a senator. These positions have very different skill sets and again, it strikes me as a good thing. Maybe Gov. doesn't have the extensive health reform pedigree that Sen. Daschle has (although she was Insurance Commissioner, so she has an extensive understanding of the ins and outs of insurance at the state level) she does have executive/administrative experience that should be useful for managing HHS.

Last, I have no idea where Gov. Sebelius falls on preparedness issues. A quick review of the recently published Assessment of States' Operating Plans shows that at least on pandemic issues Kansas isn't doing so great. The critical infrastructure section (C in the report) is almost all "red", indicating a score of 1-49%. Kansas does have a pandemic plan posted to PandemicFlu.gov, but it looks like an older one, with a date of October 2005.

As I said, most of this is my interpretation of the information. I do think that a dedicated HHS Secretary and a dedicated WH Office of Health Reform person is a better way to go for both projects, and hope that Gov. Sebelius will put together a strong ASPR staff to ensure that preparedness efforts are maintained.

FEMA: In or Out? (Federal)

2009-03-02T06:00:00.000-08:00

One of the louder discussion related to emergency preparedness issues, especially at the Federal level, is whether FEMA should remain within the Department of Homeland Security. The arguments on both sides stem as much from politics as trying to ensure that we have a fully-functional emergency management agency.

Recently, the DHS Office of the Inspector General released a short report entitled "FEMA: In or Out?" which addresses many of the issues on both sides of the argument. From the report:

Some of the important questions that have been the subject of debate over the past 60 years, and that are particularly relevant today in the “FEMA In or Out” debate, include:
What the jurisdictional boundaries of the agency charged with emergency management should be;
How responsibility for new or emerging threats should be assigned;
Whether it is necessary (or advisable) to distinguish between natural and manmade threats;
What is meant by “all-hazards,” and what elements need to be present in an agency with an all-hazards mission;
What the relationship between crisis management and consequence management should be; and
What the relationships among the federal, state and local governments should be during a disaster, and whether the relationships should change in the face of a catastrophe.

Rather than rehash the whole report (only 21 pages), I'll encourage everyone with an interest to read it. It does a good job of presenting the history of emergency management in the US, including prior to President Carter forming FEMA in 1979. It outlines the good times (primarily under James Lee Witt) and the bad times (most of the rest).

The short version - leadership matters more than organization. FEMA excelled in the '90s because Witt was an experienced emergency manager who was also close to the president, not because it was a Cabinet-level agency at the time. Many of the difficulties experienced in other times can be traced to leadership as well.

This an important report, and I hope that many of the people within the Obama Administration, as well as Congress, the press, and the general population, take time to read it. Having an understanding of the lay of the land when FEMA was performing well and poorly is one of the most important things to consider before any thoughts of re-organization are discussed.

When good ideas go bad (Editorial)

2009-02-27T06:00:00.000-08:00

I've written often about the different levels of government and the different responsibilities each has. To some extent the levels of responsibility in preparedness/response issues mirrors the responsibilities in other areas:

Local government (cities and counties) - provide many direct services and are the first line of response;
State government - provides services that are too large-scale for local to provide (or to the local governments themselves rather than directly to the populace), and backstop local response efforts if the incident is more serious;
Federal government - provides services to the states, and backstops the state response efforts as needed.

That outlines the ideal world.

One area that isn't adequately captured in that scheme is the role of guidance. This is something the federal agencies like to provide, often with the "power of the purse" backing it up. What is presented as guidance is actually a semi-veiled requirement, in the form of "if you want money from us you will do things our way". Often this makes sense. Having all response agencies, at every level, adopt a common operating policy a la NIMS/ICS makes sense, providing a set of tools for agencies to use to asses their development a la HSEEP makes sense, providing a set of specific capabilities for everyone to work towards developing a la the TCL makes sense.

Except when it doesn't.

In recent weeks I've written about HSEEP and gotten feedback from a fellow blogger on some problems they have observed in using HSEEP, mostly due to have an existing a robust exercise program that didn't translate well to the HSEEP format. I've also spoken to a friend who is a former NDMS/DMAT team member about how the implementation of ICS terminology has led to confusion and difficulty communicating - exactly the opposite of what it was supposed to achieve.

In the next couple of weeks I will be using my Friday editorial space to highlight some programs that I see as great ideas that either had poor roll-outs or inadequate transition programs. It is clear to see that many of these programs could be salvaged and turned into valuable tools if they were just applied in the right manner. I will only be addressing these in the editorial section because they are my opinions and do not in any way reflect the opinions of the people I work for. Also, since they will be based on things I have seen and spoken to others about, I won't be able to back them up with many citations. All of that put together makes them opinion pieces, and I will present them as such.

Helping others prepare (Personal Preparedness)

2009-02-26T11:38:00.000-08:00

A little while back I posted/referenced other posts on using gift-giving occasions like Christmas to help get loved ones to prepared. Specifically, I referenced a couple of posts on the Avian Flu Diary on preparedness-oriented giving. Today I want to revisit that topic.

At the time, I declined to state what my preparedness gift was, because I hadn't distributed it yet. Now, two months later, I need to get back to it. I decided to give my family Iron Keys to get them started on building go-kits. Iron Key is a manufacturer of mil-spec USB drives, which come with built-in encryption and a heap of other useful features. My thought was that I could give these to my family, along with a list of specific documents they should load onto the drive, and it would allow them to create a secure, and extremely portable file depository in case they were ever in a forced evacuation.

There are a couple of specific reasons I chose to go with the semi-pricey Iron Keys. First is the integrated encryption. If I am asking/encouraging people to put important files like mortgages onto one of these things having built-in security is a must. Another is the durability - they're metal and sealed against water, allowing them to be run through a washing machine without problem. There are a few other reasons, but those were the two biggest.

I wrote a little instruction sheet which listed out documents by type (medical information) or name (mortgage) that should be included, as well as explaining that the idea was to have a last line of defense, in case they had to evacuate and all other records were lost. Because these are intended as a last-ditch resource they don't need to be updated daily, a once-a-year review is probably good. As of today both of my parents have begun loading information onto their keys, and hopefully the others will begin soon. Since most of my family lives in earthquake and fire-friendly California, there's no way to predict when something might occur and require the documents backed up this way.

Thoughts on the Public Health Preparedness Summit (Public Health)

2009-02-25T06:00:00.000-08:00

This past week I was in San Diego for the PHPS. This makes two years in a row that I've been able to get to the meeting and I wanted to get some thoughts about it down.

It is great to see so many public health professionals from all levels gathering to discuss issues related to preparedness. One of the things that struck me when I was working at a local health department was how segregated the preparedness topics seemed to be - most people didn't think of their work as involving a need to be educated on preparedness topics. I hope that this type of summit will continue to spread the word that public health needs to continue along the path it's on to becoming a response-ready profession.
It was great to see so many people from my "old life". Both the city I used to work for and the state I used to work in had large contingents present, despite tight budgets and having to travel across the country. Clearly, preparedness is an important issue for them.
"New" technologies were presented, although not as well as I'd hoped. I attended a session on the use of social media hoping that it would be a discussion of how public health could take advantage of tools like Twitter (which I'm not a fan of but it has it's uses), blogs, and wikis to communicate (two directionally) with their populations. Instead, it was a session on how great each of the tools are without much practical information. Introducing these things to people is okay, but it would have been much more effective to introduce a smaller number of techniques and show how each of them can be used. Oh well, maybe next year.
The sessions I attended were either labeled as "interactive" or "roundtable" and were neither. One of the most valuable aspects of a conference like this is getting information from all attendees. Most of the sessions were in too-large rooms with standard presenter/audience layouts making interactive discussion difficult. For some topics this makes sense, like the pre-summit talk on nuclear/radiation terror I attended, but for others it doesn't.

All in all the summit was a great opportunity to reconnect with some former colleagues and interact with a profession I've started to drift away from. Next year it will be back in Atlanta, and I hope I can find a way to attend.

Missing

2009-02-17T20:23:00.000-08:00

I mentioned a little while ago that time is tight for me, and that's why my posting has been spotty lately. This week I'm in San Diego for the Public Health Preparedness Summit, and hope to be able to get a few posts down in between sessions. We'll see how well that goes. After this week I should be back on a more normal timetable, which should allow me to write more regularly.

"Right At Your Door" (Personal Preparedness)

2009-02-12T06:00:00.000-08:00

I've had the film Right at Your Door in my Netflix queue for a while and haven't watched it for various reasons. Having the "Watch Instantly" option is great though, since I had some downtime over the weekend I could watch it without having to wait for a disk. This won't be a full review of the film, but rather will look at it as a tool for preparedness. I don't know how widely-known the film is, but I hadn't heard of it until it popped up as a recommendation after I added another movie to my queue.

The film follows a man and his wife living near Los Angeles. One morning, the wife leaves for work and the man later hears news of explosions in downtown LA. It later emerges that there were multiple "dirty bombs" (the quotes will be explained) and the whole LA area is closed off. People are told to seal their houses (duct tape and plastic) and shelter in place. The wife returns home only to find that her husband won't let her in because of his fear of contamination. He arranges for her to enter, after she breaks a window. Eventually the authorities make their way out to the house. I won't say more because it would spoil the ending.

The first thing I want to explain is the reason I scare-quoted dirty bomb above. In the film they refer numerous times to dirty bombs, which in this case were used to spread a contagion. In most uses, a dirty bomb is another way to refer to a radiation dispersal device - an explosive device with radioactive material added in such a way that the explosion spreads the radioactive material. I haven't heard of an explosive device being used to spread a contagion (either bacterial or viral) and would suspect that the explosion would kill most of the contagion, rendering it an ineffective means of contamination. This is only one example of some of the muddled science/terminology used in the film (another is the confusion between viruses and bacteria, with references to both being used interchangeably) but that isn't the point.

What the film does capture is the chaos, even in the quiet moments, that would most likely exist in this sort of situation. It also has a very claustrophobic feeling, with the entire film only showing the area immediately around the protagonist. Once he seals his house there is almost no action outside of it. As I watched the film it struck me that it could be a great tool for getting people to understand some of the "whys" in emergency preparedness:

Why were people told to stock up on duct tape and plastic bags? - The protagonist and a neighbor demonstrate how to seal a house against contamination;
Why do you need to store XX days of food and water? - Once the house is sealed there's no way to get more, and it takes a number of days for the "authorities" to get to that neighborhood;
Why do you need a contact plan? - The protagonist's mother-in-law calls repeatedly for news, and is frustrated when he can't tell her about her daughter;
Why do you need an evacuation plan? - The protagonist has no idea where his wife is and drives into the blast area (or as close as he can) to find her.

These are only a few that come to mind. It's about 90 minutes, and if you are a Netflix member I recommend checking it out through the Watch Instantly feature. If you have family members who are reticent to prepare for emergencies, watch it with them.

More jamming proposed (Editorial)

2009-02-06T06:00:00.000-08:00

A short time ago I wrote a post on the proposal by New York Police Commissioner Ray Kelley to develop a system to shut down or otherwise jam cell phone and other wireless communication devices in the event of a terrorist strike. The proposal was the result of analyzing the tactics of the terrorists who hit Mumbai recently, specifically their use of smart phones to monitor the law enforcement response. Another similar proposal has emerged from India itself. From the TimesOnline:

An Indian Court has been called to ban Google Earth amid suggestions the online satellite imaging was used to help plan the terror attacks that killed more than 170 people in Mumbai last month.
A petition entered at the Bombay High Court alleges that the Google Earth service, "aids terrorists in plotting attacks". Advocate Amit Karkhanis has urged the court to direct Google to blur images of sensitive areas in the country until the case is decided.

As I said before, the fact that services like this may be used by bad people is not reason enough to warrant their discontinuation. From the Guardian:

Communications infrastructure is especially valuable during a terrorist attack. Twitter was the best way for people to get real-time information about the attacks in Mumbai. If the Indian government shut Twitter down - or London blocked mobile phone coverage - during a terrorist attack, the lack of communications for everyone, not just the terrorists, would increase the level of terror and could even increase the body count. Information lessens fear and makes people safer.

My first thought is that terrorists were active before modern communications, and taking those tools away will do little to stop them. More important is that we develop better tools for law-abiding folks to use to spread the word when things like this begin. After all, if the terrorists can use technology to be more effective, shouldn't we be able to do the same?

Sources:

Hit & Run - These Boots Were Made For Terror
The Guardian - Read me first: Bruce Schneier on terrorism and the web
The TimesOnline - Google Earth accused of aiding terrorists

Rationing Health Resources in a Pandemic (Public Health)

2009-02-04T06:00:00.000-08:00

One of the stickiest issues that I encountered when I was doing pandemic planning was scarce resource allocation, especially when it came to medical resources. Few people want to talk about the issue beyond acknowledging that it will be a problem. The medical professionals I worked with looked to the government for guidance, and many in the government said that they didn't have the necessary expertise and it would be up to the hospitals. The short version is that everyone was afraid of public blowback and liability if they stuck their necks out to make a suggestion. One group that tried to get the conversation going was the Task Force for Mass Critical Care, which I wrote about in May of last year. Now, Minnesota has approached the issue again.

A website has been opened to allow public review and comment on the Minnesota Pandemic Ethics Project. From the site:

The project’s goal is to propose ethical frameworks and procedures for rationing scarce health resources in Minnesota during a severe influenza pandemic. The frameworks recommend how to decide in what order different groups of Minnesotans should be prioritized to receive resources. There are also recommendations about how to implement the ethical guidance provided by the frameworks. The preliminary recommendations have been developed by a broad-based panel and work groups of more than 100 Minnesotans. An important part of this project is to gather public input so that the final recommendations include broader perspectives.

Something I had proposed early in my work as a pandemic planner was initiating a series of public forums to discuss the challenges that would be faced in a pandemic. The goal was that they would be both educational (explaining to the public what they should be ready for) and input-soliciting (inviting public comment on the plan). Unfortunately, I left pandemic planning before we got a point where that sort of interaction would have been possible. This site is a similar tool.

If you are in Minnesota, read the site and comment. If you aren't in Minnesota, read the site and then press your state and local health departments to create something similar. We all need to take an active role in discussing a pandemic long before it happens.

For other write-ups on the site, see the sources below.

Sources:

Minnesota Pandemic Ethics Project
Avian Flu Diary - Minnesota Unveils Draft Pandemic Ethical Guidelines, Looking for Public Comment
Project Disaster - Minnesota talks to her citizens: Rationing Medicine in a Pandemic
Avian Flu Diary - CIDRAP News Summarizes the Minnesota Pandemic Ethics Discussion

DHS Action Directive: FEMA, State, and Local Integration (State/Local)

2009-02-03T06:00:00.000-08:00

As I mentioned yesterday, one of the more recent Action Directive issued by Sec. Napolitano was on FEMA integration efforts with State and Local emergency planning. Specifically:

Ensuring the nation’s preparedness for all events and all hazards is vital to economic and homeland security and a responsibility of all levels of government. To that end, FEMA shall work with state and local emergency management to:

1. Immediately review plans and activities underway to strengthen and coordinate preparedness activities and assess any overlaps and inconsistencies in these plans and activities. These assessments should include, but not be limited to, the following:

a. Post-Katrina Emergency Management Reform Act
b. Target Capabilities List; the Integrated Planning System
c. State Preparedness Reports
d. Federal Preparedness Reports
e. Nationwide Plan Reviews
f. Planning requirements for emergency management grants
g. National Response Framework

2. Immediately submit any possible restructuring or consolidations for these plans and activities that are necessary and identify areas where state and local emergency management agencies can provide input.

These directives are being issued by Sec. Napolitano as she takes the reins at DHS, and appear to be her way of getting the most information on the different aspects of the department as quickly as possible. A few things of note in this one:

The fact that one of the key items listed is for any suggestions regarding consolidations - one area of regular difficulty in working at the local level that I remember was the number of different, and often conflicting, pieces of federal guidance that would be issued on any single topic. A push for consolidation of similar programs will surely be welcomed at the state and local levels.
Highlighting the Target Capabilities List (TCL) and Integrated Planning System (IPS) - the TCL is a set of 37 specific capabilities that should be developed for preparedness, and IPS is a relatively new (final, non-draft documentation was recently issued) planning system. Pushing the use of these tools not just to state and local planners (often as a requirement for grant funding) but also to FEMA itself is the only way to ensure that all levels of planning can integrate.
Identifying areas for state and local input - there is a mindset in preparedness work that "outsiders" should be kept that way, outside. I've seen this in every level of planning I've been involved in. Often, the argument is that things need to be kept in-house until they are finalized so there aren't any misunderstandings. The problems is that this leads every agency at every level to plan in isolation and greatly increases the likelihood that those plans won't integrate with any others.

As with the other Action Directives, my take is that these reports are the equivalent of "What I did last summer" reports in school, a chance for the teacher (Sec. Napolitano) to quickly get to know the class (DHS) while not putting too much strain on them. I expect that there will be a second set of reports requested following these, where more time is allotted for specific program areas the Secretary feels warrant further study.

More from DHS (Federal)

2009-02-02T06:00:00.000-08:00

There has been some more activity over at DHS, and rather than try and stretch any single thing into a post I'm going to highlight a couple of them.

More Action Directives: In my last post on DHS I mentioned that Sec. Napolitano had issued a few Action Directives to the staff. In addition to the five issued previously, she has added two more. These address:

I'll dig more into the first tomorrow, and for a discussion of the second head over to In Case of Emergency. My short take on these directives is that they are not really about lengthy, in-depth reviews, but are more intended as a way for the Secretary to get brought up to speed on the state of the department. I would expect to see these followed by either additional reviews or specific proposals based on identified gaps.

National Exercise Simulation Center opens: One of the largest issues encountered with planning emergency response exercises is how to make them seem real. Most large-scale exercises include something called a SimCell, where people simulate the various agencies and resources not participating. This allows participants to pick up the phone and "call" the same places they would for real, and interact with someone simulating that service.

From the FEMA press release:

The 2006 Post-Katrina Emergency Management Reform Act (PKEMRA) Section 664 called for the establishment of a National Exercise Simulation Center that uses a mix of live, virtual and constructive simulations to:

Prepare elected officials, emergency managers, emergency response providers and emergency support suppliers at all levels of government to operate cohesively;

Provide a learning environment for Homeland Security personnel of all federal agencies;

Assist in the development of operational procedures and exercises, particularly those based on catastrophic incidents; and

Allow incident commanders to exercise decision making in a simulated environment.

Leadership Journal continues: One of the blogs that I subscribed to but rarely read was the Leadership Journal. This was a blog written by different people at DHS and the general tone of it always struck me as "we know better than you". It was great to see the issues that they felt were important, but the tone of the writing turned me off. What I have been pleased to see is that the new leadership at DHS seems inclined to keep the Journal running. There have been three consecutive posts (27-30 Jan), which indicate they are from Sec. Napolitano. I do hope that the department keeps this blog going. Even though, as I said, I wasn't a fan of the way it was written before, knowing what the leadership of DHS feels are the most important issues facing the department is valuable.

Sources:

In Case of Emergency - Quickly Noted: DHS Action Directives
On the Homefront - HS Secretary Issues Two New Action Directives
FEMA Press Release - National Exercise Simulation Center Opens at FEMA
Leadership Journal

FEMA reorganization (Editorial)

2009-01-30T06:00:00.000-08:00

In my post on Monday I mentioned that Sec. Napolitano's naming of a new FEMA Administrator is complicated by the added pressure coming from many in Congress and elsewhere to remove FEMA from DHS and make the Agency independent.

From the Washington Post:

Besides serving as the president's top adviser during domestic disasters, the next FEMA chief will be under the gun as Congress, Napolitano and the White House debate whether to make FEMA a stand-alone agency or to reorganize it. FEMA also is still rebuilding from its disastrous response to Hurricane Katrina under then-Director Michael D. Brown and subsequent reorganizations.

And, from the Wall Street Journal:

Asked if she saw FEMA as an integral part of homeland security, Napolitano said, “I think it’s an integral part until it isn’t.” That’s not going to be reassuring for FEMA’s boosters, including leading Democrats in Congress.

While recognizing there are clearly some needed changes within FEMA, I have to ask if another reorganization is really going to help. This would be the third major (and who knows how many minor) reorganization since the creation of DHS. Specifically:

Inclusion in DHS - There are few people who will try to claim that the combination of 40+ different agencies and offices into the Department of Homeland Security has gone smoothly. In the case of FEMA, major components of the Agency were separated into different branches of the new Department, with an idea that some aspects of the Agency's work (preparedness, response, recovery, mitigation) would be best placed with other parts of DHS. This was part of the general attempt to form a single unified Department out of scores of separate agencies. Many of the problems related to Hurricane Katrina can be traced to this separation of components.
Post-Katrina Emergency Management Reform Act of 2006 - "Directs that FEMA be maintained as a distinct entity within DHS. Prohibits the Secretary from reducing its authorities, responsibilities, functions, or capabilities, except as specifically provided in subsequent Acts. Prohibits certain transfers of FEMA assets, functions, or mission." This occurred as a part of the Homeland Security Appropriations bill, with Title VI - National Emergency Management, Section 601 being named for the earlier Senate Act referred to above. This Act also returned to FEMA some of the components which had been removed by the prior reorganization (specifically the Preparedness Directorate), undoing much of the previous years.

Clearly, major restructurings like this cannot take place without major impacts on the ability of the Agency to do its job. Every time there is a major reorganization it takes time for the employees to learn the new systems, to know who is responsible for what and who reports to who. In a "normal" organization (i.e. one that doesn't have to go into devastated areas and try to restore normalcy at a moment's notice) this can cause delays and reduce efficiency. In an organization like FEMA, reduced efficiency means people suffer.

I hope that whatever is decided, there is enough time for the Agency to adapt to the new system before it has to go to work helping people rebuild their lives. For all the criticisms that have been leveled at FEMA over the last few years, both deservedly and not, are there people who really think that we would be better off with no FEMA response?

State Pandemic Plans Reviewed (Public Health)

2009-01-28T06:00:00.000-08:00

In a report recently delivered to the Homeland Security Council a team led by Dr. William Raub, Science Advisor to the Secretary of Health and Human Services, reviewed the plans submitted by the states and territories for pandemic influenza. These are specifically operating plans - meaning that they should have operational information, detailing specific actions that will be taken and not simply assessments of the threat or actions that should be taken. This is an important distinction, because many pandemic plans (at all levels) contain extensive discussion and modeling without containing specific, actionable tasks to be carried out in the event of a pandemic.

The report indicates that state and territory planning is moving in the right direction. “The results of this assessment provide a broad-brush picture of strengths and weaknesses across various aspects of pandemic preparedness,” Science Advisor Dr. William Raub said. “The report shows that, on the whole, states and territories have accomplished a tremendous amount in a short time. The results also indicate that much remains to be done to become prepared as a nation.”

Rather than fill this space with my interpretation of the report I encourage anyone interested in pandemic planning to head over to the site and review the whole thing themselves. It is well-organized and easy to read. Following a single table which includes all of the states and territories and their rankings are a series of Objective-specific discussions, with simple tables showing the breakdown of numbers of states for each ranking and states with no major gaps listed. Following these, the report has a set of concluding observations, summaries of the general trends the working groups made while reviewing the plans.

Again, I encourage anyone interested in pandemic preparedness to check the report out. The whole thing can be found at: http://www.pandemicflu.gov/plan/states/state_assessment.html

Sources:

ProjectDisaster.com - Swiss Cheese: States' Plans for Pandemic Influenza

Sec. Napolitano and DHS (Federal)

2009-01-26T06:00:00.000-08:00

I haven't had much time for keeping up with the news or writing for the last few weeks. Between traveling for work and a short but nasty bout of a stomach flu, I've mainly been marking articles to read later. Hopefully things are going to be a little slower for the next few weeks and I'll be able to get caught back up.

Today I'm going to pull from a few different articles I've seen over the last couple of days, all discussing various actions Sec. Napolitano has taken or is expected to take. These include issuing some action directives, pointing out the direction of the department, and some actions related specifically to FEMA.

One of the first things that Sec. Napolitano, and all of the new Cabinet Secretaries, is tackling is restaffing the Department. Traditionally, political appointees resign their offices effective Inauguration Day. This is done to allow the incoming administration to staff those positions with personnel of their choosing. In the case of DHS many Bush appointees have stayed on, at the request of the incoming Obama administration, to ensure that the Department would be able to respond if needed during the transition.

From the Washington Post:

By contrast, Homeland Security Secretary Janet Napolitano has retained the department's second-ranking official, Deputy Secretary Paul A. Schneider, and its top border security official, U.S. Customs and Border Protection Commissioner W. Ralph Basham, as well as its operations director and the assistant secretaries responsible for policy and private sector coordination. The heads of the Coast Guard and Secret Service, who are not political appointees, and DHS Undersecretary for Management Elaine C. Duke, whose tenure is set by law, also remain.

In addition to the large number of appointed positions that need to be filled, there are also positions where the incumbents have already stepped down. One of the most significant of these is FEMA. Currently, Nancy Ward the Regional Administrator for Region IX (a career hire, not a political appointee) is serving as the Acting Administrator for FEMA. With the recent history of FEMA fresh in everyone's minds it is clear that this will not be an easy post to fill.

From the Washington Post:

Besides serving as the president's top adviser during domestic disasters, the next FEMA chief will be under the gun as Congress, Napolitano and the White House debate whether to make FEMA a stand-alone agency or to reorganize it. FEMA also is still rebuilding from its disastrous response to Hurricane Katrina under then-Director Michael D. Brown and subsequent reorganizations.

Reorganization is one of the largest issues when it comes to FEMA, with some fearing yet another major reorganization, the third since the formation of DHS (1st - inclusion into DHS and some structural changes as a part of that inclusion, 2nd - the Post-Katrina Emergency Management Reform Act of 2006 (S. 3721 [109th]), 3rd - any proposed by Pres Obama or Sec. Napolitano). Whatever the goals of reorganization, implementation will hamper the ability of FEMA to respond while the changes percolate through the agency, leaving room for another poor showing, which no-one can afford. (This is an issue I will return to more thoroughly in the near future.)

Finally, Sec. Naoplitano has issued a set of five Action Directives focused on one of the primary missions of the Department, Protection.

From the press release:

The action directives Secretary Napolitano issued today on protection instruct specific offices and agencies to gather information, review existing strategies and programs, and to provide oral and written reports back to her by a time certain. The areas in which today’s action directives were issued are: critical infrastructure protection; risk analysis; state and local intelligence sharing; transportation security; and state, local and tribal integration.

All in all it appears that Sec. Napolitano has tried to hit the ground as close to running as possible and keep the Department moving smoothly while beginning to get a handle on how she will alter the Department to fit President Obama's and her own vision of what it should be.

Sources:

The Washington Post - Who Will Lead Brownie's Old Troop?
The Washington Post - Many Bush Officials Held Over at DHS
The Wall Street Journal - Napolitano to Asses FEMA, Borders
DHS Press Release - Secretary Napolitano Issues First in a Series of Action Directives
GovTrack.us - S. 3721 [109th]: Post-Katrina Emergency Management Reform Act of 2006

Travel

2009-01-19T20:36:00.000-08:00

I'm on the road for the next few weeks, with little down time. I hope that I'll have time to write in the evening, but if not I'll be doing some reposts of stuff from some of the blogs I follow with some minor commentary.

Thanks for understanding.

Daschle and HHS (Public Health)

2009-01-14T14:35:00.000-08:00

Since my earlier PH post was pretty brief and didn't provide much information I figured I'd toss another one out there.

Yesterday the Politico ran a set of profiles on the cabinet secretaries and the departments they've been nominated for. The piece on Daschle and HHS is available here. It is a good, if basic summary of some of the major strengths that Daschle brings to the office. There isn't anything groundbreaking, but it is a good starting place if you're trying to "get to know" Tom Daschle again before he moves back into public life.

The Public Health Preparedness Summit (Public Health)

2009-01-14T06:00:00.000-08:00

Last year I attended the Public Health Preparedness Summit in Atlanta. That made sense as I was a Pandemic Coordinator for a local public health department. This year I will get to go to San Diego, despite having moved out of public health into general emergency management. Looking over the agenda I found a number of sessions where the topics play into upcoming exercises, and so I have my ticket.

Rather than spend a lot of time talking up the PHPS (and I would, it was great last year), I just want to encourage anyone who reads this that is involved in public health makes an effort to be there. I push that if only because it's a great chance to network and meet other people in the field. Having someone to commiserate with when the job gets a little too rough is always nice.

The other thing I want to do is put out an open call - if you read this blog and are going to be in San Diego for the PHPS leave a comment or email me. I would love to meet up with some of the people I've swapped emails with.

Jamming communications (State/Local)

2009-01-13T08:13:00.000-08:00

During the recent Mumbai terrorist strike the attackers apparently used smart phones to stay in contact and revise their planning on the fly. As a result, New York Police Commissioner Ray Kelley is seeking the ability and authority to shut down mobile networks should a similar attack occur in New York. In testimony before the Senate Committee on Homeland Security and Government Affairs he stated:

We also discussed the complications of media coverage that could disclose law enforcement tactics in real time. This phenomenon is not new. In the past, police were able to defeat any advantage it might give hostage takers by cutting off power to the location they were in. However, the proliferation of handheld devices would appear to trump that solution. When lives are at stake, law enforcement needs to find ways to disrupt cell phones and other communications in a pinpointed way against terrorists who are using them.

Yes, access to this sort of real-time communications is a problem, but is shutting down or jamming the network the best response, or merely another example of our security personnel reacting to prevent the last terrorist attack rather than the next?

I think it is safe to say that the terrorists used the tools available to them. The group in Mumbai was organized and prepared. If the cell network had gone down they may have had a back-up system, and even if they didn't, it is likely that the next group to try this will. There are a number of alternates that come to mind, but the simplest to use are Family Radio Service (the little two-way radios you can get at Wal Mart) or HAM radios. FRS have the advantage of being available cheaply from just about anywhere, and HAM radios can operate in frequencies that would be too complicated to jam. A truly prepared and organized group could go as far as acquiring a set of 800 MHz radios (the reserved public safety band) and use those.

Perhaps more important than the limited impact this might have on the attackers is the massive impact it would have on the victims. People within the area of attack need to be able to call for help, to relay information to responding personnel, and to get information about what is going on. Shutting down cell and Wi-Fi networks would cripple these individuals and may result in the loss of more lives than it saves.

This is clearly something we need to be prepared to deal with, I just wonder if the best way to go about it is to be thinking in terms of jamming. I don't have any answers, I do hope that as police and Homeland Security personnel begin to develop plans they keep the whole situation in mind.

Sources:

Danger Room (Wired) - NYPD Wants to Jam Cell Phones During Terror Attack
Danger Room (Wired) - Open Wi-Fi Aids Terrorists, Mumbai Cops Say
IntoMobile - NYPD wants to jam mobile phones in case of a terrorist attack

More government Twitter accounts

2009-01-13T07:45:00.000-08:00

Yesterday I posted about a Twitter "press conference" that FEMA Administrator Paulison was holding. Later in the day I came across an article on the BearingPoint blog (New thinking for a changing world) entitled GovTwitter Directory. The article is here, and it includes a fantastic list of government agencies (at all levels) on Twitter. If you don't use Twitter (I don't) this won't mean much for you, but if you want to follow your favorite bureaucrat, here you are.

The post is below:

Looking for government agencies using Twitter or other social media? We want the GovTwit directory (below) to include all facets of government on Twitter: state and local, federal, contractors, reporters, academics and more. The list below will be a living list, and we hope to keep it updated via our own research, as well as your submissions.

To start, we have included only Twitter IDs and links to official government blogs and URLs noted in Twitter bios.
If you have information that should be added, please post using the comments feature here and we’ll get it included (list name, agency/firm/group, Twitter ID and blog or other URL). You can go to www.BearingPoint.com/GovTwit to get to the directory directly, and you can follow GovTwit on Twitter, where BearingPoint’s Steve Lunceford will tweet directory updates.

FEMA on Twitter (Federal)

2009-01-12T08:21:00.000-08:00

I'm in training this week, and didn't have the time to write this up last night. Below is a press release on a Twitter availability for David Paulison this afternoon. If you have a Twitter account and are interested in FEMA this is a great opportunity.

FEMA In Focus Twitter Media Conference

FEMA Administrator David Paulison will participate in an all access social media press conference through the agency's Twitter account, femainfocus, Monday, January 12, 2009 from 3 - 3:30 pm EST. Administrator Paulison will use the opportunity to speak directly to the public through the social media tool on how the agency has evolved over the years and the direction it is currently heading. Administrator Paulison will make a few short statements before opening the floor for questions.

The agency chose to offer the public availability to highlight the value of social media tools in emergency management and disaster response. Tools, such as Twitter, Flickr and YouTube, to name a few sites, have been used by emergency responders, citizens and mass media to gather information and disseminate emergency messages. FEMA recognizes the value of web-based and SMS tools that help the public prepare for and respond to disasters.

FEMA has been using Twitter since October 2008 as a means to offer information about the agency's mission, efforts and perspective. The agency also launched its YouTube page www.youtube.com/fema in 2008 to provide stories about how its programs work in communities nationwide as they prepare for, respond to and recover from disasters.

The public can join the Twitter discussion by going to www.twitter.com/femainfocus and clicking on "follow" under the icon. Those logged in on their own free accounts can ask a question or make a statement by sending a @femainfocus tweet. FEMA staff are encouraged to view the exchange if they are able. If not, the full transcript will be available online with accompanying audio

Since this is intended to provide an opportunity for the general public to interact with and ask questions about the agency, FEMA employees are asked to use internal communications channels such as FEMA-Employee-Communications @dhs.gov or FEMA-Transition@dhs.gov to pose questions to senior leadership. Employees who wish to submit statements or questions as part of the Twitter press conference are asked to identify themselves as FEMA employees.

Administrator Paulison will try to answer questions in order as they arrive; and any questions not answered by the Administrator during the half hour availability will be answered throughout the day by representatives from the agency.

More information is available at http://www.fema.gov/media/2009/010909.shtm

When: Monday, January 12, 2009 from 3 - 3:30 pm EST
Where: www.twitter.com/femainfocus
Who: FEMA Administrator David Paulison

Gupta for Surgeon General? (Federal/Public Health)

2009-01-07T13:43:00.000-08:00

This is an extra Fed/PH post for the week, but I didn't feel like sitting on it and putting it up a week late when nobody cares.

This morning my RSS reader was filled with stories about Dr. Sanjay Gupta, correspondent for CNN, being named as a potential/likely nominee for Surgeon General. Gupta's background is in neurosurgery (yes, that's an MD-type Dr. prefixing his name), which he apparently continues to practice - in one case while detailed to cover a story.

I have seen comments on many of the stories arguing that Dr. Gupta is a bad choice, focusing on two reasons. The first is that his background is in medicine and not public health. There is a significant difference in the way the two professions think (single patient vs. population is only the beginning of it) and a surgeon may not have the right mindset. The other is that he is a correspondent and not a policy person, more accustomed to asking questions than answering. There is some fear that if he accepts and is approved he would be nothing more than a mouthpiece.

Well, that's the main point of the Surgeon General - to be a loud advocate for public health.

The Office of the Surgeon General (OSG) sits within the Office of Public Health and Science, under the Secretary of HHS. According to the HHS website "(t)he role of the Surgeon General is to protect and advance the health of the nation." These days the Surgeon General accomplishes that task mainly as the public face/voice of the White House on public health issues, and the OSG page describes the role as "America's chief health educator by providing Americans the best scientific information available on how to improve their health and reduce the risk of illness and injury" and on that front Dr. Gupta is perfect. He is knowledgeable, and even if he is not expert in public health he understands the issues. He is clearly skilled at presenting complicated and potentially jargon-filled information in a manner that is easy to understand. Lastly, and just as important, he brings some name recognition to the part.

After all - can you name the current Surgeon General?

Sources:

Business and Media Institute - CNN's Gupta: A Surgeon General Who Backs an Obesity Tax?
Economist.com - The surgeon general from CNN
Economist.com - Sanjay silenced
The Guardian - Obama picks CNN's Sanjay Gupta as surgeon general
NYT: The Caucus Blog - CNN Medical Correspondent as Surgeon General?
Project Disaster - Hip Hip Horray for Sanjay! Likely to be Surgeon General
Project Disaster - Sanjay Gupta, Surgeon General?
SF Chronicle - CNN: Gupta approached about surgeon general post
Slate - A Spoonful of Sugar: Sanjay Gupta is a sweet choice for surgeon general
The Volokh Conspiracy - A Celebrity SG
WaPo - TVs Gupta Chosen for Medical Post
WaPo - TV Doctor Gets Paged
WaPo - Obama Wants Journalist Gupta for Surgeon General
WSJ Health Blog - CNN's Sanjay Gupta, Surgeon General?
WSJ Health Blog - Gupta Could Reclaim Surgeon General's Bully Pulpit

(I said there were a lot of them)

Ready or Not 2008 (Public Health)

2009-01-07T06:00:00.000-08:00

In previous years I've paid more attention to the Trust For America's Health annual review of public health preparedness report (Ready or Not?) than this time around. Last year I was working in a local health department, on preparedness issues, and prior to that I was in a graduate program for public health preparedness. Since I haven't had much time to review the whole report, I'll point you towards a couple of excellent reviews at Avian Flu Diary and In Case of Emergency.

For those who aren't aware, the Ready or Not? report looks state and Federal public health preparedness. From the TFAH Ready or Not? page:

Trust for America's Health (TFAH) and the Robert Wood Johnson Foundation (RWJF) released the sixth annual Ready or Not? Protecting the Public's Health from Diseases, Disasters, and Bioterrorism report, which finds that progress made to better protect the country from disease outbreaks, natural disasters, and bioterrorism is now at risk, due to budget cuts and the economic crisis. In addition, the report concludes that major gaps remain in many critical areas of preparedness, including surge capacity, rapid disease detection, and food safety.

In addition to reviewing the state of preparedness, the report includes a set of recommendations ranging from some that are self-evident (restoring full funding for preparedness programs) to more "outside the box" thinking (creating an emergency health benefit to ensure that even the uninsured can receive needed medical care during a bioterror attack).

I am especially excited to see Section 3. Hospital Emergency Preparedness. When I was working in public health I was heavily involved in a community-wide (read: many hospitals) surge planning effort. The hospitals in the community were working together (despite there being facilities from three nationally-acclaimed medical systems, as well as a number of independent competitors) to develop a fare-share medical surge plan. In brief, the goal was to develop a plan that would have the different hospitals taking a different part of the surge, depending on their capabilities. The initial planning was for a pandemic, which is how I was involved, but the intent was to expand to "trauma" situations following the "infectious" pandemic planning.

One problem we ran into was a lack of well-developed guidance and tools for hospitals to use for surge planning. There are some guides for it, but there was no clear science behind the numbers. One set that comes to mind was contained in Federal guidance from a few years back and recommended adding capacity by measures like "100 additional beds per 10,000 population for event XX". Another problem was a lack of guidance on altered standards of care - a necessity in a true surge situation. One set of guidance was published by the Task Force for Mass Critical Care, and I wrote about it here (part 1, part 2).

My hope is that having the issue discussed in a report as well-known in the field as the Ready or Not? series will drive more research into this crucial area.

Sources:

TFAH - Ready or Not? 2008
Avian Flu Diary - TFAH Report Card
In Case of Emergency - Ready or Not 2008, Part 1; Part 2

California and Good Samaritans (State/Local)

2009-01-06T06:00:00.000-08:00

In mid-December a California Supreme Court ruling came down which may impact citizen-responders across the nation. The 4-3 ruling by the court limited the Good Samaritan law in California to only those responders providing medical care. From the AP:

California's Supreme Court ruled that the state's Good Samaritan law only protects people from liability if the are administering emergency medical care, and that Lisa Torti's attempted rescue of her friend didn't qualify.

From the SF Chronicle:

The case dates from 2004, when a group of friends including Torti and Alexandra Van Horn left a bar in suburban Chatsworth (Los Angeles County) in two cars after a Halloween party.

The car in which Van Horn was a passenger went out of control and hit a light pole. Torti, in the other car, pulled Van Horn out just before emergency crews arrived to take her to the hospital, where she underwent surgery for a spinal cord injury and a lacerated liver.

Torti testified that she had carried her friend out carefully, with one arm under her legs and one behind her back. But Van Horn said Torti had grabbed her by the arm and yanked her out.

I learned the Good Samaritan law (for CA) for the first time when I was in high school and took the Red Cross classes to be a lifeguard. I had a much more thorough exposure to it when I took wilderness first aid (WFA), wilderness first responder (WFR), and urban emergency medical technician (EMT-B) classes. What I learned in those classes is that there are fairly strong protections for responders, providing they:

Stay within the scope of their training and practice;
Follow their duty to act (if any);
Are not specifically negligent in the care they provide.

I am not going to get into the full details of the protections, or the care provided in the case at hand, but rather look at the law and how the ruling impacts it. From the WSJ:

In 1980, the California legislature enacted the Health and Safety Code, which provides that “no person who in good faith, and not for compensation, renders emergency care at the scene of an emergency shall be liable for any civil damages resulting from any act or omission.”

The majority held that the legislature intended only to shield "those persons who in good faith render emergency medical care at the scene of a medical emergency" (WSJ) and not any and all persons involved responding to an emergency. The dissent argued that creating a distinction between medical and non-medical actions would be counter to the aim of the law, which they stated was "to encourage persons not to pass by those in need of emergency help, but to show compassion and render the necessary aid." (WSJ)

I am not an attorney, so I can't argue the legal aspect of what the Court has ruled. My fear is that rulings like this will increase the likelihood that witnesses to accidents and emergencies will stand and watch rather than getting involved. When I was training, especially in the WFA/WFR courses, we often spoke about how bystanders will remain as bystanders until a single individual steps forward and acts. Even then it often takes calling specific people ("Hey, you with the red shirt") to get them to help out. I think the closing quote from the Law.com article says it best:

Appellate specialist Lisa Perrochet, a partner with Encino, Calif.'s Horvitz & Levy who wasn't involved in the case, had what will likely be the average person's take on the ruling:

"Remind me not to try to help anyone escape from burning buildings or fast-flowing rivers," she said in an e-mail. But in a follow-up message, she added that in hindsight reasonable people could disagree.

I'd like to believe that her second thought is the truth, but fear that the initial response is more accurate.

Sources:

Associate Press - Calif. Court: Would-be Good Samaritan can be sued
San Francisco Chronicle - Bumbling Good Samaritan can be sued
Law.com - Calif. Supreme Court Ruling May Deter Good Samaritans
WSJ Law Blog - Good Samaritans & the Law: Cali Court Establishes Liability for Rescuers
Project Disaster - Good Samaritan? Screw You!!!!!
Overlawyered - California Good Samaritan ruling, cont'd

Domestic Military Deployment (Federal)

2009-01-05T06:00:00.000-08:00

I first noticed this story a few months ago, and was reminded of it by a recent post on the Project Disaster blog. In brief: there is a proposal undergoing pilot-testing and cost estimating to reassign approximately 20,000 U.S. Army troops for domestic response activities. The full program won't be active until 2011, but currently 4,700 troops stationed at Fort Stewart, GA are engaged as a pilot program.

The idea is to have military personnel specifically assigned for domestic response for CBRNE events. From the Washington Post (12/01/08):

Last month, McHale said, authorities agreed to begin a $1.8 million pilot project funded by the Federal Emergency Management Agency through which civilian authorities in five states could tap military planners to develop disaster response plans. Hawaii, Massachusetts, South Carolina, Washington and West Virginia will each focus on a particular threat -- pandemic flu, a terrorist attack, hurricane, earthquake and catastrophic chemical release, respectively -- speeding up federal and state emergency planning begun in 2003.

This idea has concerned a number of civil liberties and small government organizations, who are concerned both about the increasing militarization of domestic police forces and a potential weakening of the Posse Comitatus Act. The Act was enacted in 1878 and made it illegal to use "any part of the Army or the Air Force as a posse comitatus or otherwise to execute the laws". Following Hurricane Katrina, President Bush called on Congress to revise Federal law to allow the military to act to restore order in the aftermath of natural disasters. This change was written into the John Warner National Defense Authorization Act for Fiscal Year 2007 (H.R. 5122 2006). Specifically, the Act:

Expanded the President's authority to declare martial law;
Allowed the President to directly take charge of U.S. National Guard troops without the approval of state governors.

Those aspects of the Act were repealed in their entirety by the National Defense Authorization Act for Fiscal Year 2008 (H.R. 4986 2007).

The military clearly has valuable training and expertise in dealing with many of the scenarios presented by CBRNE, as well as having great logistical capabilities, and many of the tools needed for response. Indeed, there is already a close association through the Defense Coordinating Officer/Element (DCO/DCE) - a military liaison that works within FEMA regional offices. From FEMA:

The Department of Defense (DoD) has appointed ten DCOs and assigned one to each FEMA region. If requested and approved, the DCO serves as DoD's single point of contact at the Joint Field Office (JFO). With few exceptions, requests for Defense Support of Civil Authorities (DSCA) originating at the JFO are coordinated with and processed through the DCO. The DCO has a Defense Coordinating Element (DCE) consisting of a staff and military liaison officers to facilitate coordination and support to activated Emergency Support Functions (ESFs). Specific responsibilities of the DCO (subject to modification based on the situation) include processing requirements for military support, forwarding mission assignments (MAs) to the appropriate military organizations through DoD-designated channels, and assigning military liaisons, as appropriate, to activated ESFs.

All of which makes me wonder if there is need for this new program. The Pentagon, through the DCOs, already has a presence in the FEMA Regional offices. Through the DCO/DCE personnel, FEMA has access to the military expertise referenced in the Washington Post piece (above) as the basis of the pilot program, without setting aside specific combat-trained troops. FEMA regions work closely with the states they represent to provide all the assistance they can for planning, meaning that the resources of the DCE are available to the states for the asking. Indeed, if the program functions in the way it seems it will (providing military planners directly to the states without FEMA involvement) there is a risk that state planning and Federal (FEMA) planning will not agree, leading to difficulties should coordinated response be needed.

While I am not as concerned as some about the civil liberties threats posed by this new program I do question its necessity. We have a system in place for Federal assets to be made available to states and any time we move away from that system we risk creating, rather than avoiding, problems.

Sources:

Project Disaster - Calling in DoD assets for disasters sparks mixed reactions...
Time - Should the Military Be Called in for Natural Disasters?
Cato Dispatch - Pentagon to Deploy Troops to Bolster Domestic Security
Washington Post - Pentagon to Detail Troops to Bolster Domestic Security
Salon.com - "Glenn Greenwald Radio" Gene Healy discusses the Pentagon's new plan to deploy 20,000 U.S. Army troops inside the U.S. (podcast)

Short break

2008-12-29T07:45:00.000-08:00

I hadn't intended to take time off, but between moving and not having active internet service at the new house I haven't been able to write. I'm going to yield to the inevitable and take a short vacation through next weekend, when my internet will be hooked up.

Hope everyone has a happy and safe New Year's.

NIMS Resource Center (Federal)

2008-12-22T07:46:00.000-08:00

This will be an unfortunately brief post. I spent the weekend moving which meant no time for writing. Today, the new National Incident Management System (NIMS) Resource Center has gone live. This set up is similar to the NRF Resource Center, which I wrote about previously. When I have had a chance to look through the site I'll write a set of posts, as I did for the NRF.

Gifts and Preparedness (Personal/Family Preparedness)

2008-12-18T06:00:00.000-08:00

I won't try to claim this is a remotely original idea, but over the last few years I've been giving more and more preparedness items as gifts. The first ones I did were pre-fab kits (day-glow backpack with useful stuff) for my younger brothers, mainly because they were living on their own (no roommates) for the first time and I doubted either of them had the basics. The next year I went with hand-crank radios, and for the foreseeable future I'll keep riffing on that theme.

There are a few nice things about gifting preparedness. The first is that you know the people you care about have the tools they need. The second, in some ways more important for me, is that it is a lot easier to figure out gifts for everyone this way. I'm almost famously bad at figuring out what people might like, and going extremely practical in an area that I know something about certainly helps.

I'm being quiet on this year's gift because this time everyone (parents and siblings) are getting the same thing. In this case it makes perfect sense and after the wrapping paper is torn I'll write it up. I stumbled across the wee little thing a little while back, on one of the military blogs I read I think, and it struck me as a perfect companion to a bug-out-bag. Having most of my family in California (famous for its earthquakes and wildfires) means that they all need to be prepared to run at short notice, which means having a BOB ready to go.

For anyone else out there who has as much trouble as I do with gifts, think about preparedness items. For more ideas check out:

World at Risk (Public Health)

2008-12-17T09:00:00.000-08:00

Before I begin, an apology. I had fully intended to write this post, a follow up to last Monday's post on the report from the Commission on the Prevention of Weapons of Mass Destruction Proliferation and Terrorism, and have it out last Wed. Unfortunately my job "got int the way" and I ended up in the office late on Tuesday getting ready for meetings on Wednesday and Thursday, which also kept me there late. I decided to stick to the calendar for topics that I've been establishing, rather than jumping back to the post out of order.

This post is to carry on the discussion I started last week on the World at Risk report. The Commission's full name is in the blurb above and I hope you will forgive me if I don't spell it all out again. In my first post I discussed some issues I had with the report in general. Today I will focus on the public health related aspects. The Commission (as its name suggests) was pulled together to look at a number of WMD-related issues, and they decided to focus their investigations to what they saw as the most pressing threat to the greatest number of people: bioweapons and nuclear proliferation.

A reminder of my background as I get into today's discussion. Before my current job I worked in a local health department in the preparedness office, and we were a CRI community. Prior to going to grad school to get my MPH I was in bio-research in both academic and private settings, primarily doing DNA-based detection work.

On the bioweapons side the report focuses initially on issues related to the BSL- 3 and 4 labs operated throughout the country, and the information is sobering. The section on Biological Risks begins with a description of a team of individuals "on a mission" at a BSL-4 lab (the highest Biosafety Level labs in the US) at Georgia State University:

These individuals discovered that in a number of places, the lab was unprotected by barriers and that outsiders could walk right up to the building housing these deadly pathogens. Around back, they watched and took notes as a pedestrian simply strolled into the building through an unguarded loading dock.

(World at Risk: Section 1 - Biological Risks, p3)

The report then describes the same team visiting another lab, in San Antonio, and having similar results. Fortunately the team outlined were investigators for the Commission, and not agents of a hostile power. The report outlines a number of improvements that need to be made to the management of the BSL system in the United States, none of which seem out of line. My only concern comes from the fact that there were no biologists on the Commission and some of their conclusions about how researchers should be working reflect that lack of understanding. The Commission makes some reasonable suggestions for the research community, such as developing training programs to enhance researchers' understanding of the dual-use nature of much of their work, but there is a lack of clarity about who those recommendations are aimed at. While it may be true that many researchers use theoretically dangerous "bugs" in their work, that doesn't mean that every single one of them needs to go through a Federally coordinated bioweapon training.

The area of the report that truly concerns me follows the discussion of the BSL system:

ACTION: The Department of Health and Human Services, in coordination with the Department of Homeland Security, should take steps to enhance the nation’s capacity for rapid response to prevent an anthrax attack from inflicting mass casualties.

(World at Risk: Section 1 - Biological Risks, p32)

As I discussed at great length previously, we have such a program. We have had it since 2004 and currently 72 metropolitan areas are covered by it. Information about the CRI program is available on-line from the CDC website by following the following pathway: CDC Homepage (to) Emergency Preparedness and Response (to) Preparation and Planning. Simply plugging the initials of the program into the page search box results in this list. Somehow, the Commission completed their interviews without a single person mentioning the CRI program in relation to anthrax with enough emphasis for the Commissioners to look into it. Heck, a Google search for the program yields this list.

My concern here is that the Commission does not address the existence of a four year old program that has spent hundreds of millions of dollars on the singular threat of anthrax. Page 32-34 of the Commission report address their suggestions for anthrax response:

As a first step in addressing these issues, the Bush administration submitted a fiscal year 2009 budget amendment request asking Congress for an additional $969 million to fund the development and manufacture of medical countermeasures, innovative approaches to distribution and decontamination, and upgrades to the BioWatch network of air samplers designed to permit early detection of a bioterrorist attack. These urgent funding requirements should be taken up early in the next Congress. In addition, the next administration should, as a matter of national priority, fully implement an effective anthrax preparedness strategy.

(World at Risk: Section 1 - Biological Risks, p34)

Again, these are not first steps, these are steps that need to be added to ongoing efforts. We do not need another program for distribution (there are currently two - the local government organized PODs from the CRI and Sec. Leavitt's recently announced initiative with the USPS). As much as I try to not let the lack of CRI discussion in the report not impact the way I read it, the fact that a significant program directly related to one of the specific threats covered by the Commission is completely omitted from their document really has me wondering what else they missed, apparently by not looking.

State/Federal Concept of Operations (CONOP) (State)

2008-12-16T06:00:00.000-08:00

Yesterday I wrote about Federal/state CONOP planning in the abstract, discussing the benefits of the efforts. Today I will speak specifically about the California/FEMA CONOP and its application during the recent California Golden Guardian catastrophic earthquake exercise.

I've written before about the ideal world of emergency response, where local governments respond to an incident and call on the state for help, followed by the state calling on the Feds if the incident is too large. Catastrophic incidents throw the ideal world out the window. Events like Hurricane Katrina blow past what local and state resources can handle more rapidly then the standard system is designed for, and that is where Federal/state CONOPs come into play.

Recently I had the chance to see the California/FEMA CONOP exercised. The California Golden Guardian exercise was built around a realistic scenario of a 7.8 earthquake in southern California, which would absolutely decimate the infrastructure of about a third of the state. The scenario for the exercise was built by the USGS based on potential, real earthquakes that the USGS is concerned about. (Details of the scenario are available here.) This scenario was a perfect chance to explore the relationship between FEMA and Cal OES in a catastrophic incident.

The CONOP lays out the important issues around incident management, including the leadership structure and the time lines for activating various command centers. The primary group for organizing the response is the Unified Coordination Group (UCG), which operates out of the Joint Field Office (JFO). Some information on the JFO can be found in the NRF, but in general it is a temporary facility where Federal, state, local, and tribal personnel gather to manage an incident. The UCG is the coordinating group made up of the senior leaders for the different levels of government present in the JFO. The time lines referred to are important, because the JFO isn't normally activated for 48-72 hours after an incident. Prior to that most Federal response is managed from the Regional Response Coordinating Center (RRCC) at the Regional Office, and the state response is managed from either the State Operations Center (SOC) in Sacramento or one of the Regional Emergency Operations Centers (REOCs).

What is important to note is that the CONOP does not set out specific response actions. Instead, it sets out the structure that will be used to sync up Federal and state efforts. Having this organization established at the outset of the response effort should make it easier for Federal and state personnel to work together, complimenting each other without wasteful redundancy. From what I saw during GG this was the case. I hope that these plans spread, with all states and FEMA Regions developing similar documents in the future.

State/Federal Concept of Operations (CONOP) (Federal)

2008-12-15T03:00:00.000-08:00

Last week I had some pointed comments about the Hurricane Ike recovery efforts and the appropriate roles Federal and state resources should play. The more I thought about it, the more I realized that I had done something I dislike - griped without providing a solid alternative. The next two days I'm going to talk about joint Federal and state planning. Today I'll address is from the Federal side in general terms, and tomorrow I'll highlight the California/FEMA plan which I have seen exercised.

A short time ago I spent a few days discussing the National Response Framework (NRF), the updated Federal system for managing and responding to disasters. The NRF outlines how Federal agencies, under the leadership of FEMA, respond and lays out specific responsibilities for many agencies through the Emergency Support Function (EST) system. What it does not do is lay out how the Federal system interacts with states. Instead, there is a placeholder on the NRF site for Response Partner Guides which states:

Response Partner Guides are designed to provide a ready reference of key roles and actions for local, tribal, State, Federal, and private-sector response partners.

You may want to sign up for email updates to receive a message when these guides are completed.

Not having completed partner guides leaves open the possibility of misunderstanding over Federal and state roles. A long-standing axiom in emergency management is that all incidents are handled at the lowest (most local) possible level, but where things get complicated is when Federal aid is involved.

Complications can come from many different sources:

Confusion over who is actually in charge of the response efforts;
Questions over the system for requesting asset deployment;
Miscommunication over mission assignments;
Uncertainty about commodity distribution/Points of Distribution (PODs);
Disagreement over who will pick up the tab.

To resolve some of these points of confusion FEMA region offices work with their states to draft CONOPs which outline the Federal/state response protocols and provide:

Unity of effort;
Coordination of prioritization;
Robust management of resources;
Effective management of well-intentioned political involvement.

(List from a power point describing the California/FEMA Region IX CONOP planning effort, available here.)

This type of collaborative planning is essential to avoid the jurisdictional turf battles that often arise in these types of events. The problems arising in the Hurricane Ike clean-up are the sort of things that would be addressed in a CONOP which would at least remove questions about responsibility. Once the questions about who is responsible are answered either the response/recovery efforts will go smoothly or it will be easy to take the right agency to task for failings.

Tomorrow I will discuss the California/FEMA CONOP as a specific example.

Preparedness and Response

Briefly Noted - Everyday Preparedness

What I hope to get to this week

Briefly Noted - 2011 State-by-State Update on Laboratory Capabilities and Response Readiness Planning

Public Health Preparedness: 2011 State-by-State Update on Laboratory Capabilities and Response Readiness Planning

A report on CDC-funded preparedness and response activities in 50 states and 4 cities

Tuesday, September 20, 2011

FEMA launching "Ready Indian Country"

FEMA to Launch Ready Indian Country Preparedness Campaign

FEMA webinar on preparedness for aging Americans - TODAY

Getting Real II - Promising Practices in Inclusive Emergency Management for the Whole Community

NIMS Guideline for the Credentialing of Personne

National Preparedness Month

National Preparedness Month webinars

Presidential Policy Directive 8: National Preparedness Goal

Background Information: The first two requirements of the Directive are to develop a National Preparedness Goal and the National Preparedness System. For more information on these requirements, visit www.fema.gov/pdd8.

FEMA and Hurricane Irene

What has been consuming my time - THIRA part 1

Reunification

Public Health Preparedness Summit

"Get a Kit"

Better late than never

Returning in 2011

Briefly noted - National Disaster Recovery Framework

Unified Command

Quick note - HHS Haitit resources

An apology

Reporting - Three of Four: Operations

Reporting - Two of Four: Preparedness

Reporting - One of Four

Returning

Hiatus

Pandemic - What now? (Public Health)

Pandemic (Public Health)

Reccommended article (Public Health)

WHO, Pandemic Alerts, and Severity (Public Health)

Briefly - Hurricane Preparedness Week (Federal)

On the road again

H1N1 (Public Health)

H1N1 (State)

H1N1 (Federal)

What I'm working on

Cutting off the nose to spite the face (Federal/Editorial)

A few, semi-connected rants

H1N1 publicity (Public Health)

Resources for journalists

During Swine Flu Outbreak, CDC Once Again Impresses

Diagnosing the Swine Flu Infodemic

By Adam Elkus | April 30, 2009

Swine flu - the lighter side

Welcome to the Jungle? (Public Health)

Senate Confirms Sebelius as Health Secretary

IOM releases free electronic book on Swine Flu (Public Health)

Swine Flu - State Responses (State)

Briefly - Swine flu

The Fugate hearing (Federal)

Unintentional hiatus

Planning with my mom (Personal preparedness)

Alternate power (Personal preparedness)

Institute of Medicing Preparedness Forum (Public Health)

Interactive agencies (Federal)

Getting your home ready (Personal preparedness)

Rita lessons and Ike (State/Local)

Cleaning house (update)

Pandemic Preparedness (Public Health)

Fugate at FEMA (Federal)

Problems

Target Capabilities (Editorial)

Locators (Personal Preparedness)

HHS Secretary, take 2 (Public Health)

FEMA: In or Out? (Federal)

When good ideas go bad (Editorial)

Helping others prepare (Personal Preparedness)

Thoughts on the Public Health Preparedness Summit (Public Health)

Missing

"Right At Your Door" (Personal Preparedness)

More jamming proposed (Editorial)

Rationing Health Resources in a Pandemic (Public Health)

DHS Action Directive: FEMA, State, and Local Integration (State/Local)

More from DHS (Federal)