Description
When the team is in place, the emergency management planning team’s first task is to conduct a hazard vulnerability analysis (HVA). An HVA identifies potential threats, risks, and emergencies and the potential impact these emergencies may have on the community.
An Emergency Planning Guide for America’s Communities
Standing Together Standing Together
Standing Together
An Emergency Planning Guide for America’s Communities
The Joint Commission is proud to acknowledge its partnership
with the following organizations
in developing this planning guide:
Illinois Department of Public Health
Maryland Institute of Emergency Medical Services Systems
National Center for Disaster Preparedness at Columbia University
© Copyright 2005 by the Joint Commission on Accreditation of Healthcare Organizations.
All rights reserved. No part of this book may be reproduced in any form or by any means without written permission from the publisher.
iii
Table of Contents
Standing Together: An Emergency Planning Guide for America’s Communities
Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iv
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Emergency Management Leadership . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Essential Components of the Planning Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Section 1. Define the Community . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Section 2. Identify and Establish the Emergency Management Preparedness
and Response Team . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Section 3. Determine the Risks and Hazards the Community Faces . . . . . . . . . . . . . 15
Section 4. Set Goals for Preparedness and Response Planning . . . . . . . . . . . . . . . . . 20
Section 5. Determine Current Capacities and Capabilities . . . . . . . . . . . . . . . . . . . . 31
Section 6. Develop the Integrated Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Section 7. Ensure Thorough Communication Planning . . . . . . . . . . . . . . . . . . . . . . . 53
Section 8. Ensure Thorough Mental Health Planning . . . . . . . . . . . . . . . . . . . . . . . . . 62
Section 9. Ensure Thorough Planning Related to Vulnerable Populations . . . . . . . . . 67
Section 10. Identify, Cultivate, and Sustain Funding Sources . . . . . . . . . . . . . . . . . . . 70
Section 11.Train, Exercise, and Drill Collaboratively . . . . . . . . . . . . . . . . . . . . . . . . . 72
Section 12. Critique and Improve the Integrated Community Plan . . . . . . . . . . . . . 80
Section 13. Sustain Collaboration, Communication, and Coordination . . . . . . . . . . . 84
Closing Comment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
Acknowledgment of Roundtable Members . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90
Selected Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
Executive Summary
iv
Despite the passage of four full years since
September 11, 2001, many small communities in
the United States are struggling to meet the man-
date for emergency preparedness and response
that would enable them to function on their own
in the hours or days before help arrives from
regional, state, and federal sources. Readiness bar-
riers include lack of clarity about who is respon-
sible for preparedness and response planning, what
elements of the planning and response processes
are critical, how to coordinate with state and fed-
eral emergency management programs, and how
to obtain and sustain funding.Whenever or what-
ever disaster or mass casualty event occurs, com-
munity and local response will be key to survival;
communities must look to themselves and adjoin-
ing communities for answers.
This planning guide provides expert guidance on
the emergency management planning process that
is applicable to small, rural, and suburban commu-
nities. Its goal is to remove readiness barriers by
providing all communities with strategies, process-
es, and tools for coordinated emergency manage-
ment planning. The target audience is local lead-
ers—including elected or appointed officials,
health care providers and practitioners, public
health leaders, and others who are responsible for
initiating and coordinating the emergency man-
agement planning effort in towns, suburbs, and
rural areas throughout the United States.
To develop this planning guide, the Joint
Commission partnered with the Illinois
Department of Public Health, the Maryland
Institute of Emergency Medical Services Systems,
and the National Center for Emergency
Preparedness at Columbia University and con-
vened two expert roundtable meetings in May
and October of 2004.These roundtables addressed
the issue of emergency management planning in
small, rural, and suburban communities; synthe-
sized the challenges; and framed potential solu-
tions. This document reflects the extensive input
received from roundtable participants.
Although no one planning tool or template can
provide the breadth of guidance needed, this plan-
ning guide is offered as a multifunctional tool or
template. It outlines 13 essential components of an
effective community-based emergency manage-
ment planning process and provides multiple
planning strategies addressing each component.
The components include the following:
1. Define the community.
2. Identify and establish the emergency manage-
ment preparedness and response team.
3. Determine the risks and hazards the communi-
ty faces.
4. Set goals for preparedness and response plan-
ning.
5. Determine current capacities and capabilities.
6. Develop the integrated plan.
7. Ensure thorough communication planning.
8. Ensure thorough mental health planning.
9. Ensure thorough planning related to vulnerable
populations.
10. Identify, cultivate, and sustain funding sources.
11. Train, exercise, and drill collaboratively.
12. Critique and improve the integrated commu-
nity plan.
13. Sustain collaboration, communication, and
coordination.
Each of the 13 sections includes supporting tools
and provides links to Web sites that offer up-to-
date information.The planning strategies are sum-
marized at the beginning of each component sec-
tion for ready reference. Thus, this guide can be
used in a modular fashion to address discrete areas
of interest to particular planning team members.
Or it can be read cover to cover as a comprehen-
sive guide to community emergency management
planning.
Standing Together: An Emergency Planning Guide for America’s Communities
Standing Together: An Emergency Planning Guide for America’s Communities
This guide emphasizes two planning strategies
that are of particular significance to small, rural,
and suburban communities. The first is to enable
people to care for themselves, and the second is to
build on existing relationships.
Enable people to care for themselves
Planning that prepares the community to help
itself can serve to reduce the potential surge in
demand for services experienced during an actu-
al emergency. The emergency plan needs to
include a well-defined risk communication plan
that contains information on the guidance that
will be provided to the public and how that guid-
ance will occur (for example, through distribution
of fliers or other written material, or public ser-
vice announcements on local radio and television
stations). Some types of emergencies can be man-
aged in homes if proper information, such as how
to prevent and treat influenza in low-risk individ-
uals during an outbreak in the community, is
made available. For certain kinds of chemical
exposure, the instruction to stay at home and take
a shower rather than go to the hospital to be
decontaminated is appropriate. Other types of
emergencies will require mass evacuation, which
is best supported by ongoing public communica-
tion, education, testing, and drills. Hurricane plans
in Florida provide an excellent example of proac-
tive, multilingual, and pervasive preparedness;
evacuation signs are well recognized throughout
communities in Florida.
Community awareness, education, and engage-
ment can be supported not only through formal
public health and public safety mechanisms and
the local media, but also at a “grass roots” level
through a range of community groups, such as
civic organizations, religious groups, Boy/Girl
Scout troops, and high school sport teams, among
others. These groups provide not only informa-
tion, but also social support for participation in
the planning and response effort that will help
individuals stay engaged over time, even during
times of perceived “low risk” when apathy about
preparedness can become pervasive.
Highly organized community preparedness efforts
should also be supported. Communities whose
residents have not yet experienced Community
Emergency Response Teams (CERTs) may wish
to consider offering this program. CERTs are
funded by Congress through Citizen Corps pro-
gram grants, which are made available to local
communities.A key component of Citizen Corps,
the CERT program trains citizens to be better
prepared to respond to emergency situations in
their communities. When emergencies occur,
CERT members can give critical support to first
responders, provide immediate assistance to vic-
tims, and organize volunteers at a disaster site.
The CERT program is a 20-hour course, typical-
ly delivered over a seven-week period by a local
government agency, such as the emergency man-
agement agency or fire or police department.
Training sessions cover disaster preparedness, dis-
aster fire suppression, basic disaster medical opera-
tions, light search and rescue, and team operations.
The training also includes a disaster simulation in
which participants practice skills that they learned
throughout the course.
Build on existing relationships
The time and resource requirements associated
with emergency management planning, response,
and recovery are considerable. Communities
should carefully and creatively examine their cur-
rent assets and expand upon them to best capital-
ize on their investment in preparedness. A key
asset is the relationships that already exist among
potential planning partners in the community;
these relationships can serve as an important plat-
form for building response capability.
v
Standing Together: An Emergency Planning Guide for America’s Communities
Small communities located near military installa-
tions, nuclear power plants, hydroelectric dams,
and other large-scale industrial entities are famil-
iar with the extensive public education and col-
laboration required to maintain general public
safety. Periodic joint meetings involving the local
utility company, telecommunications company,
water bureau, public health department, hospital,
fire department, police, and emergency medical
services (EMS) are not unusual in such communi-
ties, but in other communities there are long-
standing walls that must be breached to facilitate
collaborative planning. In such situations, it may
be advisable to begin with natural allies who can
quickly identify common ground. The following
examples illustrate how to “call the first meeting”
over a focused issue, then expand the work group
into a broader, integrated community planning
team:
? EMS leadership partners with the local hospital
around first responder/first receiver communi-
cation issues, pulling in fire and police to initi-
ate discussions about potential improvements.
Further planning discussions expand the dialog
and include the risks associated with certain
types of communicable disease outbreaks. For
additional expertise and operational informa-
tion, the local health department, state labora-
tories, and bureau of primary health care clinics
are brought to the table.The integrated com-
munity planning team builds from here to
include broader areas of risk and response
expertise respecting potential issues facing the
community.
? A local municipality, in responding to the need
to establish special-needs shelters, has—through
its department of human services and local
nursing homes—identified all the vulnerable
disabled and elderly residents in institutions but
has not identified all those living in the com-
munity.The municipality establishes a work
group that includes representatives from human
services, nursing homes, the largest home
health agency serving the community, the
largest retail pharmacy serving the community,
and the local postal service.They establish a
preliminary plan for locating the vulnerable
disabled and elderly in the community and, on
the basis of this preliminary plan, are able to
pull in representatives from local police, the
911 call facility, EMS, county mental health
agency, and others to help refine the plan and
address issues of service needs, communication
strategies, transport, and medical equipment
and supplies. Problem solving around this spe-
cific issue leads to collaboration on broader
issues of emergency management planning in
the community, and the integrated community
planning team builds from there.
Finding dual uses for existing or emerging capa-
bilities is also particularly critical for resource-
strapped small, rural, and suburban communities.A
reverse 911 call system established by a communi-
ty for law enforcement emergencies could also be
used to communicate information about other
types of emergencies. Motels and college dormito-
ries can be utilized to provide additional bed
capacity. Investments made by local public health
departments in upgrading laboratory services for
smallpox, sudden acute respiratory syndrome
(SARS), anthrax, and other specialized testing can
buttress routine laboratory services in the commu-
nity. Boats or school buses can provide alternative
means of emergency transportation. Businesses
with call-center capabilities, such as telemarketing
and airline operations, can support community
communication needs during a disaster.
By creating an informed and empowered citizen-
ry, and by bringing to the table the full range of
assets within the community including planning
partners perhaps not previously considered, small,
rural, and suburban communities can deepen and
extend their capability to plan for and respond to
all types of natural and man-made disasters.
vi
Introduction
Standing Together: An Emergency Planning Guide for America’s Communities
We cannot live for ourselves alone. Our lives are
connected by a thousand invisible threads, and
along these sympathetic fibers, our actions run as
causes and return to us as results.
Herman Melville
It would seem to take more than a village to
respond to the catastrophic events witnessed in
recent years. Terrorists, tsunamis, tornadoes, and
other threats affect whole cities, countries, and
continents. Yet most disasters and mass casualty
events are experienced locally; in this country,
incidents are generally handled at the lowest pos-
sible jurisdictional level.
1
When significant events
occur, the “intrusive reality” is that small, rural,
and suburban communities in the United States
may be on their own for 24 to 72 hours before
help arrives from regional, state, and federal
sources. Community and local response will be
key to survival; communities must look to them-
selves and adjoining communities for answers.
The invisible threads that connect individuals, as
described by Melville, must be pulled together to
create a surviving community fabric.
The goal of and need for this publication
The goal of this publication is to provide small
communities with strategies, processes, and tools
for coordinated emergency management plan-
ning.To be fully effective, such information must
stimulate and sustain linkages among the individ-
uals and agencies composing a small community’s
fabric. Rural areas may be particularly vulnerable
to terrorist threats and they also may be least pre-
pared to respond. Because nuclear power plants,
uranium and plutonium storage facilities, and all
U.S. Air Force missile launch facilities are located
in rural areas, these communities represent poten-
tial terrorist targets.
2
In addition, the interstate
transit of hazardous materials through small com-
munities nationwide and the location of agricul-
tural chemical facilities make chemical threats a
reality as well. Moreover, following a terrorist
event, residents fleeing large urban areas and in
need of food, shelter, clothing, and health care
could very well “land on the doorsteps” of small
communities and overwhelm community
resources.
Terrorists, of course, are not always the cause of
“events” that overwhelm local resources. Every
community is vulnerable to an influenza pan-
demic—an event considered by most infectious
disease specialists to be long overdue. According
to a recent report from the Institute of Medicine,
experts believe that “the world stands on the
verge”
3(p. 1)
of such a pandemic.
4,5
Its estimated
impact in the United States is 89,000 to 207,000
deaths, 300,000 to 700,000 hospitalizations, and
18 million to 42 million individuals requiring
outpatient care. Every community must face the
possibility of responding to influenza with mini-
mal or no external resources or support.
3
Many
small communities with already seriously bur-
dened and limited health facilities simply will not
be able to care for the surge of patients.
Despite the passage of four full years since
September 11, 2001, many small communities are
struggling to meet the mandate for preparedness
and response that would “return” the desired
“results,” as described by Melville. Challenges
abound (Sidebar 1), but perhaps the most threat-
ening of these challenges is complacency. “The
feeling of relative safety brought on by the belief
that rural areas are at a lower risk for terrorism
may reduce rural communities’ sense of urgency
and limit preparation and responsiveness,” notes
one government report.
2(p. 4)
Studies published in
2002 and 2003 indicate that public health emer-
gency preparedness at the local level may be
improving, but that gaps persist even in larger
communities.
6–8
In reality, many of America’s
1
Standing Together: An Emergency Planning Guide for America’s Communities
small communities are still “waiting for someone
to call the meeting.”
9(p. 11)
Readiness barriers
include lack of clarity about who is responsible
for preparedness and response planning, what ele-
ments of the planning and response processes are
critical, how to coordinate with state and federal
emergency management programs, and how to
obtain and sustain funding.
The audience
This planning document seeks to help remove
these barriers by providing expert guidance on
the emergency management planning process
that is applicable to small, rural, and suburban
communities.The target audience is local leaders,
including elected or appointed officials, health
care practitioners and providers, public health
leaders, and others who are responsible for initi-
ating and coordinating the emergency manage-
ment planning effort in small towns, suburbs, and
rural areas throughout the United States. These
leaders bear responsibility for creating the inter-
connectedness that will help ensure the safety and
well-being of individuals in their communities.
This publication builds on a white paper pub-
lished by the Joint Commission in May 2003
entitled Health Care at the Crossroads: Strategies for
Creating and Sustaining Community-wide Emergency
Preparedness Systems.
9
That white paper framed the
issues that must be addressed in developing com-
munitywide preparedness and noted that “public-
private sector partnerships offer the best overall
prospect for research on and development of rel-
evant, scalable models that will meet local com-
munity needs in a variety of urban, suburban, and
sparsely populated settings. There is considerable
urgency to move this work forward.”
No community is exactly like another. Structures,
governance, resources, and capabilities vary wide-
ly. Development of a one-size-fits-all emergency
plan thus is neither doable nor desirable. The
model or template offered in this planning guide
is a community-based planning process that con-
tains 13 components essential to the development
and implementation of effective emergency pre-
paredness and response. Strategies, tools, case
studies, and “how-to” material provide local lead-
ers with ways to make this planning process hap-
pen. Tools or templates can guide operational
planning in organizations, agencies, and commu-
nities and can outline functional relationships
across such entities and within a state or region.
By their very nature, tools and templates can help
community leaders overcome resistance to
change and political barriers by maintaining focus
on shared goals rather than narrow agendas. Over
2
? A limited public health infrastructure
? A short supply of health providers
? Lack of hospital bed surge capacity
? Seasonal surge capacity and surge capacity from
nearby urban areas
? Mostly volunteer first responders
? Limited mental health services
? Limited access to hazardous materials units,
recognition capability and decontamination train-
ing
? Lower Medicare payments to health care organi-
zations than to urban counterparts for equivalent
services
? Difficult access to needed emergency services due
to geography; residents may face greater trans-
portation difficulties reaching needed services
? Complacency based on the belief that rural areas
are at a lower risk for terrorism than urban areas
Sources: Robert M. Gougelet, M.D.; National Rural
Health Association: What’s different about rural health
care?http://www.nrharural.org; U.S. Dept. of Health and
Human Services, Office of Rural Health Policy (HHS):
Rural Communities and Emergency Preparedness. Washington,
DC: HHS. Apr. 2002.
SIDEBAR 1. COMMON EMERGENCY PREPAREDNESS
CHALLENGES IN RURAL AREAS
Standing Together: An Emergency Planning Guide for America’s Communities
time, by fostering focus, perseverance, and trust,
planning templates and tools can facilitate change
within the community and can help to sustain
linkages with mission-critical partners in other
communities.
Developmental process
Since 2000, the Joint Commission has expanded
its traditional disaster preparedness requirements
for health care organizations into a community-
based emergency management framework.
Health care provider organizations are now
expected to be at the community planning table.
However, they cannot possibly manage alone a
mass casualty event of the proportions proved
possible by 9/11; it takes a whole community to
do so.
To develop this planning guide, the Joint
Commission partnered with the Illinois
Department of Public Health, the Maryland
Institute of Emergency Medical Services Systems,
and the National Center for Emergency
Preparedness at Columbia University and con-
vened two expert roundtables in May and
October 2004. These roundtables addressed the
issue of emergency management planning in
small, rural, and suburban communities; synthe-
sized the challenges; and framed potential solu-
tions.
This document reflects the extensive input
received from roundtable participants (page 90).
It also incorporates selected emergency prepared-
ness lessons learned and recommendations
appearing in seminal publications. These include
the final report of the National Commission on
Terrorist Attacks Upon the United States—The
9/11 Commission Report—published in July
2004
10
and the National Incident Management
System
11
and National Response Plan
1
published by
the U.S. Department of Homeland Security
(DHS) in March and December 2004, respective-
ly.The examples, tools, strategies, and other infor-
mation provided in this document cannot by
their very nature be comprehensive, but rather are
offered as representative of the many excellent
planning efforts under way in various domains.
References
1. U.S. Department of Homeland Security (DHS):
National Response Plan. Washington, DC: DHS, Dec.
2004.
2. U.S. Department of Health and Human Services,
Office of Rural Health Policy (HHS/ORHP): Rural
Communities and Emergency Preparedness. Washington,
DC: HHS/ORHP, Apr. 2002.
3. Institute of Medicine: The Threat of Pandemic
Influenza: Are We Ready? A Workshop Summary.
Washington, DC: National Academies Press, 2004.
4. World Health Organization: WHO Consultation on
Priority Public Health Interventions Before and During an
Influenza Pandemic.Apr. 27, 2004.http://www.who.int/
csr/disease/avian_influenza/consultation/en/
(accessed Aug. 10, 2005).
5. Chen H., et al.: The evolution of H5N1 influenza
viruses in ducks in southern China. PNAS 101(28):
10452-10457.
6. U.S. General Accounting Office (GAO): Bioterrorism:
Preparedness Varied Across State and Local Jurisdictions.
Washington, DC: GAO, Apr. 2002.
7. National Association of City and County Health
Officials (NACCHO): Local Public Health Agencies
Better Equipped to Handle Bioterrorist Attacks.
Washington, DC: NACCHO, Jan. 2003.
8. U.S. General Accounting Office (GAO): Hospital
Preparedness: Most Urban Hospitals Have Emergency
Plans but Lack Capacities for Bioterrorism Response.
Washington, DC: GAO, Aug. 2003.
9. Joint Commission on Accreditation of Healthcare
Organizations (JCAHO): Health Care at the
Crossroads: Strategies for Creating and Sustaining
Community-wide Emergency Preparedness Systems.
Oakbrook Terrace, IL: JCAHO, 2003.
10. National Commission on Terrorist Attacks Upon the
United States: The 9/11 Commission Report. New
York: W.W. Norton, 2004.
11. U.S. Department of Homeland Security (DHS):
National Incident Management System. Washington,
DC: DHS, Mar. 1, 2004.
3
Emergency Management Leadership
Standing Together: An Emergency Planning Guide for America’s Communities
4
Local jurisdictions of all sizes, including towns,
cities, counties, and tribal governments, are
responsible for saving lives, protecting property,
protecting the economic base of the community,
and preserving the environment.
1
Most emergen-
cy “incidents” are managed locally, yet because
small communities are structured and governed
differently, “incident management”—the
response to a major event or emergency—may be
coordinated by individuals with many differing
roles. Some communities have a mayor; others
have a city or county manager. The chief leader
may be elected or appointed, may have direct
control over public safety and health, or may
work through a council or manager.
This planning guide uses the term chief executive
to indicate the elected or appointed leader of the
small, rural, suburban, or tribal (when a tribal
nation exists in the area) community who is held
accountable for the safety and well-being of the
population and community.To fulfill this role, the
chief executive typically works closely with lead-
ers of fire, law enforcement, emergency medical
services (EMS), public works, public health,
health care organizations, and other agencies and
groups. Coordinated emergency management
planning and decision making requires the chief
executive to assume a leadership role in some cir-
cumstances (for example, within his or her own
community) and yield the leadership role, assum-
ing a team-player role, in other circumstances (for
example, when participating in multicommunity
or regional planning efforts). Sidebar 2 outlines
the responsibilities of the local chief executive, as
defined by the U.S. Department of Homeland
Security (DHS).
Responsibility for the development and coordi-
nation of emergency management planning is
often assumed by the chief executive. However, in
some communities, a fire chief, police chief, EMS
coordinator, or administrator of the county health
department or health system (through the efforts
of emergency department physicians, local hospi-
tal associations, and so forth) initiate and coordi-
nate the planning effort.This planning guide uses
the term local planner to refer to the individual
who initiates the emergency management plan-
ning process for the community, and uses the
term planning team to refer to the group of indi-
viduals that conduct emergency management
preparedness and response planning, as described
in Section 2. Sidebar 3 describes three emergen-
cy management planning roles often assumed by
local elected officials.
? Coordinates local resources to address the full
spectrum of actions to prevent, prepare for,
respond to, and recover from incidents involving
all hazards, including terrorism, natural disasters,
accidents, and other contingencies.
? When necessary, uses the extraordinary powers of
the position (depending on state and local law) to
establish a curfew, direct evacuations, and/or, in
coordination with the local health authority, to
order a quarantine.
? Provides leadership and plays a key role in com-
municating to the public, and in helping people,
businesses, and organizations cope with the con-
sequences of any type of domestic incident with-
in the jurisdiction.
? Negotiates and enters into mutual aid agreements
with other jurisdictions to facilitate resource shar-
ing.
? Requests state and, if necessary, federal assistance
through the governor of the state when the juris-
diction’s capabilities have been exceeded or
exhausted.
Tribal chief executives can elect to deal directly with
the federal government (although a state governor
must request a presidential disaster declaration).
Source: U.S. Dept. of Homeland Security (DHS): National
Response Plan. Washington, DC: DHS, Dec. 2004.
SIDEBAR 2. RESPONSIBILITIES OF THE LOCAL CHIEF
EXECUTIVE
Reference
1. U.S. Department of Homeland Security (DHS):
National Response Plan. Washington, DC: DHS, Dec.
2004.
Standing Together: An Emergency Planning Guide for America’s Communities
5
Coordinator: A local elected official serving in this
role coordinates critical local services such as law
enforcement, emergency medical services, and social
services. As the community prepares and tests its
emergency plan, the official can make a point of
clarifying and defining the roles of each local agen-
cy and each agency head to prevent gaps or overlaps
of function. During an emergency event, the local
elected official will meet regularly with agency
heads so that he or she can continuously monitor
the work of the agencies and adjust functions and
responsibilities, as necessary.
Liaison: Local elected officials will also find them-
selves in the role of liaison among various federal
and state agencies, community agencies, the business
community, and the public. To perform this role
effectively, local officials must maintain regular con-
tact with state and federal entities, such as the state
police and the regional FBI office. The liaison must
understand the roles of these state and federal agen-
cies, as well as their needs in an emergency situation,
and must communicate these roles and needs to
local agencies. Similarly, local elected officials act as a
link to local government for both the business com-
munity and the public, working to ensure that needs
and concerns are met.
Representative: Local officials act as representatives of
their communities in the wider regional emergency
planning effort. Most regions and metropolitan
areas, regardless of size, have some kind of regional
coordination effort in place, such as mutual aid
agreements or transportation plans. If no regional
entity exists, local officials can work to convene one.
Source: Adapted from National League of Cities (NLC):
Homeland Security: Practical Tools for Local Governments.
Washington, DC: NLC, Nov. 2002.
SIDEBAR 3. POSSIBLE ROLES OF LOCAL ELECTED
OFFICIALS IN LOCAL EMERGENCY PLANNING
Essential Components of the Planning Process
Standing Together: An Emergency Planning Guide for America’s Communities
The 13 essential components of an effective community-based emergency management planning process
are outlined here and provide the structure for the rest of the planning guide. These components can be
considered steps, with the caveat that the sequence of the activities may need to be varied or repeated based
on the community’s unique needs. The components are as follows:
1. Define the community.
2. Identify and establish the emergency management preparedness and response team.
3. Determine the risks and hazards the community faces.
4. Set goals for preparedness and response planning.
5. Determine current capacities and capabilities.
6. Develop the integrated plan.
7. Ensure thorough communication planning.
8. Ensure thorough mental health planning.
9. Ensure thorough planning related to vulnerable populations.
10. Identify, cultivate, and sustain funding sources.
11. Train, exercise, and drill collaboratively.
12. Critique and improve the integrated community plan.
13. Sustain collaboration, communication, and coordination.
These components are similar to those described in the Joint Commission’s March 2003 white paper.
However, the strategies and examples that follow here for each component are geared specifically to small,
rural, and suburban communities, rather than the nation as a whole.
6
Webster’s, which provides a starting point, defines
community as follows: “A social group of any size
whose members reside in a specific locality, share
government, and often have a common cultural
and historical heritage.”
1
This definition embraces
both the functional and structural realm of communi-
ty as described by sociologists
2
:
? A functional community can be defined as the
associations that are required by groups of peo-
ple living together within a specific geographical
area.
? A structural community can be defined as the
types of interconnectedness that individuals
choose to make with one another, such as
through social organizations.
3
This planning guide focuses on functional commu-
nity while recognizing the critical importance of
structural community to the emergency prepared-
ness and response process. Strategies to help achieve
an accurate definition of the community follow.
Identify key stakeholders in defining the
community.
The effectiveness of planning is dependent on the
ability of communities nationwide to determine
the appropriate functional planning and response
unit for emergencies.
4
As the chief executive will be
accountable for the safety and well-being of the
population during a disaster, his or her first task is
to collaborate with key stakeholder groups in the
community to define the community for the pur-
poses of emergency management planning.
Collaboration ensures that the scope of services
provided and the populations served by each enti-
ty are well understood early in the planning pro-
cess. Integrated, comprehensive planning reflects
associations between the stakeholders who are pro-
viding basic societal functions based on identified
1. Define the Community
Standing Together: An Emergency Planning Guide for America’s Communities
7
Recommended Planning Strategies:
? Identify key stakeholders in defining
the community.
? Consider geopolitical and other defi-
nitional factors.
? Consider impact of federal definitions.
The effectiveness of planning is dependent on the ability of communities nationwide to deter-
mine the appropriate functional planning and response unit for emergencies.
? Public safety and security (fire, law enforcement,
emergency medical services)
? Public works (roads, bridges, dams, transportation,
sanitation, post office)
? Public health (immunizations, food safety, animal
safety, epidemiology/disease surveillance, labora-
tory services)
? Schools, colleges, and universities
? Housing agencies
? Utilities (energy, water, communications)
? Health care providers (including, among others,
hospitals, skilled nursing facilities, ambulatory and
rural health clinics, rehabilitation centers, mental
health facilities, and home care agencies)
? Private industry (for example, chamber of com-
merce, local industries, corporations)
? Service (for example, Scouts, Lions Club) and
religious organizations (for example, churches,
synagogues)
? Federally funded local response initiatives (for
example, Metropolitan Medical Response
System, Medical Reserve Corps, and Community
Emergency Response Teams)
SIDEBAR 4. KEY STAKEHOLDERS IN DEFINING THE
COMMUNITY
Standing Together: An Emergency Planning Guide for America’s Communities
roles and responsibilities. Sidebar 4 lists the stake-
holders that provide key services in most com-
munities.
Consider geopolitical and other
definitional factors.
Small, rural, and suburban communities will be able
to define themselves as distinct geopolitical units
(village, town, county, parish) under the leadership
of a mayor, manager, council, or other governing
entity. Other definitional elements that can be con-
sidered include the following:
? Specific aspects of the geography (for example,
mountains, valleys, flatland, rivers or other bodies
of water)
? Residential patterns
? Highways and other infrastructure
? Employment type (farming, industry, corporate)
? Culture and language
? Climate
Geography is a significant factor in access to essen-
tial services during and following a disaster, but
essential services such as health care providers, fire,
law enforcement, emergency medical services
(EMS), public health planning districts, schools,
utilities, and water supplies do not necessarily con-
form to the same geopolitical boundaries. For
example, health care providers may draw patients
from several towns across one or two counties; pub-
lic health services may not be under the jurisdiction
of a mayor.
In addition, because disasters occur across geo-
graphic and political boundaries, the chief execu-
tive may need to consider legal jurisdictional lines
and assemble planning partners who can address
certain types of emergencies across various bound-
aries. “In many states, there are multiple prepared-
ness regions for different functions. Law enforce-
ment regions may not be contiguous with EMS
regions or hospital catchment areas, which in turn,
may not line up with emergency management
planning regions. Political jurisdictions may no
longer have much to do with population patterns.
Each community must be able to assess its capacity
as part of many different functional regions,” notes
one region’s planning white paper.
4
Consider impact of federal definitions.
The federal government has many different meth-
ods for defining urban and rural or metropolitan and
nonmetropolitan America, largely for purposes of
administering federal programs.
5
These definitions
are not likely to provide local chief executives with
much help in defining the community, except in
the area of funding resources.
For example, the Census Bureau’s new classification
system, released with an update of the Census 2000
data, indicates that rural includes open country and
small settlements of fewer than 2,500 persons. Small
towns and cities that have adjoining towns or sub-
urbs and collectively exceed 2,500 persons, regard-
less of political boundaries, are considered urban. A
small town of 2,000 people with an adjacent dense-
ly settled suburb of 800 people would be designat-
ed as an urban cluster with a population of 2,800.
6
The Census Bureau’s definition notwithstanding,
such an “urban”community is one addressed in this
planning guide.
8
Because disasters occur across geographic and political boundaries, the chief executive may
need to consider legal jurisdictional lines and assemble planning partners who can address
certain types of emergencies across various boundaries.
The process of identifying who must be at the
table for successful and sustained community-
based emergency management, which includes
four phases (prevent, prepare, respond, and recov-
er), is a critical one. A team approach brings
increased creativity, knowledge, and experience
to each phase of emergency management plan-
ning. A team-developed plan, which includes
multiple viewpoints and reflects shared goals, is
more likely to be successfully implemented in the
community. Closer professional and personal rela-
tionships among the team members should trans-
late into better coordination and teamwork in
emergencies.
7
In small communities, the team identification pro-
cess is often about bringing together neighbors
who work and live together routinely. These indi-
viduals assume that their communities need to be
self-sufficient and frequently do not expect the state
or federal government to provide resources quick-
ly in the event of a large-scale disaster. However,
they do expect that representatives of local govern-
ment and emergency response providers will be
there for them immediately following a major
event. In addition, they often expect to be involved
in the response themselves. In small communities,
emergency response frequently revolves around
neighbors helping neighbors.
Strategies to help ensure the best-possible emer-
gency management preparation and response team
follow.
Build on existing relationships.
Rather than beginning a planning process from a
blank page, the chief executive or local planner, as
appropriate and available, can build on effective
existing relationships and patterns of communica-
tion between community stakeholders as a founda-
tion for emergency management planning. Natural
pre-existing relationships and mutual aid agree-
ments—for example, between the police depart-
ment and the mayor’s office, local pediatricians and
the public health department, and EMS and the
county hospital—are found in virtually every com-
munity. Many communities view their fire depart-
ment and EMS (and its link to area hospitals) as the
backbone of emergency response. Thus, linkages
between fire departments, EMS, hospitals, and var-
ious other community constituents may already be
well established.
? Example: Following 9/11, a small community of
5,500 in Ohio formed an auxiliary force modeled on
the former civil defense system for the community.The
goal was to meet community needs during the first 72
hours after a disaster.The force, which now includes 31
individuals, is working with the county in order to
dovetail with county efforts and obtain needed funding.
8
2. Identify and Establish the Emergency Management Preparedness
and Response Team
Standing Together: An Emergency Planning Guide for America’s Communities
9
Recommended Planning Strategies:
? Build on existing relationships.
? Identify appropriate planning partners.
? Consider start-up logistics.
A team-developed plan, which includes multiple viewpoints and reflects shared goals, is more
likely to be successfully implemented in the community.
Standing Together: An Emergency Planning Guide for America’s Communities
Efficient and effective processes also may be in
place to handle local emergencies (for example,
dam overflows, chemical spills from a train derail-
ment). Some communities have citizens watch
groups; others have formed or are forming
Community Emergency Response Teams
(CERTs), a program sponsored by the Federal
Emergency Management Agency (FEMA) (see
page v.). These existing relationships can provide
the foundation of the emergency management
planning team. In addition, the Metropolitan
Medical Response System (MMRS) was created
in 1997 to build a system that enhances the local
community’s ability to respond. Although
MMRS is primarily based in urban areas, the
Northern New England MMRS, formed in
2003, has a rural base and multistate jurisdiction.
Most communities have some form of emergen-
cy preparedness planning group, so “reinventing
the wheel” may not be necessary. It is important
to review the groups’ constituents to ensure that
all key players are at the table.
? Example: An emergency department physician in
the major hospital in a small community in the
Midwest built relationships and connections critical
to integrated emergency management planning.
Working first with infection control nurses in his
own hospital, he linked to the county health depart-
ment’s communicable disease specialist and health
director, and subsequently to the emergency services
directors.These individuals now exist as a
medical/public health subcommittee within a region-
al emergency planning team established under the
authority of the council of governments.
Where no relationships seem to exist, or where
relationships are not functioning effectively, the
chief executive or local emergency management
planner will need to solicit interested parties to cre-
ate a working group to begin the planning process.
? Example: In Texas, hospital leaders across the state
brought together emergency management, law
enforcement, and other community stakeholders to
conduct emergency preparedness planning at the local
level.
9
Leaders and participants can emerge from many
different places, as described in the following
planning strategy.
Identify appropriate planning partners.
Sidebar 5 lists key areas from which to draw par-
ticipants to the planning table. The emergency
support functions as defined by the U.S.
Department of Homeland Security (DHS)
(Sidebar 6) can provide another means to identi-
fy appropriate representatives. Individuals who
live in the community may already serve in coun-
tywide or regional emergency management ini-
tiatives and might be willing to play a dual role.
This is particularly true with health care
providers who often have full-time health care
jobs and also volunteer with the local EMS or are
members of state national guard units. If not
available in the community, representatives from
nearby communities or counties can be invited to
join the team. In addition, to expand the com-
munity’s capability to respond to and recover
from a disaster, partners and resources outside the
community will be essential. These partners
should be brought to the table so that collabora-
tive planning can occur and mutual aid relation-
ships can be defined.
Representation from each area identified in
Sidebar 5, as available in the community or sur-
rounding communities, is important, but several
warrant further explanation, as follows.
Hospitals and other health care organizations are crit-
ical to a community’s ability to prepare for and
respond to an emergency and must be at the
10
Standing Together: An Emergency Planning Guide for America’s Communities
11
planning table. Hospitals can work collaborative-
ly with all community health care organizations
to plan for and respond to a surge in patients or a
facility-disabling disaster that could overwhelm
any single health care organization. Home health
agencies can supplement a community’s surge
capacity by providing trained health care person-
nel and medical equipment and supplies. Long-
term care facilities have the bed capacity, supplies,
and skilled staff to care for non-acutely ill or
injured disaster victims. Ambulatory care clinics
and surgical centers can provide trained person-
nel and equipment and can triage disaster victims
so that hospitals receive only the most severely ill
or injured patients.
Local colleges and universities are an important ele-
ment of the infrastructure in many communities.
They can often offer a variety of critical
resources, such as facilities appropriate to emer-
gency needs; pharmacy, nursing, and medical stu-
dents who have some health-related training; staff
with expertise in various areas of interest to
emergency preparedness and response; and medi-
cal and transportation vehicles. Numerous aca-
demic institutions are attracting funding, generat-
ing valuable research, and developing innovative
processes related to emergency preparedness.
Representatives from the following areas should be
brought together as planning partners:
? Local government (mayor, village manager, or
other elected official)
? Fire
? Law enforcement
? EMS
? Search/rescue agency
? Transportation
? Public health
? Public schools
? Housing agency
? Utilities (gas, water, electric, telecommunications)
? Local or regional FBI office
? Health care (ambulatory care, rural health clinic,
hospital, long term care, rehabilitative, mental
health, home care, laboratories)
? Private industry (e.g., chamber of commerce,
local industries, corporations)
? Special needs populations (children, elderly, non-
English-speaking, disabled)
? CERT
? Citizen Corps/Medical Reserve Corps
? Colleges and universities
? American Red Cross
? Media and communications (print, radio, TV)
? Mutual aid partners outside the community
? Civilians
SIDEBAR 5. PARTICIPANTS AT THE PLANNING TABLE
continued
ESF #1. Transportation ? Federal and civil transportation support
? Transportation safety
? Restoration/recovery of transportation infrastructure
? Movement restrictions
? Damage and impact assessment
ESF #2. Communications ? Coordination with telecommunications industry
? Restoration/repair of telecommunications infrastructure
? Protection, restoration, and sustainment of national cyber and information technology resources
ESF #3. Public Works and
Engineering
? Infrastructure protection and emergency repair
? Infrastructure restoration
? Engineering services, construction management
? Critical infrastructure liaison
SIDEBAR 6. EMERGENCY SUPPORT FUNCTIONS
Standing Together: An Emergency Planning Guide for America’s Communities
12
Source: U.S. Dept. of Homeland Security (DHS): National Response Plan. Washington, DC: DHS, Dec. 2004, p. 12.
SIDEBAR 6. EMERGENCY SUPPORT FUNCTIONS (CONTINUED)
ESF #4. Firefighting ? Firefighting activities on Federal lands
? Resource support to rural and urban firefighting operations
ESF #5. Emergency
Management
? Coordination of incident management efforts
? Issuance of mission assignments
? Resource and human capital
? Incident action planning
? Financial management
ESF #6. Mass Care,
Housing, and Human
Services
? Mass care
? Disaster housing
? Human services
ESF #7. Resource Support ? Resource support (facility space, office equipment and supplies, contracting services, etc.)
ESF #8. Public Health and
Medical Services
? Public health
? Medical
? Mental health services
? Mortuary services
ESF #9. Urban Search and
Rescue
? Life-saving assistance
? Urban search and rescue
ESF #10. Oil and
Hazardous Materials
? Materials Response
? Oil and hazardous materials (chemical, biological, radiological, etc.) response
? Environmental safety and short- and long-term cleanup
ESF #11. Agriculture and
Natural Resources
? Nutrition assistance
? Animal and plant disease/pest response
? Food safety and security
? Natural and cultural resources and historic properties protection and restoration
ESF #12. Energy ? Energy infrastructure assessment, repair, and restoration
? Energy industry utilities coordination
? Energy forecast
ESF #13. Public Safety and
Security
? Facility and resource security
? Security planning and technical and resource assistance
? Public safety/security support
? Support to access, traffic, and crowd control
ESF #14. Long-Term
Community Recovery and
Mitigation
? Social and economic community impact assessment
? Long-term community recovery assistance to states, local governments, and the private sector
? Mitigation analysis and program implementation
ESF #15. External Affairs ? Emergency public information and protective action guidance
? Media and community relations
? Congressional and international affairs
? Tribal and insular affairs
Standing Together: An Emergency Planning Guide for America’s Communities
Regional academic medical centers can identify
best practices in the current medical literature
and be valuable planning and response partners
(for example, by providing resources such as diag-
nostics capabilities, personnel, equipment, and
supplies).
Local private industry represents key elements of a
community’s infrastructure and resources, and
disruption of their business operations may have
major community or regional impact. For exam-
ple, utility and telecommunications companies
have a vested interest in interoperability and
emergency preparedness and therefore can be
particularly helpful at the planning table.
The federal government is encouraging the private
sector to create emergency response plans and
information-sharing processes and protocols that
are tailored to their needs but that also map to
regional, state, and local emergency preparedness
plans and information-sharing networks.
10
Participation at the community-based planning
table is one way to ensure congruence between
community-based and industry-based plans and to
help obtain needed resources when disasters occur.
? Example: Caterpillar, one of the largest industries in
the Peoria, Illinois, area, was invited to the region-
wide planning table. Caterpillar participated exten-
sively in plan development and offered specific
response help in the form of heavy construction
equipment that might be needed in the event of a
disaster. In a collaborative spirit, the area’s public
works office indicated that its staff members would
assume responsibility for driving the equipment.
Where they are active, Citizen Corps representa-
tives should be at the local planning table. The
U.S. Citizen Corps brings together leaders from
law enforcement, fire, emergency medical and
other emergency management services, volunteer
organizations, local elected officials, the private
sector, and other community stakeholders to help
make communities safer, stronger, and better pre-
pared to address the threat of disasters of all
kinds.
10
It works through a national network of
state, local, and tribal Citizen Corps councils.
The American Red Cross plays an integral role in
the federal emergency response plan and has
available nursing and mental health resources,
and, as such, a local or regional representative
should be at the table for local planning as well.
This humanitarian organization, led by volun-
teers and guided by a Congressional charter, pro-
vides relief to victims of disasters and helps peo-
ple prevent, prepare for, and respond to emergen-
cies. It functions independently of the govern-
ment but works closely with government agen-
cies, such as FEMA, during times of major crises.
The American National Red Cross (as distinct
from the International Red Cross) is one of a
very few national disaster relief agencies specifi-
cally cited in the Robert T. Stafford Disaster
Relief and Emergency Assistance Act of 2000.
Civilian representation at the planning table is
critical. One of the key lessons learned from the
World Trade Center attacks of 9/11 was that the
“first” first responders during an emergency typ-
ically are private-sector civilians. “Because 85
percent of our nation’s critical infrastructure is
controlled not by government but by the private
sector, private-sector civilians are likely to be the
first responders in any future catastrophes,” noted
the National Commission.
11(p. 317)
Civilians that
could address special needs populations should
also be considered; recommendations from state
task forces could assist in identifying knowledge-
able planning partners. For example, Missouri has
a state Special Needs Population Task Force that
has brought together more than 17 organizations,
agencies, and consumers to address this area.
13
Standing Together: An Emergency Planning Guide for America’s Communities
14
In considering media and communications, it is
vital to identify someone in the community who
is well recognized, respected, and trusted to serve
in the role of communicating with the public
before, during, and following a major event. The
chief executive or local planner might also wish
to consider an individual who could engage the
public and professionals as volunteers; this person
may be involved with the Citizen Corps/Medical
Reserve Corps, a CERT, the American Red
Cross, or other organizations.
Consider start-up logistics.
Start-up logistics can be complex and include
such mundane but essential tasks as who should
send the invitational letters for the first meeting,
where and when meetings are to be held, and so
forth. When the chief elected official or another
community leader calls the meeting, it may be
helpful to have someone such as the state com-
missioner of public health generate the invitation
letters.
Initial decisions will need to be made regarding the
leadership structure of the team and how commu-
nication will take place. The local planner who
“calls the first meeting” is not necessarily the lead-
er who coordinates the ongoing emergency man-
agement processes after they have been established.
In many communities, this leader is the mayor or
another chief elected official, hospital administrator,
city manager, public health director, emergency
management director, fire chief, or police chief.
Means to ensure effective collaboration across
political and organizational barriers will need to be
negotiated and implemented.
Throughout the start-up and ongoing process,
the chief executive or local planner will want to
be conscious of the need to build a common lan-
guage among planning participants. Different
types of professionals speak different languages,
which may require explanation. For example, the
term surveillance, commonly used by public health
officials and health care professionals, may not be
known or may come across negatively in the
business community, or it may mean something
entirely different to law enforcement agents.
12
Professional terminology can be defined or
explained during meetings and in key docu-
ments.
The local planner who “calls the first meeting” is not necessarily the leader who coordinates
the ongoing emergency management processes after they have been established.
When the team is in place, the emergency man-
agement planning team’s first task is to conduct a
hazard vulnerability analysis (HVA). An HVA
identifies potential threats, risks, and emergencies
and the potential impact these emergencies may
have on the community. It is a formal assessment
of the risks that could potentially affect the com-
munity or an agency within the community and
move it to implement its emergency manage-
ment plan. Specific strategies for determining the
risks and hazards faced by the community follow.
Use an “all-hazards approach.”
An all-hazards approach enables communities to
be prepared to manage any number or type of
emergencies. It facilitates prevention, preparation,
response, and recovery, based on the broad scope
of what could happen within and beyond the
community. Conducting a risk assessment
involves proactively identifying what might affect
the community and its surrounding area.
In addition to other documents such as written
analyses of capabilities and capacities, an HVA can
help to overcome communitywide or stakeholder-
specific resistance to emergency preparedness. It
offers an objective information source and requires
a cross section of expertise and perspective from
the community to construct, implement, and ana-
lyze. The process of performing an HVA requires
commitment to accuracy and thoroughness and
continuing expertise and motivation.
Communities can perform an HVA in many
ways; there is no right or wrong way. Any
methodology or approach that works effectively
should be used and referenced in the emergency
management plan. Some systems use a quantita-
tive scoring method to rank the potential emer-
gencies, but this is not essential. The key is that
each community’s emergency management plan-
ning team identifies the events for which prepa-
ration is necessary and that the evaluation is con-
ducted through a collaborative approach.
Whether the full extent of emergency prepared-
ness is possible given the community’s resources
is, of course, a critical issue. The Secretary of the
U.S. Department of Homeland Security, Michael
Chertoff, recently announced that even the U.S.
government, with all its resources, cannot protect
the American public from all possible terrorist
attacks and instead must focus on trying to pre-
vent more serious or catastrophic strikes. In com-
ments made in March 2005, Chertoff advocated
adopting a risk-based approach: “Risk manage-
ment must guide our decision-making as we
examine how we can best organize to prevent,
respond, and recover from an attack. For that rea-
son, the Department of Homeland Security is
working with state, local, and private sector part-
ners on a National Preparedness Plan to target
resources where the risk is greatest.”
13
For more
information on focusing and funding communi-
ty emergency preparedness efforts, see Sections 4
and 10.
3. Determine the Risks and Hazards the Community Faces
Standing Together: An Emergency Planning Guide for America’s Communities
15
Recommended Planning Strategies:
? Use an “all-hazards approach.”
? Acknowledge the potential for a
catastrophic event.
? Compile a list of potential hazards.
? Recognize the problems inherent in
hazard lists.
? Assess and prioritize the listed hazards.
? Fine-tune the list by conducting a
“gap analysis.”
Standing Together: An Emergency Planning Guide for America’s Communities
Acknowledge the potential for a
catastrophic event.
If this acknowledgment has not occurred previ-
ously and has not served as the motivator for
emergency management planning, the acknowl-
edgment must occur at this point.Team members
must dispel all notions that “a catastrophic event
is not going to happen to us.”
A study recently conducted by the Joint
Commission indicates that significant progress in
this area needs to be made. When asked whether
their communities were at increased risk of expe-
riencing catastrophic events, such as an act of ter-
rorism, respondents from urban and rural hospi-
tals had differing perceptions: Respondents from
urban hospitals reported slightly more hazards or
threats on average per hospital than respondents
from rural hospitals, who were most concerned
about events such as hazardous materials acci-
dents, tornadoes, winter storms, and floods.
14
Compile a list of potential hazards.
The list of hazards can be generated during
something similar to a brainstorming session,
where every idea is written down without cen-
sorship or editorial comment. A review of com-
munity historical data may provide additional
items for the list.
When assembling this list, the team should be
careful not to limit it only to incidents that the
community has traditionally thought of as “disas-
ters”—hurricanes, earthquakes, tornadoes, and
other natural disasters. Mass casualty events, such
as transportation accidents, that may be more
commonly experienced should be listed. The
9/11 attack has forced Americans to “think out-
side the box” about the realm of possible man-
made incidents. Aircraft used as guided missiles,
nuclear, chemical, and biological weapons, and
other acts of terrorism have become a reality and
have forced emergency management teams to
think broadly. Insidious events, such as those that
could occur from an emerging infectious disease
outbreak, either intentional or unintentional,
have also expanded the realm of possible emer-
gencies.
Teams must exercise imagination and challenge
their assumptions about likely threats.The extent to
which the community may be at risk for terrorist-
induced events should be assessed by the team as
seriously as the risk of natural disaster, industrial
accident, or pandemic disease outbreak. The team
should consider the risk to their community as a
primary target of terrorism due to sensitive instal-
lations (industrial plants, military bases, federal
office buildings) or as a secondary target of terror-
ism due to larger neighboring towns needing a des-
tination to which they can evacuate residents or
from which they can borrow assets.
Sidebar 7 lists examples of community-based
emergencies.Teams will also want to consider the
threats recently identified by the U.S. Department
of Homeland Security (Sidebar 8).
16
Teams must exercise imagination and challenge their assumptions about likely threats.
Standing Together: An Emergency Planning Guide for America’s Communities
Recognize the problems inherent in
hazard lists.*
Hazard lists pose two problems. The first problem
is the possibility of exclusion or omission:There is
always a potential for new and unexpected hazards,
which is part of why maintaining an all-hazards
capability is important.
The second problem is that such lists involve
groupings, which can affect subsequent analysis.A
list may give the impression that hazards are inde-
pendent of one another, when in fact they are
often related (for example, an earthquake might
give rise to dam failure). In addition, lists may
group under one category very different causes or
sequences of events that require different types of
response. For example,“flood”might include dam
failure, cloudbursts, or heavy rain upstream. Lists
also may group a whole range of consequences
under the category of a single hazard.
“Hurricane” might include not only high winds,
storm surge, and battering waves, but even the
weakened, post-landfall tropical storm system that
can cause inland flooding.
It may be necessary, as the hazard analysis evolves,
to refine the list of hazards to ensure inclusion of
newly identified hazards (for example, a new
chemical plant in the region) and elimination of
previously listed hazards that no longer pose a
hazard (for example, rerouting trucks carrying
toxic substances).
Assess and prioritize the listed hazards.
The hazards and potential emergencies identified
in the HVA must be assessed and prioritized so
that appropriate prevention, preparation,
response, and recovery activities can be undertak-
en. One place to start this process is with the like-
lihood or probability of occurrence.Very likely, data on
the frequency of given incidents already exist.
Disasters that have occurred before in the com-
munity or its surrounding area will move toward
the top of the list of issues to be addressed, while
those with essentially no possibility of occurrence
will migrate to the bottom. A pandemic flu out-
break and other occurrences identified as priori-
ty disaster planning events (Sidebar 8) should
appear near the top of the list.
17
? Extremes of weather/climate/geography
? earthquake
? hurricane
? flood
? tornado
? blizzard
? drought
? volcanic eruption
? mudslide or avalanche
? Dam failure
? Regional power outage
? Civil disturbance
? Terrorism and weapons of mass destruction
? bombs (conventional or nuclear)
? biological/chemical agents
? cyberterrorism
? Public health emergencies (such as an outbreak of
SARS or pandemic influenza)
? Wildland or community-based fires
? Commercial transportation accidents
? train derailments
? air crashes
? multiple highway casualties
? Hazardous materials release
? radiation
? toxic chemicals
? Sudden influx of residents with health care and
other basic needs (food, water, shelter, clothing)
from neighboring communities
SIDEBAR 7. EXAMPLES OF COMMUNITY-BASED
EMERGENCIES
* The section was excerpted from Federal Emergency Management Agency: State and Local Guide (SLG) 101: Guide for All-Hazard
Emergency Operations Planning. 1996, pp. 2–5.http://www.fema.gov/pdf/rrr/2-ch.pdf (accessed Feb. 2005).
Standing Together: An Emergency Planning Guide for America’s Communities
For example, a major earthquake or chlorine tank
explosion would be high on the list of potential
emergencies for small communities in southern
California, but snowstorms and nuclear detona-
tions would be low on the list. Power failure and
flood might be somewhere in between. An
explosion in a chemical factory, groundwater
contamination from agricultural runoff, or a gas
main break near the local high school are other
examples of occurrences that may need to be
assessed, depending upon the community. Risk
may change if there are major construction pro-
jects under way or seasonal events, such as local
fairs or the ski season. Location may influence
risk, such as whether a community’s industrial
plant is on a floodplain or near a fault line. Maps
will be needed to assess location-related risk. Risk
assessment matrices can be found on state and
regional agency Web sites (see Tools).
Tools are available to help local officials identify
and compare potential hazards. For example, the
Center for Infrastructure Expertise, which is part
of the National Infrastructure Institute and oper-
ates under a grant from the U.S. Department of
Commerce’s National Institute of Standards and
Technology, has developed a software tool,
CARVER2.™ Offered free of charge, the tool
enables local, state, and national planners to iden-
tify and compare potential critical infrastructure
terrorist targets and assists government officials in
the allocation of grants and protective resources
(see Tools).
Severity is the next factor in the analysis to be
considered by the team. If the event occurs, the
team should consider how it will impact the
community. Could lives be lost or the health and
safety of individuals be threatened? If the answer
is “yes,” the hazard moves up on the list. If the
answer is “no,” the team can consider other ways
in which the community may be impacted, such
as disruption of services or damage to infrastruc-
ture. The team then adjusts the ranking of the
potential hazards according to the answers.
The final factor that merits consideration is the
community’s level of preparedness.This represents the
vulnerability portion of the HVA. If one of the
high-ranking incidents on the list took place
tomorrow, how well would the community man-
age the incident? Would other neighboring com-
munities be able to provide assistance? Do mutu-
al aid agreements exist? For each hazard, the team
develops an assessment of the community’s cur-
rent susceptibility to the hazard.
15
If the commu-
nity is not prepared for the incident, that poten-
tial hazard will need more attention than the ones
covered by well-established plans and agreements.
18
TOOLS:
? Map sources include Federal Emergency
Management Agency (http://www.fema.gov),
U.S. Geological Survey (http://www.usgs.gov),
state geological surveys, National Weather
Service (http://www.nws.noaa.gov), Federal
Insurance Administration (http://www.fema.gov/
about/fedins.shtm), the Local Emergency
Planning Committee Database
(http://www.epa.gov/ceppo/lepclist.htm), and
the Multi-Hazard Mapping Initiative
(http://www.hazardmaps.gov/atlas.php).
? The Center for Infrastructure Expertise’s
CARVER2™ software is available athttp://www.ni2cie.org.
? Pennsylvania Emergency Management Agency
offers an online introduction to hazard mitiga-
tion planning that includes hazard risk matrices.http://www.pema.state.pa.us/pema/CWP/vie
w.asp?a=198&Q=179259&pemaNavDLTEST
=%7C4715%7C4749%7C4752%7C4028%7C
(accessed Jun. 21, 2005).
Standing Together: An Emergency Planning Guide for America’s Communities
Fine-tune the list by conducting a
“gap analysis.”
A gap analysis of the vulnerabilities helps to iden-
tify incidents for which the community is not
prepared. The analysis identifies the key compo-
nents of each vulnerability, determines compo-
nents that are common across multiple hazards,
identifies issues that create high-impact weak-
nesses, and compares the relative costs and bene-
fits of the steps needed to rectify the situation.
15
If
community resources could not be called on for
assistance in addressing the incident, the team
should move the incident up on the list. This
analysis may result in some less-probable events
being moved up on the list due to the fact that
the most anticipated events are usually those for
which the community is most prepared.
The completed list of potential hazards will now
have those events that merit the most attention
near the top, whether because of probability of
occurrence, impact on the community, or level of
preparedness. Hazards that are less serious and not
as likely to happen should be near the bottom.All
of this ranking is dependent on judgment and
evaluation of the various considerations discussed
previously. There should be some rationale for
general placement on the list, although it may be
difficult to distinguish the placement of two
events that are sequenced consecutively. Because
of varying factors and judgment, two similar
communities in the same region may have differ-
ing analyses.
The hazard vulnerability analysis will help drive
consensus within the planning team about the
risk of specific hazards to the community.
However, the community itself will have its own
priorities related to perceptions of risk that the
planning group will have to understand in order
to develop preparedness goals and plans, to com-
municate effectively with the public, and, ulti-
mately, to sustain the public’s cooperation with
planning and response activities. These topics are
addressed in Section 7.
19
The hazard vulnerability analysis will help drive consensus within the planning team about the
risk of specific hazards to the community.
TOOLS:
? Federal Emergency Management Agency:
State and Local Guide (SLG) 101: Guide for
All-Hazard Emergency Operations Planning.http://www.fema.gov/preparedness/
state_local_prepare_guide.shtm.
Given scarce resources, small, rural, and suburban
communities must set goals for emergency plan-
ning and response efforts.The basic questions plan-
ning teams consider are What do we need to pre-
pare for? Are we prepared? and At what cost?
“Tilting at all the windmills”—trying to do every-
thing—represents an impossibility for most small
communities. The cost is just too great.
“Preparedness represents the ‘right place’ on the con-
tinuum between blind complacency (and bureau-
cratic inertia) and overwhelming paranoia,” notes
Irwin Redlener, M.D., associate dean and director
of the National Center for Disaster Preparedness.
Preparedness must be based on a real assessment of
hazard risk conducted through the hazard vulnera-
bility analysis (HVA) process. Risk can never be
totally ameliorated through the planning process;
some level of ongoing risk will always be present.
The emergency management planning team will
develop specific goals and objectives based on its
HVA. However, for any emergency management
plan, the general goals are as follows:
1. Save lives and protect health.
2. Protect and sustain the critical infrastructure,
property, and the environment needed to save
lives and protect health.
3. Find dual uses for existing or emerging capa-
bilities.
Goals 1 and 2 are inherent to emergency man-
agement planning; goal 3 is a strategic goal that
will help communities broaden the usage of
existing or emerging capabilities and investments.
According to the U.S. Department of Homeland
Security’s (DHS’s) National Response Plan, local
communities develop local emergency prepared-
ness plans “to provide a framework for under-
standing vulnerability to and risk from hazards,
and identify the pre-disaster and post-disaster
mitigation measures to reduce the risk from those
hazards.”
10(p. 62)
Much effort is under way in
numerous government agencies to identify pre-
paredness goals and thresholds in an empirical
manner. Because smaller communities have more
limited resources, planners in these communities
will need to derive their planning goals primari-
ly from their HVAs and rely on objective thresh-
olds as a secondary reference tool rather than a
primary planning tool.
Specific strategies that can help communities meet
the three goals mentioned in this section follow.
4. Set Goals for Preparedness and Response Planning
Standing Together: An Emergency Planning Guide for America’s Communities
20
Recommended Planning Strategies:
? Ensure that planning covers basic
societal functions.
? Make the planning process as doable
as possible.
? Address the four phases of emergency
management.
? Address human resources require-
ments.
? Plan for convergent responders.
? Involve the public in community pre-
paredness efforts.
? Enable people to care for themselves.
? Plan for layered preparedness and
response.
? Ensure compatibility with unified
command functions and the incident
command system.
? Link the community’s plan to the
NIMS and the NRP.
? Consider linking to the Joint Field
Office.
? Link to county and state plans and
planning initiatives.
? Establish mutual aid agreements.
Ensure that planning covers basic
societal functions.
Prioritizing the hazards as described in the previous
sections will support a planning effort that is more
relevant, cost-effective, and engaging for the plan-
ning team and the community as a whole. It will
support planning around very real crises (for exam-
ple, pandemic flu may receive a higher planning
priority than smallpox) and their potential impacts
on the basic societal functions. Preparedness and
response planning starts with the assumption that
basic societal functions are critical and must be
assured during and following an emergency.
Societal functions include the following:
? Public health
? Medical care
? Public works
? Energy supply
? Environment
? Economy
? Water/sanitation
? Shelter/clothing
? Food
? Communication
? Security
? Logistics/transport
? Search/rescue
For example, loss of power, whether due to tech-
nology failure (as with the blackouts on the East
Coast, fires on the West Coast), or hurricanes on
the eastern seaboard, has a ripple effect on access
to communication systems, water, fuel, and other
basic utilities that support societal functions.
Make the planning process as doable
as possible.
To get a jump start on emergency preparedness
and response planning, teams in small communi-
ties can consult available planning resources. The
Federal Emergency Management Agency
(FEMA), the National League of Cities, and state
municipal leagues provide in-depth guidance
through their publications and Web sites.
Planning teams will want to review the federal
government’s Universal Task List (UTL), which
defines what tasks need to be performed by fed-
eral, state, local, and tribal jurisdictions and the
private sector to prevent, protect against, respond
to, and recover from events defined in the
National Planning Scenarios.
16
Version 2.1 identi-
fies approximately 1,600 unique tasks. According
to that document,“The purpose of the UTL is to
list ‘what’ tasks need to be performed, while
reserving the flexibility to determine ‘who’
should perform them and ‘how.’ No single juris-
diction or agency is expected to perform every
task. Rather, individual jurisdictions will need to
assess and select the tasks based on their own spe-
cific roles, missions, and functions.”
In addition, the DHS released a list of 15 hypo-
thetical terrorist attacks, disease outbreaks, and
natural disasters that is being used to set DHS
spending priorities and to focus emergency plan-
ning efforts (Sidebar 8).
Standing Together: An Emergency Planning Guide for America’s Communities
21
TOOLS:
? Federal Emergency Management Agency:http://www.fema.gov/preparedness/
state_local_prepare_guide.shtm.
? The National League of Cities, which repre-
sents 49 state municipal leagues, and through
them more than 18,000 cities and towns
nationwide, offers links and tools through its
Web site.http://www.nlc.org/
state_municipal_leagues.
TOOLS:
? U.S. Dept. of Homeland Security: Universal
Task List: Version 2.1. May 23, 2005.http://www.ojp.usdoj.gov/odp/docs/
UTL2_1.pdf.
Standing Together: An Emergency Planning Guide for America’s Communities
Address the four phases of emergency
management.
Planning should address each of the four phases
of emergency management, which are prevention,
preparation, response, and recovery. The labels and
sequence used for these four phases vary slightly
in government and agency documents. At times,
mitigation, preparedness, and protection appear
instead of, or in addition to, one of the previous-
ly mentioned terms.
*
This planning guide uses
the phrases appearing with greatest frequency in
the National Response Plan.
Prevention involves, according to the National
Response Plan, actions taken to avoid an incident
or to intervene to stop an incident from occur-
ring. Prevention involves actions taken to protect
lives and property. Prevention actions related to
terrorism threats and incidents include law
enforcement activities and protective activities.
Initial prevention efforts include, but are not lim-
ited to, actions to do the following:
? Collect, analyze, and apply intelligence and
other information
? Conduct investigations to determine the full
nature and source of the threat
? Implement countermeasures such as surveil-
lance and counterintelligence
? Conduct security operations, including vulner-
ability assessments, site security, and infrastruc-
ture protection
? Conduct tactical operations to prevent, inter-
dict, preempt, or disrupt illegal activity
? Conduct attribution investigations, including
an assessment of the potential for future relat-
ed incidents
? Conduct activities to prevent terrorists, terror-
ist weapons, and associated materials from
entering or moving within the United States
The majority of initial actions in the threat or
hazard area are taken by first responders and local
government authorities and include efforts to
protect the public and minimize damage to prop-
erty and the environment.
10(p. 53)
The closely related concept of mitigation involves
activities that attempt to lessen the severity and
impact a potential disaster or emergency may
have on a community. Mitigation activities may
reduce, or even eliminate, the possibility of disas-
ter occurrence. Often they are required by other
22
The U.S. Department of Homeland Security (DHS)
released this list of 15 hypothetical terrorist attacks,
disease outbreaks, and natural disasters that is being
used to set DHS spending priorities and to focus
emergency planning efforts.
1. Nuclear detonation
2. Pandemic flu disease outbreak
3. Aerosolized anthrax biological attack
4. Pneumonic plague biological attack
5. Food contamination biological attack
6. Foot and mouth disease biological attack
7. Blister agent chemical attack
8. Toxic industrial chemicals attack
9. Nerve agent chemical attack
10. Chlorine tank explosion chemical attack
11. Major earthquake
12. Major hurricane
13. Dirty bomb radiological attack
14. Improvised bomb explosives attack
15. Cyber attack
Source: U.S. Dept. of Homeland Security. http://
www.dhs.gov/dhspublic.
SIDEBAR 8. NATIONAL PLANNING SCENARIOS
*The Joint Commission uses mitigation, preparedness, response, and recovery. Other presentations will put mitigation or prevention at the end of
the process, recognizing that what is learned in response and recovery should inform future mitigation activities. The National Response
Plan uses six terms—prevention, preparation, response, recovery, mitigation, and protection—but predominantly refers to prevention, preparation,
response, recovery.
Standing Together: An Emergency Planning Guide for America’s Communities
codes and standards. For example, compliance
with the National Fire Protection Association’s
Life Safety Code
®
will mitigate the impact of a fire
in a facility.*
Preparation (or preparedness) is defined as those
activities a community undertakes to build capac-
ity and identify resources that may be used should
a disaster or emergency occur. Preparedness
involves planning how to respond if a disaster
occurs. This activity has been the foundation of
emergency planning for many years. Some
important preparation steps include the following
and are outlined in this planning guide:
? Creating an inventory of resources that may be
needed in an emergency, including prear-
ranged agreements with neighboring commu-
nities and bordering states
? Maintaining an ongoing planning process
? Training community members in basic
response actions
? Implementing communitywide and regional
exercises and drills
Response refers to the actual emergency manage-
ment. Response involves identifying and treating
victims, reducing secondary impact to the com-
munity (for example, the spread of disease in the
community), and controlling the negative effects
of emergency situations. The National Response
Plan’s definition of response follows:
Response is those activities that address the short-
term, direct effects of an incident.These activities
include immediate actions to preserve life, proper-
ty, and the environment; meet basic human needs;
and maintain the social, economic, and political
structure of the affected community. Response
actions also include immediate law enforcement,
fire, ambulance, and emergency medical service
actions; emergency flood fighting; evacuations;
transportation system detours; emergency public
information; actions taken to minimize additional
damage; urban search and rescue; the establishment
of facilities for mass care; the provision of public
health and medical services, food, ice, water, and
other emergency essentials; debris clearance; the
emergency restoration of critical infrastructure;
control, containment, and removal of environmen-
tal contamination; and protection of responder
health and safety. During the response to a terrorist
event, law enforcement actions to collect and pre-
serve evidence and to apprehend perpetrators are
critical.These actions take place simultaneously
with response operations necessary to save lives
and protect property, and are closely coordinated
with the law enforcement effort to facilitate the
collection of evidence without impacting ongoing
life-saving operations.
10(pp. 53-54)
The recovery phase involves the restoration of the
community’s functions and activities following a
disaster. Recovery involves how the community
will get back to business as usual when the inci-
dent is over, including how the public will be
reassured that it is safe to return to normal activ-
ities, such as work and school. Recovery aspects
of an emergency management plan depend, of
course, on the nature of the incident, whether the
emergency is ongoing, and whether the local area
or region is still affected. The recovery section of
emergency management plans generally specifies
recovery steps or stages. The National Response
Plan defines recovery as follows:
Recovery is the development, coordination, and exe-
cution of service- and site-restoration plans and the
reconstitution of government operations and ser-
vices through individual, private-sector, nongovern-
mental, and public assistance programs. Recovery
involves actions needed to help individuals and
communities return to normal when feasible.
10(p. 54)
Address human resources requirements.
When an emergency occurs, small, rural, and sub-
urban communities often face significant human
23
* Life Safety Code
®
is a registered trademark of the National Fire Protection Association, Quincy, MA.
Standing Together: An Emergency Planning Guide for America’s Communities
resources challenges because their populations are
smaller than those of cities. The availability of first
responders and medical personnel often presents a
particularly significant problem. For example, the
already limited number of community members
who are volunteers in the National Guard or
Community Emergency Response Team (CERT)
may not be available because they may already be
activated and overseas or helping in a different
locale. Double-counting of available resources often
occurs. Whenever possible, lists of possible first
responders and medical personnel in the commu-
nity should be de-duplicated.
? Example:The emergency planning team of a small
suburban community approximately 30 miles out-
side Cleveland recognized that the community was
totally dependent on its volunteer firefighters and
volunteer paramedics as first responders. Most of
these individuals had full-time jobs in other commu-
nities, so any sense of comfort that the individuals
would be available to the community as first respon-
ders during an areawide disaster was a false sense of
comfort.The team’s preparation and response efforts
focused on how to prepare the community to respond
without the full benefit of its all-volunteer first
responder force.This involved consideration of appro-
priate training programs for community residents.
17
For agencies and other employers in hurricane-
prone areas and surrounding communities, a
range of staffing-related issues requires considera-
tion before, during, and after a major storm. For
example, as part of its annual hurricane prepared-
ness activities, Health First Health System in
Melbourne, Florida, maintains and updates
extensive human resources policies, procedures,
and communication plans. These policies address
the following:
? Storm staffing and communications
? Requirements and exemptions for reporting to
work
? Childcare enrollment forms for storm volunteers
? Sleeping arrangements
? Facility safety
? Sheltering for patients and their families
? Sheltering for employees and their families
? Preparing and securing work areas (personal
computers, telephones, miscellaneous desktop
items)
? Payroll and compensation arrangements during
and after the storm
? Leave of absence policies
? Securing pets and livestock
Plan for convergent responders.
In any disaster, the initial search and rescue is usu-
ally done by laypeople in the immediate area.The
phenomenon known as convergence—people
gathering quickly at a disaster site—is well docu-
mented.
18
It is part of human nature to want to
help. Contrary to popular belief, people do not
panic in the first phases of a disaster; most behave
in a rational manner and take what seem to them
logical steps to save themselves and others at a
disaster site.
19
As a result, the actual first responders are likely to
be not professionals or specially trained personnel
but local school teachers, parents, business execu-
tives, teenagers, or other “convergent volunteers”
who are there at the time of the disaster. “The
people who spontaneously come forward to vol-
unteer following a major disaster genuinely want
to help disaster victims. But from the perspective
of first responders and relief agencies, their gen-
erosity looks quite different. From their perspec-
tive, convergent volunteers can be liabilities, not
assets. They physically get in the way of people
doing vital work, they divert resources away from
serving victims to processing the volunteers, and
they raise serious questions of liability, both if the
volunteer is injured and if the volunteer does
injury,” notes one report from California.
20
Some observers indicated that convergent
response following the Loma Prieta earthquake
24
Standing Together: An Emergency Planning Guide for America’s Communities
25
in 1989 was “the disaster within the disaster” in
some communities. To minimize risks associated
with convergent responders, communities should
take steps to prepare its citizenry to participate
effectively in emergency response efforts. Medical
volunteers also are very likely to arrive at disaster
scenes “ready to help.” Community response
plans must address such an influx so that valuable
attention and resources are not diverted unneces-
sarily from response coordination to managing
excess unplanned volunteers.
? Example: In the Oklahoma City terrorist bombing
of the federal building in 1995, the many laypeople
that converged on the scene following the blast per-
formed a great service to the victims they helped.
However, they were also a concern to the trained res-
cuers. Convergence can be used to advantage if it is
organized. In Oklahoma City, hospital emergency
rooms and clinics that were overrun by volunteers
sent medical teams to the bombing site.
21
This
increased risk to the trained fire department rescue
teams who become responsible not only for the vic-
tims but also for extra medical personnel. In more
than one case during this disaster, fire department
personnel removed their own protective gear and
placed it over volunteer medical personnel who found
themselves in dangerous situations.
Strategies for managing volunteers include the
following:
? Developing volunteer professional registries
? Developing a system to register other volun-
teers and provide baseline and “just-in-time”
training
? Training volunteers based on emergency pre-
paredness and response competencies (see
Section 11)
? Developing a system to do background checks
and credential checks on volunteers (see infor-
mation on the federal government’s credential-
ing initiative, Emergency System for Advanced
Registration of Volunteer Health Care Personnal
(ESAR-VHP), on page 49)
? Developing a system to identify registered pro-
fessionals at disaster scenes
? Developing a tracking system to account for
volunteers at disaster scenes
? Addressing legal/liability related to cre-
dentialing and other issues
Some communities are also considering establish-
ing a “personnel processing point” or location for
registering and tracking medical volunteers who
report to a disaster scene. Robert M. Gougelet,
M.D., assistant professor of medicine and medical
director, disaster response, at the Dartmouth
Hitchcock Medical Center, recommends that med-
ical volunteers be divided into two distinct groups:
? Individuals who are members of an established
response team, such as a Disaster Medical
Assistance Team (DMAT), Medical Reserve
Corps (MRC), or Metropolitan Medical
Response System (MMRS) strike team, or
who are registered before an event occurs
? Individuals who arrive spontaneously at the
scene
“The on-scene incident command should have a
process to verify the identification and the cre-
dentials of responders.This process should include
checking a government-issued identification card
and a professional identification card such as a
hospital identification card. In addition, this pro-
cess should include independent third-party veri-
The on-scene incident command should have a process to verify the identification and the
credentials of responders.
Standing Together: An Emergency Planning Guide for America’s Communities
fication, such as confirming with the state’s medi-
cal professional database,” says Gougelet.
22
Sponsored by the Office of the Surgeon General,
the MRC program, a component of the Citizen
Corps, provides an organized way for medical and
public health volunteers, such as practicing,
retired, or student physicians, nurses, other health
professionals, and citizens interested in health
issues, to offer their skills and expertise during
local large-scale emergency situations.
23
The
MRC provides surge capacity personnel by pre-
identifying, training, and credentialing supple-
mental personnel to assist with emergency oper-
ations, such as mass antibiotic dispensing or mass
immunization campaigns.
? Example: In Connecticut hospitals, each specific disci-
pline, such as nursing, diagnostic imaging, respiratory
therapy, and physicians, has a representative that helps
to recruit and organize fellow practitioners to serve in
the MRC.The momentum has been considerable and
the state has been selected by the Health Resources
and Services Administration as one of the 10
advanced credentialing demonstration projects.
Involve the public in community
preparedness efforts.
Teams should consider plans to educate the public
about the existence of community preparedness
plans and should communicate with the public
about how to prepare for and respond to an emer-
gency situation.This involves targeting the family-
unit level (including individuals living alone) for
educational initiatives related to emergency equip-
ment, training, and preparedness.This also involves
identifying and planning to meet the needs of par-
ticularly vulnerable populations, including chil-
dren; the elderly; non-English-speaking people;
individuals with mental health issues, chemical
dependencies, or developmental disabilities; those
who are speech, hearing or mobility impaired;
institutionalized populations; the homeless; and
those individuals who are significantly geographi-
cally isolated.
The Redefining Readiness Study conducted by
the Center for the Advancement of Collaborative
Strategies in Health indicated that the American
public has had little or no role in developing ter-
rorism preparedness plans and that half of the
American people (55%) say their community is not
at all or only a little prepared to deal with the kinds
of terrorist attacks addressed in the study (a dirty
bomb and a smallpox outbreak).
24
“An important
finding of our study is the documentation that a
large proportion of the American people are inter-
ested in community-level planning—not just in
learning more about plans, but in being actively
involved in developing plans,” note the study’s
authors.
24(p. 44)
Similarly, a study by Columbia
University’s National Center for Disaster
Preparedness indicated that only 35% of Americans
think their community has an adequate emergency
response plan currently in place.
25
Such studies indicate that communities must be
better prepared to handle the more frightening
aspects of disasters, about which they often are “in
the dark.” For example, the process could address
how to handle unknown hazardous agents, how to
manage an unanticipated influx of victims at the
local hospital’s emergency department, and how to
decontaminate or isolate contaminated victims.
Public education and information dissemination
about isolation and quarantine for infectious dis-
eases are critically important inclusions in planning
efforts. The public must know that they may be
isolated at the hospital or quarantined at home, and
significant preparations will need to be made in
advance. Laws may need to be enacted on state or
local levels, and law enforcement and court system
personnel must be educated about their roles dur-
ing an event requiring isolation or quarantine.
26
Standing Together: An Emergency Planning Guide for America’s Communities
Basic needs for those living under quarantine must
be addressed, such as health services provided at
home or the ability of children in the household
to attend school.
? Planners should work directly with community
residents throughout the planning process.
Some segments of the community may be pre-
pared, but U.S. communities as a whole are not
prepared and not involved in preparedness
planning. Citizens can also be part of actual
events or drills that test emergency plans (see
Section 11).
Enable people to care for themselves.
The community must be informed and prepared.
The emergency plan needs to include a well-
defined risk communication plan that contains
information on the guidance that will be provid-
ed to the public and how that guidance will
occur. For example, the plan could indicate that
in the event of widespread exposure to a certain
chemical agent, the public will be educated
through distribution of fliers, other written mate-
rial, and public service announcements on local
radio and television stations, that it is better to
stay at home and take a shower than to go to the
hospital to be decontaminated. Planning that pre-
pares the community to help itself can reduce the
potential surge in demand for services experi-
enced during an actual emergency.
Ultimately, the ability of a community to survive
a major incident is dependent on its residents’
ability to provide self-care. Education and risk
communication at a “grass roots” level through all
kinds of community groups, such as high school
football teams, Boy/Girl Scouts, and the local
civic organizations, are critical to effective self-
care. Community awareness, education, and
engagement are essential. Hurricane plans in
Florida provide an excellent example of proac-
tive, multilingual, and pervasive preparedness.
Evacuation signs appear throughout the state and
are well-recognized in all communities.
Public concern about emergencies has not neces-
sarily translated into appropriate protective
actions in personal preparedness. “There is strong
baseline data that support efforts to increase the
public’s awareness of the need and necessary steps
to prepare themselves for a disaster. Only 20 per-
cent report being prepared for a terrorist-related
disaster, and only 13 percent report having a
neighborhood plan for disasters,” notes a DHS
Office of Citizen Corps report.
26
Less than half of
survey respondents have both an emergency plan
and at least one emergency supply kit.
? Example: Consider what might be involved in edu-
cating the public to respond to an influenza pan-
demic. In most cases, influenza can be treated at
home.The message to the public can be “Stay at
home, take care of yourself following basic self-care
protocols distributed by the health department; seek
hospital care if you experience any of the severe
symptoms described in the protocol.”
Plan for layered preparedness and
response.
Teams can consider whether and how it might be
possible to ensure some level of layered prepared-
ness and response mechanisms. For example, to
avoid systemwide failure, plans could specify pro-
cesses for redundant systems and contingency
plans to pick up the burden in case one part of
the system is disabled or overwhelmed.
? Example:The local hospital or other health care
organization considers multiple levels of redundancy
for its communications systems, including backup
phone systems, additional radio licenses for portable
radios, cell phones, Ham radios, satellite phones, per-
sonal digital assistants, e-mail, and so forth. Use of
these technologies assures not only redundancy but a
level of interoperability so that the organization’s
27
Standing Together: An Emergency Planning Guide for America’s Communities
emergency command operation can maintain commu-
nications with municipal, regional, or state emergen-
cy operations centers and/or fire and emergency
medical services (EMS) agencies.
Ensure compatibility with unified
command functions and the incident
command system.
Community planning templates and processes
should dovetail with unified command functions
and the incident command system (ICS). Unified
command concepts, widely used by civil author-
ities, provide guidelines and enable agencies with
different legal, geographic, and functional respon-
sibilities to coordinate, plan, and interact effec-
tively.
27
According to the DHS, “The ICS is a
management system designed to enable effective
and efficient domestic incident management by
integrating a combination of facilities, equip-
ment, personnel, procedures, and communica-
tions operating within a common organizational
structure, designed to enable effective and effi-
cient domestic incident management.”
27(p. 7)
The National Incident Management System (NIMS)
adopts the basic tenets of the ICS and outlines the
interrelationship of the ICS and the NIMS as fol-
lows:
The initial response to most domestic incidents
is typically handled by local 911 dispatch cen-
ters, emergency responders within a single juris-
diction, and direct supporters of emergency
responders. Most responses need go no further.
In other instances, incidents that begin with a
single response discipline within a single juris-
diction may rapidly expand to multidiscipline,
multijurisdictional incidents requiring significant
additional resources and operational support.
Whether for incidents in which additional
resources are required or are provided from dif-
ferent organizations within a single jurisdiction
or outside the jurisdiction, or for complex inci-
dents with national-level implications (such as
an emerging infectious disease or a bioterrorist
attack), the ICS provides a flexible core mecha-
nism for coordinated and collaborative incident
management.When a single incident covers a
large geographical area, multiple local ICS orga-
nizations may be required. Effective cross-juris-
dictional coordination using processes and sys-
tems described in the NIMS is absolutely critical
in this instance.
27(p. 7)
Link the community’s plan to the NIMS
and the NRP.
Commencing in 2005, the DHS has made adop-
tion of the NIMS and the National Response Plan
(NRP) a requisite for access to federal funding by
local organizations.
27
Sidebar 9 is an overview of
the federal initiatives and how they relate to local
initiatives. Community plans and initiatives
should link to the NIMS and the NRP for both
funding and coordination purposes.
The NRP requires communities to do the fol-
lowing:
? Use established incident reporting protocols to
notify local and regional Joint Terrorism Task
Forces (JTTFs) and the Homeland Security
Operations Center (HSOC), as appropriate.
? Coordinate with the HSOC regarding proce-
dures for establishing connectivity for domes-
tic incident management purposes. Local gov-
ernment procedures should be coordinated
with the respective state government and/or
emergency management agency.
? Modify existing incident management and
emergency operations plans to ensure proper
alignment with NRP coordinating structures,
processes, and protocols.
? Notify the secretary of homeland security of
any substantial conflicts between this plan and
state or tribal government laws or regulations.
This plan is not intended to compromise
existing state or tribal government laws or
corresponding incident management or emer-
gency response plans.
10
28
Standing Together: An Emergency Planning Guide for America’s Communities
29
Community planning teams must ensure that
they complete these tasks.
Consider linking to the Joint Field
Office.
Community teams can consider assigning a liai-
son to the Joint Field Office (JFO) to facilitate
interaction, communication, and coordination in
an emergency. According to the DHS’s National
Response Plan, the JFO is a multiagency coordi-
nation center that provides a central point for
federal, state, local, tribal, nongovernmental, and
private-sector organizations with primary
responsibility for incident oversight, direction,
and/or assistance.The JFO uses the scalable orga-
nizational structure of the NIMS ICS, not for
managing on-scene emergency operations but
for providing support to on-scene efforts and
conducting broader support operations that may
extend beyond the incident site.
10
Link to county and state plans and
planning initiatives.
Local elected officials should ensure that their com-
munities’ plans are linked to the regional emergen-
cy plan (for example, at the county or multicounty
level), which should itself be linked to a state-
approved emergency plan approved by FEMA.This
can support a more efficient and timely allocation
of resources. Planning can begin with an existing
county or state plan or initiatives that local leaders
have already acknowledged or bought into, such as
a local emergency planning committee (LEPC).
State planning initiatives include LEPCs, which
are appointed by State Emergency Response
Commissions. The focus of these committees has
traditionally revolved around hazardous materials;
the federal proponent is the Environmental
Protection Agency. LEPC members are volun-
teers and government employees who live with-
The goal of the National Incident Management System
and the National Response Plan (NRP), to be used as a
joint tool, is to provide “a consistent nationwide tem-
plate to enable federal, state, local, and tribal govern-
ments and private-sector and nongovernmental orga-
nizations to work together effectively and efficiently
to prevent, prepare for, respond to, and recover from
domestic incidents, regardless of cause, size, or com-
plexity, including acts of catastrophic terrorism.”
A basic premise of the NRP is that incidents are gen-
erally handled at the lowest jurisdictional level possi-
ble. Police, fire, public health and medical, emergency
management, and other personnel are responsible for
incident management at the local level. In some
instances, a federal agency in the local area may act as
a first responder and may provide direction or assis-
tance consistent with its specific statutory authorities
and responsibilities. In the vast majority of incidents,
state and local resources and interstate mutual aid nor-
mally provide the first line of emergency response and
incident management support.
When an incident or potential incident is of such
severity, magnitude, and/or complexity that it is con-
sidered an “Incident of National Significance”accord-
ing to the criteria established in the NRP, the secre-
tary of homeland security, in coordination with other
federal departments and agencies, initiates actions to
prevent, prepare for, respond to, and recover from the
incident.These actions are taken in conjunction with
state, local, tribal, nongovernmental, and private-sec-
tor entities as appropriate to the threat or incident. In
the context of Stafford Act disasters or emergencies,
U.S. Department of Homeland Security (DHS) coor-
dinates supplemental federal assistance when the con-
sequences of the incident exceed state, local, or tribal
capabilities.
Source: U.S. Dept. of Homeland Security (DHS): National
Incident Management System.Washington, DC: DHS, Mar. 1,
2004, p. ix; and U.S. Dept. of Homeland Security (DHS):
National Response Plan. Washington, DC: DHS, Dec. 2004,
p. 15.
SIDEBAR 9. A KEY TOOL FOR SCALABLE INCIDENT
MANAGEMENT
Standing Together: An Emergency Planning Guide for America’s Communities
30
in a specific local emergency planning district.
Federal legislation states that, at a minimum, each
LEPC shall include representatives from the fol-
lowing groups: elected officials, law enforcement,
civil defense, fire fighting, first aid, health, local
environmental, hospital, transportation personnel,
broadcast and print media, community groups,
and owners/operators of facilities. For, example,
there are 20 LEPCs in the state of Alaska.
Examples:
? In Illinois, the West Central Municipal Conference
has created a regional Homeland Security
Coordinating Committee, which includes the mayors
of 38 communities, some large and some small.
Among other activities, this committee monitors alloca-
tions and expenditures by local, state, federal, and pri-
vate entities for homeland security and develops and
influences policies, protocols, and coordinated efforts.
? The Mayoral Institute for WMD (Weapons of
Mass Destruction) and Terrorism Incident
Preparedness, provided through the Idaho Institute
of Emergency Management, provides the nation’s
mayors a “mayors only” forum to discuss strategic
and executive-level issues and challenges and to
share proven strategies and practices related to
WMD/terrorism preparedness.
? The Peoria County Emergency Services and Disaster
Agency, in Peoria, Illinois, coordinates all phases of
comprehensive emergency management, defined by the
agency as mitigation, preparedness, response, and
recovery, for Peoria County. It functions collaboratively
within a five-county region to integrate planning and
response across multiple jurisdictions.
? Missouri’s Department of Health and Senior
Services has a close working relationship with the
Missouri Hospital Association (MHA).Three
MHA planners work with the 144 member hospi-
tals and coordinate hospital planning efforts, assuring
that hospital representatives are at the local, regional,
and state planning table and linked to each plan.
Establish mutual aid agreements.
Emergency response agencies establish mutual aid
agreements, sometimes called memorandums of
understanding or memorandums of agreement, with
neighboring jurisdictions to support a more
effective response effort. Disaster mutual aid con-
sists of organized and supervised coordination, in
which reciprocal help is given by neighboring or
contractual communities during public emergen-
cies in the form of personnel, equipment, and
physical facilities. Mutual aid agreements include
policies and procedures for maintaining coverage
on a day-to-day basis and during emergencies.
Given the resource limitations of most small,
rural, and suburban communities, establishing and
maintaining mutual aid agreements are critical to
community ability to prepare for and respond to
an emergency. However, communities, no matter
how small, must not neglect to establish a baseline
level of capacity and capability.
TOOLS:
? American Hospital Association: Model Hospital
Mutual Aid Memorandum of Understanding.http://www.hospitalconnect.com/aha/
key_issues/disaster_readiness/resources/
content/ModelHospitalMou.doc.
The planning team’s next activity is to determine
the community’s current capacities and capabili-
ties for emergency prevention, preparation,
response, and recovery. A systematic asset inven-
tory can be conducted to account for the major
services required to achieve general emergency
management goals identified in Section 4.
Created by all relevant planning partners identi-
fied so far, at a minimum those listed in Sidebar
4, this inventory describes the assets under their
purview. Strategies to assist communities in
determining capacities and capabilities follow.
Use federal government asset categories
and target capabilities as a guide.
To assure a thorough identification of inventory
asset categories, community planning teams can use
the national resource typing list published by the
federal government in the National Response Plan
(NRP) and National Incident Management Systems
(NIMS) documents. Sidebar 10 outlines these cate-
gories, which closely parallel the emergency sup-
port functions (ESFs) outlined in Sidebar 6.When
community resources are limited in any one cate-
gory, the resource typing categories can be used as
a guide to areas where mutual aid agreements are
needed.
5. Determine Current Capacities and Capabilities
Standing Together: An Emergency Planning Guide for America’s Communities
31
Recommended Planning Strategies:
? Use federal government asset cate-
gories and target capabilities as a
guide.
? Specifically consider the public as an
asset category.
? Consider other groups not yet repre-
sented at the planning table.
? Identify geographic features and vul-
nerabilities that may affect capabilities.
? Consider surge capacity and consult
surge planning resources.
? Consider all community health
resources.
? Define critical capacities for each
health entity and link to state
databases.
? Know the federal government’s defi-
nition of required surge capacity.
? Consider the issues involved with
standards of care during mass casualty
events.
? Identify dual uses for existing or
emerging capabilities.
? Identify alternative care and shelter
facilities.
? Identify federal resources in the com-
munity.
? Identify gaps in community assets.
? Mass care: To support efforts to meet the mass care
needs of disaster victims, including delivering
such services as supplying victims with shelter,
food, and emergency first aid; supplying bulk dis-
tribution of emergency relief supplies; and col-
lecting information to and for a disaster welfare
information system designed to report on victim
status and assist in reuniting families.
? Health and medical: To meet public health and
medical care needs following a disaster or emer-
gency or during a potential developing medical
situation.
? Food and water: To identify, secure, and arrange for
the transportation of safe food and water to
affected areas during a disaster or emergency.
? Search and rescue: To provide specialized lifesaving
assistance in the event of a disaster or emergency,
including locating, extricating, and providing on-
site medical treatment to victims trapped in col-
lapsed structures.
continued
SIDEBAR 10. RESOURCE CATEGORIES USED IN THE
NATIONAL RESOURCE TYPING SYSTEM
Standing Together: An Emergency Planning Guide for America’s Communities
The capabilities identified by the federal govern-
ment can also provide helpful guidance. Sidebar
11 provides the U.S. Department of Homeland
Security’s (DHS’s) Target Capabilities List (TCL),
which includes 36 critical capabilities needed to
perform the tasks identified in the DHS’s
Universal Task List described earlier.
32
? Energy: To help restore energy systems following a
disaster or emergency.
? Fire fighting: To detect and suppress fires.
? Law enforcement and security: To provide law
enforcement assistance during response and
recovery operations; to assist with site security
and investigation.
? Hazardous materials response: To support the
response to an actual or potential discharge
and/or release of hazardous materials.
? Public works and engineering: To assist those engaged
in lifesaving, life-sustaining, damage mitigation,
and recovery operations following a major disas-
ter or emergency by providing technical advice,
evaluation, and engineering services; contracting
for construction management and inspection and
for the emergency repair of water and wastewater
treatment facilities; supplying potable water and
ice and emergency power; and arranging for
needed real estate.
? Volunteers and donations: To support the manage-
ment of unsolicited goods and unaffiliated volun-
teers, and to help establish a system for managing
and controlling donated goods and services.
? Information and planning: To collect, analyze, pro-
cess, and disseminate information about a poten-
tial or actual disaster or emergency to facilitate
overall activities in providing assistance to support
planning and decision making.
? Communications: To provide communications sup-
port for incident management efforts.
? Resource management: To provide operational assis-
tance for incident management operations.
? Public information: To contribute to the well-being
of the community following a disaster by dissem-
inating accurate, consistent, timely, and easy-to-
understand information; to gather and dissemi-
nate information about disaster response and
recovery process.
? Transportation: To provide transportation to per-
form incident management missions following a
major disaster or emergency; to coordinate inci-
SIDEBAR 10. RESOURCE CATEGORIES USED IN THE
NATIONAL RESOURCE TYPING SYSTEM (CONTINUED)
dent management operations and restoration of
the transportation infrastructure.
? Animals and agricultural issues: To coordinate activ-
ities responding to an agricultural disaster and/or
when the health or care of animals is at issue.
Source: Adapted from U.S. Dept. of Homeland Security
(DHS): National Incident Management System. Washington,
DC: DHS, Mar. 1, 2004, p. 122.
TOOLS:
? U.S. Dept. of Homeland Security: Target
Capabilities List.http://www.ojp.usdoj.gov/odp/
assessments/hspd8.htm.
Common-target capabilities
1. Planning (preparedness)
2. Interoperable communications (communica-
tions and information management)
Prevent mission area-target capabilities
3. Information collection and threat recognition
(manage data collection)
4. Intelligence fusion and analysis (analyze intel-
ligence)
5. Information sharing and collaboration (dis-
seminate threat information)
6. Terrorism investigation and apprehension
(investigate and apprehend terrorist suspects)
7. CBRNE* detection (defeat weapons)
Protect mission area-target capabilities
8. Risk analysis (assess vulnerabilities)
9. Critical infrastructure protection (protect
assets and property)
continued
SIDEBAR 11. TARGET CAPABILITIES LIST
(VERSION 1.1)
* Chemical, biological, radiological, nuclear, or explosive
Standing Together: An Emergency Planning Guide for America’s Communities
Specifically consider the public as an
asset category.
Rather than being looked at primarily as poten-
tial casualties, the public can be considered part of
the community’s assets in emergency manage-
ment initiatives. As such, the capacities and capa-
bilities of the general public should be accounted
for where possible.The willingness of the average
person to be an early responder may vary
depending upon whether the event is a slow-
moving biological event or a sudden-impact nat-
ural or man-made event. The team thus should
carefully consider whether certain assignments
might be ones assumed by volunteers as opposed
to trained or professional responders.
Consider other groups not yet
represented at the planning table.
Such groups may offer additional capabilities in
supporting communication or transportation
efforts, providing temporary shelter and supplies,
and assisting with other emergency needs. One
way to identify such groups is to consider voca-
tional or avocational special interest groups that
represent certain skills or resources that might be
valuable in an emergency, such as truck drivers,
33
10. Food and agriculture safety and defense
(safeguard public health)
11. Public health epidemiological investigation
and laboratory testing (safeguard public
health)
12. Citizen preparedness and participation (pre-
pare the public)
Respond mission area-target capabilities
13. On-site incident management (manage incident)
14. Emergency operations center management
(manage incident)
15. Critical resource logistics and distribution
(manage incident)
16. Volunteer management and donations (man-
age incident)
17. Worker health and safety (manage incident)
18. Public safety and security response (manage
incident)
19. Animal health emergency support (respond
to hazard)
20. Environmental health and vector control
(respond to hazard)
21. Explosive device response operations
(respond to hazard)
22. Fire-fighting operations/support (respond to
hazard)
23. Weapons of Mass Destruction/hazardous
materials response and decontamination
(respond to hazard)
24. Citizen protection: evacuation and/or in-
place protection (implement protective
actions)
25. Isolation and quarantine (implement protec-
tive actions)
26. Search and rescue (conduct search and res-
cue)
27. Emergency public information and warning
(distribute public information)
28. Triage and pre-hospital treatment (provide
medical care)
29. Medical surge (provide medical care)
30. Medical supplies management and distribu-
tion (provide medical care)
SIDEBAR 11. TARGET CAPABILITIES LIST
(VERSION 1.1) (CONTINUED)
31. Mass prophylaxis (distribute prophylaxis)
32. Mass care (sheltering, feeding, and related
services) (provide mass care)
33. Fatality management (manage fatalities)
Recover mission area-target capabilities
34. Structural damage assessment and mitigation
(rebuild property)
35. Restoration of lifelines (restore lifelines)
36. Economic and community recovery (restore
economic institutions)
Source: U.S. Dept. of Homeland Security: Target
Capabilities List: Version 1.1. May 23, 2005.http://www.ojp.usdoj.gov/odp/docs/TCL1_1.pdf
(accessed Jun. 17, 2005).
Standing Together: An Emergency Planning Guide for America’s Communities
34
snowmobile owners, youth group members,
recreational boaters, and so forth. For example, in
one community drill that tested distribution of an
emergency pharmaceutical stockpile, high school
football teams were trained and deployed to sup-
port security around the stockpile prior to its dis-
tribution in the community.
Identify geographic features and
vulnerabilities that may affect
capabilities.
In addressing current and needed capacities and
capabilities, “the planning team should note geo-
graphic and topographic features that may affect
operations, for example, dependence on a single
main transportation artery in and out of the juris-
diction. The group will want to map out where
special needs groups are concentrated and be alert
to other issues that could affect planning assump-
tions,” notes one document.
7(pp. 2–11)
Current tech-
nology allows planners and responders to consider
alternative routes for security or weather concerns
and allows for multiple modes of transportation.
Potential areas of vulnerability for terrorism iden-
tified by Federal Emergency Management
Agency (FEMA) include traffic (on roads, tun-
nels, bridges, and so forth), trucking and transport
activity (including HazMat cargo), waterways,
airports, trains/subways, government facilities,
recreation facilities, military installations, HazMat
facilities, utilities, and nuclear facilities.
29
This planning effort should be coordinated with
state or local geographic information systems
(GIS)/mapping resources, which can provide
valuable information, such as GIS locations of
hospitals, mass prophylactic sites, and regional
pharmaceutical and medical equipment
resources.
Consider surge capacity and consult
surge planning resources.
The planning team must consider surge capacity,
defined as “the ability to expand capabilities in
response to sudden or more prolonged
demand,”
30(p. 19)
and identify sources and methods
for adding additional capacity (staff, supplies,
technology, medications, transport vehicles).
Although commonly considered in communities
as medical surge capacity and capability, the concept
of surge capacity applies to all assets. Rural, small,
and suburban areas are typically resource-strapped
and find it difficult to expand capacity in many, if
not most, key capability areas as listed in Sidebars
10 and 11.
The focus here is on medical surge capacity, defined
as the ability to care for a markedly increased vol-
ume of casualties that challenges or exceeds nor-
mal operating capacity.
15
Because the first goal of
community emergency preparedness and
response efforts is to save lives (which encom-
passes preventing the spread of disabling disease
and injuries), if the community’s medical system
is overwhelmed, the community simply will lose
its capacity to meet this goal.
The Medical Reserve Corps, described earlier, is
specifically designed to provide surge capacity
Rather than being looked at primarily as potential casualties, the public can be considered part
of the community’s assets in emergency management initiatives.
Standing Together: An Emergency Planning Guide for America’s Communities
35
personnel in the event of a large-scale emergen-
cy. Federal resources, available through ESF #8:
Public Health and Medical Services, may be
called upon to provide additional medical surge
capacity and capability. For example, under
FEMA’s National Disaster Medical System,
Disaster Medical Assistance Teams (DMATs) pro-
vide assistance in the event of large-scale disasters.
DMATs are volunteer groups of medical and
nonmedical individuals, usually from the same
region where the disaster is occurring. Because
the material in this planning guide is intended to
help small communities stand on their own for
the first day or days and develop and maintain as
much capacity as possible, federal and state
resources are not itemized here but should be
familiar to the community planning team.
If a hospital or a number of hospitals are present
in the community, the leaders of these organiza-
tions must determine their surge capacity and
evaluate strategies to enhance capacity. This cal-
culation of capacity should include at a minimum
the number and type of beds, personnel, pharma-
ceuticals, supplies, and equipment, among other
critical items.
Professionals working in all community settings,
such as schools, businesses, and health facilities,
can consult their professional organizations for
assistance in surge planning. Several examples
appear in the tool box.
Consider all community health
resources.
In communities of all sizes, critical medical surge
capacity can come from not only hospitals, but
urgent care centers, home health agencies, com-
munity health centers, clinics, ambulatory care
facilities, physicians’ offices, and long term care
and other health facilities. Doctors, nurses, home
health aides, social workers, retired health profes-
sionals, and all other medically trained profession-
als can help to meet medical surge personnel
needs. Other required surge needs include
decontamination facilities, laboratory capacity,
and immunization supplies, among many other
elements. As part of the planning process, and in
advance of an emergency, planning teams should
identify all community health resources and assess
the ability of each resource to contribute to
emergency prevention, preparedness, response,
and recovery.
Define critical capacities for each
health entity and link to state
databases.
Surge capacity for a hospital is different than surge
capacity for a long term care facility or a commu-
nity health center.The planning team should agree
on what role each organization will play in a large-
scale emergency and ensure that health facilities
are linked to any resource-coordinating databases
operated by the state or region. Figure 1 illustrates
a regional planning matrix of critical capabilities
for health care–related resources.
TOOLS:
? CNA Corporation: Medical Surge Capacity and
Capability: A Management System for Integrating
Medical and Health Resources During Large-Scale
Emergencies.http://www.cna.org/
documents/mscc_aug2004.pdf.
? School administrators: National
Clearinghouse for Educational Facilities.http://www.edfacilities.org/rl/disaster.cfm.
? Emergency physicians: American College of
Emergency Physicians.http://www.acep.org.
? Business owners: National Business Group on
Health.http://www.businessgrouphealth.org.
36
? Example:The Maryland Institute for Emergency
Medical Services Systems maintains a Web-based
Facility Resource Emergency Database to expedite
the flow of resources (including emergency depart
ment and pediatric bed availability, medications,
blood, medic unit availability, and emergency
response personnel and apparatus) to the scene of an
incident or to an emergency operations center.
Hospitals, public health, 911 centers, specialty refer-
ral centers, law enforcement agencies, and other com-
ponents of the emergency medical services system
monitor this Web page.
FIGURE 1. CONNECTICUT REGIONAL EMERGENCY AND PUBLIC HEALTH PREPAREDNESS: HEALTH CARE
AGENCY BIOTERRORISM ANNEX PLANNING CRITERIA.
Source: Connecticut Regional Emergency and Public Health Preparedness: Health Care Agency Bioterrorism Annex
Planning Criteria. Used by permission.
Standing Together: An Emergency Planning Guide for America’s Communities
Standing Together: An Emergency Planning Guide for America’s Communities
37
Know the federal government’s
definition of required surge capacity.
The Health Resources and Services
Administration’s (HRSA’s) capacity projections
in a mass casualty event are based on a population
of one million, which obviously exceeds the pop-
ulation of small, rural, and suburban communities
addressed in this planning guide. However, local
planners should be aware of HRSA guidance
related to surge capacity because it impacts the
ability of surrounding communities to handle
victims of mass casualty events. A critical bench-
mark identified by the HRSA for regional surge
capacity for the care of adult and pediatric vic-
tims of terrorism and other public health emer-
gencies is as follows:
Establish systems that, at a minimum, can provide
triage treatment and initial stabilization, above the
current daily staffed bed capacity, for the following
classes of adult and pediatric patients requiring
hospitalization within three hours in the wake of
a terrorism incident or other public health emer-
gency:
? 500 cases per million population for patients
with symptoms of acute infectious disease,
especially smallpox, anthrax, plague,
tularemia, and influenza
? 50 cases per million population for patients
with symptoms of acute botulinum intoxica-
tion or other acute chemical poisoning,
especially that resulting from nerve agent
exposure
? 50 cases per million population for patients
suffering burn or trauma
? 50 cases per million population for patients
manifesting the symptoms of radiation-
induced injury, especially bone marrow sup-
pression
31(p. 3)
For decontamination surge capacity related to the
numbers of patients indicated above, the critical
benchmark is as follows:
Insure that adequate portable or fixed decon-
tamination systems exist for managing adult and
pediatric patients, as well as health care person-
nel, who have been exposed during a chemical,
biological, radiological, or explosive incident in
accordance with the numbers associated with
CBM # 2-1 (those indicated above). As stated
in OSHA (Occupational Safety and Health
Agency) Best Practices for Hospital-Based First
Receivers of Victims from Mass Casualty Incidents
Involving the Release of Hazardous Substances: “All
participating hospitals shall be capable of pro-
viding decontamination to individual(s) with
potential or actual hazardous agents in or on
their body. It is essential that these facilities have
the capability to decontaminate more than one
patient at a time and be able to decontaminate
both ambulatory and stretcher bound patients.
The decontamination process must be integrat-
ed with local, regional and state planning.”All
decontamination assets must be based on how
many patients/providers can be decontaminated
on an hourly basis.The awardee should plan to
be able to decontaminate all patients and
providers within three hours of the onset of the
event.
31(p. 34)
? Example: Numerous states are considering or have
purchased deployable, mobile, military-type trailers to
meet some of the needs for surge capacity.These
trailers can offer extra bed and additional isolation
capacity. Although small communities are unlikely to
have the financial resources to purchase such trailers,
resource pooling may be a possibility.
Consider the issues involved with
standards of care during mass
casualty events.
Americans are hesitant to think about “austere
care”—defined as the level of medical care that is
provided when health care resources, medical
supplies, and medical personnel are limited or
unavailable for an extended response
period—and expect to obtain only the highest
level of care.This obviously may be difficult if not
impossible for small communities to provide in
Standing Together: An Emergency Planning Guide for America’s Communities
mass casualty events involving thousands of vic-
tims. As part of the planning process, planning
teams should wrestle with the issues involved
with standards of care in mass casualty events.
To assist in doing so, in May 2005, the Agency for
Healthcare Research and Quality (AHRQ) and
the Office of Public Health Emergency
Preparedness issued a report for officials on how
to plan for delivering health and medical care in
a mass casualty event.
32
The report recommends
that planners at all levels, including the commu-
nity level and health systems level, develop or
revise both triage guidelines for specific types of
events and allocation guidelines for the use of
scarce resources such as ventilators, burn beds, or
surgical suites. The report also addresses such
issues as what circumstances would trigger a call
for altered standards of care, who is authorized to
make that call, and the sources of relief available
to address concerns about financial resources and
reimbursement of medical care costs. Planning
teams should be alert for further reports on this
important topic.
Identify dual uses for existing or
emerging capabilities.
Finding dual uses for existing or emerging capa-
bilities is particularly critical for resource-
strapped small, rural, and suburban communities.
A reverse 911 call system established by a com-
munity for law enforcement emergencies, for
example, could also communicate other types of
emergencies. Investments made by local public
health departments in upgrading laboratory ser-
vices for smallpox, SARS, anthrax, and other spe-
cialized testing can benefit more routine labora-
tory services in the community as well.The plan-
ning team can identify businesses with call-center
capabilities, such as telemarketing and airline
operations, as potential emergency call centers
during disasters.
Identify alternative care and shelter
facilities.
Most individual health care facilities in small,
rural, suburban, and even urban communities
have limited, if any, surge supplies, personnel, and
equipment. Backup systems for critical assets are
often shared among community facilities. “This
double counting of resources diminishes the abil-
ity to meet individual projected surge demands
across multiple institutions during a medical
emergency,” notes one report.
15(pp. 3-5)
The planning team should identify supplemental
facilities, such as hotels, motels, college infir-
maries, dormitories, libraries, high schools, places
of worship, and other structures that could meet
health care and shelter surge needs. For example,
a small town in Texas identified its community
college as a facility that could be turned into a
surge hospital. However, the team should also
38
TOOLS:
? Agency for Healthcare Research and Quality:
Altered Standards of Care in Mass Casualty
Events.http://www.ahrq.gov/research/altstand.
Investments made by local public health departments in upgrading laboratory services for
smallpox, SARS, anthrax, and other specialized testing can benefit more routine laboratory
services offered to the community.
Standing Together: An Emergency Planning Guide for America’s Communities
remember that the facilities cannot function
without concurrent plans for additional staffing,
supplies, and equipment and that the alternative
facilities must be accessible to the disabled.
Checklists are available for assessing the adequacy
of facility accessibility (see Tools).
Identify federal resources in the
community.
Federal resources located in the community may
or may not be available to the community in the
event of a large-scale emergency. Communities
near military installations can consider military
assets that might be available as appropriate, such
as beds in Veterans Administration (VA) hospitals,
naval search and rescue capabilities, army heli-
copters, and so forth. The planning team deter-
mines who initiates contact with these assets to
help determine how their resources may be
incorporated in planning and response activities.
The planning team also needs to consider that
during a major emergency, as defined in the
Stafford Act, the president can direct federally
controlled resources located in the community,
such as VA hospitals, Bureau of Primary Health
Care facilities, military hospitals, and any other
medical or nonmedical federal assets, to respond
in ways directed by the president. As this directive
may or may not include assistance to the particu-
lar community in which such resources are per-
manently housed,
10
the planners need to prepare
for contingencies when such personnel, equip-
ment, supplies, facilities, and managerial,
technical, and advisory services might not be
available to the community.
Identify gaps in community assets.
The planning team then reviews the asset inven-
tory information so that gaps and areas of com-
monality can be identified. During development
of the integrated plan—the next activity
(addressed in Section 6)—the team begins to
identify strategies to close the gap between what
is needed and what is available for disaster pre-
paredness and response. “Shortfalls may require
negotiating agreements with private suppliers or
other jurisdictions. Determination of the
resource base also should include a consideration
of what facilities are vital to emergency opera-
tions and how they might be affected by hazards:
problems that cannot be mitigated should be
taken into account in the emergency operations
plan, not assumed away,” notes the FEMA plan-
ning guide.
7(pp. 2-10)
39
TOOLS:
? New York State Office of Advocate for
Persons with Disabilities: ADA Accessibility
Checklist for Existing Facilities.http://www.ghi.com/pdf/adachecklist.pdf
(accessed Jun. 20, 2005).
The integrated emergency management plan is
designed to meet the needs defined for the com-
munity based on its hazard vulnerability analysis
(HVA; Section 3), its goals for preparedness and
response planning (Section 4), and its current
capacities and capabilities (Section 5). Through
the HVA, goal setting, and capabilities identifica-
tion processes, the team determines what is being
planned for and what assets might be needed and
allocated.
Plans, of course, have both a political and strate-
gic value in their quantification and description
of available and needed resources. Small, rural,
and suburban communities must be realistic; the
planning and asset allocation process will
undoubtedly require trade-offs. The integrated
plan’s objectives include achieving a level of pre-
paredness and response that is sustainable and
building capabilities for the future as needs
evolve. It addresses the four phases of emergency
management described in Section 4—preven-
tion, preparation, response, and recovery.
The plan is a living document and must be
reviewed, updated, and tested as risks, goals, and
capabilities change over time (Section 12).
Transitions in team leadership and responsibility
must also be considered as the planning process
matures and moves into implementation and
maintenance phases.
The plan’s coverage of issues related to commu-
nication, mental health needs, and the needs of
special populations warrants in-depth descrip-
tion. Thus, these issues are covered in separate
sections in this planning guide: Section 7 address-
es communication, Section 8 addresses mental
health needs, and Section 9 addresses the needs of
special populations. Teams must ensure that these
topics are thoroughly covered in their final inte-
grated plan. A description of selected strategies
that can help teams to develop high-quality inte-
grated plans follows.
Maintain a collaborative effort;
broaden planning partnerships where
necessary.
All stakeholders, including the media and others
as identified in Section 2, are included as partners
in plan development.The value of a collaborative
planning process cannot be overemphasized.
Although a document is the tangible result at this
6. Develop the Integrated Plan
Standing Together: An Emergency Planning Guide for America’s Communities
40
Recommended Planning Strategies:
? Maintain a collaborative effort;
broaden planning partnerships where
necessary.
? Choose an approach to developing
the plan.
? Use available guidance and resources.
? Determine how the plan is to be
drafted and the expected time frame.
? Agree on meeting frequency.
? Review existing plans, laws, and
mutual aid agreements.
? Commit to the use of simple language.
? Clearly delineate roles and
responsibilities.
? Determine how the plan will be
organized.
? Address all types of events and cover
all defined goals.
? Specifically address health and medi-
cal facility emergency planning.
? Specifically address how to meet
needs for pharmaceuticals and medi-
cal supplies.
? Identify and address hazards and
resources that cross jurisdictions.
? Identify how preparedness and
response success will be measured.
? Consider the lessons learned from 9/11.
Standing Together: An Emergency Planning Guide for America’s Communities
41
stage, intangible results, such as new and
improved relationships, have significant positive
value above and beyond the document. Planning
conducted with a group over an extended period
of time builds and enhances partnerships and
communication that will be essential during an
actual emergency. Partnerships often also extend
to neighboring communities and the surround-
ing region. Subgroups or committees can be
formed to focus on particular areas of planning.
Communication, reporting, and decision-making
channels must be developed and maintained so
that the efforts of subset groups are integrated
into overall plans.
? Example: Arlington, Massachusetts (population
43,000), formed a subcommittee of the local emer-
gency planning committee to enhance the communi-
ty’s ability to respond to the threat of terrorism.
Subcommittee initiatives included targeted hardening
of critical infrastructure; specialized police training for
incident command; updating of mutual aid agree-
ments; acquisition of protective equipment and emer-
gency operations planning software; enhancement of
the town’s emergency management plan; develop-
ment of emergency plans for specific locations, such
as schools; and emergency operations exercises at a
high-profile institution.
33
Choose an approach to developing the
plan.
The planning team can take one or a combination
of four general approaches to creating an integrat-
ed plan based on the HVA. The team should note
that three of the four approaches involve adapting
existing plans, not adopting existing plans. The dis-
tinction between adapting and adopting is critical. If
the team chooses one of the adaptation options, it
will need to carefully review all elements of the
existing plan and revise plan elements to meet the
community’s unique needs and resources as identi-
fied through the team’s HVA. Adopting a plan and
transferring it “wholesale” from one community to
another, “cookie-cutter style,” is extremely risky
and ill-advised.The four approaches are as follows:
? Develop the plan from a blank sheet.
? Adapt a plan that already exists in one of the
community’s organizations (for example, fire
department, school system, local hospital).
? Adapt a plan obtained through the emergency
management literature.
? Adapt a county, regional, state, or national plan.
Again, whether starting from a blank sheet or
adapting an existing plan, the planning team must
tailor the plan to the risks, capabilities, and goals
defined for the specific community through its
HVA.
Use available guidance and resources.
The blank sheet approach may be more time-con-
suming than other approaches. Most states can pro-
vide valuable assistance to local jurisdictions. States
typically publish their own planning guides, con-
duct training, and may assign planners to work with
local community planners. Federal guidance, such
as the Public Health Emergency Response Guide for
State, Local, and Tribal Public Health Directors, pub-
lished by the Centers for Disease Control and
Prevention (CDC), can provide valuable planning
guidance and templates for documentation of con-
tacts and actions, leadership assignments, and inci-
dent-specific preparedness (see Tools).
Determine how the plan is to be drafted
and the expected time frame.
Decisions include Who will draft the plan and
prepare the needed graphics? To whom will the
draft plan be circulated? How will changes be
agreed upon and incorporated? Who will receive
a copy of the final plan? and What is the desired
time frame for the plan’s drafting, revision, and
finalization? Sidebar 12 provides selected sample
steps outlined by the Federal Emergency
Management Agency (FEMA).
Standing Together: An Emergency Planning Guide for America’s Communities
42
Agree on meeting frequency.
The planning team and its subcommittees or task
groups may meet weekly or monthly during differ-
ent phases of planning and implementation.
Meetings with neighboring, regional, state, or fed-
eral partners may occur on a monthly, quarterly, or
biannual basis after the relationships are established.
Review existing plans, laws, and
mutual aid agreements.
Local, state, and federal laws, rules, and regulations
may impact the plans that are developed.
Appropriate plans, laws, codes, and regulations
and existing agreements with neighboring com-
munities, private-sector organizations, and others
should be reviewed carefully by the team.
7
These
should include plans concerning command and
control and, in particular, the integration from an
incident command system structure to a unified
command system.
Commit to the use of simple language.
The emergency management plan should be
written in plain English. Team members can
define all terms at the beginning and avoid using
too many acronyms or abbreviations. A clearly
marked glossary at the end of the document may
define the acronyms or abbreviations that are
used.
TOOLS:
? Centers for Disease Control and Prevention
(CDC): Public Health Emergency Response
Guide for State, Local, and Tribal Public Health
Directors, Version 1.0.http://www.bt.cdc.gov/
planning/responseguide.asp.
? National Association of County & City Health
Officials: Bt PREP:A Bioterrorism Response Plan
Design Guide for Local Public Health Agencies, 1st
ed., 2003.http://www.naccho.org/pubs.
? Resources for local planning for pandemic dis-
ease, available through the CDC, include:
Pandemic Influenza Preparedness and Response:http://www.hhs.gov/nvpo; State and Local
Pandemic Planning Guide:http://www.hhs.gov/
nvpo/pubs/pandemicflu.htm.
? Northern New England Metropolitan Medical
Response System: Community Planning Guide:
Improving Local and State Agency Response to
Terrorist Incidents Involving Biological Weapons, Jun.
2003.http://www.nnemmrs.org/surge.html.
? Develop a rough draft of the basic plan to serve as
a point of departure for the planning team.
? Develop agendas and invitation lists for the first
cycle of planning meetings.
? Conduct a presentation meeting, establish com-
mittees for parts of the plan, appoint committee
chairs, and schedule a follow-up meeting.
? Work with committees on successive drafts.
? Prepare necessary graphics (for example, maps
and organizational charts).
? Produce a final draft and circulate the draft to the
planning team for review and comment.
? Hold a meeting to incorporate final changes, dis-
cuss an implementation strategy and necessary
distribution, and obtain informal commitments to
provide information that could necessitate revi-
sion.
? Obtain concurrence from organizations with
identified responsibilities for implementing the
plan.
? Obtain official promulgation of the plan by local
elected officials and advise the media of this in
advance.
? Print and distribute the plan, with a copy (or press
release) to local media. Maintain a record of the
organizations and persons that received a copy (or
copies) of the plan.
Source: Adapted from Federal Emergency Management
Agency: State and Local Guide (SLG) 101: Guide for All-
Hazard Emergency Operations Planning. 1996. pp. 2-11–2-
12.http://www.fema.gov/rrr/gaheop.shtm (accessed
Feb. 2005).
SIDEBAR 12. SAMPLE STEPS TOWARD CREATING A
WRITTEN EMERGENCY OPERATIONS PLAN
Standing Together: An Emergency Planning Guide for America’s Communities
Clearly delineate roles and
responsibilities.
The plan should clearly describe areas of respon-
sibility, the circumstances under which the plan is
to be activated, who is initially in charge, and
who is authorized to activate the plan. As men-
tioned earlier, coordinated emergency manage-
ment planning and decision making require com-
munity leaders and team players to play different
roles in different circumstances. The plan also
should outline alternative roles for personnel dur-
ing emergency situations, including who they
should report to within a command structure.
Roles and responsibilities must be determined in
advance because, during an emergency, turf bat-
tles or lack of clarity about who is to do what can
result in lost time, resources, and perhaps lives.
Operational duties and goals for key positions can
be provided in checklist format.
Determine how the plan will be
organized.
FEMA and other government agencies do not
mandate a particular format for emergency plans.
However, it is important that the plan be orga-
nized in a format that the team is comfortable
with and one that enables users to obtain with
ease the information they need. Additional issues
includes sequencing of the material (is it logical?),
consistency of sections, adaptability of material to
multiple situations, and compatibility with plans
of other jurisdictions.
7
A functional approach to the plan’s structure
enables communities to address the effects com-
mon to hazards without having to develop sepa-
rate plans for each hazard. For example, as men-
tioned earlier, the National Response Plan is orga-
nized around 15 emergency support functions,
such as transportation; mass care, housing, and
human services; and others (Sidebar 6). FEMA
provides the following list of core functions that
warrant attention and may require that specific
actions be taken during emergency response
operations:
? Direction and control
? Communications
? Warning
? Emergency public information
? Evacuation
? Mass care
? Health and medical services
? Resource management
7(p. 5-1)
Figure 2 illustrates how each core function can be
assigned to specific organizations or individuals.
Sidebar 13 outlines the components of an integrat-
ed plan that uses a functional structural approach.
Address all types of events and cover
all defined goals.
Plan contents should address all those elements
outlined as goals for preparedness and response in
Section 4. For example, the emergency manage-
ment plan should include a brief description of
the various activities the organization plans to
43
Roles and responsibilities must be determined in advance; during an emergency,
turf battles or lack of clarity about who is to do what can result in lost
time, resources, and perhaps lives.
Standing Together: An Emergency Planning Guide for America’s Communities
44
FIGURE 2. RESPONSIBILITIES FOR RESPONSE FUNCTIONS
Source: Federal Emergency Management Agency: State and Local Guide (SLG) 101: Guide for All-Hazard
Emergency Operations Planning, 1996.http://www.fema.gov/rrr/gaheop.shtm (accessed Feb. 2005).
The Basic Plan: The basic plan is an overview of the jurisdiction’s emergency response organization and policies. It
cites the legal authority for emergency operations, summarizes the situations addressed by the emergency opera-
tions plan (EOP), explains the general concept of operations, and assigns responsibilities for emergency planning
and operations.
continued
SIDEBAR 13. COMPONENTS OF A FUNCTIONALLY STRUCTURED EMERGENCY PLAN
Standing Together: An Emergency Planning Guide for America’s Communities
undertake in each of the four emergency man-
agement phases (prevention, preparation,
response, and recovery).
The plans also should include the following:
? Organizations and individuals responsible for
carrying out specific actions at projected times
and places in an emergency that exceeds the
capability or routine responsibility of any one
agency (for example, the fire department)
? Authority and organizational relationships, and
how all actions will be coordinated
? How people and property will be protected in
emergencies and disasters
? Personnel, equipment, facilities, supplies, and
other resources available—within the jurisdic-
tion or by agreement with other
jurisdictions—for use during response and
recovery operations
? Steps to address mitigation concerns during
response and recovery activities
7
However the plan is organized, the team should
ensure that the plan is flexible enough to respond
to different situations. Communities must be pre-
pared for natural disasters, unintentional disasters,
and intentional disasters.
Specifically address health and medical
facility emergency planning.
Local planners must take into account the ser-
vices required to support operations for health
care delivery during and after a disaster affecting
the community. For example, planners must con-
sider the following:
? Plans and decisions regarding water reservoirs,
tanks, or other sources can impact a health
care facility’s access to water essential for sani-
tation, sterilization, cooling of generators, and
other utility-related functions.
? Closure of or limited access to banks and
ATMs impacts a health care provider’s ability
to pay essential staff continuing to work
through the crisis.
45
Functional Annexes: Functional annexes are plans
organized around the performance of a broad task.
Each annex focuses on one of the critical emergen-
cy functions that the jurisdiction will perform in
response to an emergency. The number and type of
functional annexes included in the EOP may vary
from one jurisdiction to another, depending on
needs, capabilities, and organization. Because func-
tional annexes are oriented toward operations, their
primary audience consists of those who perform the
tasks. They do not repeat general information con-
tained in the basic plan.
Hazard-Specific Appendixes: Hazard-specific appendix-
es provide additional detailed information applicable
to the performance of a particular function in the
face of a particular hazard. They are prepared when
hazard characteristics and regulatory requirements
warrant and are attached to the relevant functional
annex(es).
SOPs and Checklists: Standard operating procedures
(SOPs) and checklists provide the detailed instruc-
tions that an organization or an individual needs to
fulfill responsibilities and perform tasks assigned in
the EOP. They may be attached to the EOP or ref-
erenced as deemed appropriate.
Source: Federal Emergency Management Agency: State
and Local Guide (SLG) 101: Guide for All-Hazard
Emergency Operations Planning. 1996, pp. 3-2–3-3.http://www.fema.gov/rrr/gaheop.shtm (accessed Feb.
2005).
SIDEBAR 13. COMPONENTS OF A FUNCTIONALLY
STRUCTURED EMERGENCY PLAN (CONTINUED)
TOOLS:
? A suggested format for a terrorist incident
appendix to a basic all-hazards emergency plan
can be found in Federal Emergency
Management Agency: State and Local Guide
(SLG) 101: Guide for All-Hazard Emergency
Operations Planning: Chapter 6, Attachment G.
Apr. 2001.http://www.fema.gov/pdf/rrr/
allhzpln.pdf.
Standing Together: An Emergency Planning Guide for America’s Communities
46
? The receipt, storage, and distribution sequence
of mass prophylaxis for first responders and
their families, first receivers and their families,
other health and public safety workers, and the
general public must be determined collabora-
tively and in advance to avoid confusion.
? Plans and decisions regarding curfew, road clo-
sures, or traffic routing can impact the ability
of health care professionals to get to and from
health care facilities and alternative care sites.
Health care organizations accredited by the Joint
Commission on Accreditation of Healthcare
Organizations must meet emergency manage-
ment planning and drill requirements as outlined
in Joint Commission accreditation manuals for
ambulatory care, behavioral health care, critical
access hospitals, health care staffing, home care,
hospitals, laboratory, long term care, and office-
based surgery facilities.The goal of these require-
ments is to ensure that health care organizations
prepare for and can respond to an emergency
within their organizations or in their communi-
ties that suddenly and significantly affects the
need for their services or their ability to provide
those services.
34
Health facility leaders on the community plan-
ning team, who represent Joint Commission-
accredited facilities, will be familiar with Joint
Commission emergency management require-
ments and can advise the team on their facilities’
ability to provide capacities and capabilities in the
areas outlined in this section. Not all health care
organizations are accredited by the Joint
Commission, however, so communities with
acute care and other health facilities should
address such facilities’ capacities and capabilities
to meet needs, including (but not limited to) the
following:
Ongoing risk assessment: A risk assessment process,
such as HVA, ensures that the health care organi-
zation identifies potential emergencies that could
affect the need for its services or its ability to pro-
vide those services.
Surge capacity: Surge capacity is not just a hospital
issue, but a community issue, as described in
Section 5. During disasters, surge capacity is per-
haps the most fundamental component of a
health care organization’s emergency prepared-
ness program. Surge capacity is the organization’s
ability to expand care capabilities in response to
sudden or more prolonged demand. It encom-
passes the following elements:
? Potential patient beds
? Available space in which patients may be
triaged, managed, treated, vaccinated, decon-
taminated, or simply located
? Available personnel of all types
? Necessary medications, supplies, and equipment
? Legal capacity to deliver health care services
under situations that exceed authorized capacity
Surge capacity has both a point-in-time aspect
(that is, the ability to accommodate patients for a
limited time period during the acute crisis) and a
longitudinal dimension (the ability to manage
longer-term care needs).
Plans and decisions regarding water reservoirs, tanks, or other sources can impact a health
care facility’s access to water essential for sanitation, sterilization, cooling of generators, and
other utility-related functions.
Standing Together: An Emergency Planning Guide for America’s Communities
Evacuation and alternative care sites: When a facili-
ty’s physical environment can no longer support
adequate care and treatment, the organization
must have plans for both horizontal (on the same
floor or level) and vertical (to a different floor)
evacuation. Procedures for horizontal evacuation
to areas of safety beyond closed smoke barriers
are written into every health care facility’s fire
plans and should be familiar to all staff. Even
though less common, vertical evacuation must
also be considered in the planning process. Other
evacuation planning considerations include Who
is responsible for the decision to evacuate? With
what company(ies) will transportation of patients
be arranged (for example, local paratransit or
ambulance services)? What evacuation routes will
be used? Where will these routes be posted? Who
is responsible for maintaining the medical and
medication profile sheet throughout the event
and after?
35
Hospitals and long term care organizations are
required by the Joint Commission to identify an
alternative care site(s) that has the capabilities to
meet the needs of patients when their own facil-
ities are not able to do so due to the effects of a
disaster. Consideration must be made for the type
of patients being relocated, with assurance that
the chosen alternative site can meet the clinical
needs of the individuals it receives.
Emergency communications and building utility systems:
Health facilities must ensure an appropriate back-
up for key internal and external communications
systems in the event of failure during emergen-
cies. Hospitals or other health care organizations
frequently consider multiple levels of communi-
cations systems redundancy, including backup
phone systems, additional radio licenses for
portable radios, cell phones, Ham radios, satellite
phones, personal digital assistants, e-mail, and so
forth.
Facilities must identify an alternative means of
meeting essential building utility needs when the
facility must provide continuous service during
an emergency. Electricity, water, ventilation, fuel
sources, and medical gas/vacuum systems may
each require special consideration. Key questions
related to utility failure include Does the organi-
zation’s emergency management plan address
how the organization would handle a utility fail-
ure caused by an interruption in service by a util-
ity provider? By a lightening strike? What effect
would a utility failure have on the organization?
How has the plan addressed such effects? What
backup systems are in place in the event of a util-
ity failure? Sidebar 14 provides Greater New York
Hospital Association’s planning categories related
to communication and power issues.
Emergency education and training of health care staff:
Orientation and education about potential emer-
gencies and their expected risks and conse-
quences, how to respond to each type of emer-
gency, and how to provide the best possible care
to disaster victims, as appropriate, should be pro-
47
The major information categories of the draft guidelines
in development at the Greater New York Hospital
Association include the following:
Communication considerations: internal phone switches, ana-
log phone lines, long-distance service provider trunks,
runner system, radios, walkie-talkies, cell phones, overhead
speaker and paging system, stand-alone computer and
Internet access, access to external information systems,
communications directories, and vendor contact numbers.
Power considerations: standards, fuel supplies, supplemental
emergency generators, operation of emergency generators,
placement and security of emergency generators, elevators,
radios, critical equipment, and contingency planning.
Source: Greater New York Hospital Association, New York. Used
with permission.
SIDEBAR 14. COMMUNICATION AND POWER
CONSIDERATIONS FOR HEALTH CARE FACILITIES
Standing Together: An Emergency Planning Guide for America’s Communities
vided to health care staff before a disaster occurs.
When a disaster or emergency occurs, there is lit-
tle or no time for staff training to be conducted.
An orientation and education program for all
personnel, including licensed independent practi-
tioners who participate in implementing the
emergency management plan, is required by the
Joint Commission for accreditation and is recom-
mended for all organizations. Education address-
es, as appropriate to the individual, the following:
? Specific roles and responsibilities during emer-
gencies
? How to recognize specific types of emergencies
? The information and skills required to per-
form assigned duties during emergencies
? The backup communication system used dur-
ing emergencies
? How supplies and equipment are obtained
during emergencies
Incident command system (ICS)/unified command:
The health care organization’s command struc-
ture must link with the community’s command
structure. The Hospital Emergency Incident
Command System (HEICS), used by many hos-
pitals nationwide, is based upon public safety’s
ICS all-hazards structure.
Isolation and decontamination: A community must
know what is available for radioactive, biological,
and chemical isolation and decontamination and
how to access such capabilities. Not all hospitals
have facilities for such decontamination, but cur-
rent belief is that it is advisable for hospitals to
work with the community to develop decontam-
ination plans and capabilities. The team should
also obtain information on hospital/health facili-
ty capacity to support ventilator-dependent indi-
viduals and to isolate and quarantine individuals
who require isolation and quarantine. According
to a recent study of hospital and community
emergency preparedness linkages,
14
only about
half of respondents from rural hospitals reported
that their community plan addresses the hospital’s
capacity to isolate individuals, as needed, and to
support ventilator-dependent patients.
Security/lockdown: According to some experts, a
plan to secure the facility within a few minutes of
an internal or known external biologic or chem-
ical incident in order to protect current care
recipients, the facility, and staff is appropriate, and
entry should be permitted only to noncontami-
nated staff and decontaminated care recipients.
36
Good perimeter control and access control points
around health facilities are often critical to pre-
vent the spread of infectious diseases and agents.
Security planning issues include What additional
security staff is required in the event of a com-
munitywide disaster? How might such staff be
obtained during an emergency? What “emergen-
cy lock-down” control procedures should be
implemented in the event of a disaster? How will
these occur? Who will implement them? What
role will local law enforcement agencies play in
assisting the organization during a community-
wide incident? How will the organization’s secu-
rity staff communicate with local agencies during
a communitywide incident?
? Example:To decrease the possibility of contamina-
tion of treatment areas, the Medical Center of
Central Georgia in Macon designed a physically
separate space for decontamination. If an individual
is or may be contaminated, staff posted at the emer-
gency medical services (EMS) entrance ramp ensures
that the person is directed from the private vehicle or
ambulance into a decontamination room prior to
entering the emergency department.
37
Surveillance and laboratory capacity: The team
should also work to ensure that hospitals and
public health agencies in the area have a collabo-
rative plan for timely and appropriate identifica-
tion and testing of suspected agents of bioterror-
ism, which include anthrax, smallpox, and others.
48
Standing Together: An Emergency Planning Guide for America’s Communities
Drills/exercises: Health care organizations must
give drills and exercises serious and comprehen-
sive attention.Testing of every aspect of an emer-
gency management plan includes all equipment
the organization will be using during an emer-
gency (for example, communications backups,
emergency generators), involving community
agencies, deploying the clinical staff, setting up
the incident command center, evacuating and
transporting the patient population, and request-
ing and receiving emergency supplies and equip-
ment from other organizations.
Emergency credentialing: Credentialing of disaster
volunteers in order to expand community capa-
bility warrants special focus. As described in
Sections 4 and 5, the team should consider the
range of potential volunteers, from local health
care professionals such as Medical Reserve Corps
and Community Emergency Response Team,
through Disaster Medical Response teams at the
federal level. The planning team or a subgroup
will need to establish appropriate credentialing
processes. Approximately one third of study
respondents from hospitals in rural communities
have no established mechanism for credentialing
volunteer staff during an emergency.
14
“This issue
has been a big problem in those communities that
have already experienced a variety of different
kinds of disasters, and deserves significant atten-
tion,” comments Jerod M. Loeb, Ph.D., executive
vice president of the Joint Commission’s Division
of Research.
Credentialing of disaster volunteers appears to be
lacking nationwide in both urban and rural areas
and should be examined by community planners.
Through a program called Emergency System for
Advance Registration of Volunteer Health Care
Personnel (ESAR-VHP), the Health Resources
and Services Administration (HRSA) is working
with states and jurisdictions to establish a com-
mon approach to credentialing licensed health
care professionals. “ESAR-VHP will be a nation-
al system in the sense that every state and juris-
diction will have developed their systems using
the ESAR-VHP national guidelines. States and
jurisdictions will be encouraged to enter into
agreements to create local and regional consor-
tia,” notes Marilyn Biviano, chief of HRSA’s
ESAR-VHP Branch.
38
With the assistance of state licensing boards and
medical staff offices at local hospitals, some com-
munities and community hospitals are establish-
ing databases that include information (and pho-
tos) of credentialed medical volunteers. Photo
identification cards facilitate the accurate identifi-
cation of credentialed volunteers.
Specifically address how to meet needs
for pharmaceuticals and medical
supplies.
Health care organizations and health departments
have routine medical and pharmaceutical suppli-
ers and often negotiate special supply arrange-
ments with these and other suppliers for emer-
gency situations. Supply arrangements must be
identified as part of the community planning
effort in order to ensure that all potential surge
supply sources are included in the community
plan and to prevent multiple organizations from
unknowingly relying on the same supplier, there-
by running the risk of an early depletion of sup-
plies with no alternative supply arrangements in
place.
Successful emergency management planning
includes identifying contingency suppliers that
can provide the resources that may be needed to
handle a patient surge. Resources include people,
equipment, food, and medical supplies, among
other items. Leaders should establish agreements
ahead of time with community agencies, other
49
Standing Together: An Emergency Planning Guide for America’s Communities
50
health care providers, and backup suppliers to
ensure that the organization’s resource needs can
be met during a dramatic patient surge. Having
adequate quantities of ventilators and personal
protective equipment is of particular concern
with a large influx of patients with severe respira-
tory problems.
In the event of major emergencies or disasters,
hospitals in local communities contact the local
health department or, in jurisdictions with no
local health department, hospitals call the state
health department to request state assistance in
meeting needs for drug and medical supplies that
exceed local resources. Sidebar 15 provides addi-
tional information on this process. The state’s
governor’s office can request federal assistance if
local needs exceed state resources. The CDC’s
Strategic National Stockpile (SNS), formerly
known as the National Pharmaceutical Stockpile
(NPS), can be made available to any community
in need of additional medicinal support in
response to an event involving a number of dif-
ferent threat agents. It consists of several tons of
needed pharmaceutical supplies and equipment,
strategically located throughout the United
States, which will be delivered to the local com-
munity within 12 hours of an event.The National
Response Plan does not need to be activated in
order for the stockpile to be requested by the
governor for use in a local community.
39
All communities, both large and small, must
address how they will procure and distribute
additional supplies from local stockpiles and the
national stockpile. Responsibility currently varies
widely by community and includes local health
care providers, public health officials, EMS, fire
services, law enforcement, and other services. In
testimony before a U.S. House of Representatives
subcommittee, a CDC official stated:“Local orga-
nizations at the city, county, and regional level
will be essential in the effort to reach all citizens
who need medical help after a terrorist incident.
However, these partners need to become fully
aware of the NPS to ensure that they are able to
most effectively plan for and use this valuable
resource.”
40
To meet this need, the CDC is now offering
extensive training to fully prepare state and local
partners. According to the CDC, “The prepared-
ness training and education program is for state
and local health care providers, first responders,
and governments (to include federal officials,
governors’ offices, state and local health depart-
ments, and emergency management agencies).
This training not only explains the SNS pro-
gram’s mission and operations, it alerts state and
local emergency response officials to the impor-
tant issues they must plan for in order to receive,
secure, and distribute SNS assets.”
41
Training
information is available at www.bt.cdc.gov/train-
ing.
Given the availability to hospitals of external
sources of drugs and related supplies from the
CDC’s SNS, the American Hospital Association
recommends that hospitals be prepared to sustain
a 24-hour supply of pharmaceutical products at
the most common dosage and that a standardized
formulary should be developed to adequately
determine stock requirements for medical/surgi-
cal supplies and equipment.
42
In its white paper,
the Joint Commission recommends ensuring a
48- to 72-hour stand-alone capability through the
appropriate stockpiling of necessary medications
and supplies.
30
Identify and address hazards and
resources that cross jurisdictions.
Disasters do not recognize jurisdictional lines (for
example, hurricanes affect multiple municipalities
and counties simultaneously); similarly, resources
Standing Together: An Emergency Planning Guide for America’s Communities
must cross jurisdictional lines to meet the needs
of communities affected by disasters (for example,
by transporting residents of one county without
an acute care facility to another county with such
a facility). The plan should address both realities.
Identify how preparedness and
response success will be measured.
Drills, exercises, and real events described in
Section 10 can shed light on the success (or lack
thereof) of preparedness and response efforts out-
lined in the plan. However, while developing the
plan, the team will want to consider parameters
or indicators that will be used to measure success.
Communities need realistic feedback regarding
the true level of preparedness.This helps to estab-
lish realistic expectations, ensure identification of
gaps, and enable these gaps to be filled in the best
possible way, given the community’s resources.
Consider the lessons learned from 9/11.
The Pentagon’s use of a unified command system
during the 9/11 attack was considered by many to
be a model of implementation in terms of coordi-
nating the roles of emergency responders, first
receivers (hospitals), public health, law enforce-
ment, the FBI, and others.The emergency response
at the World Trade Center was heroic, yet there
were significant lessons learned. Communities, no
matter how small, can learn from what went right
and what went wrong. The 9/11 Commission
Report
11
cited the following lessons:
? Avoid bureaucratic inertia.
? Simplify oversight and clarify accountability.
Too many parties dilute the effectiveness of
response and run the risk that no one assumes
responsibility.
? Challenge assumptions about what the likely
threats will be. Think outside the box.
? Assure joint operational planning. Give up turf
and collaborate for efficiency. Avoid duplica-
tion of effort.
51
During the occurrence of a major emergency or dis-
aster, a hospital in the local region may quickly need
additional support in the form of drugs and medical
supplies. The hospital will have activated its emer-
gency response plans using the Hospital Emergency
Incident Command System (HEICS) or another
incident command system (ICS).
The individual functioning as Incident Commander,
as specified under the ICS structure, or a person to
whom he or she has delegated this responsibility, will
initiate a request with the local public health depart-
ment (LHD) that serves the jurisdiction in which
the hospital is located. The Incident Commander
alerts the LHD to the fact that the hospital is expe-
riencing rapid depletion of certain medications or
supplies due, perhaps, to a widespread problem
affecting the area’s residents.
Before an emergency occurs, it therefore is critical
that the Incident Commander and other hospital
leaders know who the hospital’s public health offi-
cials are and how to contact them. Hospital leaders
must establish ongoing relationships with their pub-
lic health officials. In rural areas of the nation, where
there is no local public health department, the state
health department provides public health services to
local jurisdictions.
Local health departments can request further sup-
port from state health departments. State health
departments, through the governor, can request fed-
eral support, including pharmaceuticals and medical
supplies from the CDC’s Strategic National
Stockpile.
Source: Christine C. Bradshaw, D.O., M.P.H., M.B.A.,
medical officer, Centers for Disease Control and
Prevention, Coordinating Office of Terrorism
Preparedness and Emergency Response.
SIDEBAR 15. ASSURING DRUGS AND MEDICAL
SUPPLIES IN LOCAL COMMUNITIES
Standing Together: An Emergency Planning Guide for America’s Communities
52
? Provide layered preparedness and response
mechanisms.
? Designate who will be the communicator at
each response and operations entity.
? Technology is an asset but can also be a liability.
If power fails, is there a means for communica-
tion and other functions served by technology?
? Train people as backup for technology.
? Ensure detailed and effective transfer of
knowledge when new persons come into
important roles or during other transitions/
transfers of authority or responsibility.
? Develop standardized operating procedures
covering how different commands should
communicate during an incident.
? Make sure first responder civilians know what
to do.
? Assure that each participant of the unified
incident management system has command
and control of its own units and adequate
internal communications.
? Conduct regional drills in order to establish
professional relationships and trusts.
? Promote and reward information sharing.
? Match resources to responsibility and function.
Train people as backup for technology.
? Federal Emergency Management Agency (FEMA):
State and Local Guide (SLG) 101: Guide for All-Hazard
Emergency Operations Planning, 1996. http://
www.fema.gov/rrr/gaheop.shtm.
Published in 1996, this guide outlines the preparedness,
response, and short-term recovery planning components
that FEMA recommends be included in state and local
emergency operations plans. Attachment G, published in
April 2001, provides specific guidance for terrorism plan-
ning.http://www.fema.gov/pdf/rrr/allhzpln.pdf.
? State and Local Preparedness Guidance:http://www.fema.gov/preparedness/
state_local_prepare_guide.shtm.
Emergency Operations Planning Guidance is designed
to help state and local governments fine-tune their
EOPs and address critical planning considerations to
include a focus on weapons of mass destruction
(WMD) incidents, interstate and intrastate mutual aid
agreements, resource typing, resource standards, protec-
tion of critical infrastructure, inventory of critical
response equipment and teams, continuity of opera-
tions, and family and community preparedness.
? Managing the Emergency Consequences of Terrorist
Incidents—Interim Guidelines: http://
www.fema.gov/preparedness/managing.shtm.
This interim planning guide provides state and local
emergency management planners with a framework for
developing supplemental emergency operations plans
that address the consequences of a terrorist attack
involving WMD. It encourages the efficient integration
of state, local, and federal terrorism response activities
and provides current information regarding planning
and operational challenges faced by communities that
have dealt with terrorist events.
? National Capability Assurance:http://www.fema.gov/preparedness/nca.shtm.
FEMA’s Capability Assurance effort focuses on
resources and programs to help the state, tribal, and
local emergency management and response communi-
ties be better prepared to respond to disasters and inci-
dents of all kinds. These processes and resources focus
primarily on assessment and exercise-related programs,
processes, and systems.
TOOLS:
Two principal goals of communications planning in
emergency management are (1) to establish and
maintain a common operating picture and (2) to
ensure accessibility and interoperability across juris-
dictions and functional agencies.
27
Although
progress toward meeting these goals has been made,
much work remains to be done. During the 9/11
attacks, for example, the response efforts of the first
fire fighters to arrive at the World Trade Center
were hampered by radio communications prob-
lems. Those first responders thus actually had less
knowledge about what was happening inside the
buildings than those outside the buildings.
In any community, communication patterns devel-
op and change to fit the day-to-day needs of the
community. These communication patterns, both
internal and external, are influenced by equipment
use, procedures, and channels for collecting, orga-
nizing, and exchanging information among com-
munity agencies and organizations. Planning for the
provisions that should be available for communica-
tions during an emergency is difficult because
emergencies are by their very nature unpredictable,
and so are their effects on the community. Elements
of an emergency response plan for communications
that works for one community may not meet the
needs of other communities due to differing com-
munications infrastructure, equipment, channels of
communication, and dozens of other possible fac-
tors. Strategies that can help communities achieve
thorough communications planning follow.
Understand how communication is
transmitted.
An understanding of how communication meth-
ods work is critical to effectively planning for the
communications consequences of an emergency
because emergencies can interrupt established
communication systems (see section on “Plan for
alternative and backup communication links and
systems.”). Communications are usually transmit-
ted by wire line, radio, or a combination of the
two. Wire line communications, such as tele-
phone and telegraph, involve sending and receiv-
ing an electromagnetic signal by a closed con-
ducting path, such as a copper wire or fiber-optic
7. Ensure Thorough Communication Planning
Standing Together: An Emergency Planning Guide for America’s Communities
53
Recommended Planning Strategies:
? Understand how communication is
transmitted.
? Plan for alternative and backup com-
munications links and systems.
? Plan and provide for emergency back-
up power to communications systems.
? Ensure interoperability of communi-
cations systems.
? Use available communications plan-
ning resources.
? Review and build on existing com-
munications planning initiatives.
? Obtain/prepare information for crisis
communications.
? Define emergency communications
protocols or procedures.
? Establish communications credibility
with the public.
? Recognize and plan for the critical
role played by the media.
? Identify how every community mem-
ber can be reached in an emergency.
? Plan to provide decisional support.
? Ensure culturally sensitive communi-
cation.
? Use publicly available communica-
tions materials.
? Ensure integration of the local health
care organization’s communications
plans.
Standing Together: An Emergency Planning Guide for America’s Communities
cable. In radio communications, signals are sent
and received by electromagnetic radiation, gener-
ally through the atmosphere, without a connect-
ing wire. Combination communications systems,
such as cellular radio, use both wire line and radio
transmission paths. Sidebar 16 itemizes types of
communications equipment.
For effective emergency response, reliable commu-
nications must exist between specific fixed loca-
tions, between fixed and nonfixed (mobile) loca-
tions, and between two or more mobile locations.
Some of the communication paths that must be
planned for and established include local emergen-
cy medical services (EMS) radio dispatching, health
care organizations to each other and to ambulances,
ambulances to a medical communications control
center, fire and law enforcement to command cen-
ters and to each other, and so forth.
Plan for alternative and backup
communications links and systems.
Although many small communities may find it
challenging enough to establish and maintain need-
ed communications links and systems, backup links
and systems may be equally critical to effective
emergency response. (see Sidebar 17 on page 55.)
For example, the public telephone network can be
overloaded easily by increased traffic or become
physically disrupted during a major disaster.
Because radio and microwave systems can also be
damaged, communities should consider available
replacement supplies of antennas, coaxial cable, and
other hardware susceptible to damage. Make sure
that telephone lines coming into community com-
munications centers are buried (where feasible),
clearly marked, and protected from damage.
A designated radio frequency can be used for
point-to-point community disaster coordination.
Because a single frequency is often easily over-
loaded and abused during even minor emergen-
cies, incorporate into the system a method for
preventing overload. This might include a prac-
ticed system discipline (such as limitations on the
lengths of messages) and alternative communica-
tions paths (such as switching to cellular radio
telephone to handle a communications overload).
When possible, radio transmitter/receivers
equipped to operate on multiple frequencies
should be available.
? Example:The Huntington Beach (California) Fire
Department has a volunteer program called Radio
Amateur Civil Emergency Services (RACES), which
provides backup communications during disasters. In
54
SIDEBAR 16. COMMUNICATIONS EQUIPMENT
Radio
Equipment Wire Line Combination
Two-way
radio Telephone
Cellular
telephone
Pagers Fax machine
Satellite
telephone
Broadcast
radio
Computer
modem
Television
Public address
system
Satellite Intercom
For effective emergency response, reliable communications must exist between specific fixed loca-
tions, between fixed and nonfixed (mobile) locations, and between two or more mobile locations.
Standing Together: An Emergency Planning Guide for America’s Communities
2001 the fire department trained RACES to back up
its 800 MHz system. In September 2004, just two
weeks after an exercise to test preparedness, the fire
department’s 800MHz fire radio system went down
for the entire county.The fire department placed a
RACES member in the police dispatch where the
911 calls came in and one in each fire engine, truck,
and ambulance. RACES provided emergency commu-
nications for the city for several hours.
43
Plan and provide for emergency backup
power to communications systems.
Facilities with fixed communications systems
should have adequate standby power sources that
are independent (batteries or generators, for
example) to avoid dependence on commercial
power. Important locations in a service area, such
as health care organizations, should have more
55
The State of New Hampshire, as part of the Critical Benchmark expectations of the Cooperative Agreement Grant:
The National Bioterrorism Hospital Preparedness Program with the Health Resources and Services Administration
(HRSA), has developed a strategy to update ambulance-to-hospital (HEAR) radio equipment and provide for redun-
dant communications for the 26 acute care hospitals in New Hampshire.The benchmark in the grant is as follows:
Critical Benchmark #2-10: Surge Capacity: Communications and Information Technology
A survey of each hospital’s HEAR radio system was completed. It was discovered that some, but not all, hospitals had
a backup radio. Many of the hospitals had very old equipment, especially in small rural hospitals. Few if any hospitals
had digital capability. Concurrent with this effort has been an ongoing statewide radio interoperability project for police
and fire services.
The radio subcommittee of the New Hampshire Hospital Association’s Hospital Emergency Preparedness Working
Group developed the following simple objectives for the radio purchase project to ensure that each hospital:
? has APCO 25 compliant equipment (http://www.apcointl.org/frequency/project25/information.html)
? has digital capability (part of APCO 25 compliance)
? has redundant radio capability (by preserving their existing system)
? Another objective of the committee is to have the same equipment in hospitals throughout the State in order for it
to be familiar to personnel in the event they are called to respond to a mass casualty event where they are working
in another hospital, etc.
Based on these criteria, we decided to purchase a base station radio that has 16 channels and can work in either ana-
log or digital (some of our more rural and mountainous parts of the State cannot support digital). It is understood that
though a hospital may choose to use the new radio for their primary radio for continuous EMS monitoring/commu-
nication, having the built-in capability on the other channels is prudent and could be useful during a large scale emer-
gency.
Source: Personal communication from Jose’Their Montero, M.D., state epidemiologist of New Hampshire, Aug. 10, 2005.
SIDEBAR 17. BACKUP COMMUNICATIONS
Establish a secure and redundant communications system that ensures connectivity during a terror-
ist incident or other public health emergency between health care facilities and state and local health
departments, emergency medical services, emergency management agencies, public safety agencies,
neighboring jurisdictions and federal public health officials.
Standing Together: An Emergency Planning Guide for America’s Communities
56
than one radio site so that communications will
not be totally lost if one radio site fails. If possi-
ble, teams can consider whether it is possible to
install extra equipment at different geographic
locations throughout the community.
The system’s design should allow for enough
telephone lines, radio channel capacity, and oper-
ating positions, or rapid expansion capability to
handle the heavy communications traffic loads
generated by disasters. For example, health care
facilities can consider having several telephone
lines with unlisted numbers, which makes it eas-
ier to make outgoing telephone calls when there
is heavy incoming telephone traffic.
Ensure interoperability of
communications systems.
Interoperability of communications systems in
emergency planning involves primarily the abili-
ty of first responders and emergency coordinators
to communicate directly by radio with individu-
als from other agencies.The ability of computers,
mutual aid entities, and planning groups across
jurisdictions to participate in joint efforts is also
often considered part of interoperability.
Lack of interoperability is a significant problem
nationwide and was a well-publicized obstacle
faced by the New York City fire and police
departments during the 9/11 attacks. Local and
state first responders currently are spread across
10 different radio frequency bands and often can-
not communicate directly with each other.
Interoperability challenges result from spectrum
limitations, funding limitations, incompatible
technology, and lack of systems planning. In
response, the 9/11 Commission called for
Congress to support pending legislation for the
expedited and increased assignment of radio
spectrum for public safety purposes.
11
The Federal Emergency Management Agency
(FEMA) eGov Disaster Management Program
provides responders with a Web-based service
called the Disaster Management Interoperability
Services Interoperability Backbone, which offers
free communication tools that allow responders
to share information with other responder orga-
nizations. “Responder groups receive and trans-
mit information over the web, enabling them to
rapidly develop and exchange incident informa-
tion with other responder organizations. This
capability of sharing incident information gives
all responders greater knowledge of a particular
disaster event by leveraging technology to gain
efficiency,” notes the Web site
44
(see Tools).
? Example: Laurel, Maryland, a city of 22,000 locat-
ed near Washington, D.C., created a low-cost com-
mand center with used computers and donated soft-
ware from the federal government.The center pro-
vides interoperability with four counties surrounding
D.C. Its software includes instant messaging capa-
bilities that allow users to access and share docu-
ments over a private network.
33
Use available communications planning
resources.
Like other planning efforts, communications
planning need not involve reinventing the wheel.
Teams can consult available resources. For exam-
ple, a Web-based guide and toolkit provided by
TOOLS:
? The goals of the DMIS Interoperability
Backbone Web site are to improve disaster
response by enabling responders to share
information seamlessly between organizations,
and to provide new software tools at no cost
to responder organizations for increased disas-
ter response effectiveness. http://
www.cmi-services.org/dmishp_what_is_
dmis.html.
Standing Together: An Emergency Planning Guide for America’s Communities
the National Education Association for school
administrators includes tips, resources, ideas, and
examples for being prepared before a crisis, being
responsive during a crisis, being diligent in mov-
ing beyond a crisis, and for hands-on assistance
for educators (see Tools).
Local planners can consult federal Web sites that
provide free access to collaborative communica-
tion tools. One such Web site is http://
www.disasterhelp.gov (see Tools).
Review and build on existing
communications planning initiatives.
Communications planning may already have
occurred in numerous agencies within small
communities, such as law enforcement, fire, hos-
pitals, and school systems. These initiatives might
provide an appropriate starting point for overall
community communications planning. Plans
should be reviewed thoroughly and adapted as
needed.
? Example: Nuclear power plants are required by law
to facilitate and fund community-based emergency
planning and to engage in education, information,
preparedness, and drills with their community resi-
dents on a regular basis. Such relationships, which
cross jurisdictional lines, can serve as models for other
communities to engage in integrated communication
planning, coordination, and public education.
Obtain/prepare information for crisis
communications.
Lists of contacts, with addresses and phone num-
bers, should be established and maintained regu-
larly
45
to support timely access to critical individ-
uals, information and resources. The team can
prepare emergency proclamations, citizen alerts,
and other important documents in advance.
46
Much of the success of effective crisis communica-
tion, communication that occurs during an actu-
al crisis, is predicated on the effort that goes into
communications planning, information provision
prior to a crisis, and ongoing public education
often called risk communication.
Sidebar 18 provides the rules of risk communica-
tion recommended by the U.S. Environmental
Protection Agency.
57
TOOLS:
? Agency for Toxic Substances and Disease
Registry: A Primer on Health Risk
Communication Principles and Practices. http://
www.atsdr.cdc.gov/HEC/primer.html.
? American Red Cross: Talking About Disasters:
Guide for Standard Messages (2004). http://
www.redcross.org/disaster/safety/guide.html.
? National Education Association: Crisis
Communications Guide and Toolkit, 2003.http://www.nea.org/crisis.
? U.S. Department of Health and Human
Services (DHHS): Communicating in a Crisis:
Risk Communication Guidelines for Public Officials.
Washington, DC: DHHS, 2002. http://
www.riskcommunication.samhsa.gov/
index.htm.
? Wyatt W.: Be Prepared: Communicating in a Crisis.http://www.ncsl.org/programs/legman/nlssa/
402crisis.htm.
? DisasterHelp offers collaborative tools, includ-
ing instant messaging and chat, discussion
threads, and secured document sharing to the
responder community.http://www.diasterhelp.gov.
Standing Together: An Emergency Planning Guide for America’s Communities
Define emergency communications
protocols or procedures.
Disaster communications procedures should be
clearly defined, with an emphasis on interagency
coordination. These procedures should be a
straightforward expansion of day-to-day proce-
dures rather than a radical change in normal oper-
ating procedures.There should be established com-
munications paths with military, amateur, air, pub-
lic utility, and other radio operations outside the
Public Safety Radio Service. Communication
must be accurate and up-to-date and provide
information in “real time” so that messages will be
correct and consistent across all entities.
The planning team should ensure intact protocols
that allow law enforcement, fire, EMS, and hospi-
tals to communicate with each other during disas-
ter operations. A crisis communication protocol is
a key element of community plans; community
planners should be aware of protocol contents.
According to the study of hospital and communi-
ty emergency preparedness linkages,
14
the majority
of respondents from rural hospitals indicated that a
crisis communication protocol existed in their
community, but many still did not know whether
such a protocol was available.
Some communications techniques include using
common disaster channels and multichannel radios
and cross-banding or cross-patching of channels
through communication-center consoles.
Establish communications credibility
with the public.
Communication with the public during and fol-
lowing an emergency must be clear, credible, and
consistent. This requires thorough planning in
advance of any major occurrence. Residents of
small towns and rural communities often turn to
local leaders as the most direct source of informa-
tion in their towns and communities.
46
Identification of a spokesperson who is well
respected is key. In some communities, this might
be the mayor or other elected official, hospital
leader, religious leader, or others. Prior to any
emergency, this individual can be involved in edu-
cating and building trust with the community.
“People are more likely to follow official instruc-
tions when they have a lot of trust in what officials
tell them to do and are confident that their com-
munity is prepared to meet their needs,” notes one
study.
24
? Example: Poison control centers, nurse call lines, and
other types of medical contact systems can serve as a
conduit of credible information to the public. As part
58
1. Accept and involve the public as a partner. Your
goal is to produce an informed public, not to
defuse public concerns.
2. Plan carefully and evaluate your efforts. Different
goals, audiences, and media require different
actions.
3. Listen to the public’s specific concerns. People
often care more about trust, credibility, compe-
tence, fairness, and empathy than about statistics
and details.
4. Be honest, frank, and open. Trust and credibility
are difficult to obtain; once lost, they are almost
impossible to regain.
5. Work with other credible sources. Conflicts and
disagreements among organizations make com-
munication with the public much more difficult.
6. Meet the needs of the media.The media are usu-
ally more interested in politics than risk, simplic-
ity than complexity, danger than safety.
7. Speak clearly and with compassion. Never let
your efforts prevent your acknowledging the
tragedy of an illness, injury, or death.
Source: Covello V., Allen F.: Seven Cardinal Rules of Risk
Communication. Washington, DC: U.S. Environmental
Protection Agency, Office of Policy Analysis, 1988.
SIDEBAR 18. SEVEN CARDINAL RULES OF RISK
COMMUNICATION
Standing Together: An Emergency Planning Guide for America’s Communities
of their normal, day-to-day operations, they become a
familiar source of health and safety information for the
public. During an emergency, the public is likely to
seek information from these sources, which become an
important means of community response support. By
addressing questions on exposure, symptoms, and care
over the telephone, they can help reduce the demand
on acute care facilities.
? Example:To answer questions about how residents
can prepare for all types of emergencies and how their
city and county were preparing for emergencies,
Roseville, Minnesota (population 34,000), hosted a
community emergency readiness night.
46
The presenta-
tion and discussion were open to all residents.Topics
included how to prepare for all types of severe weather
and preparing for Y2K problems, which was an issue
of concern at that time.
Recognize and plan for the critical role
played by the media.
The media observe and report, but they also edu-
cate and warn. As indicated in Section 2, the plan-
ning team includes the media, but special effort
can be made to integrate the media’s two key
functions in planning.“In the first role (to observe
and report), the media acts as an outsider to the
community; in the second role (to educate and
warn), the media is an integral part of the emer-
gency preparedness system. Seldom are the two
roles well integrated, leading to a weaving back
and forth from one role to the other, and confus-
ing media users. News stories provide the opera-
tive ‘reality’ about the crisis period for almost
everyone,”notes E.L. Quarantelli, cofounder of the
Disaster Research Center at the University of
Delaware.
47
Identify how every community member
can be reached in an emergency.
Community preparedness requires a “locational”
system that can reach every person in a communi-
ty, from cradle to rocking chair. Communication
channels, including telephone, television, radio,
and computer (for Internet and e-mail, for exam-
ple), can be thoroughly considered by the plan-
ning team.According to a recent survey conduct-
ed for the U.S. Department of Homeland
Security’s (DHS’s) Office of Citizen Corps, there
is no one channel of communication that all
Americans prefer for receiving information.
26
? Example: Many communities have developed and
are using a “reverse 911” system to contact residents
in the event of an emergency and to provide ongoing
guidance during an emergency (for example, indicat-
ing that hospital X cannot take more patients, but to
go for care at hospital Y instead). Depending upon
the length of the message and system capabilities,
automated telephone calling systems can, within a
one-minute period, dial a dozen to hundreds of tele-
phone numbers and deliver a prerecorded message.
Targeted messages can be delivered to certain areas
and in different languages, as appropriate.Through
educational efforts, residents can be encouraged to
provide the reverse 911 agency with their unpub-
lished or cell phone numbers.
Plan to provide decisional support.
During an emergency, people want to know what
is happening, what they should do, and where to
get help. For events such as a terrorist attack, it is
not always possible to provide complete informa-
tion. However, it is imperative that communication
occurs and that the spokesperson plans to establish
an immediate presence and provide as much accu-
rate and timely information as possible.
46
“Although we live in an electronic age and a lot
of information is available through the Internet,
obtaining information or advice from another
human being appears to be critically important to
the American public in this situation. Both the
survey and our discussions with community resi-
dents around the country document that people
are looking for decision-making support, not just
59
Standing Together: An Emergency Planning Guide for America’s Communities
60
facts. People want to talk to someone to (1) con-
firm what they are hearing from government
officials or through the media, (2) get additional
information to answer their questions, and (3)
help them resolve difficult tradeoffs so they can
make the best decisions for themselves and their
families,” indicates the Redefining Readiness
study.
24(p. 19)
“Good communication is perceived differently
by the communicator, who wants public cooper-
ation and understanding in a time of crisis, and
the public, which wants inclusion, consideration,
respect, expert guidance, and proof that officials
have justly considered the public. (High quality)
risk communication bridges this gap by providing
individuals and communities with information
that allows them to make the best possible deci-
sions about their well-being,”notes an Institute of
Medicine (IOM) report.
48(p. S-38)
Ensure culturally sensitive
communication.
Consideration of the communication form and
language is critical. Given the large portion of
non-English-speaking residents in the United
States, cultural sensitivity must be assured.
Communities with significant cultural diversity
need to plan for communication in the appropri-
ate languages.
The planning team should consider if there are
cultural or linguistic groups not represented at
the planning table. These should be included or
consulted to assure that the most effective strate-
gies, messages, and modes of communication for
those groups are incorporated in the planning.
The anthrax attacks in 2001 illustrated the risk of
providing mixed messages to different communi-
ties. Ethnic groups who have experienced dispar-
ities in health care and/or social services may
look upon certain pronouncements with an atti-
tude of skepticism rather than cooperation, espe-
cially messages regarding, for example, the phased
distribution of prophylaxis or the need for isola-
tion or quarantine. Houses of worship, business
groups, and ethnic radio/TV and print media are
frequently trusted sources of information within
ethnic communities. Community-organized tele-
phone support networks can provide culturally
in-tune and accurate advice when integrated into
the planning process. Other “high-touch” meth-
ods, including in-person outreach, may be need-
ed in some communities.
“Unless public messages are tailored to gain the
attention of specific segments of our racially and
culturally diverse society, they are likely to be
ignored. (For example,) clear communication will
be essential to obtaining adherence to mass vac-
cination campaigns during a pandemic,” notes a
recent IOM report.
48(p. S-37)
? Example:The hurricanes of 2004 hit hard in por-
tions of DeSoto County, Florida, where migrant
farm workers lived and worked in the area’s citrus
groves.The local hospital, health department, and the
Centers for Disease Control and Prevention (CDC)
were concerned about the communitywide risks posed
Good communication is perceived differently by the communicator, who wants public cooperation
and understanding in a time of crisis, and the public, which wants inclusion, respect,
expert guidance, and proof that officials have justly considered their needs.
Standing Together: An Emergency Planning Guide for America’s Communities
by standing and contaminated water and other health
hazards. In the past, migrant workers typically used
the local hospital to meet their health care and infor-
mation needs. However, leery of contact with govern-
ment officials on the scene, many workers chose to stay
in the citrus groves rather than seek hospital care.The
hospital sent mobile care units, staffed by bilingual
individuals, into the citrus groves to identify and treat
injuries, provide information on safe water use, and try
to reestablish contact and trust.
Use publicly available communications
materials.
Small communities need not create their own
public awareness and readiness advertisements,
materials, and other communications vehicles
concerning certain standardized content. Such
information is available through numerous
sources, including the American Red Cross
(http://www.redcross.org/press/psa/psaPrint.html),
FEMA (http://www.fema.gov), and other agen-
cies. Resources offered by the American Red
Cross include preparedness print advertisements
devoted to specific emergencies (for example,
“Are you ready for an earthquake?”), and televi-
sion, radio, and Web banner public service
announcements in English and Spanish. FEMA
offers guides, educational materials for teachers,
fact sheets, and so forth.
? Example: A Midwestern town hung on its down-
town lamp posts two American Red Cross banners:
One banner read “Together We Prepare.”The sec-
ond banner listed five activities people could carry
out to get prepared: make a plan; build a kit; get
trained; volunteer; and give blood.
Ensure integration of the local health
care organization’s communications
plans.
Because many community residents will call or
come to the local health facility for care, for
information on their loved ones’ location or
health status, simply for general information on
disaster response, or as a safe haven, these facilities
must have a communications plan that includes a
triage communication procedure. The plan must
be integrated with the communitywide plan to
ensure consistency between the message deliv-
ered by the health facility’s administrator and the
communitywide spokesperson. “Hospitals need
to work with local emergency service organiza-
tions to provide clear, accurate information dur-
ing large-scale emergencies. To avoid disseminat-
ing conflicting information, hospitals that use
incident command systems provide for an indi-
vidual who will coordinate with other response
groups and communicate with the media and
other outside organizations,” notes an
Occupational Safety and Health Agency
report.
49(p. A-16)
A well-designed communication
plan can decrease the flood of individuals not
requiring care but coming to health facilities as a
preventive measure, as was experienced by many
New York health facilities on 9/11 and the days
following the attacks.
61
Standing Together: An Emergency Planning Guide for America’s Communities
62
Reactions to disasters may vary from one indi-
vidual to another, and stress reactions can occur
immediately following the disaster or many
months later.
50,51
These reactions may include
physiological symptoms (nausea, dizziness, chills),
cognitive/intellectual symptoms (distractibility,
difficulty communicating thoughts), emotional
symptoms (anxiety, grief, depression), behavioral
symptoms (insomnia, substance abuse), and spiri-
tual symptoms (challenges to faith beliefs, anger
and blaming, and so forth). These reactions may
be experienced by both victims of the disaster
and those who responded to help the victims.
Some of these reactions may be severe enough to
require an individual’s referral to behavioral
health services.
Mental health problems following natural or man-
made disasters impact communities of all sizes, but
rural and small communities may find it particu-
larly challenging to respond to the needs of their
residents. In the best of circumstances, such com-
munities lack a sufficient number of mental health
specialists. Moreover, their residents, whether due
to geographic, economic, cultural, ethnic, or other
impediments, may be unable or unwilling to
access mental health specialists. “Even more than
other areas of health and medicine, the mental-
health field is plagued by disparities in the avail-
ability of and access to its services. These dispari-
ties are viewed readily through the lenses of racial
and cultural diversity, age, and gender,” notes a
U.S. Surgeon General’s report.
52(p. vi)
Strategies teams can use to address mental health
needs follow.
Use available mental health disaster
planning resources.
Since publication in 2003 of the Mental Health
All-Hazards Disaster Planning Guidance by the
Center for Mental Health Services of the U.S.
Department of Health and Human Services,
53
state and local mental health leaders have had a
key resource for the creation or revision of all-
hazards mental health response plans (see Tools).
The publication outlines the planning process,
plan contents, and resources. An appendix out-
lines the discrete elements of an all-hazards state
disaster mental health plan.
Sidebar 19 lists numerous organizations that pro-
vide information on the behavioral consequences
of disasters.
Link to pastoral care resources.
In times of crisis and long after the crisis is over,
many people look to their familiar clergy and
other religious leaders in the community for
comfort and guidance. Planning teams should
consider community faith-based social support
systems and how to link to pastoral and spiritual
caregivers who can provide assistance to individ-
uals seeking spiritual and emotional support, reas-
surance, and guidance. National pastoral crisis
resources, including the American Red Cross, the
International Critical Incident Stress Foundation,
8. Ensure Thorough Mental Health Planning
Recommended Planning Strategies:
? Use available mental health disaster
planning resources.
? Link to pastoral care resources.
? Consider organizing self-help groups.
? Link to and know how to access fed-
eral and state disaster mental health
plans/resources.
? Recognize and plan for the emotion-
al effect of crises on rescue and
health care workers.
Standing Together: An Emergency Planning Guide for America’s Communities
Inc., and the Salvation Army, can also be consid-
ered. In a disaster relief operation, Salvation Army
volunteers offer emotional comfort and spiritual
comfort through a “ministry of presence.”
Recognition of the diversity of faith traditions
and belief systems is critical to the effectiveness of
pastoral services.
Consider organizing self-help groups.
Self-help groups or teams can be helpful in pro-
viding needed assistance following a disaster, par-
ticularly if mental health professionals are not avail-
able in or to the community. Emotional encour-
agement and practical support (working with
neighbors to board up windows and clean homes
after a catastrophic fire, escorting neighborhood
children to school past tornado-damaged homes,
63
TOOLS:
? Institute of Medicine: Preparing for the
Psychological Consequences of Terrorism: A Public
Health Strategy. Washington, DC: National
Academies Press, 2003.http://www.nap.edu/
openbook/0309089530/html.
? U.S. Department of Health and Human
Services (DHHS). Mental Health All-Hazards
Disaster Planning Guidance. DHHS Pub. No.
SMA 3829. Rockville, MD: Center for
Mental Health Services, Substance Abuse and
Mental Health Services Administration, 2003.http://www.mentalhealth.samhsa.gov/
publications/allpubs/SMA03-3829/default.asp.
? U.S. Department of Health and Human
Services (DHHS): Mental Health Response to
Mass Violence and Terrorism: A Training Manual.
DHHS Pub. No. SMA 3959. Rockville, MD:
Center for Mental Health Services, Substance
Abuse and Mental Health Services
Administration, 2004. http://
www.mentalhealth.samhsa.gov/publications/
allpubs/SMA-3959/default.asp.
The following list identifies a few of the numerous
organizations that provide information on the
behavioral consequences of disasters.
? American Academy of Child and Adolescent
Psychiatryhttp://www.aacap.org
? International Critical Incident Stress
Foundation, Inc.http://www.icisf.org
? American Academy of Experts in Traumatic Stresshttp://www.aaets.org
? National Alliance for the Mentally Illhttp://www.nami.org
? American Psychiatric Associationhttp://www.psych.org
? National Association of School Psychologistshttp://www.nasponline.org
? American Psychiatric Nurses Associationhttp://www.apna.org
? National Association of Social Workershttp://www.naswdc.org
? American Psychological Associationhttp://www.apa.org
? National Center for Post-Traumatic Stress Disorderhttp://www.ncptsd.org
? American Red Crosshttp://www.redcross.org
? National Depressive and Manic Depressive
Associationhttp://www.ndmda.org
? The Center for Mental Health Serviceshttp://www.mentalhealth.org
? National Institute of Mental Healthhttp://www.nimh.nih.gov
? Disaster Mental Health Institute at the University
of South Dakotahttp://www.usd.edu/dmh
? National Mental Health Associationhttp://www.nmha.org
? Federal Emergency Management Agencyhttp://www.fema.gov
SIDEBAR 19. BEHAVIORAL HEALTH INFORMATION
RESOURCES FOR DEALING WITH THE EFFECTS OF
DISASTERS
Standing Together: An Emergency Planning Guide for America’s Communities
and so forth) are invaluable during a disaster and
throughout the recovery phase as people try to
respond to the crisis and rebuild their lives.
? Example:Westport, Connecticut, developed a com-
munity support and counseling team to address the
mental health needs of its approximately 26,000
residents in times of crisis.The team is developing
training for mental health professionals, school and
community clinicians, home health care providers,
child care workers, and volunteers.
33
Link to and know how to access federal
and state disaster mental health
plans/resources.
When disasters strike, regional or state mental
health/substance abuse agencies and local service
providers may be suddenly thrust onto the front
line for response and recovery efforts because of
geographic proximity to the area affected by dis-
asters. Often they find themselves confronting
new or unknown problems for which no amount
of preplanning is possible.
54
The provision of
mental health services following a disaster will be
beyond the capability of many small, rural, and
suburban communities. Such communities must
link their plans to state disaster mental health
plans and must know how to access regional,
state, or federal services (Sidebar 20).
The state of New Hampshire has little experience
with terrorism, and the most rural areas lack the
resources to prepare for and respond to disasters.
Historically New Hampshire’s behavioral health
response to critical incidents came from two
areas: community mental health centers and the
Red Cross mental health branch. Following the
events of 9/11 it soon became apparent that New
Hampshire like many other states lacked the
capacity to respond to the behavioral health
needs of its citizens if a major disaster were to
occur. The Substance Abuse and Mental Health
Services Administration (SAMHSA) issued a
request for proposal to increase state behavioral
health response capacity. New Hampshire was
one of 35 states to receive a $200,000 grant from
SAMHSA for this purpose.The majority of these
funds have been used to identify behavioral
health professionals, encourage them to volun-
teer, and train them in the unique aspects of dis-
aster behavioral health response. In addition,
training has been provided to emergency medi-
cal, public health, and public safety organizations
to familiarize them with the psychosocial impact
of disasters and the existence of behavioral health
response in New Hampshire.
The New Hampshire Department of Safety’s
Bureau of Emergency Management (BEM) has
developed organized teams of behavioral health
providers to respond to the mental health needs
of New Hampshire residents following disasters.
Five regional disaster behavioral health response
teams (DBHRTs) totaling over 500 professionals
have been created and can be deployed immedi-
ately anywhere in the state. These teams would
respond to disasters or critical incidents when
local behavioral health resources have been
64
Planning teams should consider community faith-based social support systems and how to
link to pastoral and spiritual caregivers who can provide assistance to individuals seeking
spiritual and emotional support, reassurance, and guidance.
Standing Together: An Emergency Planning Guide for America’s Communities
65
depleted or are overwhelmed. The goal of the
DBHRTs is to provide an organized response to
individual victims, family members, survivors, or
the community affected by critical incidents or
disasters. Teams include individuals with experi-
ence in human services, psychology, mental
health, substance abuse, social work, psychiatry,
education, or spirituality. DBHRT members have
completed specialized training. Team members
operate under the supervision of BEM’s disaster
behavioral health coordinator, receive ongoing
training, and participate in communitywide drills.
Team members can provide interventions in
three distinct phases that may be delivered at a
disaster site, in an affected community, or
statewide. The phases and interventions include
the following:
Immediate Response: Behavioral health needs
assessment, psychological first aid, crisis interven-
tion, community outreach, public information,
and behavioral health consultation
Transition to Recovery: Brief supportive counsel-
ing, information dissemination, screening and
referral, support groups, and public education
Preparedness and Mitigation: Disaster behavioral
health planning and networking, prevention ser-
vices designed to strengthen community
resilience, specialized training initiatives for team
members and community partners, and research
Activation of the DBHRT is done through the
governor, or a designee at the BEM, during fed-
eral or state emergencies. If an emergency is not
declared, local municipalities or emergency
response systems may request assistance in order
to meet the behavioral health needs of commu-
nities in local crises by contacting the disaster
behavioral health coordinator located at the
BEM.
55
The American Red Cross (http://www.
redcross.org/services/disaster) also provides men-
tal health services to anyone in affected areas fol-
lowing any emergency and to families outside the
disaster area. Services, which are available on
average for a few days or a week following the
event, include counseling and referral by licensed
mental health professionals.
The Department of Justice’s Office for Victims of
Crime (http://www.ojp.usdoj.gov/ovc) provides
advocacy and other services, including support
for short- and long-term mental health services,
to victims of criminal acts (including terrorism).
SAMHSA DTAC
Established by the Substance Abuse and Mental
Health Services Administration (SAMHSA), the
Disaster Technical Assistance Center’s (DTAC’s) mis-
sion is to ensure that the United States is prepared
and able to respond rapidly when events increase the
need for trauma-related mental health and substance
abuse services. The agency performs the following
functions:
? Preparation: Assists states and territories with “all-
hazards” disaster response planning by providing
consultation to review disaster plans, conducting
literature reviews, and brokering knowledge and
support.
? Response: Assists in identifying suitable publica-
tions, psychoeducational materials, and expert
consultants, and organizes training events and
workshops to share the experiences of states that
have confronted certain types of disasters.
? Communication and resources: Maintains a contact
database of state/territory mental health commis-
sioners, substance abuse directors, and disaster
coordinators, and a roster of federal agencies and
nongovernmental organizations involved in disas-
ter and trauma research and/or service delivery.
Also maintains a collection of technical assistance
publications.
continued
SIDEBAR 20. FEDERAL MENTAL HEALTH
RESOURCES
Standing Together: An Emergency Planning Guide for America’s Communities
Recognize and plan for the emotional
effect of crises on rescue and health
care workers.
Numerous national crises have taught important
lessons about the extent of the emotional effect
of crises on rescue and health care workers. No
one who responds to a mass casualty incident is
untouched by it; training as a first responder or
caregiver does not provide such immunity. Stress
management assistance is often needed and
should be considered by community planning
teams. One form of assistance—psychological
debriefing—which usually occurs within days of
a critical event, aims to help first responders and
others exposed to a traumatic event to talk about
their feelings and reactions in order to reduce
traumatic stress.
56
Planning teams should consider
the possible range of staff support needs, match
the plans and potential interventions to those
needs, and prepare to solicit additional mental
health resources from local, state, or federal
sources should staff needs during response and
recovery exceed expectations and plans.
66
For more information:http://www.mentalhealth.samhsa.gov/dtac/default.asp
FEMA Crisis Counseling Program
The Federal Emergency Management Agency’s
(FEMA’s) Crisis Counseling Program provides
short-term services to eligible survivors of presiden-
tially declared major disasters who are experiencing
normal reactions to very abnormal situations. Its
mission is to help relieve any grieving, stress, or
mental health problems caused or aggravated by a
disaster or its aftermath. The confidential services,
typically lasting for about a year following a disaster,
are provided by FEMA as supplemental funds grant-
ed to state and local mental health agencies.
Individuals may contact FEMA’s toll-free helpline
number, 1-800-621-FEMA (TTY 1-800-462-
7585), to learn where these services can be obtained.
Crisis counselors are often on hand at disaster recov-
ery centers (when they are established). Crisis
Counseling grants are applied for by a State Mental
Health Authority when local resources cannot meet
local needs in a presidentially declared disaster.
For more information:http://www.fema.gov/rrr/inassist.shtm
SIDEBAR 20. FEDERAL MENTAL HEALTH
RESOURCES (CONTINUED)
The needs of vulnerable populations should be
considered by planning teams. These individuals
can easily suffer harm disproportionately during
or following an emergency because they may not
be able to seek help, care for themselves, or pur-
sue other survival and recovery strategies pursued
by nonvulnerable populations. Strategies teams
can use to address the needs of vulnerable popu-
lations follow.
Identify special-needs populations to
support effective communication,
outreach, and planning.
In disaster preparedness and response, the Centers
for Disease Control and Prevention (CDC) defines
special populations as “groups whose needs are not
fully addressed by traditional service providers or
who feel they cannot comfortably or safely access
and use the standard resources offered in disaster
preparedness, relief, and recovery.They include, but
are not limited to, those who are physically or
mentally disabled (blind, deaf, hard-of-hearing,
cognitive disorders, mobility limitations), limited
or non-English-speaking, geographically or cultur-
ally isolated, medically or chemically dependent,
homeless, frail/elderly, and children.”
57
They may
also include certain institutionalized populations,
such as those in foster care or nursing homes. A
number of resources from governmental agencies,
not-for-profit organizations, and commercial com-
panies are available to local planners preparing to
serve vulnerable populations. For example,
PrepareNow.org provides tools, expertise, and
access to resources to assist anyone engaged in dis-
aster planning for individuals with special needs.
Older and disabled people are particularly vul-
nerable during and following a disaster. Following
the 9/11 World Trade Center attacks, older peo-
ple and those with disabilities living near the dis-
aster area were trapped for days before being res-
cued.
58
Even in a city as large as New York, at that
time there was no effective way to identify vul-
nerable people who were not connected to a
community service agency. There also was no
means for community service providers to enter
the disaster area to provide critical assistance and
information to older and disabled people.
Identifying vulnerable individuals as part of the
emergency management plan and alerting, relo-
cating, or otherwise aiding them when disaster
appears imminent is essential in preventing harm.
For example, the National Organization on
Disability urges media outlets to follow closed-
captioning guidelines for persons with hearing
disabilities when broadcasting emergency infor-
mation to the general community.
Include a cross section of partners in
planning and response efforts related
to vulnerable populations.
The Disability Preparedness Center advises plan-
ners to include individuals and organizations with
disabilities not only as information resources, but
as active planning partners and in drills and exer-
cises so that responders can refine the necessary
skills in working with these populations.
9. Ensure Thorough Planning Related to Vulnerable Populations
Standing Together: An Emergency Planning Guide for America’s Communities
67
Recommended Planning Strategies:
? Identify special-needs populations to
support effective communication,
outreach, and planning.
? Include a cross section of partners in
planning and response efforts related
to vulnerable populations.
? Consider the unique needs of children.
? Involve the school nurse in emergency
preparedness and response.
The team might involve social workers and home
health care agencies in locating vulnerable indi-
viduals who will need special assistance. High
school and college students can also play a signif-
icant role in planning and response activities.
? Example: AmeriCorps Emergency Readiness teams
in California provide opportunities for students in
local community colleges to provide disaster/emergen-
cy preparedness services to vulnerable populations.
59
? Example:The Teen School Emergency Response
Training (SERT) program is an in-class curriculum-
based program that helps students make informed
decisions regarding emergency readiness and
response.
60
Pilot-tested for the nation at Pueblo West
High School in Colorado in November 2003, the
program is offered over a nine-week period for one
hour per day.
Consider the unique needs of children.
According to the National Center for Disaster
Preparedness (NCDP) at Columbia University’s
Mailman School of Public Health, the needs of
Standing Together: An Emergency Planning Guide for America’s Communities
68
In February 2005 the Disability Preparedness Center
conducted a needs assessment on disability preparedness,
which generated a number of valuable findings and rec-
ommendations regarding strategies for including people
with disabilities in emergency management planning
activities. Their specific recommendations were focused
on the National Capital Region (NCR), but many of the
recommendations are applicable to different types of
communities across the country:
1. Survey first responders and regional and local plan-
ners to assess (and raise awareness of) resources and
needs for disability preparedness in localities
throughout the region.
2. Provide technical assistance and skills development
to first responders to assist them in including per-
sons with disabilities in planning activities and in
response and recovery plans.
3. Identify people with disabilities living indepen-
dently, with family, or in residential facilities and
recruit them to participate in planning activities.
4. Plan and implement an information campaign to
inform the public about ways to better prepare in
the event of an emergency.
5. Establish an NCR Disability Advisory Committee
to be a visible public presence and oversee devel-
opment of inclusive emergency preparedness,
response, and recovery.
6. Hold a one-day regional conference on the roles
and responsibilities in emergency preparedness of
people with disabilities, advocates, agencies, and
service providers.
7. Develop a curriculum for persons with disabilities
to prepare them to participate effectively in plan-
ning and to pass on their skills to other people with
disabilities.
8. Develop a “planning participation course” for dis-
ability agency staff and service provider staff to help
prepare them to do effective emergency planning
and implementation.
9. Develop an enhanced emergency communication
network for persons with disabilities.
Source: Disability Preparedness Center (DPC): NCR Needs
Assessment on Disability Preparedness. Washington, DC: DPC,
2005.
SIDEBAR 21. NEEDS ASSESSMENT ON DISABILITY
PREPAREDNESS
TOOLS:
? Pennsylvania Department of Health: Special
Populations Emergency Preparedness Planning.http://www.dsf.health.state.pa.us/health/
cwp/view.asp?a=171&q=233957.
? Federal Emergency Management Agency’s
Emergency Management Institute offers a
course on emergency planning and special
needs populations (EMI - G197) that can be
downloaded from its Web site: http://
training.fema.gov/EMIWeb/pub/register.html.
? National Organization on Disabilityhttp://www.nod.org.
? Disability Preparedness Centerhttp://www.disabilitypreparedness.org.
Standing Together: An Emergency Planning Guide for America’s Communities
children have rarely been highlighted in disaster
planning and, hence, have rarely been planned
for.
61
Special pediatric considerations cited at the
2003 NCDP Pediatric Preparedness for Disasters
and Terrorism National Consensus Conference
include the following:
? Children are more vulnerable to chemical
agents that are absorbed through the skin or
inhaled, and are closer to the ground, thereby
more susceptible to gases that are heavier than
air.
? Children have special susceptibilities to dehy-
dration and shock from biological agents.
? Children require different dosages or different
antibiotics and antidotes to many agents.
? Children are more susceptible to the effects of
radiation exposure and require different
responses than adults.
? Children have unique psychological vulnera-
bilities, and special management plans are
needed in the event of mass casualties and
evacuation.
? Children’s developmental ability and cognitive
levels may impede their ability to escape dan-
ger.
? Emergency medical services, medical, and hos-
pital staff may not have pediatric training,
equipment, or facilities available.
The Program for Pediatric Preparedness is cur-
rently working on a Model Pediatric Component
for State Disaster Plans.
61
In addition, initiatives
are under way in a group of California hospitals
to enhance training of emergency department
staff in treatment, equipment, supplies, medica-
tions, and techniques required to treat pediatric
patients more effectively in a disaster situation.
The American Academy of Pediatrics sponsors a
Web page titled “Children, Terrorism &
Disasters,” which provides extensive information
not only for physicians and parents, but also for
teachers and community planners.
Involve the school nurse in emergency
preparedness and response.
The more than 60,000 school nurses in the
nation’s public and private elementary and sec-
ondary schools represent an important resource
for emergency preparedness and response for
children in small communities nationwide, par-
ticularly in the area of bioterrorism preparedness
and response. “School nurses have easier access to
large populations of people than most health pro-
fessionals and are, therefore, in positions to mon-
itor unusual symptoms or signs, recognize pat-
terns of symptom presentation, act to protect
against spread of communicable diseases, and pro-
vide immediate treatment and decontamination
for members of the school community,” notes the
National Association of School Nurses.
62
School
nurses are in a unique position to monitor school
absenteeism and to follow up with students and
the local public health department on any suspi-
cious patterns of symptoms.
69
TOOLS:
? Resources for planning, care, and treatment
concerning children in disasters is offered by
the American Academy of Pediatrics athttp://www.aap.org/terrorism/index.html.
Involve social workers and home health care agencies in locating vulnerable individuals who
will need special assistance.
Standing Together: An Emergency Planning Guide for America’s Communities
70
Many local governments are hard-pressed to pro-
vide basic services and, as a result, funds and
resources needed for “special activities,” including
emergency preparedness, often are sorely lacking.
Federal and state governments provide for fund-
ing at the local level for emergency preparedness
planning; however, many communities have
either not attained or not pursued the funding
that will enable them to develop and implement
emergency management plans.
In some states, fire, law enforcement, public
health, emergency medical services, or hospitals
may be designated to receive the lion’s share of
federal funding. However, collaborative planning
and preparedness require funding of and training
for all response partners. Commenting on fund-
ing disparities in the public health arena,
researchers involved in a study of public health
preparedness in 12 U.S. communities noted:
“Despite the large inflow of federal dollars to
some communities, the cost of implementing or
improving communications and surveillance sys-
tems, training, planning, and labs remains daunt-
ing.”
63
Because details pertaining to funding
sources and requirements can change rapidly, this
section focuses on broad strategies that can be
used to identify, cultivate, and sustain funding and
identifies a key resource for obtaining current
information on a range of funding sources.
Proactively pursue funding.
Many small communities for a variety of reasons
have not been proactive in providing states with
plans and initiatives eligible for federal funds
through the state. As a result, some state govern-
ments have not allocated all funds or have applied
funds to other projects. To gain access to federal
funding to which they are entitled, local planning
bodies must be proactive and persistent. A good
“one-stop shopping” source of information relat-
ed to available grants appears in the Tools box.
10. Identify, Cultivate, and Sustain Funding Sources
Recommended Planning Strategies:
? Proactively pursue funding.
? Include all planning partners in the
funding requests.
? Consider revenue-raising opportunities.
? Seek funding collaboratively and
regionally.
? Consider the impact of funding
reductions.
TOOLS:
? U.S. Department of Homeland Security (DHS)
grants Web site:http://www.dhs.gov/
dhspublic/display?theme=18.
This site provides information on homeland security
and public safety grant opportunities offered by agen-
cies across the federal government and is intended to
simplify access to these grants by placing information
in a single, easily accessible site. It includes grants
offered by the DHS, as well as other federal depart-
ments and agencies. Critical state and local missions
supported through these grants include the prepared-
ness of first responders and citizens, public health,
infrastructure security, and other public safety activi-
ties. Grants described can be awarded to a variety of
entities, including local governments, Native
American tribal government partners, and private
nonprofit organizations.
DHS grants listed include those administered by the
Office of Domestic Preparedness, the Federal
Emergency Management Agency, and the
Transportation Security Administration. Other feder-
al agency programs include public health prepared-
ness grants from the Department of Health and
Human Services, Department of Justice grants for
counterterrorism and general-purpose law enforce-
ment activities, and Environmental Protection
Agency grants for enhancing the security of the
nation’s water supplies.
Standing Together: An Emergency Planning Guide for America’s Communities
71
Include all planning partners in the
funding requests.
Many communities do not receive their full share
of funding because the role of all partners in the
emergency management plan is not represented
in the funding requests. Requests for funding
made to county, state, federal, and other entities
should present the full spectrum of participants
that require support.
Consider revenue-raising opportunities.
The chief executive of small communities can
support funding within his or her community,
region, or state by sponsoring or supporting tax
incentives, bonding bills, grants, and other mea-
sures. Such measures can either direct funding to
the community or incentivize planning partners
to participate more fully in planning and response
efforts.The incentives can be especially important
for increased access to response capabilities and
assets held by industrial and telecommunications
entities, hospitals, and other private businesses.
Seek funding collaboratively and
regionally.
Distribution of funds may be a bigger problem in
some states than the actual availability of funds.
Getting resources into the right hands often is
related to the availability of all key players at the
table.To increase leverage in funding negotiations
or to take advantage of economies of scale, chief
executives should foster collaboration within
their communities and across jurisdictions to
coordinate funding requests. Leaders of small,
rural, and suburban communities with a hospital
or hospitals can make special effort to partner
with hospital leaders in emergency preparedness
planning. Hospitals may have access to numerous
emergency preparedness funding streams, and
collaborative grant-seeking can be productive.
States often allocate federal funds on a regional
basis. Mayors and other leaders of small commu-
nities should consider participating in the plan-
ning and hazard mitigation efforts of multijuris-
dictional regional councils of government, for
example, in order to increase awareness of plan-
ning and funding initiatives. Through linkages to
regional and state planning efforts, elected and
other leaders of small communities can partici-
pate in funding requests, thereby securing the
necessary seat at the table and a voice to articu-
late the community’s full range of planning, train-
ing, response, and recovery needs.
Consider the impact of funding
reductions.
A risk that must be considered in the funding
strategy is that budgets at the state and federal
level change with fiscal and political pressures.
The planning team can prepare for potential
reductions in funding by identifying alternative
or creative sources and methods for sustaining
preparedness funding levels.
Through linkages to regional and state planning efforts, elected and other leaders of small
communities can participate in funding requests, thereby securing the necessary seat at the
table and a voice to articulate the community’s full range of planning, training, response, and
recovery needs.
Communitywide emergency preparedness and
response training, exercises, and drills allow com-
munities to test their plans, identify weaknesses,
and correct those to reduce the risk of process
failures during an actual emergency.The planning
and response partners are required to work col-
laboratively, many of them for the first time, to
test their communication and coordination sys-
tems designed to save lives, protect health and
property, and restore operability of essential com-
munity functions and services. Health care
providers, public health officials, first responders,
the general public, and all response partners
require training and practice in their intended
roles.
Identify who should be trained and the
training needs for each.
Individuals responsible for responding to a disas-
ter situation must be identified and trained. Not
everyone is capable of performing every func-
tion. For example, not all individuals working in
the health field may wish to participate or are
suited to enter a disaster environment; some staff
will require training in decontamination proce-
dures and others will not.
? Example: In various communities in Texas, selected
mental health workers, social workers, school coun-
selors, drug abuse counselors, faith-based counselors,
and others can attend a 16-hour training program in
emergency response. If the community or a neighbor-
ing community requires mental health support, these
individuals are activated to provide mental health
services through the emergency operation center.
64
Training sessions ideally are provided to represen-
tatives of the major organizations or agencies
involved in emergency response, including emer-
gency medical services (EMS) personnel, fire ser-
vice, law enforcement, emergency management
personnel, business leaders, local health care facil-
ity personnel, public health officials, and others as
appropriate.
In smaller communities, face-to-face training and
drills can be challenging, especially where one per-
son may wear several “hats.”To meet this challenge,
the planning team can identify a variety of training
methodologies and schedules as appropriate to
meet required competencies, roles and responsibil-
ities, and time and technology constraints. Some
11. Train, Exercise, and Drill Collaboratively
Standing Together: An Emergency Planning Guide for America’s Communities
72
Recommended Planning Strategies:
? Identify who should be trained and
the training needs for each.
? Ensure competency-based training
programs.
? Identify cross-training opportunities.
? Consider offering the CERT program.
? Access other training programs offered
through the federal government.
? Ensure incident command training
for appropriate personnel.
? Recognize drills or exercises as a
critical element of the emergency
preparedness process.
? Involve all players in exercises and
drills.
? Be sure to include local businesses in
training, exercises, and drills.
? Access available resources.
? Practice with other communities.
? Identify performance measures for
drills and exercises.
? Ensure the realism of drills and exer-
cises.
? Include alternative care sites and
shelters in disaster drills.
? Activate the emergency plan.
Standing Together: An Emergency Planning Guide for America’s Communities
73
preparedness partners (for example, an EMS agen-
cy) may be able to obtain extensive classroom
training for each staff member; others may need to
use Web-based training, CDs, or videos.
Ensure competency-based training
programs.
Education and training programs should be com-
petency based, with programming that is specific
to the individual’s role in emergency response.
Individuals responding to a disaster situation must
have the knowledge, skills, abilities, and behaviors
needed to perform tasks correctly and skillfully.
Some education and training will be appropriate
for both the general public and emergency
responders (for example, CPR), while other pro-
grams will be appropriate only for specialized
personnel (for example, decontamination).
Identify cross-training opportunities.
In small communities, cross training of first
responders increases the ability of individuals to
respond appropriately in different situations, such
as fire, rescue, hazardous materials, and weapons
of mass destruction. Cross training also extends
available skill sets during disasters involving dis-
placement of large numbers of people, evacuation
of hospitals, nursing homes, or other settings, and
emergencies of long duration.
? Example:Tyler,Texas (population 84,000), recently
purchased several hundred low-cost ventilators and
the training program to use these ventilators.
Emergency personnel are teaching disaster life support
very broadly among possible first responders, health
care personnel, and other citizens in the community.
Consider offering the CERT program.
Communities whose residents have not yet expe-
rienced the Community Emergency Response
Team (CERT) program
65
may wish to consider
offering the program. CERT is funded by
Congress through Citizen Corps program grants,
which may be available to local communities.
Citizen Corps is the community-based initiative
to engage citizens in homeland security and
community and family preparedness through
public education and outreach, training opportu-
nities, and volunteer service. A key component of
Citizen Corps, the CERT program trains citizens
to be better prepared to respond to emergency
situations in their communities. When emergen-
cies occur, CERT members can give critical sup-
port to first responders, provide immediate assis-
tance to victims, and organize volunteers at a dis-
aster site.
The CERT program is a 20-hour course, typical-
ly delivered over a seven-week period. Training
sessions cover disaster preparedness, disaster fire
suppression, basic disaster medical operations,
light search and rescue, and team operations. The
training also includes a disaster simulation in
which participants practice skills that they learned
throughout the course.
The CERT course is taught in the community by
a trained team that has completed a CERT Train-
Some preparedness partners (for example, an EMS agency) may be able to obtain extensive
classroom training for their team members; other partners may need to use
Web-based training, CDs, or videos.
Standing Together: An Emergency Planning Guide for America’s Communities
74
the-Trainer course conducted by their state train-
ing office for emergency management or by the
Federal Emergency Management Agency’s
(FEMA’s) Emergency Management Institute
(EMI). CERT programs currently serve in more
than 170 communities nationwide. A local gov-
ernment agency, such as the emergency manage-
ment agency, fire department, or police depart-
ment, typically provides the CERT classes.
CERTs are active in the community before a dis-
aster strikes, sponsoring events such as drills,
neighborhood cleanups, and disaster education
fairs. Trainers offer periodic refresher sessions to
CERT members to reinforce the basic training
and to keep participants involved and practiced in
their skills.
? Example: Iredell County in North Carolina (popu-
lation 130,000) applied and obtained a $10,000
grant through the state Citizen Corps to offer three
CERT training programs during 2003.The coun-
ty’s Board of Commissioners defined the programs’
purpose as follows: (1) enhance the overall prepared-
ness of Iredell County’s citizenry; (2) provide infor-
mation about the CERT program and improve pre-
paredness and safety; (3) use local agencies in the
training; (4) collaborate with local agencies to pro-
mote/support Neighborhood Watch/Community
Watch programs and Volunteers in Policing pro-
grams; and (5) obtain commitment from the Citizen
Corps council and local emergency planning commit-
tee to support the CERT efforts/programs.
66
Says
Tracy Jackson, the county’s Director of Emergency
Services, “An effective disaster preparedness program
must reach out to and educate all citizens and orga-
nizations within the community.The CERT pro-
gram is a great means to do just that.”
67
Access other training programs offered
through the federal government.
Training courses developed by numerous federal
agencies provide a broad curriculum and enable
local communities to tailor programs to their spe-
cific training needs. For example, FEMA’s EMI
offers independent-study training programs on
such topics as special-events contingency plan-
ning for public safety agencies, livestock in disas-
ters, radiological emergency management, devel-
oping and managing volunteers, community hur-
ricane preparedness, principles of emergency
management, multihazard emergency planning
for schools, and dozens of others (see Tools).
TOOLS:
? Federal Emergency Management Agency’s
Emergency Management Institute Web site
provides a resource center on best practices
for starting and maintaining a Community
Emergency Response Team program. http://
training.fema.gov/EMIWeb/CERT/
new_CERT/index.htm. Funding information
is available through State Citizen Corps
points of contact listed at http://
www.citizencorps.gov/citizenCorps/statepoc.do.
TOOLS:
? A complete list of training resources offered
through the Federal Emergency Management
Agency can be accessed at http://
training.fema.gov/EMIWeb.
? A complete list of training resources offered
through the U.S. Department of Homeland
Security is available athttp://www.dhs.gov/
dhspublic/display?theme=63.
? Training offered by the Centers for Disease
Control and Prevention’s Agency for Toxic
Substances and Disease Registry is available athttp://www.atsdr.cdc.gov/
hazmat-emergency-preparedness.html.
Emergency preparedness and response training
programs related to biological, nuclear, and
radiological terrorism are listed at http://
www.bt.cdc.gov/training.
Standing Together: An Emergency Planning Guide for America’s Communities
Ensure incident command training for
appropriate personnel.
The National Incident Management System (NIMS)
and the National Response Plan (NRP) require
incident management personnel to be appropri-
ately trained to improve all-hazards incident
management capability nationwide.
27
The EMI
offers training related to key elements of the
NIMS. The EMI also offers courses in prepared-
ness and resource management. Both the NIMS
and the NRP are being incorporated into virtu-
ally every course offered by the EMI. For more
information, accesshttp://training.fema.gov/
emiweb/emicourses/e449.asp.
Recognize drills or exercises as a
critical element of the emergency pre-
paredness process.
Drills are integral to the process of troubleshoot-
ing weaknesses in emergency management plans.
They are designed both to provide training exer-
cises and to identify weaknesses in the response
plan so that shortcomings can be addressed.
Communities should regularly test (at least annu-
ally) their emergency preparedness plans through
reality-based drills for the purpose of identifying
opportunities for improving and refining the
plan. Sidebar 22 provides the U.S. Department of
Homeland Security’s definitions for various types
of drills and exercises.
? Example: During a semiannual communitywide
emergency management plan drill in California, the
medical center that organized the drill discovered
some holes in its emergency management response
plan.
68
The scenario was a radioactive waste spill.
After scrambling to locate the appropriate personal
protective equipment, staff discovered that the decon-
tamination suits did not fit. Several even ripped
while the engineers tried to put them on.
Furthermore, several “paper patients” were lost in
transit.When investigating what went wrong, the
organization discovered that the lost paper patients
were actually transferred to an off-site location, but
there was no way to indicate this on the emergency
response patient transfer form.
75
Tabletop Exercises
Tabletop exercises focus on facilitating understand-
ing of concepts, identifying strengths and shortfalls,
and/or achieving a change in attitude. Exercises gen-
erally involve senior staff, middle management, and
other key personnel who are encouraged to discuss
issues in depth and develop decisions through slow-
paced problem solving rather than rapid, sponta-
neous decision making.
Games
A game is a simulation of emergency management
operations that often involves teams, usually in a
competitive environment, and does not involve the
use of actual resources. The goal is to explore
decision-making processes and the consequences of
those decisions. Players are commonly presented
with scenarios and asked to perform a task associat-
ed with the scenario episode.
Operations-Based Exercises
Operations-based exercises represent the next level
in the exercise cycle and are used to validate the
plans, policies, agreements, and procedures.
Operations-based exercises include drills, functional
exercises, and full-scale exercises and are character-
ized by mobilization of resources and commitment
of personnel over an extended period of time.
Drills
A drill is a coordinated test used to evaluate a spe-
cific operation or function in a single department or
nursing unit. Drills can be used to provide training
on new equipment, test new policies or procedures,
or practice skills.
continued
SIDEBAR 22. DEFINITIONS OF VARIOUS FORMS OF
DRILLS AND EXERCISES
Involve all players in exercises and
drills.
Full-scale exercises and drills, involving all the
major emergency response participants, provide
full-scale value in terms of lessons learned. Local
leaders, public health authorities, EMS, fire, law
enforcement, volunteers, the general public, and
all other appropriate parties should be involved in
communitywide drills.“The key to making prac-
tice pay off for your city or town is to seek out
opportunities to test your plan in as many ways as
possible, at all levels of your government.
Everyone who works for the city should at some
point be part of the testing, with a special focus
on first responders and managers of all city
departments,” advises the National League of
Cities.
46 (p. 14)
Health care organizations accredited by the Joint
Commission will be experienced partners
because they are required to conduct drills relat-
ed to their emergency management plan at least
twice yearly; one of these drills is expected to be
a communitywide one. However, not all health
care organizations are accredited, and, according
to a recent study of hospital and community
emergency preparedness linkages,
14
involvement
of key players in hospital-initiated community-
wide emergency drills in rural areas is inconsis-
tent. Local health departments and government
agencies were reported to be involved in fewer
than half of communitywide drills; traditional
first responders (fire, EMS, law enforcement)
were most commonly included in community-
wide drills.
? Example: Using FEMA’s Comprehensive Hazmat
Emergency Response - Capability Assessment
Program (CHER-CAP), Lake Havasu City,
Standing Together: An Emergency Planning Guide for America’s Communities
76
Functional Exercises
Functional exercises are designed to test multiple
functions, activities, and departments with a focus on
exercising the plans, policies, procedures, and staffs.
Functional exercises simulate the operations by pre-
senting realistic problems requiring responses.
Full-Scale Exercises
The full-scale exercise is the most comprehensive
level in the exercise cycle and usually includes mul-
tidepartment, multiorganization, multijurisdiction
agencies. The full-scale exercise simulates the reality
of operations in multiple functional areas through
the presentation of realistic problems requiring crit-
ical thinking, rapid problem solving, and effective
responses. Full-scale exercises are used to assess orga-
nizational and individual performance, demonstrate
interagency cooperation, review allocation of
resources and personnel, assess equipment capabili-
ties, activate personnel, assess interjurisdictional
cooperation, test public information and communi-
cation systems and analyze memoranda of under-
standing, standard operating procedures, plans, poli-
cies, and procedures.
Source: U.S. Department of Homeland Security, Office of
Domestic Preparedness: Homeland Security Exercise and
Evaluation Program,Vol. 1: Overview and Doctrine Revised. May
2004.http://www.ojp.usdoj.gov/odp/docs/HSEEPv1.pdf
(accessed Jun. 21, 2005).
SIDEBAR 22. DEFINITIONS OF VARIOUS FORMS OF
DRILLS AND EXERCISES (CONTINUED)
Local leaders, public health authorities, emergency medical services, fire, law enforcement,
volunteers, the general public, and all other appropriate parties should be involved in
communitywide drills.
Standing Together: An Emergency Planning Guide for America’s Communities
Arizona (population 50,000), conducted a full-scale
field exercise that was supported by 40 agencies.The
exercise provided weapons of mass destruction
(chemical bomb) training to emergency management
personnel. A follow-up tabletop exercise included
newly elected city officials and assisted the school
district and local hospital with their emergency
plans.The CHER-CAP exercise program is used
nationwide to increase response capabilities to tech-
nological hazards.
33
? Example: In December 2004, the Northern New
England Metropolitan Medical Response System, in
coordination with Dartmouth Hitchcock Medical
Center and community emergency planners, offered a
successful flu vaccination clinic in an indoor sports
arena at Dartmouth College. More than 1,900 pri-
marily high-risk patients were vaccinated.
Involvement of multiple agencies and organizations
in this type of “routine” care reinforced the concept
of working together but also provided valuable expe-
rience and insight into what may occur within that
community during an actual emergency.
? Example: Every U.S. nuclear plant is required by
law to develop and periodically test an on-site com-
prehensive emergency response plan and ensure that
off-site plans exist.These plans are approved by the
Nuclear Regulatory Commission (NRC) and
FEMA. Local, state, and national officials are
included in the plans and in periodic exercises.
Every two years, each nuclear plant conducts a full-
scale emergency exercise involving a confidential
emergency scenario to be handled by on-site and off-
site emergency response organizations, including
plant employees, local hospitals, county emergency
management agencies, and radiological monitoring
teams.The NRC evaluates performance and identi-
fies improvements of the on-site plan; FEMA evalu-
ates the off-site plan. In alternate years, plants con-
duct on-site training drills involving such key factors
as coordination; communications; assessment of emer-
gency, medical, and fire brigade response; and radia-
tion dose measurement. For example, a nuclear
plant sited on the Susquehanna River in
Pennsylvania has a large emergency response net-
work consisting of 27 municipalities, county and
state governments, school districts, hospitals, fire com-
panies, ambulance and EMS, and federal agencies.
The level of response to an event depends on the
potential threat to public health and safety.
69
Be sure to include local businesses in
training, exercises, and drills.
Involvement of local businesses in the training
and exercise process is very important. First
responders, fire, law enforcement, and other agen-
cies can provide basic training sessions in compa-
nies, covering such topics as what to do in an
emergency, what can be expected from local law
enforcement or fire personnel, where to obtain
information, and so forth.
? Example:Saco, Maine (population 16,000), held a
disaster recovery workshop and simulation exercise
focused on its information technology infrastructure.
The city tested its plan to safeguard data and sys-
tems in the event of a natural disaster, or even a
man-made technological disaster, such as computer
hacking. Representatives from all city agencies and
some local businesses participated in the simulation.
Backup computer storage, telecommunications, and
backup power generation were among the systems
tested.
46
Corporate America has become increasingly
involved in emergency preparedness. The
tragedies of 9/11 showed once again that many
disasters occur while individuals are at work.
Incidents result in significant interruption of
business operations, lost productivity, and
increased employee stress. In response, the
National Business Group on Health developed a
project with the Centers for Disease Control and
Prevention to explore ways that private-sector
employers and public health agencies can partner
to better prepare communities for bioterrorism
and other public health emergencies
12
(see Tools ).
77
Standing Together: An Emergency Planning Guide for America’s Communities
Access available resources.
Whenever possible, communities should use train-
ing programs and exercises, such as tabletop drills,
that are already in place and available through fed-
eral, state, professional associations, and other
sources. For example, the National Association of
County & City Health Officials offers customiz-
able bioterrorism tabletop exercises and a “bt tool-
box” with links to other available exercises and
programs (http://www.naccho.org/bttoolbox).
Practice with other communities.
It may be particularly cost- and time-effective for
small, rural, and suburban communities to conduct
joint exercises and drills with neighboring com-
munities. Because natural and man-made disasters
cross borders, and emergency response services are
likely to overlap in small and rural areas, joint exer-
cises are not only desirable, but necessary.
Identify performance measures for
drills and exercises.
The purpose of drills and exercises—to improve
performance—cannot be accomplished without
agreement about what constitutes success and
how indicators of success are to be measured.The
community’s emergency management team
should prospectively identify appropriate metrics
for drill/exercise evaluation.
Ensure the realism of drills and
exercises.
As the realism of drills and exercises increases, so
too do the learning and improvement opportuni-
ties.To achieve real value, a drill or exercise should
be planned to truly inconvenience the participants
and the community—as a real disaster would.
30
Communities should be encouraged to rigorous-
ly exercise and drill the system or function being
tested. An exercise that tests the limits of a plan or
its subparts can effectively identify weak spots and
opportunities for improvement.
? Example: Santa Monica, California (population
88,000), obtained a Federal Transit Administration
grant to conduct a full-scale functional exercise in
which armed terrorist role players, who claimed to
have a bomb, commandeered a city bus with 20
civilians on board.
33
Communities can consider conducting drills and
exercises involving the most likely disaster scenar-
ios, such as pandemic influenza in any communi-
ty, hurricanes in Florida, or earthquakes in
California, for example, and potentially the most
vulnerable function or system within the
response plan. For example, disaster communica-
tions systems and procedures should be tested
regularly, and the results of these tests should be
reviewed so that any failures can be corrected.
Critical backup systems should also be tested as
part of the drill or exercise.
Include alternative care sites and
shelters in disaster drills.
Although testing of current health care sheltering
capabilities is critical, it may be equally important
to include alternative health care sites and shelters
78
TOOLS:
? The National Business Group on Health
offers numerous resources, including an
employer toolkit on terrorism preparedness
and planning and an employer checklist on
forming business and public health prepared-
ness partnerships. These are available athttp://www.businessgrouphealth.org/
prevention/et_terrorismpreparedness.cfm.
? The Building Owners and Managers
Association offers numerous resources to help
building managers and owners fight terror-
ism.http://www.boma.org.
Standing Together: An Emergency Planning Guide for America’s Communities
in the exercises and drills. During drills and exer-
cises, the community can test the use of sites such
as ambulatory clinics, doctors’ offices, schools,
churches, and other facilities identified in the
emergency management plan. Such testing
increases communitywide awareness of the exis-
tence, location, strengths, and challenges of such
facilities.
Activate the emergency plan.
Activating the community’s emergency plan
provides a way of testing, reinforcing, and refin-
ing communication, technology, coordination,
decision making, and other issues. Even “non-
catastrophic emergencies,” such as when a hospi-
tal air conditioner malfunctions in August in the
South, can be used to test, stress, and improve
coordinated response before a catastrophic emer-
gency hits. Emergency plans should be activated
when smaller-scale emergencies occur. Regular
tests of communications systems and plans enable
response partners to become familiar with each
other’s roles and processes and will help to ensure
that people know what to do when a large-scale
disaster occurs.
79
Community emergency management plans can-
not be static documents; they must be evaluated
and revised on an ongoing basis through an inte-
grated, iterative, team-based process.The commu-
nity’s hazard vulnerability analysis (Section 3),
goals for preparedness and response (Section 4),
and current capacities and capabilities (Section 5)
require review on a regular basis in order to pro-
vide for changing environmental conditions, fed-
eral and state regulations, standards and require-
ments, community resources, and many other
factors. Use of a matrix that outlines key plan ele-
ments can help teams ensure a thorough
approach to plan review and improvement.
Conduct periodic review and
reprioritization of possible
emergency incidents.
Before 9/11, crashing a civilian airplane into a
high-rise building was unthinkable.Anthrax attacks
in fall 2001 also made the possibility of biological,
chemical, and radiation incidents all too real. The
majority of disaster scenarios identified by U.S.
Department of Homeland Security for planning
purposes (Sidebar 8) were, in fact, not on the radar
screens of most emergency preparedness planners.
SARS and recent outbreaks of avian influenza have
reinforced the “inevitability” of catastrophic pan-
demics. Every community should be redefining the
realm of possible disasters, community needs, and
preparedness and response mechanisms on an
ongoing basis. The priority issues identified in the
community’s hazard vulnerability analysis provide
the foundation for planning efforts. Building and
sustaining capabilities to address disasters in the
community and region are integral to the planning
goals, processes, and collaborative efforts with part-
ners across disciplines and organizations.
Review the emergency management
plan on an annual basis.
The community’s emergency plan should be
reviewed on at least an annual basis. Collaborative
and regular review keeps the plans current and
relevant, incorporates new partners or processes,
and retires obsolete content. “The emergency
operations plan is a living document. Problems
emerge, situations change, gaps become apparent,
requirements are altered—and the plan must be
adapted to remain useful and up-to-date,” notes
the Federal Emergency Management Agency’s
guide for local communities.
7(p. 2-12)
Base the review on an analysis of
performance.
Following an actual emergency, a community
identifies and analyzes data related to its imple-
mentation of the emergency management plan.
In the absence of an actual emergency, data from
plan drills, training, and exercises should be col-
lected and analyzed. Performance-monitoring
data form the backbone of regular evaluation.
Thus, it is appropriate that these data be present-
ed, trended, and analyzed. Documentation pro-
vided by drill observers, for example, can provide
relevant performance data on the adequacy of
12. Critique and Improve the Integrated Community Plan
Standing Together: An Emergency Planning Guide for America’s Communities
80
Recommended Planning Strategies:
? Conduct periodic review and reprior-
itization of possible emergency inci-
dents.
? Review the emergency management
plan on an annual basis.
? Base the review on an analysis of
performance.
? Discuss posttest problems and assign
remedial actions.
? Consider obtaining external feedback.
? Review the planning process.
Standing Together: An Emergency Planning Guide for America’s Communities
training, risks and needs, missing steps, and
opportunities for improvement.
Exercises and drills can be critiqued through an
“after-action” report, which summarizes the
event and the response, identifies strengths and
weaknesses in the response effort, and offers
explicit recommendations for improvement.
After-action reports should be based on predeter-
mined performance objectives.
? Example:The public health bio-defense team in
Montgomery County, Maryland, conducted a table-
top training exercise to test the system for accessing
the Strategic National Stockpile (SNS) and dissem-
inating the SNS supplies to public and private
points of distribution.The exercise involved 18 pub-
lic and private agencies. An after-action, “lessons
learned” report summarized problems encountered
and potential solutions as follows:
81
Notes: PHCC is Public Health Command Center; RSS is receipt, store, and stage; FLOP is finance, logistics, operations, and
planning. Full report available athttp://www.naccho.org/bttoolbox/index.cfm (accessed Jun. 24, 2005).
Discuss posttest problems and assign
remedial actions.
Information captured from tests, exercises, and
after-action reports must be used to improve cur-
rent preparedness and response plans.The planning
team meets to discuss problems that were evident
or that emerged during drills and exercises and to
objectively assess performance. The team identifies
and agrees on remedies and assigns to appropriate
individuals and organizations the responsibility for
corrective actions. Needed actions may involve
revision of planning goals, assumptions, training,
communication, or a myriad of other issues.
After corrective actions have been implemented, a
tabletop exercise can be scheduled as a follow-up
activity to ensure that the corrective actions did in
fact address the issues identified during the drill.
The critiques of the plan, the exercises, and the drill
after-action analyses must have the support of the
leadership of the planning team and of the indi-
vidual agencies and organizations involved, par-
Standing Together: An Emergency Planning Guide for America’s Communities
82
TOOLS:
The Federal Emergency Management Agency has
developed the Hazardous Materials Exercise
Evaluation Manual (HM-EEM), and its companion
guidance, the HM-EEM Evaluation Forms, as guid-
ance and technical assistance to assist state and
local governments, first responders, and industry in
the development, implementation, and evaluation
of their own realistic and challenging exercise pro-
grams.The evaluation form has many sections that
can be helpful to community emergency manage-
ment planning teams.The section evaluating alert
and notification of the public appears here, and
the whole document is available at http://
www.training.fema.gov/emiweb/downloads/
HMFormsEval%20forms.doc.
Standing Together: An Emergency Planning Guide for America’s Communities
ticularly in terms of accountability, follow-up, and
resources for improvement.
Consider obtaining external feedback.
Emergency planning teams can consider selecting
an external reviewer or an internal reviewer with
limited exposure to the plan to provide objective
feedback on a continuing basis. Neighboring
communities, the county, or the state can be asked
to review the community’s emergency plan to
suggest improvements based on their accumulat-
ed experience.
7
External feedback can be helpful
in identifying gaps and assumptions that need to
be filled or rethought. The top 10 weaknesses
often identified in emergency management plans
appear as Sidebar 23.
Review the planning process.
A community’s emergency management plan-
ning team would be well served to regularly
review not only the plan, but the planning pro-
cess used to create the plan. Sidebar 24 offers 10
possible assessment criteria.
83
1. Have a lack of critical information.
2. Are not flexible enough.
3. Do not address communication issues broadly or in
enough detail.
4. Do not contain enough multidisciplinary input.
5. Do not contain adaptable forms for managing
information.
6. Do not consider enough scenarios (or enough haz-
ard vulnerabilities).
7. Do not document incidents well.
8. Do not include troubleshooting tools.
9. Lack alarm points signaling that critical supplies are
running low.
10. Have not undergone a detailed review with all
appropriate local agencies and do not consider
community linkages or processes.
Source: Bruce C.: Troubleshooting your top ten weaknesses
in emergency preparedness plans. Environment of Care
®
News
3(2):11, 2000.
SIDEBAR 23. TOP TEN WEAKNESSES IN EMERGENCY
MANAGEMENT PLANS
High-quality local disaster planning is characterized
by the following:
1. Focuses on the planning process rather than the
production of a written document.
2. Recognizes that disasters are both quantitatively
and qualitatively different from minor emergen-
cies and everyday crises.
3. Is generic rather than agent specific.
4. Avoids the development of a “command and
control” model.
5. Focuses on general principles and not specific
details.
6. Is based on what is likely to happen.
7. Is vertically and horizontally integrated.
8. Strives to evoke appropriate actions by anticipat-
ing likely problems and possible solutions or
options.
9. Uses the best social science knowledge possible
and not myths and misconceptions.
10. Recognizes that crisis disaster planning and dis-
aster management are separate processes.
Source: E.L. Quarantelli, Disaster Research Center,
University of Delaware. Used with permission.
SIDEBAR 24. TEN CRITERIA FOR ASSESSING
COMMUNITY DISASTER PLANNING
The critiques of the plan, the exercises, and the drill after-action analyses must have the support of
the planning team leadership and of the individual organizations involved, particularly
in terms of accountability, follow-up, and resources for improvement.
The final activity described in this planning
guide—sustaining collaboration, communication,
and coordination—assures the continued viabili-
ty of community emergency preparedness and
response. The planning process and the plan that
results from this process are only as good as their
weakest link. Continued collaboration, coordina-
tion, and communication are critical to reinforc-
ing and maintaining established links, processes,
and plans. Strategies for sustaining the processes
and plans outlined in this publication follow.
Ensure proper documentation and
dissemination of plans and
supporting information.
As described in Section 11, policies, procedures,
contact information, and plans must be main-
tained and periodically reviewed to assure accura-
cy and relevance to community preparedness and
response. In addition to having a copy of the inte-
grated community plan, all partners must have
copies of each organization’s individual plans to
which they are a party, either as a recipient or as a
supplier. This facilitates a comprehensive under-
standing of roles and resources that should be
maintained and adjusted over time, as needed.
Ideally, the community emergency management
plan has elements that are integral to the normal
operations of some of the partners who support
communication and coordination as part of their
regular business or service functions within the
community. In other cases, contact between part-
ners will be limited to emergencies and disasters.
Establish mechanisms for receiving and
reviewing regional, state, and federal
plans.
Just as local community plans change and require
updating, so too do plans created by regional,
state, and federal agencies. Local communities
should establish a means to receive and review the
changes made to regional, state, and federal plans.
Such changes can have a significant impact on
community resources and preparedness and
response initiatives.
The National Response Plan (NRP) will be reviewed
and updated every four years but will have interim
13. Sustain Collaboration, Communication, and Coordination
Standing Together: An Emergency Planning Guide for America’s Communities
84
Recommended Planning Strategies:
? Ensure proper documentation and
dissemination of plans and support-
ing information.
? Establish mechanisms for receiving
and reviewing regional, state, and
federal plans.
? Collect and disseminate information
about effective models, practices, and
lessons learned.
? Build multilayered relationships and
prepare for transitions.
? Ensure ongoing communication with
the public.
Ideally, the community emergency management plan has elements that are integral to the
normal operations of some of the partners who support communication and coordination as
part of their regular business or service functions within the community.
Standing Together: An Emergency Planning Guide for America’s Communities
85
revisions as needed between full reviews. The U.S.
Department of Homeland Security is required to
distribute notices of changes to the NRP to all
regional offices and state emergency management
offices. Thus, local community planning teams can
access the information through these sources.
10
Collect and disseminate information
about effective models, practices, and
lessons learned.
All planning partners can benefit from receiving
information about effective models, practices, and
lessons learned in other communities and in the
region, state, and nation. Developing an “informa-
tion stockpile”to support educational and commu-
nications activities can be helpful. Such information
can be gathered from a variety of sources, including
local and regional meetings, Internet resources,
desktop exercises, and reviews of how other com-
munities are planning for or have responded to
emergencies and disasters. The Tools section pro-
vides a sampling of sources for best-practice and
lessons learned–related information.
Build multilayered relationships and
prepare for transitions.
Over time, individuals leave organizations or
change jobs, organizations change the scope or
nature of their services, planning partners drop
out of the planning process, and new partners
emerge.The planning team must prepare for tran-
sitions in roles and responsibilities. Relationship
building for long-term sustainability requires
multiple relationships within groups with differ-
ent levels and types of stakeholders.
Ensure ongoing communication with the
public.
An active and disciplined communication effort
will help to mitigate the impact of changes that
occur over time. Ongoing communication
should be provided to the multiple levels of
response partners and to the public and should
include information about the functions and
responsibilities of preparedness and response part-
ners. The media provide a primary means for
communicating with the public, as described in
Section 7.
TOOLS:
? The Medical Reserve Corps (MRC) Web site
includes information on “promising prac-
tices,” such as “Guidelines for Spiritual Care
Providers,”“Volunteerism Flyer,” and “Agency
Needs Assessment,” obtained from MRC
units:http://www.medicalreservecorps.gov/
resources/result.asp?subcategory_id=43.
? National Memorial Institute for the Prevention
of Terrorism (http://www.mipt.org) hosts
Lessons Learned Information Sharing, which
is a national network of lessons learned and
best practices for emergency response
providers and homeland security officials.http://www.llis.dhs.gov.
? The Federal Emergency Management Agency’s
Mitigation Division provides best practices and
case studies.http://www.fema.gov/fima/
bp.shtm.
? The National Governors Association’s Center
for Best Practices: Homeland Security &
Technology Section includes best practices
related to agroterrorism, bioterrorism prepared-
ness, critical infrastructure protection, energy
assurance, emergency management, information
sharing and technology, intelligence, interoper-
ability, nuclear and radiological terrorism, and
telecommunications and digital infrastructure.http://www.nga.org/center.
? The Rand Corporation makes available on its
Web site a publication titled Protecting
Emergency Responders: Lessons Learned from
Terrorist Attacks by Brian Jackson et al.http://www.rand.org/publications/CF/CF176.
Standing Together: An Emergency Planning Guide for America’s Communities
Ongoing communication with the community is
essential to managing concerns within the popula-
tion about risk, maintaining public interest in and
involvement with preparedness activities, and sus-
taining trust and dialogue that will be essential in
directing the public effectively during a disaster.
? Example:The Rocky Mountain Poison and Drug
Center (the Center) in Colorado worked with the
state health department to create a public emergency
information line.The Center had a long-standing and
well-recognized public role in providing accurate and
timely information. Following 9/11, its role expand-
ed to providing information to the public on a small-
pox vaccination program, providing clinical decision
support for vaccinees and their health care providers,
and collecting reported adverse reactions to smallpox
vaccinations.The demand for smallpox information
was very modest, but the emergence of outbreaks of
the West Nile virus in 2003 allowed the Center to
adapt its capabilities to include tracking virus occur-
rence in the state and providing the public with con-
sistent, accurate information about virus risks and dis-
ease management strategies. By asking people to
report on dead birds in their yards, the service involved
the public in the response effort, helped establish a
mechanism for information exchange, and resulted in
a meaningful role for the public in the process. Since
then the service has been expanded to monitor and
support other public health issues such as influenza,
mold, hantavirus, and plague.The Center’s capabilities
continue to expand based upon emerging public health
concerns and requests for information.
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48. Institute of Medicine: The Threat of Pandemic
Influenza: Are We Ready? A Workshop Summary.
Washington, DC: National Academies Press, 2004.
49. Occupational Safety and Health Administration
(OSHA): OSHA Best Practices for Hospital-Based First
Receivers of Victims from Mass Casualty Incidents
Involving the Release of Hazardous Substances.
Washington, DC: OSHA, Dec. 2004.
50. New York State Office of Mental Health.http://www.omh.state.ny.us/omhweb/cr isis/
crisiscounseling2.html.
51. Center for Mental Health Services (part of the U.S.
Department of Health and Human Services): Self-
Care Tips for Emergency and Disaster Response Workers.
http: //www. mental heal th. org/publ i cati ons/
allpubs/KEN-01-0098/default.asp.
52. U.S. Department of Health and Human Services:
Mental Health: A Report of the Surgeon General. 1999.
ht t p: //www. ment al heal t h. s amhs a. gov/cre/
ch1_intro.asp.
53. U.S. Department of Health and Human Services.
Mental Health All-Hazards Disaster Planning Guidance.
DHHS Pub. No. SMA 3829. Rockville, MD: Center
for Mental Health Services, Substance Abuse and
Mental Health Services Administration, 2003.
54. Federal Emergency Management Agency: Individual
assistance programs.http://www.fema.gov/rrr/
inassist.shtm (accessed Mar. 2005).
55. Personal communication from Jose’ Their Montero,
MD, state epidemiologist of New Hampshire, Aug.
10, 2005.
56. McNally R.J.: Psychological debriefing does not
prevent posttraumatic stress disorder. Psych Times 21,
Apr. 2004.http://www.psychiatrictimes.com/
p040471.html (accessed Jul. 2005).
57. Pennsylvania Department of Health: Special
Populations Emergency Preparedness Planning.http://www.dsf.health.state.pa.us/health/cwp/
view.asp?a=171&q=233957 (accessed Jul. 2005).
58. O’Brien N.: Emergency preparedness for older peo-
ple. International Longevity Center Issue Brief Jan.–Feb.
2003.http://www.ilcusa.org/_lib/pdf/epopib.pdf
(accessed Mar. 2005).
59. AmeriCorps: ALERT: AmeriCorps Local Emergency
Readiness Teams Project.http://www.foundationccc.org/
fccc/americorps/americorps_alert.html (accessed Mar.
2005).
60. Rich H.:Teen SERT. The Connection:America’s Bridge
to Preparedness 7, Winter 2005. http://
www.naem.com/connection.html (accessed Mar.
2005).
61. Columbia University Mailman School of Public
Health, National Center for Disaster Preparedness:
Pediatric Preparedness for Disasters and Terrorism:A National
Consensus Conference, Executive Summary. 2003.
ht t p: //www. ncdp. mai l man. col umbi a. edu/
pediatric.html (accessed Mar. 2005).
62. National Association of School Nurses: School Nurse
Role in Bioterrorism Emergency Preparedness. Jun. 2002.
h t t p : / / w w w. n a s n . o r g / p o s i t i o n s /
2002psbioterrorism.htm. (accessed Jul. 2005).
63. McHugh M., Staiti A.B., Felland L.E.: How prepared
are Americans for public health emergencies? Twelve
communities weigh in. Health Affairs 23(3):201–209.
64. Personal communication from Ron Hilliard, Oct.
2004.
65. Federal Emergency Management Agency:
Community Emergency Response Teams (CERT).
ht t p: //t r ai ni ng. f ema. gov/EMI Web/CERT
(accessed Mar. 11, 2005).
66. Iredell County Board of Commissioners: Regular
Minutes. Jun. 3, 2003.http://www.co.iredell.nc.us/
Commissioners/minutes/Regular/June%203%
202003%20Regular%20Minutes.pdf (accessed Mar.
2005).
67. CERT program launched in Statesville, North
Carolina. The Connection: America’s Bridge to
Preparedness 7, Winter 2005.http://www.naem.com/
connection.html (accessed Mar. 2005).
68. Bruce C.: Troubleshooting your top ten weaknesses
in emergency preparedness plans. Environment of
Care News
®
3(2):11, 2000.
69. Susquehanna Energy Information Center:
Emergency Preparedness.http://www.pplweb.com/
susquehanna+energy+i nf or mat i on+cent er/
susquehanna+plant/emergency+preparedness.htm
(accessed Jun. 24, 2005).
88
Closing Comment
Standing Together: An Emergency Planning Guide for America’s Communities
Continued collaboration, coordination, and communication provide the glue needed for a truly strong and
interconnected community fabric. Returning to Melville’s quotation, “We cannot live for ourselves alone.
Our lives are connected by a thousand invisible threads, and along these sympathetic fibers, our actions run
as causes and return to us as results.”To achieve the results desired in a disaster situation—survival for two
or three days before help arrives—small, rural, and suburban communities must develop and sustain emer-
gency preparedness and response capabilities.The 13-step process outlined in this planning guide is offered
as one template for doing so. Whatever resources are used, small communities must prepare for disasters
that would inflict significant destruction in the form of lost lives, injured residents, and damage to critical
community infrastructure and property.The time for preparedness efforts—for weaving together thousands
of invisible threads—is now.
89
Acknowledgment of Roundtable Members
Standing Together: An Emergency Planning Guide for America’s Communities
Veronica Aberle, M.S.N., R.N.
Nurse Manager
Alexandria Health Department
Alexandria,VA
Ross Anthony, Ph.D.
Associate Director
Global Health RAND Health Security
Arlington,VA
Robert Bass, M.D.
Executive Director
Maryland Institute of Emergency Medical
Services Systems
Baltimore, MD
Commander Daniel S. Beck
Medical Readiness Manager
Office of Force Readiness and Deployment
Office of the Surgeon General
Rockville, MD
Gregory M. Bogdan, Ph.D.
Research Director & Medical Toxicology
Coordinator
Rocky Mountain Poison and Drug Center -
Denver Health
Denver, CO
Christine Bradshaw, D.O., M.P.H., M.B.A.
Medical Officer
Centers for Disease Control and Prevention
Coordinating Office of Terrorism Preparedness
and Emergency Response
Division of State and Local Readiness
Atlanta, GA
Commander Duane C. Caneva, M.C., U.S.N.R.
Head, Medical Plans and Policies
Navy Medicine Office of Homeland Security
Bureau of Medicine and Surgery
Washington, DC
Christopher Cannon, M.S.N., M.P.H., M.B.A.
System Director, Office of Emergency
Preparedness
Yale New Haven Health System
New Haven, CT
Paul K. Carlton, Jr., M.D., FACS (Roundtable
Moderator)
Lt. General, USAF (Ret.)
Director, Homeland Security
A&M System Health Science Center
College Station, TX
Ralph Conner
Former Mayor
City of Maywood
Maywood, IL
Charles Cook, L.C.S.W.
Project Officer
Emergency Services & Disaster Relief Branch
Center for Mental Health Services
Rockville, MD
Stephen Curren
Director, Public Health Security
Association of State and Territorial Health
Officials
Washington, DC
90
The Joint Commission sincerely thanks the roundtable members for providing their time
and expertise in the development of this planning guide.
Community-Based Emergency Management Roundtable Members
Standing Together: An Emergency Planning Guide for America’s Communities
Emily DeMers
Executive Director
Emergency Management Accreditation Program
Lexington, KY
Brett Ewig
Principal Director, Health Prevention and
Promotion Programs
Association of State and Territorial Health
Officials
Washington, DC
Michael R. Fraser, Ph.D.
Deputy Executive Director
National Association of County and City Health
Officials
Washington, DC
Robert Gougelet, M.D.
Medical Director for Emergency Response
Dartmouth Hitchcock Medical Center
Lebanon, New Hampshire
Kathy Hadlock, B.S.N., Nurse Consultant
Hospital Preparedness Program Manager
Center for Emergency Response and Terrorism
Missouri Dept. of Health and Senior Services
Springfield, MO
Ron Hilliard, R.N., L.P.
Manager, Bioterrorism Hospital Preparedness
Program
Center for Public Health Preparedness and
Response
Texas Department of Health
Austin, TX
Michael Hopmeier
Chief, Innovative and Unconventional Concepts
Unconventional Concepts, Inc.
Washington, DC
Dr. Ann R. Knebel, R.N., D.N.S.c, FAAN
Captain, U.S. Public Health Service
Commissioned Corps
Senior Program Manager, Preparedness and
Planning Team
Office of the Assistant Secretary for Public
Health Emergency Preparedness
Office of the Secretary, Depy. of Health and
Human Services
Washington, DC
Howard Levitin, M.D.
President
DQE, Inc., and Indiana University School of
Medicine
Indianapolis, IN
Patrick M. Libbey
Executive Director
National Association of County & City Health
Officials
Washington, DC
Scott Lillibridge, M.D.
Principal Investigator
University of Texas Health Science Center at
Houston School of Public Health
Academic Center for Public Health
Preparedness
Houston, TX
Rocky Lopes, Ph.D.
Former Manager, Public Education and
Outreach for Disasters
American Red Cross
Community Disaster Education
Washington, DC
91
Standing Together: An Emergency Planning Guide for America’s Communities
Mauricio Lynn, M.D.
Director for Mass Casualty Preparedness
Program
Medical Director, Trauma Resuscitation Unit,
Ryder Trauma Center, Jackson Memorial
Hospital
University of Miami
Miami, FL
Angela Martinelli, D.N.S.c, R.N., CNOR
Commander, USPHS
U.S. Public Health Service
Commissioned Corps Readiness Force
Office of the Surgeon General
Gaithersburg, MD
Commander Ludlow B. McKay
National Bioterrorism Hospital Preparedness
Program
Health Resources and Services Administration
Rockville, MD
Richard McCann
Principal
McCann & McCann Health Care Consultants
Chagrin Falls, OH
Gerald Murphy
Director, Homeland Security and Technology
Division
NGA Center for Best Practices
Washington, DC
James Pearson, Dr.P.H., B.C.L.D.
Committee Chairman
Emergency Preparedness and Response
Committee
Richmond,VA
Enrico L. Quarantelli, Ph.D.
Research Professor, Disaster Research Center
University of Delaware
Newark, DE
Irwin Redlener, M.D.
Associate Dean and Director
National Center for Disaster Preparedness
Columbia University Mailman School of Public
Health
New York, NY
Karen Roth
Senior Director
Office of Behavioral Health, New York City
Health and Hospitals Corporation
New York, NY
Gili Shenhar
Director
CERBERUS ENTERPRISES, LLC
Israel
Chief John Sinclair
Chairman, EMS Section
International Association of Fire Chiefs
Puyallup, WA
Sue Skidmore, R.N.
Product Manager, Consulting Services
DQE, Inc.
Arlington,VA
Rick Smith
Director, Division of Healthcare Emergency
Preparedness
Health Resources and Services Administration
Rockville, MD
92
Standing Together: An Emergency Planning Guide for America’s Communities
Terri Spear
National Bioterrorism Hospital Preparedness
Program
Health Resources and Services Administration
Rockville, MD
Leslee Stein-Spencer R.N., M.S.
Director, Health Systems Programs
Community Research Associates
Chicago, IL
Gina Swehla
Training Center Manager
Illinois Dept. of Public Health
Springfield, IL
Boaz Tadmore
CERBERUS ENTERPRISES, LLC
Israel
Joe Waeckerle
Chairman, Dept. of Emergency Medicine
Clinical Professor
University of Missouri Baptist Medical Center
Baptist Lutheran Medical Center
Leawood, KS
Mike Wahl, M.D.
Administrative Medical Director
Illinois Poison Center
Chicago, IL
93
Selected Resources
Standing Together: An Emergency Planning Guide for America’s Communities
Agency for Healthcare Research and Quality:
Altered Standards of Care in Mass Casualty Events.http://www.ahrq.gov/research/altstand.
Centers for Disease Control and Prevention:
Public Health Emergency Response Guide for State,
Local, and Tribal Public Health Directors, Version
1.0.http://www.bt.cdc.gov/planning/
responseguide.asp.
CNA Corporation: Medical Surge Capacity and
Capability: A Management System for Integrating
Medical and Health Resources During Large-Scale
Emergencies.http://www.cna.org/documents/
mscc_aug2004.pdf.
Columbia University Mailman School of Public
Health, National Center for Disaster
Preparedness: How Americans Feel About Terrorism
and Security:Two Years After 9/11, Aug. 2003.http://www.ncdp.mailman.columbia.edu/
How_Americans_Feel_About_Terrorism.pdf.
Columbia University Mailman School of Public
Health, National Center for Disaster Preparedness:
Pediatric Preparedness for Disasters and Terrorism:A
National Consensus Conference, Executive Summary,
2003.http://www.ncdp.mailman.columbia.edu/
pediatric.html.
Connecticut Department of Public Health:
Preparedness Planning Guidance for a Regional
Response to a Public Health Emergency, Apr. 2004.http://www.ct.gov/oem/lib/oem/
homelandsecurity/joint_dph_oem_regional_
planning_guidance.pdf.
FEMA: State and Local Guide (SLG) 101: Guide
for All-Hazard Emergency Operations Planning,
1996.http://www.fema.gov/rrr/gaheop.shtm.
FEMA: State and Local Guide (SLG) 101: Guide
for All-Hazard Emergency Operations Planning,
Chapter 6, Attachment G:Terrorism, Apr. 2001.http://www.fema.gov/pdf/rrr/allhzpln.pdf.
Institute of Medicine: Preparing for the
Psychological Consequences of Terrorism: A Public
Health Strategy. Washington, DC: National
Academies Press, 2003.http://www.nap.edu/
openbook/0309089530/html.
Institute of Medicine: The Threat of Pandemic
Influenza: Are We Ready? A Workshop Summary.
Washington, DC: National Academies Press,
Nov. 16, 2004.http://www.iom.edu/
report.asp?id=23639.
Joint Commission on Accreditation of
Healthcare Organizations (Joint Commission):
Health Care at the Crossroads: Strategies for Creating
and Sustaining Community-wide Emergency
Preparedness Systems. Oakbrook Terrace, IL: Joint
Commission, 2003.http://www.jcaho.org/
about+us/public+policy+initiatives/
emergency.htm.
Lasker R.D.: Redefining Readiness:Terrorism
Planning Through the Eyes of the Public. New York:
New York Academy of Medicine, 2004.http://www.cacsh.org.
Loeb J.M.: Assessing Hospital and Community
Emergency Preparedness Linkages. Oakbrook
Terrace, IL: Joint Commission on Accreditation
of Healthcare Organizations, Oct. 2004.
McHugh M., Staiti A.B., Felland L.E.: How pre-
pared are Americans for public health emergen-
cies? Twelve communities weigh in. Health
Affairs 23(3): 201–209.
94
Standing Together: An Emergency Planning Guide for America’s Communities
National Association of County & City Health
Officials (NACCHO): Local Public Health
Agencies Better Equipped to Handle Bioterrorist
Attacks. Washington, DC: NACCHO, Jan. 2003.
National Association of County & City Health
Officials (NACCHO): Bt PREP: A Bioterrorism
Response Plan Design Guide for Local Public Health
Agencies, 1st ed. Washington, DC: NACCHO,
2003.
National Business Group on Health (Terrorism
and Public Health Emergency Preparedness
Initiative): The Business Case:Why and How
Employers Need to Partner with Public Health, Jun.
2004.http://www.businessgrouphealth.org/
prevention/et_terrorismpreparedness.cfm.
National Commission on Terrorist Attacks Upon
the United States: The 9/11 Commission Report.
New York: W.W. Norton, 2004.
National League of Cities: Homeland Security:
Practical Tools for Local Governments, Nov. 2002.
Northern New England Metropolitan Medical
Response System: Community Planning Guide:
Improving Local and State Agency Response to
Terrorist Incidents Involving Biological Weapons, Jun.
2003.http://www.nnemmrs.org/surge.html.
Occupational Safety and Health Administration
(OSHA): OSHA Best Practices for Hospital-Based
First Receivers of Victims from Mass Casualty
Incidents Involving the Release of Hazardous
Substances. Washington, DC: OSHA, Dec. 2004.http://www.osha.gov/dts/osta/bestpractices/
html/hospital_firstreceivers.html.
Rural Health Resource Center (RHRC): An
Alternative Approach to Defining Rural for the
Purpose of Providing Emergency Medical Services.
Duluth, MN: RHRC, Jul. 2004. http://
tasc.ruralheatlh.hrsa.gov.
Texas Department of Health and the Texas
Institute for Health Policy Research: Disaster
Preparedness and Response in Texas Hospitals, Mar.
24, 2003.
U.S. Department of Health and Human Services
(DHHS): Communicating in a Crisis: Risk
Communication Guidelines for Public Officials.
Washington, DC: DHHS, 2002. http://
www.riskcommunication.samhsa.gov/index.htm.
U.S. Department of Health and Human
Services, Office of Rural Health Policy: Rural
Communities and Emergency Preparedness, Apr.
2002. ftp://ftp.hrsa.gov/ruralhealth/
RuralPreparedness.pdf.
U.S. Department of Health and Human Services
(DHHS): Mental Health All-Hazards Disaster
Planning Guidance. Washington, DC: DHHS,
2003.http://www.mentalhealth.org/
publications/allpubs/SMA03-3829/
introduction.asp.
U.S. Department of Homeland Security (DHS):
National Incident Management System.
Washington, DC: DHS, Mar. 1, 2004. http://
www.fema.gov/nims.
U.S. Department of Homeland Security (DHS):
National Response Plan. Washington, DC: DHS,
Dec. 2004.http://www.dhs.gov/interweb/
assetlibrary/NRPbaseplan.pdf.
95
Standing Together: An Emergency Planning Guide for America’s Communities
U.S. Department of Homeland Security, Office
of Citizen Corps: 2003 Citizen Corps Survey of
U.S. Households: Final Survey Report.
U.S. General Accounting Office (GAO):
Bioterrorism: Preparedness Varied across State and
Local Jurisdictions. Washington, DC: GAO, Apr.
2002.
U.S. General Accounting Office (GAO): Hospital
Preparedness: Most Urban Hospitals Have Emergency
Plans but Lack Capacities for Bioterrorism Response.
Washington, DC: GAO, Aug. 2003.
Washington State Emergency Management
Association: Elected Officials’ Guide to Emergency
Management, Feb. 2003. http://
www.emctaskforce.org/Resources/
ElectedOfficials/ElectedOfficialsGuide%20to%
20EM.pdf (accessed Feb. 17, 2005).
Washington University School of Medicine:
Department Emergency Planning Guidelines. St. Louis:
Washington U.,http://www.ehs.wustl.edu/
emergency/dptemplate.doc.
96
Index
Standing Together: An Emergency Planning Guide for America’s Communities
911 call system, 6, 28, 36, 38, 55, 59
A
Acute care hospitals, 36
Adapting emergency plans, 41
Adopting emergency plans, 41
After-action reports, 81
Agency for Toxic Substances and Disease Registry
A Primer on Health Risk Communication Principles and
Practices, 57
training programs, 74
Agricultural issues, 7, 18, 32, 86
Agriculture and natural resources, emergency support func-
tions, 12
AHRQ (Agency for Healthcare Research and Quality), Altered
Standards of Care in Mass Casualty Events, 38, 94
All-hazards approach, 15
Alternative care and shelter facilities, 38–39, 47, 78–79
Ambulatory care
emergency support functions, 11
medical surge capacity, 35
American Academy of Child and Adolescent Psychiatry, 63
American Academy of Experts in Traumatic Stress, 63
American Academy of Pediatrics, “Children, Terrorism &
Disasters”, 69
American College of Emergency Physicians, 35
American Hospital Association: Model Hospital Mutual Aid
Memorandum of Understanding, 30
American National Red Cross, 13–14
American Psychiatric Association, 63
American Psychiatric Nurses Association, 63
American Psychological Association, 63
American Red Cross
emergency response, 13
information resources, 63
mental health services, 65
pastoral care resources, 62–63
public awareness and readiness, 61
Talking About Disasters: Guide for Standard Messages,
57
AmeriCorps Emergency Readiness teams, 68
Animals, resources, 32
Anthrax, vi, 38, 60, 80
Antibiotic dispensing, 26
Asset allocation process, 40
Austere care, 37–38
Avian influenza, 80
Avocational special interest groups, 33–34
B
Backup communications, 54–55
Backup systems for critical assets, 38, 78
Bed capacity, 37
Behavioral health, 63. See also Mental health planning
Best Practices for Hospital-Based First Receivers of Victims
from Mass Casualty Incidents Involving the Release of
Hazardous Substances, 37
Bioterrorism annex planning criteria, 36
Bioterrorism preparedness, 69
Brainstorming sessions, compiling lists of potential hazards,
16–17
Building Owners and Managers Association, 78
Bureau of Emergency Management, 64–65
Bureau of Primary Health Care Facilities, 39
Business owners, 35
C
Capability Assurance effort, 52
Catastrophic events, potential for, 16
Census 2000 data, 8
Center for Infrastructure Expertise, 18
CARVER2 software, 18
State and Local Pandemic Planning Guide, 42
Strategic National Stockpile (SNS), 50
The Center for Mental Health Services
disaster planning resources, 62
information resources, 63
Center for the Advancement of Collaborative Strategies in
Health, 26
Centers for Disease Control and Prevention (CDC). See also
Agency for Toxic Substances and Disease Registry
definition of special populations, 67
Pandemic Influenza Preparedness and Response, 42
Public Health Emergency Response Guide for State,
Local, and Tribal Public Health Directors, 41–42, 94
Strategic National Stockpile (SNS), 51
training programs, 74
CERTs. See Community Emergency Response Teams
Checklists, 39, 43, 45
Chemical factory explosions, hazard analysis, 18
Chief executive, 4, 10, 14
Children
Pediatric Preparedness for Disasters and Terrorism: A
National Consensus Conference, Executive Summary, 94
school nurses and, 69
special needs, 68–69
Chlorine tank explosion, hazard analysis, 18
Citizen Corps. See also Community Emergency Response
Teams
2003 Citizen Corps Survey of U.S. Households: Final
Survey Report, 96
emergency planning, 13, 59
97
Standing Together: An Emergency Planning Guide for America’s Communities
managing volunteers, 26
training programs, v, 73
Civic responsibilities, emergency planning, 27
Civilian representation, emergency planning, 13
Clinics, 11, 25, 35
CNA Corporation, Medical Surge Capacity and Capability: A
Management System for Integrating Medical and Health
Resources During Large-Scale Emergencies, 35
Collaboration, 7–8, 40–41, 80, 84. See also Planning team
Colleges, critical resources, 11–12
Columbia University, Mailman School of Public Health,
68–69, 94
Communication. See also Documentation
alternative and backup links and systems, 54–55
building utility systems, 47
communicating with the public, 14
community locational system, 59
credibility with the public, 58–59
crisis communications, 57–58
culturally sensitive, 60–61
decisional support, 59–60
emergency backup power, 54–55
emergency communications, 36
emergency communications procedures, 58
emergency support functions, 11
equipment, 54
goals, 53
initiatives, 57
integration with local health care organizations, 61
interoperability of communications systems, 56
media’s role, 59
planning resources, 56–57
planning strategies, 53, 84
power considerations, 47
public awareness and readiness, 61
resources, 32
risk communication plan, 27, 36
rules of risk communication, 58
transmission, 53–54
Community awareness. See also Emergency management;
Funding; Integrated community plan; Risks and hazards
communication patterns, 53
education, 27, 36
existing relationships, v–vi, 9–10
federal resources, 39
gaps in community assets, 39
geopolitical and definitional factors, 8
“grass roots” level, v, 27
“intrusive reality” events, 1
planning strategies, 7, 9
readiness and, 61
roles and responsibilities, 43
stakeholders, 7–8
terrorism threats, 16
Community-based planning, 13
Community emergency preparedness
demand for services, 27
examples of emergencies, 17
funding, 15
HVA (hazard vulnerability analysis), 18
incident management, 29
initiatives linking to NIMS and NRP, 28
public’s involvement, 26–27
saving lives, 34
Community Emergency Response Teams (CERTs). See also
Emergency preparedness
emergency credentialing, 49
existing relationships, 10
funding through Citizen Corps, v
human resources, 24
program, 73–74
Community health resources, 35, 36
Community medical providers, 36
Community planning teams, 28–29
Community response plans, managing volunteers, 25
Competency-based training programs, 73
Complacency, 1–2
Connecticut Department of Public Health. Preparedness
Planning Guidance for a Regional Response to a Public
Health Emergency, 94
Connecticut regional emergency and public health prepared-
ness, 36
Contingency plans, 27
Convergent responders, 24–26
Cooperative Agreement Grant: The National Bioterrorism
Hospital Preparedness Program, 55
Coordination. See also Collaboration; Communication
Corporate America, 77
Corrective actions, 82
County planning initiatives, 29
Court system personnel, 26
Credentials
capabilities, 36
emergency credentialing, 49
medical volunteers, 26
Crisis communications, 57–58
Critical assets, backup systems, 38
Critical benchmark, HRSA, 37
Critical medical surge capacity, 35
Cross-training opportunities, 73
Cultural diversity, 62
98
Standing Together: An Emergency Planning Guide for America’s Communities
Current capacities and capabilities
alternative care and shelter facilities, 38–39
asset categories and target capabilities, 31–33
community health resources, 35
dual uses for existing or emerging capabilities, 38
federal resources in communities, 39
gaps in community assets, 39
geographic features and vulnerabilities, 34
groups involved in planning, 33–34
health care-related resources, 35–36
planning strategies, 31
public as an asset category, 33
surge capacity and consult-surge planning resources,
34–35, 37
D
Decontamination, 27, 35, 36, 37, 48
Department of Health and Senior Services, Missouri, 30
DHS. See U.S. Department of Homeland Security
Disability Preparedness Center, 67–68
Disabled population, 26, 39, 67
Disaster behavioral health response teams (DBHRT), 64–65
Disaster Management Interoperability Services (DMIS), 56
Disaster Medical Assistance Team (DMAT), 25, 35, 49
Disaster Mental Health Institute at the University of South
Dakota, 63
Disaster mental health plans/resources, 64–65
Disaster mutual aid, 30
Disaster planning, 27, 83. See also Preparedness and
response planning
Disaster Technical Assistance Centers (DTAC), 64
DisasterHelp, 57
Disasters
information resources, 63
stress reactions, 62
DMAT. See Disaster Medical Assistance Team
Doctors, medical surge capacity, 35
Documentation. See also Communication
community-level planning, 26
draft of emergency plan, 41–42
emergency operations plan, 42, 44, 80
guidance and resources, 41
information and planning, 32
integrated emergency management plan, 42–43
provided by drill observers, 80–81
Donated goods and services, 32
Drills, 36, 75, 80-81. See also Emergency preparedness
E
Earthquakes, hazard analysis, 18
Elderly population, 67
Emergency credentialing, 49
Emergency management. See also FEMA; Integrated emer-
gency management plan
developmental process, 3
emergency support functions, 12
funding, 2
in homes, v, 63
leadership, 4
phases, 22–23
planning partners, 10–14
planning process, 2–3, 6
planning strategies, 84–85
response functions, 44
strategies for managing volunteers, 25
weaknesses, 83
Emergency Management Institute (EMI), 75
Emergency medical services. See EMS
Emergency operations plan (EOP), 42, 44, 80
Emergency physicians, 35
Emergency preparedness. See also Community Emergency
Response Teams; Current capacities and capabilities;
Planning team; Preparedness and response planning;
Vulnerable populations
Assessing Hospital and Community Emergency
Preparedness Linkages, 94
communitywide training, exercises and drills
activating emergency plans, 79
alternative care sites and shelters, 38–39, 47, 78–79
competency-based programs, 73
cross-training opportunities, 73
emergency response personnel, 72–73
federal government programs, 74
incident command training, 75
involving local businesses, 77–78
participants, 76–77
performance measures, 78
planning strategies, 72
practice with other communities, 78
resources, 78
troubleshooting weaknesses, 75–76
Corporate America, 77
functionally structured emergency plan, 44–45
local planning, 4–5, 14
measuring, 51
planning group, 10
readiness barriers, 2
risk-based approach, 15
school nurses and, 69
teams, 27–28
Emergency supply kit, 27
99
Standing Together: An Emergency Planning Guide for America’s Communities
Emergency Support Function (ESF), 11, 35
Emergency System for Advance Registration of Volunteer
Health Care Personnel (ESAR-VHP), 49
Emotional support, 62–63
EMS (emergency medical services)
community relationships, vi
geopolitical and definitional factors, 8
medical surge capacity, 36
Energy
emergency support functions, 12
resources, 32
English Team members, 42–43
EPA. See U.S. Environmental Protection Agency
Equipment, planning criteria, 36
Evacuation planning criteria, 36, 47
Evacuation signs, 27
Exercises, 36
External affairs, emergency support functions, 12
F
Facility preparedness, 36
Federal Emergency Management Agency (FEMA), 10, 13
Federal government
asset categories and target capabilities, 31–33
definition of required surge capacity, 37
emergency preparedness programs, 74
encouraging the private sector, 13
guidance and resources, 41
mental health plans/resources, 64–66
Federal legislation, local planning initiatives, 29–30
FEMA (Federal Emergency Management Agency)
Capability Assurance effort, 52
Comprehensive Hazmat Emergency Response - Capability
Assessment Program (CHER-CAP), 76–77
Crisis Counseling Program, 66
educational materials, 61
eGov Disaster Management Program, 56
Emergency Management Institute, 68, 74
emergency operations plan, 42
grants offered, 70
Hazardous Materials Exercise Evaluation Manual (HM-
EEM), 82
independent study training programs, 74
information resources, 63
list of core functions, 43
Mitigation Division, 85
National Disaster Medical System, 35
nuclear plants, response plans, 77
planning guide, 39
potential areas of vulnerability, 34
resources, 18, 21, 29
State and Local Guide (SLG) 101: Guide for All-Hazard
Emergency Operations Planning, 19, 45, 52, 94
Firefighting
emergency support functions, 12
Life Safety Code, 23
resources, 32
First responders, 13–14, 29
Fliers, 27
Floods, hazard analysis, 18
Flu, pandemic outbreaks, 17
Food, 31
Full-scale exercises, 76
Functional annexes, 45
Functional exercises, 76
Funding
emergency management programs, 2
impact of funding reductions, 71
planning partners, 71
planning strategies, 70
proactive approaches, 70
regional resources, 71
revenue-raising opportunities, 71
G
Games, 75
Gap analysis, 19
Gas main break, hazard analysis, 18
Geographic Information Systems (GIS) mapping, 34
Geopolitical factors, 8
Grants, as funding sources, 70
Groundwater contamination, hazard analysis, 18
H
Hazard-specific appendixes, 45
Hazard vulnerability analysis (HVA), 15, 17–18, 41, 80
Hazardous materials
Best Practices for Hospital-Based First Receivers of
Victims from Mass Casualty Incidents Involving the
Release of Hazardous Substances, 37
interstate transit, 1
resources, 32
Hazards, compiling lists of, 16–17
Health Affairs, 95
Health and medical facilities, emergency planning, 45–49
Health Care at the Crossroads: Strategies for Creating and
Sustaining Community-wide Emergency Preparedness
Systems, 2
Health care organizations
bioterrorism annex planning criteria, 36
communications, 61
drills and exercises, 49
100
Standing Together: An Emergency Planning Guide for America’s Communities
emergency preparedness, 10–11
Health care staff, orientation and education, 48
Health department
communitywide training, exercises and drills, 76
emergency management, 4
emergency preparedness, 9–10, 69
laboratory services, 38
pharmaceuticals and medical supplies, 49–50
Health First Health System, Florida, 24
Health Resources and Services Administration (HRSA), 37,
55
High-touch methods, 60
Home health care
emergency support functions, 11
medical surge capacity, 35
Homeland Security Grants Web site, 70
Homeland Security Operations Center (HSOC), 28. See also
U.S. Department of Homeland Security
Hospital catchment areas, 8
Hospital Emergency Incident Command System (HEICS), 48,
51
Hospitals
Assessing Hospital and Community Emergency
Preparedness Linkages, 94
bed capacity, 37
communication procedures, 61
emergency preparedness, 10–11
funding efforts, 71
GIS locations of, 34
identifying alternative care sites, 47
medical surge capacity, 35
National Bioterrorism Hospital Preparedness Program, 55
planning initiatives, 30
Veteran’s hospitals, 39
Human resources requirements, 23–24
Humanitarian organizations, emergency response, 13
Hurricane plans, in Florida, v, 27
Hurricanes, hazard analysis, 17
HVA (hazard vulnerability analysis), 15, 17–18
I
ICS. See Incident Command System
Idaho Institute of Emergency Management, 30
Immunization supplies, 35, 36
Incident Command System (ICS), 27, 36, 48, 51
“Incident of National Significance”, 29
Industry-based planning, 113
Information and planning, 32
Initial stabilization, 37
Institute of Medicine (IOM)
culturally sensitive communication, 60-61
decisional support, 60
future pandemic, 1
mass vaccination campaigns, 60
Preparing for the Psychological Consequences of
Terrorism: A Public Health Strategy, 63, 94
Integrated community plan
annual emergency management review, 90
external feedback, 93
performance analysis, 90–92
planning process review, 93
planning strategies, 80
posttest problems and remedial actions, 92–93
Integrated emergency management plan
collaborative efforts, 40–41
documentation, 42–43
draft of emergency plan, 41–42
emergency planning, 41
goals, 45
guidance and resources, 41
health and medical facility emergency planning, 45–49
jurisdictional lines, 51
lessons learned from 9/11, 51–52
measuring preparedness and response success, 51
meetings, 42
organization, 43–45
pharmaceuticals and medical supplies, 49–51
planning strategies, 40
responsibilities, 43, 44
review of existing plans, laws, and mutual aid agree-
ments, 42
International Critical Incident Stress Foundation, 62–63
International Red Cross, 13
Interoperability Backbone, 56
Interstate mutual aid, 29
Isolation, 36, 37, 48
J
Joint Commission on Accreditation of Healthcare
Organizations
Division of Research, 49
emergency management planning and drill requirements,
46
Health Care at the Crossroads: Strategies for Creating and
Sustaining Community-wide Emergency Preparedness
Systems, 94
study on potential for catastrophic events, 16
Joint Field Office (JFO), 29
Joint Terrorism Task Forces (JTTFs), 28
Jurisdictional lines, 41, 51
101
Standing Together: An Emergency Planning Guide for America’s Communities
L
Laboratory services
capabilities, vi, 36
capacity, 48
medical surge capacity, 35
upgrading, 38
Law enforcement regions, 8, 26–27, 32, 42
Layered preparedness and response, 27
LEPC. See Local Emergency Planning Committee
Liaisons, local elected officials, 5
Local emergency planning. See also FEMA
communications, 57
large-scale emergencies, 26
planning process, 10
public education, 27
roles and responsibilities, 5
services required, 45–46
Local Emergency Planning Committee Database, 18
Local Emergency Planning Committee (LEPC), 29–30
Local Emergency Planning District, 29–30
Local governments, 70
Local health departments, 36
Local planner, 4, 14
Local public health department (LHD), 51
Lockdown, 36, 48
Loma Prieta earthquake, 24–25
Long term care
emergency support functions, 11
identifying alternative care sites, 47
medical surge capacity, 35
Long-term community recovery and management, emergen-
cy support functions, 12
M
Major construction projects, hazard analysis, 18
Man-made disasters, 78
Map sources, 18
Maryland Institute for Emergency Medical Services, 36
Mass care, housing, and human services, 12, 31
Mass casualty event, 37–38
Mass immunization campaigns, 26, 36
Mass prophylactic sites, 34
Mayoral Institute for WMD (Weapons of Mass Destruction)
and Terrorism Incident Preparedness, 30
Mayor’s office
credibility with the public, 58
existing relationships, 9
funding efforts, 71
geopolitical and definitional factors, 8
leadership, 14
“Mayors only” forum, 30
Media, 59. See also Communication
Medical equipment resources, 34
Medical Reserve Corps (MRC), 25, 26, 34–35, 85
Medical supplies, 49–51
Medical surge capacity, 34–35
Medical volunteers, 25
Meeting frequency, 42
Mental health planning
disaster planning resources, 62–64
emotional effect of crises on rescue and health care
workers, 66
federal and state disaster plans and resources, 64–66
Mental Health All-Hazards Disaster Planning Guidance,
62, 95
planning strategies, 62
Metropolitan Medical Response System (MMRS), 10. See
Medical Reserve Corps
Military assets, 39
Missouri Hospital Association (MHA), 30
Mitigation, 22–23, 85
Model Pediatric Component for State Disaster Plans, 69
MRC. See Medical Reserve Corps
Multi-Hazard Mapping Initiative, 18
Mutual aid agreements, 29, 30, 42
N
National Alliance for the Mentally Ill, 63
National Association of County & City Health Officials
Bt PREP: A Bioterrorism Response Plan Design Guide for
Local Public Health Agencies, 42, 95
Local Public Health Agencies Better Equipped to Handle
Bioterrorist Attacks, 95
National Association of School Nurses, 69
National Association of School Psychologists, 63
National Association of Social Workers, 63
National Bioterrorism Hospital Preparedness Program, 55
National Business Group, 35
National Business Group on Health, 77, 78, 95
National Center for Disaster Preparedness (NCDP), 20, 26,
68–69
National Center for Post-Traumatic Stress Disorder, 63
National Clearinghouse for Educational Facilities, 35
National Commission on Terrorist Attacks upon the United
States, The 9/11 Commission Report, 95
National Depressive and Manic Depressive Association, 63
National Disaster Medical System, 35
National Education Association, Crisis Communications
Guide and Toolkit, 56–57
National Fire Protection Association, Life Safety Code, 23
National Governors Association, Center for Best Practices:
102
Standing Together: An Emergency Planning Guide for America’s Communities
Homeland Security & Technology Section, 85
National Guard, human resources, 24
National Incident Management System (NIMS), 3, 28, 29,
31–33, 75, 96
National Infrastructure Institute, 18
National Institute of Mental Health, 63
National Institute of Standards and Technology, 18
National League of Cities, 21, 76, 95
National Memorial Institute for the Prevention of Terrorism,
85
National Mental Health Association, 63
National Organization on Disability, 67, 68
National Pharmaceutical Stockpile (NPS), 50
National Preparedness Plan, 15
National resource typing system, 31–32
National Response Plan (NRP). See also U.S. Department of
Homeland Security
all-hazards incidence management, 75
basic premise, 29
categories, 31–33
linking community’s plan to, 28
phases of emergency management, 22
reviewing and updating, 84–85
Strategic National Stockpile (SNS) and, 50
Web site, 96
National Weather Service, 18
Natural disasters, 78
NCDP. See National Center for Disaster Preparedness
Needs assessment on disability preparedness, 68
New Hampshire Department of Safety, Bureau of Emergency
Management (BEM), 64–65
New York State Office of Advocate for Persons with
Disabilities: ADA Accessibility Checklist for Existing Facilities,
39
NIMS. See National Incident Management System
NIST. See National Institute of Standards and Technology
Noncatastrophic emergencies, 79
Northern New England Metropolitan Medical Response
System, Community Planning Guide: Improving Local and
State Agency Response to Terrorist Incidents Involving
Biological Weapons, 42, 95
NRP. See National Response Plan
Nuclear detonations, hazard analysis, 18
Nuclear Regulatory Commission (NRC), 77
Nurses, medical surge capacity, 35
Nursing homes, 67, 73
O
Office of Citizen Corps, DHS, 27
Office of Domestic Preparedness (ODP), 70
Office of Public Health Emergency Preparedness, 38
Office of the Surgeon General, 26
Oil and hazardous materials, emergency support functions,
12
On-scene incident command, 25
Ongoing risk assessment, 36, 46
Operations-based exercises, 75
OSHA (Occupational Safety and Health Agency), 37, 61, 95
P
Pandemic influenza outbreaks, 17
Partnerships, 41. See also Collaboration
Pastoral care resources, 62-63, 64
Patient surge, 49–50
Pediatric patients, 37, 69, 94
Pennsylvania Department of Health, Special Populations
Emergency Preparedness Planning, 68
Pentagon, unified command system, 51
Peoria County Emergency Services, 30
Performance measures, for drills and exercises, 78
Performance-monitoring data, 80–81
Personnel processing point, managing volunteers, 25
Pharmaceutical resources, 34, 49–51
Physicians’ offices, medical surge capacity, 35
Planning partners, 10–14
Planning team. See also Communication; Current capacities
and capabilities
activating emergency plans, 79
advantages, 9
approaches, 41
leadership and responsibility, 40
participants, 11
responsibilities, 4
subgroups and committees, 41
Power failure
communications and, 47
hazard analysis, 18
Preparation, National Response Plan definition, 22–23
Preparedness and response planning. See also Emergency
management
basic societal functions, 20–21
community awareness, 27
compatibility with unified command functions and ICS,
27
convergent responders, 24–26
human resources requirements, 23–24
layered approach, 27
linking community’s plan to NIMS and NRP, 28
linking to county and state plans, 29
linking to Joint Field Office, 29
mutual aid agreements, 30
plan for layered preparedness and response, 27
103
Standing Together: An Emergency Planning Guide for America’s Communities
planning process, 21–22
planning strategies, 20
public’s involvement, 26–27
self-care, 27
Preparedness, National Response Plan definition, 22–23
PrepareNow.org, 67
Prevention, National Response Plan definition, 22
Private sector
emergency planning, 13
first responders, 13–14
Program for Pediatric Preparedness, 69
Protocols, 36
Psychological support, 62–63, 66
Public education, 26–27
Public Health and Medical Services
emergency support functions, 12
medical surge capacity, 35
resources, 31
Public information, 32, 41
Public involvement, community preparedness efforts, 26–27
Public safety and security, emergency support functions, 12
Public Safety Radio Service, 58
Public service announcements, 27
Public works and engineering
emergency support functions, 11
resources, 32
Q
Quarantine, 26–27, 36
R
Racial diversity, 62
Radio communications, 54
Rand Corporation, Protecting Emergency Responders:
Lessons Learned from Terrorist Attacks, 85
Readiness barriers, 2
Recovery, National Response Plan definition, 22–23
Redefining Readiness Study, 26
Redundant systems, 27
Regional agencies
funding efforts, 71
Homeland Security Coordinating Committee, 30
risk assessment resources, 18
Regional planning, 35–36
Representatives, local elected officials, 5
Rescue workers, emotional effect of crises, 66
Resource management, 32
Resource support, emergency support functions, 12
Resource typing, 31–32, 52
Response, National Response Plan definition, 22–23
Retired health professionals, 35
Revenue-raising opportunities, 71
Reverse 911 call system, vi, 38
Risk assessment
matrices, 18
ongoing, 36, 46
Risk-based approach, 15
Risk communication plan, 27
Risks and hazards
assessing and prioritizing hazards, 17–18
catastrophic events, 16
gap analysis, 19
planning strategies, all-hazards approach, 15
problems inherent in hazard lists, 17
Robert T. Stafford Disaster Relief and Emergency Assistance
Act, 13, 29, 39
Rocky Mountain Poison and Drug Center, 86
Rural areas
federal definition, 8
vulnerability to terrorist threats, 1
Rural Health Resource Center, An Alternative Approach to
Defining Rural for the Purpose of Providing Emergency
Medical Services, 95
S
Salvation Army, 63
SARS (severe acute respiratory syndrome), vi, 38, 80
School administrators, 35
School nurses, 69
Search and rescue, 31
Security, 32, 36, 48. See also Law enforcement regions
Security planning, 48
Self-care, 27
Self-help groups, 63–64
Severity, risk assessment, 18
Shelter
current capacities and capabilities, 38
disaster drills, 78–79
hurricane preparedness, 24
temporary, 33
Skilled nursing facilities, 36
Smallpox, vi, 38, 86
Snowstorms, hazard analysis, 18
Social support systems, 64
Social workers, medical surge capacity, 35
Societal functions, 7, 20–21
SOPs (standard operating procedures), 36, 45
“Special activities”, 70
Special Needs Population Task Force, 13
Special needs populations, vi, 67, 68–69
Spiritual support, 62–63, 64
Stafford Act. See Robert T. Stafford Disaster Relief and
104
Standing Together: An Emergency Planning Guide for America’s Communities
Emergency Assistance Act
Stakeholders, defining the community, 7–8
Standards of care, 37–38
State agencies. See also FEMA
funding efforts, 71
mental health plans/resources, 64–65
risk assessment resources, 18
State Emergency Response Commissions, 29
State planning initiatives, 29
State resources, 41
Stockpiling, 36
Strategic National Stockpile (SNS), 50, 51, 81
Stress reactions to disasters, 62, 66
Students, role in planning and response activities, 68
Substance Abuse and Mental Health Services Administration
(SAMHSA), 64
Supplemental facilities, 38
Surge capacity, 34–35, 36, 37, 46
Surge needs, 35
Surgical centers, emergency support functions, 11
Surveillance, 14, 36, 48
System wide failure, 27
T
Tabletop exercises, 75
Target Capabilities List (TCL), 32–33
Team. See Emergency preparedness; Planning team
Teen SERT (School Emergency Response Training) program,
68
Temporary shelter, 33
Terrorism National Consensus Conference, 69
Terrorism threats
assessing risks in communities, 16
How Americans Feel About Terrorism and Security: Two
Years After 9/11, 94
information resources, 63
Managing the Emergency Consequences of Terrorist
Incidents-Interim Guidelines, 52
National Memorial Institute for the Prevention of
Terrorism, 85
potential areas of vulnerability, 34
Redefining Readiness study, 60, 94
in rural areas, 1
Testing. See also Community awareness
communitywide, 76
of emergency management plan, 49
specialized, 38
Texas Department of Health and the Texas Institute for
Health Policy Research, Disaster Preparedness and
Response in Texas Hospitals, 95
Training. See Emergency preparedness
Transportation
emergency support functions, 11
resources, 32
Transportation Security Administration (TSA), 70
Triage treatment, 11, 37, 38
Tribal chief executives, 4, 28
Turf battles, 43
U
Unified command. See also Incident command system
all-hazards approach, 48
guidelines, 28
integration from an ICS to, 42
Pentagon’s use of, 51
Universal Task List (UTL), 21, 32
Universities, critical resources, 11–12
Urban areas, federal definition, 8
Urban hospitals, hazards, 16
Urban search and rescue, emergency support functions, 12
Urgent care centers, medical surge capacity, 35, 36
U.S. Citizen Corps. See Citizen Corps
U.S. Department of Commerce, 18
U.S. Department of Health and Human Services
Center for Mental Health Services, 62
Communicating in a Crisis: Risk Communication
Guidelines for Public Officials, 95
grants offered, 70
Mental Health All-Hazards Disaster Planning Guidance,
62, 63, 95
Mental Health Response to Mass Violence and Terrorism:
A Training Manual, 63
Rural Communities and Emergency Preparedness, 95
U.S. Department of Homeland Security. See also National
Incident Management System; National Response Plan
2003 Citizen Corps Survey of U.S. Households: Final
Survey Report, 96
emergency support functions, 10
grants offered, 70
incident management, 29
National Response Plan, 3, 20
Office of Citizen Corps, 27, 59
review and reprioritization of possible emergency inci-
dents, 80
risk-based approach, 15
spending priorities, 21–22
Target Capabilities List (TCL), 32–33
training programs, 74
Universal Task List, 21
Universal Task List (UTL), 32
U.S. Department of Justice
grants offered, 70
105
Standing Together: An Emergency Planning Guide for America’s Communities
Office for Victims of Crime, 64–65
U.S. Environmental Protection Agency
grants offered, 70
hazardous materials initiatives, 29
rules of risk communication, 57–58
U.S. General Accounting Office (GAO)
Bioterrorism: Preparedness Varied across State and Local
Jurisdictions, 96
Hospital Preparedness: Most Urban Hospitals Have
Emergency Plans but Lack Capacities for Bioterrorism
Response, 94
U.S. Geological Survey, 18
U.S. Surgeon General, mental health planning, 62
Utility-related functions, 46, 47
V
Vaccination
for high-risk patients, 77
mass vaccination campaigns, 60
smallpox vaccination program, 86
Veteran’s hospitals, 39
Vocational special interest groups, 33–34
Volunteers
credentialing, 49
managing, 25
resources, 32
Vulnerable populations
community preparedness, 26
needs assessment on disability preparedness, 68
partners in planning and response efforts, 67–68
planning strategies, 67
special needs populations, vi, 67
tools, 68
W
Washington State Emergency Management Association,
Elected Officials’ Guide to Emergency Management, 96
Washington University School of Medicine, Department
Emergency Planning Guidelines, 96
Water, 31
West Central Municipal Conference, Illinois, 30
Wire line communications, 53–54
World Trade Center attacks, lessons learned, 13, 51–52, 67
106
doc_531828413.pdf
When the team is in place, the emergency management planning team’s first task is to conduct a hazard vulnerability analysis (HVA). An HVA identifies potential threats, risks, and emergencies and the potential impact these emergencies may have on the community.
An Emergency Planning Guide for America’s Communities
Standing Together Standing Together
Standing Together
An Emergency Planning Guide for America’s Communities
The Joint Commission is proud to acknowledge its partnership
with the following organizations
in developing this planning guide:
Illinois Department of Public Health
Maryland Institute of Emergency Medical Services Systems
National Center for Disaster Preparedness at Columbia University
© Copyright 2005 by the Joint Commission on Accreditation of Healthcare Organizations.
All rights reserved. No part of this book may be reproduced in any form or by any means without written permission from the publisher.
iii
Table of Contents
Standing Together: An Emergency Planning Guide for America’s Communities
Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iv
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Emergency Management Leadership . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Essential Components of the Planning Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Section 1. Define the Community . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Section 2. Identify and Establish the Emergency Management Preparedness
and Response Team . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Section 3. Determine the Risks and Hazards the Community Faces . . . . . . . . . . . . . 15
Section 4. Set Goals for Preparedness and Response Planning . . . . . . . . . . . . . . . . . 20
Section 5. Determine Current Capacities and Capabilities . . . . . . . . . . . . . . . . . . . . 31
Section 6. Develop the Integrated Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Section 7. Ensure Thorough Communication Planning . . . . . . . . . . . . . . . . . . . . . . . 53
Section 8. Ensure Thorough Mental Health Planning . . . . . . . . . . . . . . . . . . . . . . . . . 62
Section 9. Ensure Thorough Planning Related to Vulnerable Populations . . . . . . . . . 67
Section 10. Identify, Cultivate, and Sustain Funding Sources . . . . . . . . . . . . . . . . . . . 70
Section 11.Train, Exercise, and Drill Collaboratively . . . . . . . . . . . . . . . . . . . . . . . . . 72
Section 12. Critique and Improve the Integrated Community Plan . . . . . . . . . . . . . 80
Section 13. Sustain Collaboration, Communication, and Coordination . . . . . . . . . . . 84
Closing Comment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
Acknowledgment of Roundtable Members . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90
Selected Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
Executive Summary
iv
Despite the passage of four full years since
September 11, 2001, many small communities in
the United States are struggling to meet the man-
date for emergency preparedness and response
that would enable them to function on their own
in the hours or days before help arrives from
regional, state, and federal sources. Readiness bar-
riers include lack of clarity about who is respon-
sible for preparedness and response planning, what
elements of the planning and response processes
are critical, how to coordinate with state and fed-
eral emergency management programs, and how
to obtain and sustain funding.Whenever or what-
ever disaster or mass casualty event occurs, com-
munity and local response will be key to survival;
communities must look to themselves and adjoin-
ing communities for answers.
This planning guide provides expert guidance on
the emergency management planning process that
is applicable to small, rural, and suburban commu-
nities. Its goal is to remove readiness barriers by
providing all communities with strategies, process-
es, and tools for coordinated emergency manage-
ment planning. The target audience is local lead-
ers—including elected or appointed officials,
health care providers and practitioners, public
health leaders, and others who are responsible for
initiating and coordinating the emergency man-
agement planning effort in towns, suburbs, and
rural areas throughout the United States.
To develop this planning guide, the Joint
Commission partnered with the Illinois
Department of Public Health, the Maryland
Institute of Emergency Medical Services Systems,
and the National Center for Emergency
Preparedness at Columbia University and con-
vened two expert roundtable meetings in May
and October of 2004.These roundtables addressed
the issue of emergency management planning in
small, rural, and suburban communities; synthe-
sized the challenges; and framed potential solu-
tions. This document reflects the extensive input
received from roundtable participants.
Although no one planning tool or template can
provide the breadth of guidance needed, this plan-
ning guide is offered as a multifunctional tool or
template. It outlines 13 essential components of an
effective community-based emergency manage-
ment planning process and provides multiple
planning strategies addressing each component.
The components include the following:
1. Define the community.
2. Identify and establish the emergency manage-
ment preparedness and response team.
3. Determine the risks and hazards the communi-
ty faces.
4. Set goals for preparedness and response plan-
ning.
5. Determine current capacities and capabilities.
6. Develop the integrated plan.
7. Ensure thorough communication planning.
8. Ensure thorough mental health planning.
9. Ensure thorough planning related to vulnerable
populations.
10. Identify, cultivate, and sustain funding sources.
11. Train, exercise, and drill collaboratively.
12. Critique and improve the integrated commu-
nity plan.
13. Sustain collaboration, communication, and
coordination.
Each of the 13 sections includes supporting tools
and provides links to Web sites that offer up-to-
date information.The planning strategies are sum-
marized at the beginning of each component sec-
tion for ready reference. Thus, this guide can be
used in a modular fashion to address discrete areas
of interest to particular planning team members.
Or it can be read cover to cover as a comprehen-
sive guide to community emergency management
planning.
Standing Together: An Emergency Planning Guide for America’s Communities
Standing Together: An Emergency Planning Guide for America’s Communities
This guide emphasizes two planning strategies
that are of particular significance to small, rural,
and suburban communities. The first is to enable
people to care for themselves, and the second is to
build on existing relationships.
Enable people to care for themselves
Planning that prepares the community to help
itself can serve to reduce the potential surge in
demand for services experienced during an actu-
al emergency. The emergency plan needs to
include a well-defined risk communication plan
that contains information on the guidance that
will be provided to the public and how that guid-
ance will occur (for example, through distribution
of fliers or other written material, or public ser-
vice announcements on local radio and television
stations). Some types of emergencies can be man-
aged in homes if proper information, such as how
to prevent and treat influenza in low-risk individ-
uals during an outbreak in the community, is
made available. For certain kinds of chemical
exposure, the instruction to stay at home and take
a shower rather than go to the hospital to be
decontaminated is appropriate. Other types of
emergencies will require mass evacuation, which
is best supported by ongoing public communica-
tion, education, testing, and drills. Hurricane plans
in Florida provide an excellent example of proac-
tive, multilingual, and pervasive preparedness;
evacuation signs are well recognized throughout
communities in Florida.
Community awareness, education, and engage-
ment can be supported not only through formal
public health and public safety mechanisms and
the local media, but also at a “grass roots” level
through a range of community groups, such as
civic organizations, religious groups, Boy/Girl
Scout troops, and high school sport teams, among
others. These groups provide not only informa-
tion, but also social support for participation in
the planning and response effort that will help
individuals stay engaged over time, even during
times of perceived “low risk” when apathy about
preparedness can become pervasive.
Highly organized community preparedness efforts
should also be supported. Communities whose
residents have not yet experienced Community
Emergency Response Teams (CERTs) may wish
to consider offering this program. CERTs are
funded by Congress through Citizen Corps pro-
gram grants, which are made available to local
communities.A key component of Citizen Corps,
the CERT program trains citizens to be better
prepared to respond to emergency situations in
their communities. When emergencies occur,
CERT members can give critical support to first
responders, provide immediate assistance to vic-
tims, and organize volunteers at a disaster site.
The CERT program is a 20-hour course, typical-
ly delivered over a seven-week period by a local
government agency, such as the emergency man-
agement agency or fire or police department.
Training sessions cover disaster preparedness, dis-
aster fire suppression, basic disaster medical opera-
tions, light search and rescue, and team operations.
The training also includes a disaster simulation in
which participants practice skills that they learned
throughout the course.
Build on existing relationships
The time and resource requirements associated
with emergency management planning, response,
and recovery are considerable. Communities
should carefully and creatively examine their cur-
rent assets and expand upon them to best capital-
ize on their investment in preparedness. A key
asset is the relationships that already exist among
potential planning partners in the community;
these relationships can serve as an important plat-
form for building response capability.
v
Standing Together: An Emergency Planning Guide for America’s Communities
Small communities located near military installa-
tions, nuclear power plants, hydroelectric dams,
and other large-scale industrial entities are famil-
iar with the extensive public education and col-
laboration required to maintain general public
safety. Periodic joint meetings involving the local
utility company, telecommunications company,
water bureau, public health department, hospital,
fire department, police, and emergency medical
services (EMS) are not unusual in such communi-
ties, but in other communities there are long-
standing walls that must be breached to facilitate
collaborative planning. In such situations, it may
be advisable to begin with natural allies who can
quickly identify common ground. The following
examples illustrate how to “call the first meeting”
over a focused issue, then expand the work group
into a broader, integrated community planning
team:
? EMS leadership partners with the local hospital
around first responder/first receiver communi-
cation issues, pulling in fire and police to initi-
ate discussions about potential improvements.
Further planning discussions expand the dialog
and include the risks associated with certain
types of communicable disease outbreaks. For
additional expertise and operational informa-
tion, the local health department, state labora-
tories, and bureau of primary health care clinics
are brought to the table.The integrated com-
munity planning team builds from here to
include broader areas of risk and response
expertise respecting potential issues facing the
community.
? A local municipality, in responding to the need
to establish special-needs shelters, has—through
its department of human services and local
nursing homes—identified all the vulnerable
disabled and elderly residents in institutions but
has not identified all those living in the com-
munity.The municipality establishes a work
group that includes representatives from human
services, nursing homes, the largest home
health agency serving the community, the
largest retail pharmacy serving the community,
and the local postal service.They establish a
preliminary plan for locating the vulnerable
disabled and elderly in the community and, on
the basis of this preliminary plan, are able to
pull in representatives from local police, the
911 call facility, EMS, county mental health
agency, and others to help refine the plan and
address issues of service needs, communication
strategies, transport, and medical equipment
and supplies. Problem solving around this spe-
cific issue leads to collaboration on broader
issues of emergency management planning in
the community, and the integrated community
planning team builds from there.
Finding dual uses for existing or emerging capa-
bilities is also particularly critical for resource-
strapped small, rural, and suburban communities.A
reverse 911 call system established by a communi-
ty for law enforcement emergencies could also be
used to communicate information about other
types of emergencies. Motels and college dormito-
ries can be utilized to provide additional bed
capacity. Investments made by local public health
departments in upgrading laboratory services for
smallpox, sudden acute respiratory syndrome
(SARS), anthrax, and other specialized testing can
buttress routine laboratory services in the commu-
nity. Boats or school buses can provide alternative
means of emergency transportation. Businesses
with call-center capabilities, such as telemarketing
and airline operations, can support community
communication needs during a disaster.
By creating an informed and empowered citizen-
ry, and by bringing to the table the full range of
assets within the community including planning
partners perhaps not previously considered, small,
rural, and suburban communities can deepen and
extend their capability to plan for and respond to
all types of natural and man-made disasters.
vi
Introduction
Standing Together: An Emergency Planning Guide for America’s Communities
We cannot live for ourselves alone. Our lives are
connected by a thousand invisible threads, and
along these sympathetic fibers, our actions run as
causes and return to us as results.
Herman Melville
It would seem to take more than a village to
respond to the catastrophic events witnessed in
recent years. Terrorists, tsunamis, tornadoes, and
other threats affect whole cities, countries, and
continents. Yet most disasters and mass casualty
events are experienced locally; in this country,
incidents are generally handled at the lowest pos-
sible jurisdictional level.
1
When significant events
occur, the “intrusive reality” is that small, rural,
and suburban communities in the United States
may be on their own for 24 to 72 hours before
help arrives from regional, state, and federal
sources. Community and local response will be
key to survival; communities must look to them-
selves and adjoining communities for answers.
The invisible threads that connect individuals, as
described by Melville, must be pulled together to
create a surviving community fabric.
The goal of and need for this publication
The goal of this publication is to provide small
communities with strategies, processes, and tools
for coordinated emergency management plan-
ning.To be fully effective, such information must
stimulate and sustain linkages among the individ-
uals and agencies composing a small community’s
fabric. Rural areas may be particularly vulnerable
to terrorist threats and they also may be least pre-
pared to respond. Because nuclear power plants,
uranium and plutonium storage facilities, and all
U.S. Air Force missile launch facilities are located
in rural areas, these communities represent poten-
tial terrorist targets.
2
In addition, the interstate
transit of hazardous materials through small com-
munities nationwide and the location of agricul-
tural chemical facilities make chemical threats a
reality as well. Moreover, following a terrorist
event, residents fleeing large urban areas and in
need of food, shelter, clothing, and health care
could very well “land on the doorsteps” of small
communities and overwhelm community
resources.
Terrorists, of course, are not always the cause of
“events” that overwhelm local resources. Every
community is vulnerable to an influenza pan-
demic—an event considered by most infectious
disease specialists to be long overdue. According
to a recent report from the Institute of Medicine,
experts believe that “the world stands on the
verge”
3(p. 1)
of such a pandemic.
4,5
Its estimated
impact in the United States is 89,000 to 207,000
deaths, 300,000 to 700,000 hospitalizations, and
18 million to 42 million individuals requiring
outpatient care. Every community must face the
possibility of responding to influenza with mini-
mal or no external resources or support.
3
Many
small communities with already seriously bur-
dened and limited health facilities simply will not
be able to care for the surge of patients.
Despite the passage of four full years since
September 11, 2001, many small communities are
struggling to meet the mandate for preparedness
and response that would “return” the desired
“results,” as described by Melville. Challenges
abound (Sidebar 1), but perhaps the most threat-
ening of these challenges is complacency. “The
feeling of relative safety brought on by the belief
that rural areas are at a lower risk for terrorism
may reduce rural communities’ sense of urgency
and limit preparation and responsiveness,” notes
one government report.
2(p. 4)
Studies published in
2002 and 2003 indicate that public health emer-
gency preparedness at the local level may be
improving, but that gaps persist even in larger
communities.
6–8
In reality, many of America’s
1
Standing Together: An Emergency Planning Guide for America’s Communities
small communities are still “waiting for someone
to call the meeting.”
9(p. 11)
Readiness barriers
include lack of clarity about who is responsible
for preparedness and response planning, what ele-
ments of the planning and response processes are
critical, how to coordinate with state and federal
emergency management programs, and how to
obtain and sustain funding.
The audience
This planning document seeks to help remove
these barriers by providing expert guidance on
the emergency management planning process
that is applicable to small, rural, and suburban
communities.The target audience is local leaders,
including elected or appointed officials, health
care practitioners and providers, public health
leaders, and others who are responsible for initi-
ating and coordinating the emergency manage-
ment planning effort in small towns, suburbs, and
rural areas throughout the United States. These
leaders bear responsibility for creating the inter-
connectedness that will help ensure the safety and
well-being of individuals in their communities.
This publication builds on a white paper pub-
lished by the Joint Commission in May 2003
entitled Health Care at the Crossroads: Strategies for
Creating and Sustaining Community-wide Emergency
Preparedness Systems.
9
That white paper framed the
issues that must be addressed in developing com-
munitywide preparedness and noted that “public-
private sector partnerships offer the best overall
prospect for research on and development of rel-
evant, scalable models that will meet local com-
munity needs in a variety of urban, suburban, and
sparsely populated settings. There is considerable
urgency to move this work forward.”
No community is exactly like another. Structures,
governance, resources, and capabilities vary wide-
ly. Development of a one-size-fits-all emergency
plan thus is neither doable nor desirable. The
model or template offered in this planning guide
is a community-based planning process that con-
tains 13 components essential to the development
and implementation of effective emergency pre-
paredness and response. Strategies, tools, case
studies, and “how-to” material provide local lead-
ers with ways to make this planning process hap-
pen. Tools or templates can guide operational
planning in organizations, agencies, and commu-
nities and can outline functional relationships
across such entities and within a state or region.
By their very nature, tools and templates can help
community leaders overcome resistance to
change and political barriers by maintaining focus
on shared goals rather than narrow agendas. Over
2
? A limited public health infrastructure
? A short supply of health providers
? Lack of hospital bed surge capacity
? Seasonal surge capacity and surge capacity from
nearby urban areas
? Mostly volunteer first responders
? Limited mental health services
? Limited access to hazardous materials units,
recognition capability and decontamination train-
ing
? Lower Medicare payments to health care organi-
zations than to urban counterparts for equivalent
services
? Difficult access to needed emergency services due
to geography; residents may face greater trans-
portation difficulties reaching needed services
? Complacency based on the belief that rural areas
are at a lower risk for terrorism than urban areas
Sources: Robert M. Gougelet, M.D.; National Rural
Health Association: What’s different about rural health
care?http://www.nrharural.org; U.S. Dept. of Health and
Human Services, Office of Rural Health Policy (HHS):
Rural Communities and Emergency Preparedness. Washington,
DC: HHS. Apr. 2002.
SIDEBAR 1. COMMON EMERGENCY PREPAREDNESS
CHALLENGES IN RURAL AREAS
Standing Together: An Emergency Planning Guide for America’s Communities
time, by fostering focus, perseverance, and trust,
planning templates and tools can facilitate change
within the community and can help to sustain
linkages with mission-critical partners in other
communities.
Developmental process
Since 2000, the Joint Commission has expanded
its traditional disaster preparedness requirements
for health care organizations into a community-
based emergency management framework.
Health care provider organizations are now
expected to be at the community planning table.
However, they cannot possibly manage alone a
mass casualty event of the proportions proved
possible by 9/11; it takes a whole community to
do so.
To develop this planning guide, the Joint
Commission partnered with the Illinois
Department of Public Health, the Maryland
Institute of Emergency Medical Services Systems,
and the National Center for Emergency
Preparedness at Columbia University and con-
vened two expert roundtables in May and
October 2004. These roundtables addressed the
issue of emergency management planning in
small, rural, and suburban communities; synthe-
sized the challenges; and framed potential solu-
tions.
This document reflects the extensive input
received from roundtable participants (page 90).
It also incorporates selected emergency prepared-
ness lessons learned and recommendations
appearing in seminal publications. These include
the final report of the National Commission on
Terrorist Attacks Upon the United States—The
9/11 Commission Report—published in July
2004
10
and the National Incident Management
System
11
and National Response Plan
1
published by
the U.S. Department of Homeland Security
(DHS) in March and December 2004, respective-
ly.The examples, tools, strategies, and other infor-
mation provided in this document cannot by
their very nature be comprehensive, but rather are
offered as representative of the many excellent
planning efforts under way in various domains.
References
1. U.S. Department of Homeland Security (DHS):
National Response Plan. Washington, DC: DHS, Dec.
2004.
2. U.S. Department of Health and Human Services,
Office of Rural Health Policy (HHS/ORHP): Rural
Communities and Emergency Preparedness. Washington,
DC: HHS/ORHP, Apr. 2002.
3. Institute of Medicine: The Threat of Pandemic
Influenza: Are We Ready? A Workshop Summary.
Washington, DC: National Academies Press, 2004.
4. World Health Organization: WHO Consultation on
Priority Public Health Interventions Before and During an
Influenza Pandemic.Apr. 27, 2004.http://www.who.int/
csr/disease/avian_influenza/consultation/en/
(accessed Aug. 10, 2005).
5. Chen H., et al.: The evolution of H5N1 influenza
viruses in ducks in southern China. PNAS 101(28):
10452-10457.
6. U.S. General Accounting Office (GAO): Bioterrorism:
Preparedness Varied Across State and Local Jurisdictions.
Washington, DC: GAO, Apr. 2002.
7. National Association of City and County Health
Officials (NACCHO): Local Public Health Agencies
Better Equipped to Handle Bioterrorist Attacks.
Washington, DC: NACCHO, Jan. 2003.
8. U.S. General Accounting Office (GAO): Hospital
Preparedness: Most Urban Hospitals Have Emergency
Plans but Lack Capacities for Bioterrorism Response.
Washington, DC: GAO, Aug. 2003.
9. Joint Commission on Accreditation of Healthcare
Organizations (JCAHO): Health Care at the
Crossroads: Strategies for Creating and Sustaining
Community-wide Emergency Preparedness Systems.
Oakbrook Terrace, IL: JCAHO, 2003.
10. National Commission on Terrorist Attacks Upon the
United States: The 9/11 Commission Report. New
York: W.W. Norton, 2004.
11. U.S. Department of Homeland Security (DHS):
National Incident Management System. Washington,
DC: DHS, Mar. 1, 2004.
3
Emergency Management Leadership
Standing Together: An Emergency Planning Guide for America’s Communities
4
Local jurisdictions of all sizes, including towns,
cities, counties, and tribal governments, are
responsible for saving lives, protecting property,
protecting the economic base of the community,
and preserving the environment.
1
Most emergen-
cy “incidents” are managed locally, yet because
small communities are structured and governed
differently, “incident management”—the
response to a major event or emergency—may be
coordinated by individuals with many differing
roles. Some communities have a mayor; others
have a city or county manager. The chief leader
may be elected or appointed, may have direct
control over public safety and health, or may
work through a council or manager.
This planning guide uses the term chief executive
to indicate the elected or appointed leader of the
small, rural, suburban, or tribal (when a tribal
nation exists in the area) community who is held
accountable for the safety and well-being of the
population and community.To fulfill this role, the
chief executive typically works closely with lead-
ers of fire, law enforcement, emergency medical
services (EMS), public works, public health,
health care organizations, and other agencies and
groups. Coordinated emergency management
planning and decision making requires the chief
executive to assume a leadership role in some cir-
cumstances (for example, within his or her own
community) and yield the leadership role, assum-
ing a team-player role, in other circumstances (for
example, when participating in multicommunity
or regional planning efforts). Sidebar 2 outlines
the responsibilities of the local chief executive, as
defined by the U.S. Department of Homeland
Security (DHS).
Responsibility for the development and coordi-
nation of emergency management planning is
often assumed by the chief executive. However, in
some communities, a fire chief, police chief, EMS
coordinator, or administrator of the county health
department or health system (through the efforts
of emergency department physicians, local hospi-
tal associations, and so forth) initiate and coordi-
nate the planning effort.This planning guide uses
the term local planner to refer to the individual
who initiates the emergency management plan-
ning process for the community, and uses the
term planning team to refer to the group of indi-
viduals that conduct emergency management
preparedness and response planning, as described
in Section 2. Sidebar 3 describes three emergen-
cy management planning roles often assumed by
local elected officials.
? Coordinates local resources to address the full
spectrum of actions to prevent, prepare for,
respond to, and recover from incidents involving
all hazards, including terrorism, natural disasters,
accidents, and other contingencies.
? When necessary, uses the extraordinary powers of
the position (depending on state and local law) to
establish a curfew, direct evacuations, and/or, in
coordination with the local health authority, to
order a quarantine.
? Provides leadership and plays a key role in com-
municating to the public, and in helping people,
businesses, and organizations cope with the con-
sequences of any type of domestic incident with-
in the jurisdiction.
? Negotiates and enters into mutual aid agreements
with other jurisdictions to facilitate resource shar-
ing.
? Requests state and, if necessary, federal assistance
through the governor of the state when the juris-
diction’s capabilities have been exceeded or
exhausted.
Tribal chief executives can elect to deal directly with
the federal government (although a state governor
must request a presidential disaster declaration).
Source: U.S. Dept. of Homeland Security (DHS): National
Response Plan. Washington, DC: DHS, Dec. 2004.
SIDEBAR 2. RESPONSIBILITIES OF THE LOCAL CHIEF
EXECUTIVE
Reference
1. U.S. Department of Homeland Security (DHS):
National Response Plan. Washington, DC: DHS, Dec.
2004.
Standing Together: An Emergency Planning Guide for America’s Communities
5
Coordinator: A local elected official serving in this
role coordinates critical local services such as law
enforcement, emergency medical services, and social
services. As the community prepares and tests its
emergency plan, the official can make a point of
clarifying and defining the roles of each local agen-
cy and each agency head to prevent gaps or overlaps
of function. During an emergency event, the local
elected official will meet regularly with agency
heads so that he or she can continuously monitor
the work of the agencies and adjust functions and
responsibilities, as necessary.
Liaison: Local elected officials will also find them-
selves in the role of liaison among various federal
and state agencies, community agencies, the business
community, and the public. To perform this role
effectively, local officials must maintain regular con-
tact with state and federal entities, such as the state
police and the regional FBI office. The liaison must
understand the roles of these state and federal agen-
cies, as well as their needs in an emergency situation,
and must communicate these roles and needs to
local agencies. Similarly, local elected officials act as a
link to local government for both the business com-
munity and the public, working to ensure that needs
and concerns are met.
Representative: Local officials act as representatives of
their communities in the wider regional emergency
planning effort. Most regions and metropolitan
areas, regardless of size, have some kind of regional
coordination effort in place, such as mutual aid
agreements or transportation plans. If no regional
entity exists, local officials can work to convene one.
Source: Adapted from National League of Cities (NLC):
Homeland Security: Practical Tools for Local Governments.
Washington, DC: NLC, Nov. 2002.
SIDEBAR 3. POSSIBLE ROLES OF LOCAL ELECTED
OFFICIALS IN LOCAL EMERGENCY PLANNING
Essential Components of the Planning Process
Standing Together: An Emergency Planning Guide for America’s Communities
The 13 essential components of an effective community-based emergency management planning process
are outlined here and provide the structure for the rest of the planning guide. These components can be
considered steps, with the caveat that the sequence of the activities may need to be varied or repeated based
on the community’s unique needs. The components are as follows:
1. Define the community.
2. Identify and establish the emergency management preparedness and response team.
3. Determine the risks and hazards the community faces.
4. Set goals for preparedness and response planning.
5. Determine current capacities and capabilities.
6. Develop the integrated plan.
7. Ensure thorough communication planning.
8. Ensure thorough mental health planning.
9. Ensure thorough planning related to vulnerable populations.
10. Identify, cultivate, and sustain funding sources.
11. Train, exercise, and drill collaboratively.
12. Critique and improve the integrated community plan.
13. Sustain collaboration, communication, and coordination.
These components are similar to those described in the Joint Commission’s March 2003 white paper.
However, the strategies and examples that follow here for each component are geared specifically to small,
rural, and suburban communities, rather than the nation as a whole.
6
Webster’s, which provides a starting point, defines
community as follows: “A social group of any size
whose members reside in a specific locality, share
government, and often have a common cultural
and historical heritage.”
1
This definition embraces
both the functional and structural realm of communi-
ty as described by sociologists
2
:
? A functional community can be defined as the
associations that are required by groups of peo-
ple living together within a specific geographical
area.
? A structural community can be defined as the
types of interconnectedness that individuals
choose to make with one another, such as
through social organizations.
3
This planning guide focuses on functional commu-
nity while recognizing the critical importance of
structural community to the emergency prepared-
ness and response process. Strategies to help achieve
an accurate definition of the community follow.
Identify key stakeholders in defining the
community.
The effectiveness of planning is dependent on the
ability of communities nationwide to determine
the appropriate functional planning and response
unit for emergencies.
4
As the chief executive will be
accountable for the safety and well-being of the
population during a disaster, his or her first task is
to collaborate with key stakeholder groups in the
community to define the community for the pur-
poses of emergency management planning.
Collaboration ensures that the scope of services
provided and the populations served by each enti-
ty are well understood early in the planning pro-
cess. Integrated, comprehensive planning reflects
associations between the stakeholders who are pro-
viding basic societal functions based on identified
1. Define the Community
Standing Together: An Emergency Planning Guide for America’s Communities
7
Recommended Planning Strategies:
? Identify key stakeholders in defining
the community.
? Consider geopolitical and other defi-
nitional factors.
? Consider impact of federal definitions.
The effectiveness of planning is dependent on the ability of communities nationwide to deter-
mine the appropriate functional planning and response unit for emergencies.
? Public safety and security (fire, law enforcement,
emergency medical services)
? Public works (roads, bridges, dams, transportation,
sanitation, post office)
? Public health (immunizations, food safety, animal
safety, epidemiology/disease surveillance, labora-
tory services)
? Schools, colleges, and universities
? Housing agencies
? Utilities (energy, water, communications)
? Health care providers (including, among others,
hospitals, skilled nursing facilities, ambulatory and
rural health clinics, rehabilitation centers, mental
health facilities, and home care agencies)
? Private industry (for example, chamber of com-
merce, local industries, corporations)
? Service (for example, Scouts, Lions Club) and
religious organizations (for example, churches,
synagogues)
? Federally funded local response initiatives (for
example, Metropolitan Medical Response
System, Medical Reserve Corps, and Community
Emergency Response Teams)
SIDEBAR 4. KEY STAKEHOLDERS IN DEFINING THE
COMMUNITY
Standing Together: An Emergency Planning Guide for America’s Communities
roles and responsibilities. Sidebar 4 lists the stake-
holders that provide key services in most com-
munities.
Consider geopolitical and other
definitional factors.
Small, rural, and suburban communities will be able
to define themselves as distinct geopolitical units
(village, town, county, parish) under the leadership
of a mayor, manager, council, or other governing
entity. Other definitional elements that can be con-
sidered include the following:
? Specific aspects of the geography (for example,
mountains, valleys, flatland, rivers or other bodies
of water)
? Residential patterns
? Highways and other infrastructure
? Employment type (farming, industry, corporate)
? Culture and language
? Climate
Geography is a significant factor in access to essen-
tial services during and following a disaster, but
essential services such as health care providers, fire,
law enforcement, emergency medical services
(EMS), public health planning districts, schools,
utilities, and water supplies do not necessarily con-
form to the same geopolitical boundaries. For
example, health care providers may draw patients
from several towns across one or two counties; pub-
lic health services may not be under the jurisdiction
of a mayor.
In addition, because disasters occur across geo-
graphic and political boundaries, the chief execu-
tive may need to consider legal jurisdictional lines
and assemble planning partners who can address
certain types of emergencies across various bound-
aries. “In many states, there are multiple prepared-
ness regions for different functions. Law enforce-
ment regions may not be contiguous with EMS
regions or hospital catchment areas, which in turn,
may not line up with emergency management
planning regions. Political jurisdictions may no
longer have much to do with population patterns.
Each community must be able to assess its capacity
as part of many different functional regions,” notes
one region’s planning white paper.
4
Consider impact of federal definitions.
The federal government has many different meth-
ods for defining urban and rural or metropolitan and
nonmetropolitan America, largely for purposes of
administering federal programs.
5
These definitions
are not likely to provide local chief executives with
much help in defining the community, except in
the area of funding resources.
For example, the Census Bureau’s new classification
system, released with an update of the Census 2000
data, indicates that rural includes open country and
small settlements of fewer than 2,500 persons. Small
towns and cities that have adjoining towns or sub-
urbs and collectively exceed 2,500 persons, regard-
less of political boundaries, are considered urban. A
small town of 2,000 people with an adjacent dense-
ly settled suburb of 800 people would be designat-
ed as an urban cluster with a population of 2,800.
6
The Census Bureau’s definition notwithstanding,
such an “urban”community is one addressed in this
planning guide.
8
Because disasters occur across geographic and political boundaries, the chief executive may
need to consider legal jurisdictional lines and assemble planning partners who can address
certain types of emergencies across various boundaries.
The process of identifying who must be at the
table for successful and sustained community-
based emergency management, which includes
four phases (prevent, prepare, respond, and recov-
er), is a critical one. A team approach brings
increased creativity, knowledge, and experience
to each phase of emergency management plan-
ning. A team-developed plan, which includes
multiple viewpoints and reflects shared goals, is
more likely to be successfully implemented in the
community. Closer professional and personal rela-
tionships among the team members should trans-
late into better coordination and teamwork in
emergencies.
7
In small communities, the team identification pro-
cess is often about bringing together neighbors
who work and live together routinely. These indi-
viduals assume that their communities need to be
self-sufficient and frequently do not expect the state
or federal government to provide resources quick-
ly in the event of a large-scale disaster. However,
they do expect that representatives of local govern-
ment and emergency response providers will be
there for them immediately following a major
event. In addition, they often expect to be involved
in the response themselves. In small communities,
emergency response frequently revolves around
neighbors helping neighbors.
Strategies to help ensure the best-possible emer-
gency management preparation and response team
follow.
Build on existing relationships.
Rather than beginning a planning process from a
blank page, the chief executive or local planner, as
appropriate and available, can build on effective
existing relationships and patterns of communica-
tion between community stakeholders as a founda-
tion for emergency management planning. Natural
pre-existing relationships and mutual aid agree-
ments—for example, between the police depart-
ment and the mayor’s office, local pediatricians and
the public health department, and EMS and the
county hospital—are found in virtually every com-
munity. Many communities view their fire depart-
ment and EMS (and its link to area hospitals) as the
backbone of emergency response. Thus, linkages
between fire departments, EMS, hospitals, and var-
ious other community constituents may already be
well established.
? Example: Following 9/11, a small community of
5,500 in Ohio formed an auxiliary force modeled on
the former civil defense system for the community.The
goal was to meet community needs during the first 72
hours after a disaster.The force, which now includes 31
individuals, is working with the county in order to
dovetail with county efforts and obtain needed funding.
8
2. Identify and Establish the Emergency Management Preparedness
and Response Team
Standing Together: An Emergency Planning Guide for America’s Communities
9
Recommended Planning Strategies:
? Build on existing relationships.
? Identify appropriate planning partners.
? Consider start-up logistics.
A team-developed plan, which includes multiple viewpoints and reflects shared goals, is more
likely to be successfully implemented in the community.
Standing Together: An Emergency Planning Guide for America’s Communities
Efficient and effective processes also may be in
place to handle local emergencies (for example,
dam overflows, chemical spills from a train derail-
ment). Some communities have citizens watch
groups; others have formed or are forming
Community Emergency Response Teams
(CERTs), a program sponsored by the Federal
Emergency Management Agency (FEMA) (see
page v.). These existing relationships can provide
the foundation of the emergency management
planning team. In addition, the Metropolitan
Medical Response System (MMRS) was created
in 1997 to build a system that enhances the local
community’s ability to respond. Although
MMRS is primarily based in urban areas, the
Northern New England MMRS, formed in
2003, has a rural base and multistate jurisdiction.
Most communities have some form of emergen-
cy preparedness planning group, so “reinventing
the wheel” may not be necessary. It is important
to review the groups’ constituents to ensure that
all key players are at the table.
? Example: An emergency department physician in
the major hospital in a small community in the
Midwest built relationships and connections critical
to integrated emergency management planning.
Working first with infection control nurses in his
own hospital, he linked to the county health depart-
ment’s communicable disease specialist and health
director, and subsequently to the emergency services
directors.These individuals now exist as a
medical/public health subcommittee within a region-
al emergency planning team established under the
authority of the council of governments.
Where no relationships seem to exist, or where
relationships are not functioning effectively, the
chief executive or local emergency management
planner will need to solicit interested parties to cre-
ate a working group to begin the planning process.
? Example: In Texas, hospital leaders across the state
brought together emergency management, law
enforcement, and other community stakeholders to
conduct emergency preparedness planning at the local
level.
9
Leaders and participants can emerge from many
different places, as described in the following
planning strategy.
Identify appropriate planning partners.
Sidebar 5 lists key areas from which to draw par-
ticipants to the planning table. The emergency
support functions as defined by the U.S.
Department of Homeland Security (DHS)
(Sidebar 6) can provide another means to identi-
fy appropriate representatives. Individuals who
live in the community may already serve in coun-
tywide or regional emergency management ini-
tiatives and might be willing to play a dual role.
This is particularly true with health care
providers who often have full-time health care
jobs and also volunteer with the local EMS or are
members of state national guard units. If not
available in the community, representatives from
nearby communities or counties can be invited to
join the team. In addition, to expand the com-
munity’s capability to respond to and recover
from a disaster, partners and resources outside the
community will be essential. These partners
should be brought to the table so that collabora-
tive planning can occur and mutual aid relation-
ships can be defined.
Representation from each area identified in
Sidebar 5, as available in the community or sur-
rounding communities, is important, but several
warrant further explanation, as follows.
Hospitals and other health care organizations are crit-
ical to a community’s ability to prepare for and
respond to an emergency and must be at the
10
Standing Together: An Emergency Planning Guide for America’s Communities
11
planning table. Hospitals can work collaborative-
ly with all community health care organizations
to plan for and respond to a surge in patients or a
facility-disabling disaster that could overwhelm
any single health care organization. Home health
agencies can supplement a community’s surge
capacity by providing trained health care person-
nel and medical equipment and supplies. Long-
term care facilities have the bed capacity, supplies,
and skilled staff to care for non-acutely ill or
injured disaster victims. Ambulatory care clinics
and surgical centers can provide trained person-
nel and equipment and can triage disaster victims
so that hospitals receive only the most severely ill
or injured patients.
Local colleges and universities are an important ele-
ment of the infrastructure in many communities.
They can often offer a variety of critical
resources, such as facilities appropriate to emer-
gency needs; pharmacy, nursing, and medical stu-
dents who have some health-related training; staff
with expertise in various areas of interest to
emergency preparedness and response; and medi-
cal and transportation vehicles. Numerous aca-
demic institutions are attracting funding, generat-
ing valuable research, and developing innovative
processes related to emergency preparedness.
Representatives from the following areas should be
brought together as planning partners:
? Local government (mayor, village manager, or
other elected official)
? Fire
? Law enforcement
? EMS
? Search/rescue agency
? Transportation
? Public health
? Public schools
? Housing agency
? Utilities (gas, water, electric, telecommunications)
? Local or regional FBI office
? Health care (ambulatory care, rural health clinic,
hospital, long term care, rehabilitative, mental
health, home care, laboratories)
? Private industry (e.g., chamber of commerce,
local industries, corporations)
? Special needs populations (children, elderly, non-
English-speaking, disabled)
? CERT
? Citizen Corps/Medical Reserve Corps
? Colleges and universities
? American Red Cross
? Media and communications (print, radio, TV)
? Mutual aid partners outside the community
? Civilians
SIDEBAR 5. PARTICIPANTS AT THE PLANNING TABLE
continued
ESF #1. Transportation ? Federal and civil transportation support
? Transportation safety
? Restoration/recovery of transportation infrastructure
? Movement restrictions
? Damage and impact assessment
ESF #2. Communications ? Coordination with telecommunications industry
? Restoration/repair of telecommunications infrastructure
? Protection, restoration, and sustainment of national cyber and information technology resources
ESF #3. Public Works and
Engineering
? Infrastructure protection and emergency repair
? Infrastructure restoration
? Engineering services, construction management
? Critical infrastructure liaison
SIDEBAR 6. EMERGENCY SUPPORT FUNCTIONS
Standing Together: An Emergency Planning Guide for America’s Communities
12
Source: U.S. Dept. of Homeland Security (DHS): National Response Plan. Washington, DC: DHS, Dec. 2004, p. 12.
SIDEBAR 6. EMERGENCY SUPPORT FUNCTIONS (CONTINUED)
ESF #4. Firefighting ? Firefighting activities on Federal lands
? Resource support to rural and urban firefighting operations
ESF #5. Emergency
Management
? Coordination of incident management efforts
? Issuance of mission assignments
? Resource and human capital
? Incident action planning
? Financial management
ESF #6. Mass Care,
Housing, and Human
Services
? Mass care
? Disaster housing
? Human services
ESF #7. Resource Support ? Resource support (facility space, office equipment and supplies, contracting services, etc.)
ESF #8. Public Health and
Medical Services
? Public health
? Medical
? Mental health services
? Mortuary services
ESF #9. Urban Search and
Rescue
? Life-saving assistance
? Urban search and rescue
ESF #10. Oil and
Hazardous Materials
? Materials Response
? Oil and hazardous materials (chemical, biological, radiological, etc.) response
? Environmental safety and short- and long-term cleanup
ESF #11. Agriculture and
Natural Resources
? Nutrition assistance
? Animal and plant disease/pest response
? Food safety and security
? Natural and cultural resources and historic properties protection and restoration
ESF #12. Energy ? Energy infrastructure assessment, repair, and restoration
? Energy industry utilities coordination
? Energy forecast
ESF #13. Public Safety and
Security
? Facility and resource security
? Security planning and technical and resource assistance
? Public safety/security support
? Support to access, traffic, and crowd control
ESF #14. Long-Term
Community Recovery and
Mitigation
? Social and economic community impact assessment
? Long-term community recovery assistance to states, local governments, and the private sector
? Mitigation analysis and program implementation
ESF #15. External Affairs ? Emergency public information and protective action guidance
? Media and community relations
? Congressional and international affairs
? Tribal and insular affairs
Standing Together: An Emergency Planning Guide for America’s Communities
Regional academic medical centers can identify
best practices in the current medical literature
and be valuable planning and response partners
(for example, by providing resources such as diag-
nostics capabilities, personnel, equipment, and
supplies).
Local private industry represents key elements of a
community’s infrastructure and resources, and
disruption of their business operations may have
major community or regional impact. For exam-
ple, utility and telecommunications companies
have a vested interest in interoperability and
emergency preparedness and therefore can be
particularly helpful at the planning table.
The federal government is encouraging the private
sector to create emergency response plans and
information-sharing processes and protocols that
are tailored to their needs but that also map to
regional, state, and local emergency preparedness
plans and information-sharing networks.
10
Participation at the community-based planning
table is one way to ensure congruence between
community-based and industry-based plans and to
help obtain needed resources when disasters occur.
? Example: Caterpillar, one of the largest industries in
the Peoria, Illinois, area, was invited to the region-
wide planning table. Caterpillar participated exten-
sively in plan development and offered specific
response help in the form of heavy construction
equipment that might be needed in the event of a
disaster. In a collaborative spirit, the area’s public
works office indicated that its staff members would
assume responsibility for driving the equipment.
Where they are active, Citizen Corps representa-
tives should be at the local planning table. The
U.S. Citizen Corps brings together leaders from
law enforcement, fire, emergency medical and
other emergency management services, volunteer
organizations, local elected officials, the private
sector, and other community stakeholders to help
make communities safer, stronger, and better pre-
pared to address the threat of disasters of all
kinds.
10
It works through a national network of
state, local, and tribal Citizen Corps councils.
The American Red Cross plays an integral role in
the federal emergency response plan and has
available nursing and mental health resources,
and, as such, a local or regional representative
should be at the table for local planning as well.
This humanitarian organization, led by volun-
teers and guided by a Congressional charter, pro-
vides relief to victims of disasters and helps peo-
ple prevent, prepare for, and respond to emergen-
cies. It functions independently of the govern-
ment but works closely with government agen-
cies, such as FEMA, during times of major crises.
The American National Red Cross (as distinct
from the International Red Cross) is one of a
very few national disaster relief agencies specifi-
cally cited in the Robert T. Stafford Disaster
Relief and Emergency Assistance Act of 2000.
Civilian representation at the planning table is
critical. One of the key lessons learned from the
World Trade Center attacks of 9/11 was that the
“first” first responders during an emergency typ-
ically are private-sector civilians. “Because 85
percent of our nation’s critical infrastructure is
controlled not by government but by the private
sector, private-sector civilians are likely to be the
first responders in any future catastrophes,” noted
the National Commission.
11(p. 317)
Civilians that
could address special needs populations should
also be considered; recommendations from state
task forces could assist in identifying knowledge-
able planning partners. For example, Missouri has
a state Special Needs Population Task Force that
has brought together more than 17 organizations,
agencies, and consumers to address this area.
13
Standing Together: An Emergency Planning Guide for America’s Communities
14
In considering media and communications, it is
vital to identify someone in the community who
is well recognized, respected, and trusted to serve
in the role of communicating with the public
before, during, and following a major event. The
chief executive or local planner might also wish
to consider an individual who could engage the
public and professionals as volunteers; this person
may be involved with the Citizen Corps/Medical
Reserve Corps, a CERT, the American Red
Cross, or other organizations.
Consider start-up logistics.
Start-up logistics can be complex and include
such mundane but essential tasks as who should
send the invitational letters for the first meeting,
where and when meetings are to be held, and so
forth. When the chief elected official or another
community leader calls the meeting, it may be
helpful to have someone such as the state com-
missioner of public health generate the invitation
letters.
Initial decisions will need to be made regarding the
leadership structure of the team and how commu-
nication will take place. The local planner who
“calls the first meeting” is not necessarily the lead-
er who coordinates the ongoing emergency man-
agement processes after they have been established.
In many communities, this leader is the mayor or
another chief elected official, hospital administrator,
city manager, public health director, emergency
management director, fire chief, or police chief.
Means to ensure effective collaboration across
political and organizational barriers will need to be
negotiated and implemented.
Throughout the start-up and ongoing process,
the chief executive or local planner will want to
be conscious of the need to build a common lan-
guage among planning participants. Different
types of professionals speak different languages,
which may require explanation. For example, the
term surveillance, commonly used by public health
officials and health care professionals, may not be
known or may come across negatively in the
business community, or it may mean something
entirely different to law enforcement agents.
12
Professional terminology can be defined or
explained during meetings and in key docu-
ments.
The local planner who “calls the first meeting” is not necessarily the leader who coordinates
the ongoing emergency management processes after they have been established.
When the team is in place, the emergency man-
agement planning team’s first task is to conduct a
hazard vulnerability analysis (HVA). An HVA
identifies potential threats, risks, and emergencies
and the potential impact these emergencies may
have on the community. It is a formal assessment
of the risks that could potentially affect the com-
munity or an agency within the community and
move it to implement its emergency manage-
ment plan. Specific strategies for determining the
risks and hazards faced by the community follow.
Use an “all-hazards approach.”
An all-hazards approach enables communities to
be prepared to manage any number or type of
emergencies. It facilitates prevention, preparation,
response, and recovery, based on the broad scope
of what could happen within and beyond the
community. Conducting a risk assessment
involves proactively identifying what might affect
the community and its surrounding area.
In addition to other documents such as written
analyses of capabilities and capacities, an HVA can
help to overcome communitywide or stakeholder-
specific resistance to emergency preparedness. It
offers an objective information source and requires
a cross section of expertise and perspective from
the community to construct, implement, and ana-
lyze. The process of performing an HVA requires
commitment to accuracy and thoroughness and
continuing expertise and motivation.
Communities can perform an HVA in many
ways; there is no right or wrong way. Any
methodology or approach that works effectively
should be used and referenced in the emergency
management plan. Some systems use a quantita-
tive scoring method to rank the potential emer-
gencies, but this is not essential. The key is that
each community’s emergency management plan-
ning team identifies the events for which prepa-
ration is necessary and that the evaluation is con-
ducted through a collaborative approach.
Whether the full extent of emergency prepared-
ness is possible given the community’s resources
is, of course, a critical issue. The Secretary of the
U.S. Department of Homeland Security, Michael
Chertoff, recently announced that even the U.S.
government, with all its resources, cannot protect
the American public from all possible terrorist
attacks and instead must focus on trying to pre-
vent more serious or catastrophic strikes. In com-
ments made in March 2005, Chertoff advocated
adopting a risk-based approach: “Risk manage-
ment must guide our decision-making as we
examine how we can best organize to prevent,
respond, and recover from an attack. For that rea-
son, the Department of Homeland Security is
working with state, local, and private sector part-
ners on a National Preparedness Plan to target
resources where the risk is greatest.”
13
For more
information on focusing and funding communi-
ty emergency preparedness efforts, see Sections 4
and 10.
3. Determine the Risks and Hazards the Community Faces
Standing Together: An Emergency Planning Guide for America’s Communities
15
Recommended Planning Strategies:
? Use an “all-hazards approach.”
? Acknowledge the potential for a
catastrophic event.
? Compile a list of potential hazards.
? Recognize the problems inherent in
hazard lists.
? Assess and prioritize the listed hazards.
? Fine-tune the list by conducting a
“gap analysis.”
Standing Together: An Emergency Planning Guide for America’s Communities
Acknowledge the potential for a
catastrophic event.
If this acknowledgment has not occurred previ-
ously and has not served as the motivator for
emergency management planning, the acknowl-
edgment must occur at this point.Team members
must dispel all notions that “a catastrophic event
is not going to happen to us.”
A study recently conducted by the Joint
Commission indicates that significant progress in
this area needs to be made. When asked whether
their communities were at increased risk of expe-
riencing catastrophic events, such as an act of ter-
rorism, respondents from urban and rural hospi-
tals had differing perceptions: Respondents from
urban hospitals reported slightly more hazards or
threats on average per hospital than respondents
from rural hospitals, who were most concerned
about events such as hazardous materials acci-
dents, tornadoes, winter storms, and floods.
14
Compile a list of potential hazards.
The list of hazards can be generated during
something similar to a brainstorming session,
where every idea is written down without cen-
sorship or editorial comment. A review of com-
munity historical data may provide additional
items for the list.
When assembling this list, the team should be
careful not to limit it only to incidents that the
community has traditionally thought of as “disas-
ters”—hurricanes, earthquakes, tornadoes, and
other natural disasters. Mass casualty events, such
as transportation accidents, that may be more
commonly experienced should be listed. The
9/11 attack has forced Americans to “think out-
side the box” about the realm of possible man-
made incidents. Aircraft used as guided missiles,
nuclear, chemical, and biological weapons, and
other acts of terrorism have become a reality and
have forced emergency management teams to
think broadly. Insidious events, such as those that
could occur from an emerging infectious disease
outbreak, either intentional or unintentional,
have also expanded the realm of possible emer-
gencies.
Teams must exercise imagination and challenge
their assumptions about likely threats.The extent to
which the community may be at risk for terrorist-
induced events should be assessed by the team as
seriously as the risk of natural disaster, industrial
accident, or pandemic disease outbreak. The team
should consider the risk to their community as a
primary target of terrorism due to sensitive instal-
lations (industrial plants, military bases, federal
office buildings) or as a secondary target of terror-
ism due to larger neighboring towns needing a des-
tination to which they can evacuate residents or
from which they can borrow assets.
Sidebar 7 lists examples of community-based
emergencies.Teams will also want to consider the
threats recently identified by the U.S. Department
of Homeland Security (Sidebar 8).
16
Teams must exercise imagination and challenge their assumptions about likely threats.
Standing Together: An Emergency Planning Guide for America’s Communities
Recognize the problems inherent in
hazard lists.*
Hazard lists pose two problems. The first problem
is the possibility of exclusion or omission:There is
always a potential for new and unexpected hazards,
which is part of why maintaining an all-hazards
capability is important.
The second problem is that such lists involve
groupings, which can affect subsequent analysis.A
list may give the impression that hazards are inde-
pendent of one another, when in fact they are
often related (for example, an earthquake might
give rise to dam failure). In addition, lists may
group under one category very different causes or
sequences of events that require different types of
response. For example,“flood”might include dam
failure, cloudbursts, or heavy rain upstream. Lists
also may group a whole range of consequences
under the category of a single hazard.
“Hurricane” might include not only high winds,
storm surge, and battering waves, but even the
weakened, post-landfall tropical storm system that
can cause inland flooding.
It may be necessary, as the hazard analysis evolves,
to refine the list of hazards to ensure inclusion of
newly identified hazards (for example, a new
chemical plant in the region) and elimination of
previously listed hazards that no longer pose a
hazard (for example, rerouting trucks carrying
toxic substances).
Assess and prioritize the listed hazards.
The hazards and potential emergencies identified
in the HVA must be assessed and prioritized so
that appropriate prevention, preparation,
response, and recovery activities can be undertak-
en. One place to start this process is with the like-
lihood or probability of occurrence.Very likely, data on
the frequency of given incidents already exist.
Disasters that have occurred before in the com-
munity or its surrounding area will move toward
the top of the list of issues to be addressed, while
those with essentially no possibility of occurrence
will migrate to the bottom. A pandemic flu out-
break and other occurrences identified as priori-
ty disaster planning events (Sidebar 8) should
appear near the top of the list.
17
? Extremes of weather/climate/geography
? earthquake
? hurricane
? flood
? tornado
? blizzard
? drought
? volcanic eruption
? mudslide or avalanche
? Dam failure
? Regional power outage
? Civil disturbance
? Terrorism and weapons of mass destruction
? bombs (conventional or nuclear)
? biological/chemical agents
? cyberterrorism
? Public health emergencies (such as an outbreak of
SARS or pandemic influenza)
? Wildland or community-based fires
? Commercial transportation accidents
? train derailments
? air crashes
? multiple highway casualties
? Hazardous materials release
? radiation
? toxic chemicals
? Sudden influx of residents with health care and
other basic needs (food, water, shelter, clothing)
from neighboring communities
SIDEBAR 7. EXAMPLES OF COMMUNITY-BASED
EMERGENCIES
* The section was excerpted from Federal Emergency Management Agency: State and Local Guide (SLG) 101: Guide for All-Hazard
Emergency Operations Planning. 1996, pp. 2–5.http://www.fema.gov/pdf/rrr/2-ch.pdf (accessed Feb. 2005).
Standing Together: An Emergency Planning Guide for America’s Communities
For example, a major earthquake or chlorine tank
explosion would be high on the list of potential
emergencies for small communities in southern
California, but snowstorms and nuclear detona-
tions would be low on the list. Power failure and
flood might be somewhere in between. An
explosion in a chemical factory, groundwater
contamination from agricultural runoff, or a gas
main break near the local high school are other
examples of occurrences that may need to be
assessed, depending upon the community. Risk
may change if there are major construction pro-
jects under way or seasonal events, such as local
fairs or the ski season. Location may influence
risk, such as whether a community’s industrial
plant is on a floodplain or near a fault line. Maps
will be needed to assess location-related risk. Risk
assessment matrices can be found on state and
regional agency Web sites (see Tools).
Tools are available to help local officials identify
and compare potential hazards. For example, the
Center for Infrastructure Expertise, which is part
of the National Infrastructure Institute and oper-
ates under a grant from the U.S. Department of
Commerce’s National Institute of Standards and
Technology, has developed a software tool,
CARVER2.™ Offered free of charge, the tool
enables local, state, and national planners to iden-
tify and compare potential critical infrastructure
terrorist targets and assists government officials in
the allocation of grants and protective resources
(see Tools).
Severity is the next factor in the analysis to be
considered by the team. If the event occurs, the
team should consider how it will impact the
community. Could lives be lost or the health and
safety of individuals be threatened? If the answer
is “yes,” the hazard moves up on the list. If the
answer is “no,” the team can consider other ways
in which the community may be impacted, such
as disruption of services or damage to infrastruc-
ture. The team then adjusts the ranking of the
potential hazards according to the answers.
The final factor that merits consideration is the
community’s level of preparedness.This represents the
vulnerability portion of the HVA. If one of the
high-ranking incidents on the list took place
tomorrow, how well would the community man-
age the incident? Would other neighboring com-
munities be able to provide assistance? Do mutu-
al aid agreements exist? For each hazard, the team
develops an assessment of the community’s cur-
rent susceptibility to the hazard.
15
If the commu-
nity is not prepared for the incident, that poten-
tial hazard will need more attention than the ones
covered by well-established plans and agreements.
18
TOOLS:
? Map sources include Federal Emergency
Management Agency (http://www.fema.gov),
U.S. Geological Survey (http://www.usgs.gov),
state geological surveys, National Weather
Service (http://www.nws.noaa.gov), Federal
Insurance Administration (http://www.fema.gov/
about/fedins.shtm), the Local Emergency
Planning Committee Database
(http://www.epa.gov/ceppo/lepclist.htm), and
the Multi-Hazard Mapping Initiative
(http://www.hazardmaps.gov/atlas.php).
? The Center for Infrastructure Expertise’s
CARVER2™ software is available athttp://www.ni2cie.org.
? Pennsylvania Emergency Management Agency
offers an online introduction to hazard mitiga-
tion planning that includes hazard risk matrices.http://www.pema.state.pa.us/pema/CWP/vie
w.asp?a=198&Q=179259&pemaNavDLTEST
=%7C4715%7C4749%7C4752%7C4028%7C
(accessed Jun. 21, 2005).
Standing Together: An Emergency Planning Guide for America’s Communities
Fine-tune the list by conducting a
“gap analysis.”
A gap analysis of the vulnerabilities helps to iden-
tify incidents for which the community is not
prepared. The analysis identifies the key compo-
nents of each vulnerability, determines compo-
nents that are common across multiple hazards,
identifies issues that create high-impact weak-
nesses, and compares the relative costs and bene-
fits of the steps needed to rectify the situation.
15
If
community resources could not be called on for
assistance in addressing the incident, the team
should move the incident up on the list. This
analysis may result in some less-probable events
being moved up on the list due to the fact that
the most anticipated events are usually those for
which the community is most prepared.
The completed list of potential hazards will now
have those events that merit the most attention
near the top, whether because of probability of
occurrence, impact on the community, or level of
preparedness. Hazards that are less serious and not
as likely to happen should be near the bottom.All
of this ranking is dependent on judgment and
evaluation of the various considerations discussed
previously. There should be some rationale for
general placement on the list, although it may be
difficult to distinguish the placement of two
events that are sequenced consecutively. Because
of varying factors and judgment, two similar
communities in the same region may have differ-
ing analyses.
The hazard vulnerability analysis will help drive
consensus within the planning team about the
risk of specific hazards to the community.
However, the community itself will have its own
priorities related to perceptions of risk that the
planning group will have to understand in order
to develop preparedness goals and plans, to com-
municate effectively with the public, and, ulti-
mately, to sustain the public’s cooperation with
planning and response activities. These topics are
addressed in Section 7.
19
The hazard vulnerability analysis will help drive consensus within the planning team about the
risk of specific hazards to the community.
TOOLS:
? Federal Emergency Management Agency:
State and Local Guide (SLG) 101: Guide for
All-Hazard Emergency Operations Planning.http://www.fema.gov/preparedness/
state_local_prepare_guide.shtm.
Given scarce resources, small, rural, and suburban
communities must set goals for emergency plan-
ning and response efforts.The basic questions plan-
ning teams consider are What do we need to pre-
pare for? Are we prepared? and At what cost?
“Tilting at all the windmills”—trying to do every-
thing—represents an impossibility for most small
communities. The cost is just too great.
“Preparedness represents the ‘right place’ on the con-
tinuum between blind complacency (and bureau-
cratic inertia) and overwhelming paranoia,” notes
Irwin Redlener, M.D., associate dean and director
of the National Center for Disaster Preparedness.
Preparedness must be based on a real assessment of
hazard risk conducted through the hazard vulnera-
bility analysis (HVA) process. Risk can never be
totally ameliorated through the planning process;
some level of ongoing risk will always be present.
The emergency management planning team will
develop specific goals and objectives based on its
HVA. However, for any emergency management
plan, the general goals are as follows:
1. Save lives and protect health.
2. Protect and sustain the critical infrastructure,
property, and the environment needed to save
lives and protect health.
3. Find dual uses for existing or emerging capa-
bilities.
Goals 1 and 2 are inherent to emergency man-
agement planning; goal 3 is a strategic goal that
will help communities broaden the usage of
existing or emerging capabilities and investments.
According to the U.S. Department of Homeland
Security’s (DHS’s) National Response Plan, local
communities develop local emergency prepared-
ness plans “to provide a framework for under-
standing vulnerability to and risk from hazards,
and identify the pre-disaster and post-disaster
mitigation measures to reduce the risk from those
hazards.”
10(p. 62)
Much effort is under way in
numerous government agencies to identify pre-
paredness goals and thresholds in an empirical
manner. Because smaller communities have more
limited resources, planners in these communities
will need to derive their planning goals primari-
ly from their HVAs and rely on objective thresh-
olds as a secondary reference tool rather than a
primary planning tool.
Specific strategies that can help communities meet
the three goals mentioned in this section follow.
4. Set Goals for Preparedness and Response Planning
Standing Together: An Emergency Planning Guide for America’s Communities
20
Recommended Planning Strategies:
? Ensure that planning covers basic
societal functions.
? Make the planning process as doable
as possible.
? Address the four phases of emergency
management.
? Address human resources require-
ments.
? Plan for convergent responders.
? Involve the public in community pre-
paredness efforts.
? Enable people to care for themselves.
? Plan for layered preparedness and
response.
? Ensure compatibility with unified
command functions and the incident
command system.
? Link the community’s plan to the
NIMS and the NRP.
? Consider linking to the Joint Field
Office.
? Link to county and state plans and
planning initiatives.
? Establish mutual aid agreements.
Ensure that planning covers basic
societal functions.
Prioritizing the hazards as described in the previous
sections will support a planning effort that is more
relevant, cost-effective, and engaging for the plan-
ning team and the community as a whole. It will
support planning around very real crises (for exam-
ple, pandemic flu may receive a higher planning
priority than smallpox) and their potential impacts
on the basic societal functions. Preparedness and
response planning starts with the assumption that
basic societal functions are critical and must be
assured during and following an emergency.
Societal functions include the following:
? Public health
? Medical care
? Public works
? Energy supply
? Environment
? Economy
? Water/sanitation
? Shelter/clothing
? Food
? Communication
? Security
? Logistics/transport
? Search/rescue
For example, loss of power, whether due to tech-
nology failure (as with the blackouts on the East
Coast, fires on the West Coast), or hurricanes on
the eastern seaboard, has a ripple effect on access
to communication systems, water, fuel, and other
basic utilities that support societal functions.
Make the planning process as doable
as possible.
To get a jump start on emergency preparedness
and response planning, teams in small communi-
ties can consult available planning resources. The
Federal Emergency Management Agency
(FEMA), the National League of Cities, and state
municipal leagues provide in-depth guidance
through their publications and Web sites.
Planning teams will want to review the federal
government’s Universal Task List (UTL), which
defines what tasks need to be performed by fed-
eral, state, local, and tribal jurisdictions and the
private sector to prevent, protect against, respond
to, and recover from events defined in the
National Planning Scenarios.
16
Version 2.1 identi-
fies approximately 1,600 unique tasks. According
to that document,“The purpose of the UTL is to
list ‘what’ tasks need to be performed, while
reserving the flexibility to determine ‘who’
should perform them and ‘how.’ No single juris-
diction or agency is expected to perform every
task. Rather, individual jurisdictions will need to
assess and select the tasks based on their own spe-
cific roles, missions, and functions.”
In addition, the DHS released a list of 15 hypo-
thetical terrorist attacks, disease outbreaks, and
natural disasters that is being used to set DHS
spending priorities and to focus emergency plan-
ning efforts (Sidebar 8).
Standing Together: An Emergency Planning Guide for America’s Communities
21
TOOLS:
? Federal Emergency Management Agency:http://www.fema.gov/preparedness/
state_local_prepare_guide.shtm.
? The National League of Cities, which repre-
sents 49 state municipal leagues, and through
them more than 18,000 cities and towns
nationwide, offers links and tools through its
Web site.http://www.nlc.org/
state_municipal_leagues.
TOOLS:
? U.S. Dept. of Homeland Security: Universal
Task List: Version 2.1. May 23, 2005.http://www.ojp.usdoj.gov/odp/docs/
UTL2_1.pdf.
Standing Together: An Emergency Planning Guide for America’s Communities
Address the four phases of emergency
management.
Planning should address each of the four phases
of emergency management, which are prevention,
preparation, response, and recovery. The labels and
sequence used for these four phases vary slightly
in government and agency documents. At times,
mitigation, preparedness, and protection appear
instead of, or in addition to, one of the previous-
ly mentioned terms.
*
This planning guide uses
the phrases appearing with greatest frequency in
the National Response Plan.
Prevention involves, according to the National
Response Plan, actions taken to avoid an incident
or to intervene to stop an incident from occur-
ring. Prevention involves actions taken to protect
lives and property. Prevention actions related to
terrorism threats and incidents include law
enforcement activities and protective activities.
Initial prevention efforts include, but are not lim-
ited to, actions to do the following:
? Collect, analyze, and apply intelligence and
other information
? Conduct investigations to determine the full
nature and source of the threat
? Implement countermeasures such as surveil-
lance and counterintelligence
? Conduct security operations, including vulner-
ability assessments, site security, and infrastruc-
ture protection
? Conduct tactical operations to prevent, inter-
dict, preempt, or disrupt illegal activity
? Conduct attribution investigations, including
an assessment of the potential for future relat-
ed incidents
? Conduct activities to prevent terrorists, terror-
ist weapons, and associated materials from
entering or moving within the United States
The majority of initial actions in the threat or
hazard area are taken by first responders and local
government authorities and include efforts to
protect the public and minimize damage to prop-
erty and the environment.
10(p. 53)
The closely related concept of mitigation involves
activities that attempt to lessen the severity and
impact a potential disaster or emergency may
have on a community. Mitigation activities may
reduce, or even eliminate, the possibility of disas-
ter occurrence. Often they are required by other
22
The U.S. Department of Homeland Security (DHS)
released this list of 15 hypothetical terrorist attacks,
disease outbreaks, and natural disasters that is being
used to set DHS spending priorities and to focus
emergency planning efforts.
1. Nuclear detonation
2. Pandemic flu disease outbreak
3. Aerosolized anthrax biological attack
4. Pneumonic plague biological attack
5. Food contamination biological attack
6. Foot and mouth disease biological attack
7. Blister agent chemical attack
8. Toxic industrial chemicals attack
9. Nerve agent chemical attack
10. Chlorine tank explosion chemical attack
11. Major earthquake
12. Major hurricane
13. Dirty bomb radiological attack
14. Improvised bomb explosives attack
15. Cyber attack
Source: U.S. Dept. of Homeland Security. http://
www.dhs.gov/dhspublic.
SIDEBAR 8. NATIONAL PLANNING SCENARIOS
*The Joint Commission uses mitigation, preparedness, response, and recovery. Other presentations will put mitigation or prevention at the end of
the process, recognizing that what is learned in response and recovery should inform future mitigation activities. The National Response
Plan uses six terms—prevention, preparation, response, recovery, mitigation, and protection—but predominantly refers to prevention, preparation,
response, recovery.
Standing Together: An Emergency Planning Guide for America’s Communities
codes and standards. For example, compliance
with the National Fire Protection Association’s
Life Safety Code
®
will mitigate the impact of a fire
in a facility.*
Preparation (or preparedness) is defined as those
activities a community undertakes to build capac-
ity and identify resources that may be used should
a disaster or emergency occur. Preparedness
involves planning how to respond if a disaster
occurs. This activity has been the foundation of
emergency planning for many years. Some
important preparation steps include the following
and are outlined in this planning guide:
? Creating an inventory of resources that may be
needed in an emergency, including prear-
ranged agreements with neighboring commu-
nities and bordering states
? Maintaining an ongoing planning process
? Training community members in basic
response actions
? Implementing communitywide and regional
exercises and drills
Response refers to the actual emergency manage-
ment. Response involves identifying and treating
victims, reducing secondary impact to the com-
munity (for example, the spread of disease in the
community), and controlling the negative effects
of emergency situations. The National Response
Plan’s definition of response follows:
Response is those activities that address the short-
term, direct effects of an incident.These activities
include immediate actions to preserve life, proper-
ty, and the environment; meet basic human needs;
and maintain the social, economic, and political
structure of the affected community. Response
actions also include immediate law enforcement,
fire, ambulance, and emergency medical service
actions; emergency flood fighting; evacuations;
transportation system detours; emergency public
information; actions taken to minimize additional
damage; urban search and rescue; the establishment
of facilities for mass care; the provision of public
health and medical services, food, ice, water, and
other emergency essentials; debris clearance; the
emergency restoration of critical infrastructure;
control, containment, and removal of environmen-
tal contamination; and protection of responder
health and safety. During the response to a terrorist
event, law enforcement actions to collect and pre-
serve evidence and to apprehend perpetrators are
critical.These actions take place simultaneously
with response operations necessary to save lives
and protect property, and are closely coordinated
with the law enforcement effort to facilitate the
collection of evidence without impacting ongoing
life-saving operations.
10(pp. 53-54)
The recovery phase involves the restoration of the
community’s functions and activities following a
disaster. Recovery involves how the community
will get back to business as usual when the inci-
dent is over, including how the public will be
reassured that it is safe to return to normal activ-
ities, such as work and school. Recovery aspects
of an emergency management plan depend, of
course, on the nature of the incident, whether the
emergency is ongoing, and whether the local area
or region is still affected. The recovery section of
emergency management plans generally specifies
recovery steps or stages. The National Response
Plan defines recovery as follows:
Recovery is the development, coordination, and exe-
cution of service- and site-restoration plans and the
reconstitution of government operations and ser-
vices through individual, private-sector, nongovern-
mental, and public assistance programs. Recovery
involves actions needed to help individuals and
communities return to normal when feasible.
10(p. 54)
Address human resources requirements.
When an emergency occurs, small, rural, and sub-
urban communities often face significant human
23
* Life Safety Code
®
is a registered trademark of the National Fire Protection Association, Quincy, MA.
Standing Together: An Emergency Planning Guide for America’s Communities
resources challenges because their populations are
smaller than those of cities. The availability of first
responders and medical personnel often presents a
particularly significant problem. For example, the
already limited number of community members
who are volunteers in the National Guard or
Community Emergency Response Team (CERT)
may not be available because they may already be
activated and overseas or helping in a different
locale. Double-counting of available resources often
occurs. Whenever possible, lists of possible first
responders and medical personnel in the commu-
nity should be de-duplicated.
? Example:The emergency planning team of a small
suburban community approximately 30 miles out-
side Cleveland recognized that the community was
totally dependent on its volunteer firefighters and
volunteer paramedics as first responders. Most of
these individuals had full-time jobs in other commu-
nities, so any sense of comfort that the individuals
would be available to the community as first respon-
ders during an areawide disaster was a false sense of
comfort.The team’s preparation and response efforts
focused on how to prepare the community to respond
without the full benefit of its all-volunteer first
responder force.This involved consideration of appro-
priate training programs for community residents.
17
For agencies and other employers in hurricane-
prone areas and surrounding communities, a
range of staffing-related issues requires considera-
tion before, during, and after a major storm. For
example, as part of its annual hurricane prepared-
ness activities, Health First Health System in
Melbourne, Florida, maintains and updates
extensive human resources policies, procedures,
and communication plans. These policies address
the following:
? Storm staffing and communications
? Requirements and exemptions for reporting to
work
? Childcare enrollment forms for storm volunteers
? Sleeping arrangements
? Facility safety
? Sheltering for patients and their families
? Sheltering for employees and their families
? Preparing and securing work areas (personal
computers, telephones, miscellaneous desktop
items)
? Payroll and compensation arrangements during
and after the storm
? Leave of absence policies
? Securing pets and livestock
Plan for convergent responders.
In any disaster, the initial search and rescue is usu-
ally done by laypeople in the immediate area.The
phenomenon known as convergence—people
gathering quickly at a disaster site—is well docu-
mented.
18
It is part of human nature to want to
help. Contrary to popular belief, people do not
panic in the first phases of a disaster; most behave
in a rational manner and take what seem to them
logical steps to save themselves and others at a
disaster site.
19
As a result, the actual first responders are likely to
be not professionals or specially trained personnel
but local school teachers, parents, business execu-
tives, teenagers, or other “convergent volunteers”
who are there at the time of the disaster. “The
people who spontaneously come forward to vol-
unteer following a major disaster genuinely want
to help disaster victims. But from the perspective
of first responders and relief agencies, their gen-
erosity looks quite different. From their perspec-
tive, convergent volunteers can be liabilities, not
assets. They physically get in the way of people
doing vital work, they divert resources away from
serving victims to processing the volunteers, and
they raise serious questions of liability, both if the
volunteer is injured and if the volunteer does
injury,” notes one report from California.
20
Some observers indicated that convergent
response following the Loma Prieta earthquake
24
Standing Together: An Emergency Planning Guide for America’s Communities
25
in 1989 was “the disaster within the disaster” in
some communities. To minimize risks associated
with convergent responders, communities should
take steps to prepare its citizenry to participate
effectively in emergency response efforts. Medical
volunteers also are very likely to arrive at disaster
scenes “ready to help.” Community response
plans must address such an influx so that valuable
attention and resources are not diverted unneces-
sarily from response coordination to managing
excess unplanned volunteers.
? Example: In the Oklahoma City terrorist bombing
of the federal building in 1995, the many laypeople
that converged on the scene following the blast per-
formed a great service to the victims they helped.
However, they were also a concern to the trained res-
cuers. Convergence can be used to advantage if it is
organized. In Oklahoma City, hospital emergency
rooms and clinics that were overrun by volunteers
sent medical teams to the bombing site.
21
This
increased risk to the trained fire department rescue
teams who become responsible not only for the vic-
tims but also for extra medical personnel. In more
than one case during this disaster, fire department
personnel removed their own protective gear and
placed it over volunteer medical personnel who found
themselves in dangerous situations.
Strategies for managing volunteers include the
following:
? Developing volunteer professional registries
? Developing a system to register other volun-
teers and provide baseline and “just-in-time”
training
? Training volunteers based on emergency pre-
paredness and response competencies (see
Section 11)
? Developing a system to do background checks
and credential checks on volunteers (see infor-
mation on the federal government’s credential-
ing initiative, Emergency System for Advanced
Registration of Volunteer Health Care Personnal
(ESAR-VHP), on page 49)
? Developing a system to identify registered pro-
fessionals at disaster scenes
? Developing a tracking system to account for
volunteers at disaster scenes
? Addressing legal/liability related to cre-
dentialing and other issues
Some communities are also considering establish-
ing a “personnel processing point” or location for
registering and tracking medical volunteers who
report to a disaster scene. Robert M. Gougelet,
M.D., assistant professor of medicine and medical
director, disaster response, at the Dartmouth
Hitchcock Medical Center, recommends that med-
ical volunteers be divided into two distinct groups:
? Individuals who are members of an established
response team, such as a Disaster Medical
Assistance Team (DMAT), Medical Reserve
Corps (MRC), or Metropolitan Medical
Response System (MMRS) strike team, or
who are registered before an event occurs
? Individuals who arrive spontaneously at the
scene
“The on-scene incident command should have a
process to verify the identification and the cre-
dentials of responders.This process should include
checking a government-issued identification card
and a professional identification card such as a
hospital identification card. In addition, this pro-
cess should include independent third-party veri-
The on-scene incident command should have a process to verify the identification and the
credentials of responders.
Standing Together: An Emergency Planning Guide for America’s Communities
fication, such as confirming with the state’s medi-
cal professional database,” says Gougelet.
22
Sponsored by the Office of the Surgeon General,
the MRC program, a component of the Citizen
Corps, provides an organized way for medical and
public health volunteers, such as practicing,
retired, or student physicians, nurses, other health
professionals, and citizens interested in health
issues, to offer their skills and expertise during
local large-scale emergency situations.
23
The
MRC provides surge capacity personnel by pre-
identifying, training, and credentialing supple-
mental personnel to assist with emergency oper-
ations, such as mass antibiotic dispensing or mass
immunization campaigns.
? Example: In Connecticut hospitals, each specific disci-
pline, such as nursing, diagnostic imaging, respiratory
therapy, and physicians, has a representative that helps
to recruit and organize fellow practitioners to serve in
the MRC.The momentum has been considerable and
the state has been selected by the Health Resources
and Services Administration as one of the 10
advanced credentialing demonstration projects.
Involve the public in community
preparedness efforts.
Teams should consider plans to educate the public
about the existence of community preparedness
plans and should communicate with the public
about how to prepare for and respond to an emer-
gency situation.This involves targeting the family-
unit level (including individuals living alone) for
educational initiatives related to emergency equip-
ment, training, and preparedness.This also involves
identifying and planning to meet the needs of par-
ticularly vulnerable populations, including chil-
dren; the elderly; non-English-speaking people;
individuals with mental health issues, chemical
dependencies, or developmental disabilities; those
who are speech, hearing or mobility impaired;
institutionalized populations; the homeless; and
those individuals who are significantly geographi-
cally isolated.
The Redefining Readiness Study conducted by
the Center for the Advancement of Collaborative
Strategies in Health indicated that the American
public has had little or no role in developing ter-
rorism preparedness plans and that half of the
American people (55%) say their community is not
at all or only a little prepared to deal with the kinds
of terrorist attacks addressed in the study (a dirty
bomb and a smallpox outbreak).
24
“An important
finding of our study is the documentation that a
large proportion of the American people are inter-
ested in community-level planning—not just in
learning more about plans, but in being actively
involved in developing plans,” note the study’s
authors.
24(p. 44)
Similarly, a study by Columbia
University’s National Center for Disaster
Preparedness indicated that only 35% of Americans
think their community has an adequate emergency
response plan currently in place.
25
Such studies indicate that communities must be
better prepared to handle the more frightening
aspects of disasters, about which they often are “in
the dark.” For example, the process could address
how to handle unknown hazardous agents, how to
manage an unanticipated influx of victims at the
local hospital’s emergency department, and how to
decontaminate or isolate contaminated victims.
Public education and information dissemination
about isolation and quarantine for infectious dis-
eases are critically important inclusions in planning
efforts. The public must know that they may be
isolated at the hospital or quarantined at home, and
significant preparations will need to be made in
advance. Laws may need to be enacted on state or
local levels, and law enforcement and court system
personnel must be educated about their roles dur-
ing an event requiring isolation or quarantine.
26
Standing Together: An Emergency Planning Guide for America’s Communities
Basic needs for those living under quarantine must
be addressed, such as health services provided at
home or the ability of children in the household
to attend school.
? Planners should work directly with community
residents throughout the planning process.
Some segments of the community may be pre-
pared, but U.S. communities as a whole are not
prepared and not involved in preparedness
planning. Citizens can also be part of actual
events or drills that test emergency plans (see
Section 11).
Enable people to care for themselves.
The community must be informed and prepared.
The emergency plan needs to include a well-
defined risk communication plan that contains
information on the guidance that will be provid-
ed to the public and how that guidance will
occur. For example, the plan could indicate that
in the event of widespread exposure to a certain
chemical agent, the public will be educated
through distribution of fliers, other written mate-
rial, and public service announcements on local
radio and television stations, that it is better to
stay at home and take a shower than to go to the
hospital to be decontaminated. Planning that pre-
pares the community to help itself can reduce the
potential surge in demand for services experi-
enced during an actual emergency.
Ultimately, the ability of a community to survive
a major incident is dependent on its residents’
ability to provide self-care. Education and risk
communication at a “grass roots” level through all
kinds of community groups, such as high school
football teams, Boy/Girl Scouts, and the local
civic organizations, are critical to effective self-
care. Community awareness, education, and
engagement are essential. Hurricane plans in
Florida provide an excellent example of proac-
tive, multilingual, and pervasive preparedness.
Evacuation signs appear throughout the state and
are well-recognized in all communities.
Public concern about emergencies has not neces-
sarily translated into appropriate protective
actions in personal preparedness. “There is strong
baseline data that support efforts to increase the
public’s awareness of the need and necessary steps
to prepare themselves for a disaster. Only 20 per-
cent report being prepared for a terrorist-related
disaster, and only 13 percent report having a
neighborhood plan for disasters,” notes a DHS
Office of Citizen Corps report.
26
Less than half of
survey respondents have both an emergency plan
and at least one emergency supply kit.
? Example: Consider what might be involved in edu-
cating the public to respond to an influenza pan-
demic. In most cases, influenza can be treated at
home.The message to the public can be “Stay at
home, take care of yourself following basic self-care
protocols distributed by the health department; seek
hospital care if you experience any of the severe
symptoms described in the protocol.”
Plan for layered preparedness and
response.
Teams can consider whether and how it might be
possible to ensure some level of layered prepared-
ness and response mechanisms. For example, to
avoid systemwide failure, plans could specify pro-
cesses for redundant systems and contingency
plans to pick up the burden in case one part of
the system is disabled or overwhelmed.
? Example:The local hospital or other health care
organization considers multiple levels of redundancy
for its communications systems, including backup
phone systems, additional radio licenses for portable
radios, cell phones, Ham radios, satellite phones, per-
sonal digital assistants, e-mail, and so forth. Use of
these technologies assures not only redundancy but a
level of interoperability so that the organization’s
27
Standing Together: An Emergency Planning Guide for America’s Communities
emergency command operation can maintain commu-
nications with municipal, regional, or state emergen-
cy operations centers and/or fire and emergency
medical services (EMS) agencies.
Ensure compatibility with unified
command functions and the incident
command system.
Community planning templates and processes
should dovetail with unified command functions
and the incident command system (ICS). Unified
command concepts, widely used by civil author-
ities, provide guidelines and enable agencies with
different legal, geographic, and functional respon-
sibilities to coordinate, plan, and interact effec-
tively.
27
According to the DHS, “The ICS is a
management system designed to enable effective
and efficient domestic incident management by
integrating a combination of facilities, equip-
ment, personnel, procedures, and communica-
tions operating within a common organizational
structure, designed to enable effective and effi-
cient domestic incident management.”
27(p. 7)
The National Incident Management System (NIMS)
adopts the basic tenets of the ICS and outlines the
interrelationship of the ICS and the NIMS as fol-
lows:
The initial response to most domestic incidents
is typically handled by local 911 dispatch cen-
ters, emergency responders within a single juris-
diction, and direct supporters of emergency
responders. Most responses need go no further.
In other instances, incidents that begin with a
single response discipline within a single juris-
diction may rapidly expand to multidiscipline,
multijurisdictional incidents requiring significant
additional resources and operational support.
Whether for incidents in which additional
resources are required or are provided from dif-
ferent organizations within a single jurisdiction
or outside the jurisdiction, or for complex inci-
dents with national-level implications (such as
an emerging infectious disease or a bioterrorist
attack), the ICS provides a flexible core mecha-
nism for coordinated and collaborative incident
management.When a single incident covers a
large geographical area, multiple local ICS orga-
nizations may be required. Effective cross-juris-
dictional coordination using processes and sys-
tems described in the NIMS is absolutely critical
in this instance.
27(p. 7)
Link the community’s plan to the NIMS
and the NRP.
Commencing in 2005, the DHS has made adop-
tion of the NIMS and the National Response Plan
(NRP) a requisite for access to federal funding by
local organizations.
27
Sidebar 9 is an overview of
the federal initiatives and how they relate to local
initiatives. Community plans and initiatives
should link to the NIMS and the NRP for both
funding and coordination purposes.
The NRP requires communities to do the fol-
lowing:
? Use established incident reporting protocols to
notify local and regional Joint Terrorism Task
Forces (JTTFs) and the Homeland Security
Operations Center (HSOC), as appropriate.
? Coordinate with the HSOC regarding proce-
dures for establishing connectivity for domes-
tic incident management purposes. Local gov-
ernment procedures should be coordinated
with the respective state government and/or
emergency management agency.
? Modify existing incident management and
emergency operations plans to ensure proper
alignment with NRP coordinating structures,
processes, and protocols.
? Notify the secretary of homeland security of
any substantial conflicts between this plan and
state or tribal government laws or regulations.
This plan is not intended to compromise
existing state or tribal government laws or
corresponding incident management or emer-
gency response plans.
10
28
Standing Together: An Emergency Planning Guide for America’s Communities
29
Community planning teams must ensure that
they complete these tasks.
Consider linking to the Joint Field
Office.
Community teams can consider assigning a liai-
son to the Joint Field Office (JFO) to facilitate
interaction, communication, and coordination in
an emergency. According to the DHS’s National
Response Plan, the JFO is a multiagency coordi-
nation center that provides a central point for
federal, state, local, tribal, nongovernmental, and
private-sector organizations with primary
responsibility for incident oversight, direction,
and/or assistance.The JFO uses the scalable orga-
nizational structure of the NIMS ICS, not for
managing on-scene emergency operations but
for providing support to on-scene efforts and
conducting broader support operations that may
extend beyond the incident site.
10
Link to county and state plans and
planning initiatives.
Local elected officials should ensure that their com-
munities’ plans are linked to the regional emergen-
cy plan (for example, at the county or multicounty
level), which should itself be linked to a state-
approved emergency plan approved by FEMA.This
can support a more efficient and timely allocation
of resources. Planning can begin with an existing
county or state plan or initiatives that local leaders
have already acknowledged or bought into, such as
a local emergency planning committee (LEPC).
State planning initiatives include LEPCs, which
are appointed by State Emergency Response
Commissions. The focus of these committees has
traditionally revolved around hazardous materials;
the federal proponent is the Environmental
Protection Agency. LEPC members are volun-
teers and government employees who live with-
The goal of the National Incident Management System
and the National Response Plan (NRP), to be used as a
joint tool, is to provide “a consistent nationwide tem-
plate to enable federal, state, local, and tribal govern-
ments and private-sector and nongovernmental orga-
nizations to work together effectively and efficiently
to prevent, prepare for, respond to, and recover from
domestic incidents, regardless of cause, size, or com-
plexity, including acts of catastrophic terrorism.”
A basic premise of the NRP is that incidents are gen-
erally handled at the lowest jurisdictional level possi-
ble. Police, fire, public health and medical, emergency
management, and other personnel are responsible for
incident management at the local level. In some
instances, a federal agency in the local area may act as
a first responder and may provide direction or assis-
tance consistent with its specific statutory authorities
and responsibilities. In the vast majority of incidents,
state and local resources and interstate mutual aid nor-
mally provide the first line of emergency response and
incident management support.
When an incident or potential incident is of such
severity, magnitude, and/or complexity that it is con-
sidered an “Incident of National Significance”accord-
ing to the criteria established in the NRP, the secre-
tary of homeland security, in coordination with other
federal departments and agencies, initiates actions to
prevent, prepare for, respond to, and recover from the
incident.These actions are taken in conjunction with
state, local, tribal, nongovernmental, and private-sec-
tor entities as appropriate to the threat or incident. In
the context of Stafford Act disasters or emergencies,
U.S. Department of Homeland Security (DHS) coor-
dinates supplemental federal assistance when the con-
sequences of the incident exceed state, local, or tribal
capabilities.
Source: U.S. Dept. of Homeland Security (DHS): National
Incident Management System.Washington, DC: DHS, Mar. 1,
2004, p. ix; and U.S. Dept. of Homeland Security (DHS):
National Response Plan. Washington, DC: DHS, Dec. 2004,
p. 15.
SIDEBAR 9. A KEY TOOL FOR SCALABLE INCIDENT
MANAGEMENT
Standing Together: An Emergency Planning Guide for America’s Communities
30
in a specific local emergency planning district.
Federal legislation states that, at a minimum, each
LEPC shall include representatives from the fol-
lowing groups: elected officials, law enforcement,
civil defense, fire fighting, first aid, health, local
environmental, hospital, transportation personnel,
broadcast and print media, community groups,
and owners/operators of facilities. For, example,
there are 20 LEPCs in the state of Alaska.
Examples:
? In Illinois, the West Central Municipal Conference
has created a regional Homeland Security
Coordinating Committee, which includes the mayors
of 38 communities, some large and some small.
Among other activities, this committee monitors alloca-
tions and expenditures by local, state, federal, and pri-
vate entities for homeland security and develops and
influences policies, protocols, and coordinated efforts.
? The Mayoral Institute for WMD (Weapons of
Mass Destruction) and Terrorism Incident
Preparedness, provided through the Idaho Institute
of Emergency Management, provides the nation’s
mayors a “mayors only” forum to discuss strategic
and executive-level issues and challenges and to
share proven strategies and practices related to
WMD/terrorism preparedness.
? The Peoria County Emergency Services and Disaster
Agency, in Peoria, Illinois, coordinates all phases of
comprehensive emergency management, defined by the
agency as mitigation, preparedness, response, and
recovery, for Peoria County. It functions collaboratively
within a five-county region to integrate planning and
response across multiple jurisdictions.
? Missouri’s Department of Health and Senior
Services has a close working relationship with the
Missouri Hospital Association (MHA).Three
MHA planners work with the 144 member hospi-
tals and coordinate hospital planning efforts, assuring
that hospital representatives are at the local, regional,
and state planning table and linked to each plan.
Establish mutual aid agreements.
Emergency response agencies establish mutual aid
agreements, sometimes called memorandums of
understanding or memorandums of agreement, with
neighboring jurisdictions to support a more
effective response effort. Disaster mutual aid con-
sists of organized and supervised coordination, in
which reciprocal help is given by neighboring or
contractual communities during public emergen-
cies in the form of personnel, equipment, and
physical facilities. Mutual aid agreements include
policies and procedures for maintaining coverage
on a day-to-day basis and during emergencies.
Given the resource limitations of most small,
rural, and suburban communities, establishing and
maintaining mutual aid agreements are critical to
community ability to prepare for and respond to
an emergency. However, communities, no matter
how small, must not neglect to establish a baseline
level of capacity and capability.
TOOLS:
? American Hospital Association: Model Hospital
Mutual Aid Memorandum of Understanding.http://www.hospitalconnect.com/aha/
key_issues/disaster_readiness/resources/
content/ModelHospitalMou.doc.
The planning team’s next activity is to determine
the community’s current capacities and capabili-
ties for emergency prevention, preparation,
response, and recovery. A systematic asset inven-
tory can be conducted to account for the major
services required to achieve general emergency
management goals identified in Section 4.
Created by all relevant planning partners identi-
fied so far, at a minimum those listed in Sidebar
4, this inventory describes the assets under their
purview. Strategies to assist communities in
determining capacities and capabilities follow.
Use federal government asset categories
and target capabilities as a guide.
To assure a thorough identification of inventory
asset categories, community planning teams can use
the national resource typing list published by the
federal government in the National Response Plan
(NRP) and National Incident Management Systems
(NIMS) documents. Sidebar 10 outlines these cate-
gories, which closely parallel the emergency sup-
port functions (ESFs) outlined in Sidebar 6.When
community resources are limited in any one cate-
gory, the resource typing categories can be used as
a guide to areas where mutual aid agreements are
needed.
5. Determine Current Capacities and Capabilities
Standing Together: An Emergency Planning Guide for America’s Communities
31
Recommended Planning Strategies:
? Use federal government asset cate-
gories and target capabilities as a
guide.
? Specifically consider the public as an
asset category.
? Consider other groups not yet repre-
sented at the planning table.
? Identify geographic features and vul-
nerabilities that may affect capabilities.
? Consider surge capacity and consult
surge planning resources.
? Consider all community health
resources.
? Define critical capacities for each
health entity and link to state
databases.
? Know the federal government’s defi-
nition of required surge capacity.
? Consider the issues involved with
standards of care during mass casualty
events.
? Identify dual uses for existing or
emerging capabilities.
? Identify alternative care and shelter
facilities.
? Identify federal resources in the com-
munity.
? Identify gaps in community assets.
? Mass care: To support efforts to meet the mass care
needs of disaster victims, including delivering
such services as supplying victims with shelter,
food, and emergency first aid; supplying bulk dis-
tribution of emergency relief supplies; and col-
lecting information to and for a disaster welfare
information system designed to report on victim
status and assist in reuniting families.
? Health and medical: To meet public health and
medical care needs following a disaster or emer-
gency or during a potential developing medical
situation.
? Food and water: To identify, secure, and arrange for
the transportation of safe food and water to
affected areas during a disaster or emergency.
? Search and rescue: To provide specialized lifesaving
assistance in the event of a disaster or emergency,
including locating, extricating, and providing on-
site medical treatment to victims trapped in col-
lapsed structures.
continued
SIDEBAR 10. RESOURCE CATEGORIES USED IN THE
NATIONAL RESOURCE TYPING SYSTEM
Standing Together: An Emergency Planning Guide for America’s Communities
The capabilities identified by the federal govern-
ment can also provide helpful guidance. Sidebar
11 provides the U.S. Department of Homeland
Security’s (DHS’s) Target Capabilities List (TCL),
which includes 36 critical capabilities needed to
perform the tasks identified in the DHS’s
Universal Task List described earlier.
32
? Energy: To help restore energy systems following a
disaster or emergency.
? Fire fighting: To detect and suppress fires.
? Law enforcement and security: To provide law
enforcement assistance during response and
recovery operations; to assist with site security
and investigation.
? Hazardous materials response: To support the
response to an actual or potential discharge
and/or release of hazardous materials.
? Public works and engineering: To assist those engaged
in lifesaving, life-sustaining, damage mitigation,
and recovery operations following a major disas-
ter or emergency by providing technical advice,
evaluation, and engineering services; contracting
for construction management and inspection and
for the emergency repair of water and wastewater
treatment facilities; supplying potable water and
ice and emergency power; and arranging for
needed real estate.
? Volunteers and donations: To support the manage-
ment of unsolicited goods and unaffiliated volun-
teers, and to help establish a system for managing
and controlling donated goods and services.
? Information and planning: To collect, analyze, pro-
cess, and disseminate information about a poten-
tial or actual disaster or emergency to facilitate
overall activities in providing assistance to support
planning and decision making.
? Communications: To provide communications sup-
port for incident management efforts.
? Resource management: To provide operational assis-
tance for incident management operations.
? Public information: To contribute to the well-being
of the community following a disaster by dissem-
inating accurate, consistent, timely, and easy-to-
understand information; to gather and dissemi-
nate information about disaster response and
recovery process.
? Transportation: To provide transportation to per-
form incident management missions following a
major disaster or emergency; to coordinate inci-
SIDEBAR 10. RESOURCE CATEGORIES USED IN THE
NATIONAL RESOURCE TYPING SYSTEM (CONTINUED)
dent management operations and restoration of
the transportation infrastructure.
? Animals and agricultural issues: To coordinate activ-
ities responding to an agricultural disaster and/or
when the health or care of animals is at issue.
Source: Adapted from U.S. Dept. of Homeland Security
(DHS): National Incident Management System. Washington,
DC: DHS, Mar. 1, 2004, p. 122.
TOOLS:
? U.S. Dept. of Homeland Security: Target
Capabilities List.http://www.ojp.usdoj.gov/odp/
assessments/hspd8.htm.
Common-target capabilities
1. Planning (preparedness)
2. Interoperable communications (communica-
tions and information management)
Prevent mission area-target capabilities
3. Information collection and threat recognition
(manage data collection)
4. Intelligence fusion and analysis (analyze intel-
ligence)
5. Information sharing and collaboration (dis-
seminate threat information)
6. Terrorism investigation and apprehension
(investigate and apprehend terrorist suspects)
7. CBRNE* detection (defeat weapons)
Protect mission area-target capabilities
8. Risk analysis (assess vulnerabilities)
9. Critical infrastructure protection (protect
assets and property)
continued
SIDEBAR 11. TARGET CAPABILITIES LIST
(VERSION 1.1)
* Chemical, biological, radiological, nuclear, or explosive
Standing Together: An Emergency Planning Guide for America’s Communities
Specifically consider the public as an
asset category.
Rather than being looked at primarily as poten-
tial casualties, the public can be considered part of
the community’s assets in emergency manage-
ment initiatives. As such, the capacities and capa-
bilities of the general public should be accounted
for where possible.The willingness of the average
person to be an early responder may vary
depending upon whether the event is a slow-
moving biological event or a sudden-impact nat-
ural or man-made event. The team thus should
carefully consider whether certain assignments
might be ones assumed by volunteers as opposed
to trained or professional responders.
Consider other groups not yet
represented at the planning table.
Such groups may offer additional capabilities in
supporting communication or transportation
efforts, providing temporary shelter and supplies,
and assisting with other emergency needs. One
way to identify such groups is to consider voca-
tional or avocational special interest groups that
represent certain skills or resources that might be
valuable in an emergency, such as truck drivers,
33
10. Food and agriculture safety and defense
(safeguard public health)
11. Public health epidemiological investigation
and laboratory testing (safeguard public
health)
12. Citizen preparedness and participation (pre-
pare the public)
Respond mission area-target capabilities
13. On-site incident management (manage incident)
14. Emergency operations center management
(manage incident)
15. Critical resource logistics and distribution
(manage incident)
16. Volunteer management and donations (man-
age incident)
17. Worker health and safety (manage incident)
18. Public safety and security response (manage
incident)
19. Animal health emergency support (respond
to hazard)
20. Environmental health and vector control
(respond to hazard)
21. Explosive device response operations
(respond to hazard)
22. Fire-fighting operations/support (respond to
hazard)
23. Weapons of Mass Destruction/hazardous
materials response and decontamination
(respond to hazard)
24. Citizen protection: evacuation and/or in-
place protection (implement protective
actions)
25. Isolation and quarantine (implement protec-
tive actions)
26. Search and rescue (conduct search and res-
cue)
27. Emergency public information and warning
(distribute public information)
28. Triage and pre-hospital treatment (provide
medical care)
29. Medical surge (provide medical care)
30. Medical supplies management and distribu-
tion (provide medical care)
SIDEBAR 11. TARGET CAPABILITIES LIST
(VERSION 1.1) (CONTINUED)
31. Mass prophylaxis (distribute prophylaxis)
32. Mass care (sheltering, feeding, and related
services) (provide mass care)
33. Fatality management (manage fatalities)
Recover mission area-target capabilities
34. Structural damage assessment and mitigation
(rebuild property)
35. Restoration of lifelines (restore lifelines)
36. Economic and community recovery (restore
economic institutions)
Source: U.S. Dept. of Homeland Security: Target
Capabilities List: Version 1.1. May 23, 2005.http://www.ojp.usdoj.gov/odp/docs/TCL1_1.pdf
(accessed Jun. 17, 2005).
Standing Together: An Emergency Planning Guide for America’s Communities
34
snowmobile owners, youth group members,
recreational boaters, and so forth. For example, in
one community drill that tested distribution of an
emergency pharmaceutical stockpile, high school
football teams were trained and deployed to sup-
port security around the stockpile prior to its dis-
tribution in the community.
Identify geographic features and
vulnerabilities that may affect
capabilities.
In addressing current and needed capacities and
capabilities, “the planning team should note geo-
graphic and topographic features that may affect
operations, for example, dependence on a single
main transportation artery in and out of the juris-
diction. The group will want to map out where
special needs groups are concentrated and be alert
to other issues that could affect planning assump-
tions,” notes one document.
7(pp. 2–11)
Current tech-
nology allows planners and responders to consider
alternative routes for security or weather concerns
and allows for multiple modes of transportation.
Potential areas of vulnerability for terrorism iden-
tified by Federal Emergency Management
Agency (FEMA) include traffic (on roads, tun-
nels, bridges, and so forth), trucking and transport
activity (including HazMat cargo), waterways,
airports, trains/subways, government facilities,
recreation facilities, military installations, HazMat
facilities, utilities, and nuclear facilities.
29
This planning effort should be coordinated with
state or local geographic information systems
(GIS)/mapping resources, which can provide
valuable information, such as GIS locations of
hospitals, mass prophylactic sites, and regional
pharmaceutical and medical equipment
resources.
Consider surge capacity and consult
surge planning resources.
The planning team must consider surge capacity,
defined as “the ability to expand capabilities in
response to sudden or more prolonged
demand,”
30(p. 19)
and identify sources and methods
for adding additional capacity (staff, supplies,
technology, medications, transport vehicles).
Although commonly considered in communities
as medical surge capacity and capability, the concept
of surge capacity applies to all assets. Rural, small,
and suburban areas are typically resource-strapped
and find it difficult to expand capacity in many, if
not most, key capability areas as listed in Sidebars
10 and 11.
The focus here is on medical surge capacity, defined
as the ability to care for a markedly increased vol-
ume of casualties that challenges or exceeds nor-
mal operating capacity.
15
Because the first goal of
community emergency preparedness and
response efforts is to save lives (which encom-
passes preventing the spread of disabling disease
and injuries), if the community’s medical system
is overwhelmed, the community simply will lose
its capacity to meet this goal.
The Medical Reserve Corps, described earlier, is
specifically designed to provide surge capacity
Rather than being looked at primarily as potential casualties, the public can be considered part
of the community’s assets in emergency management initiatives.
Standing Together: An Emergency Planning Guide for America’s Communities
35
personnel in the event of a large-scale emergen-
cy. Federal resources, available through ESF #8:
Public Health and Medical Services, may be
called upon to provide additional medical surge
capacity and capability. For example, under
FEMA’s National Disaster Medical System,
Disaster Medical Assistance Teams (DMATs) pro-
vide assistance in the event of large-scale disasters.
DMATs are volunteer groups of medical and
nonmedical individuals, usually from the same
region where the disaster is occurring. Because
the material in this planning guide is intended to
help small communities stand on their own for
the first day or days and develop and maintain as
much capacity as possible, federal and state
resources are not itemized here but should be
familiar to the community planning team.
If a hospital or a number of hospitals are present
in the community, the leaders of these organiza-
tions must determine their surge capacity and
evaluate strategies to enhance capacity. This cal-
culation of capacity should include at a minimum
the number and type of beds, personnel, pharma-
ceuticals, supplies, and equipment, among other
critical items.
Professionals working in all community settings,
such as schools, businesses, and health facilities,
can consult their professional organizations for
assistance in surge planning. Several examples
appear in the tool box.
Consider all community health
resources.
In communities of all sizes, critical medical surge
capacity can come from not only hospitals, but
urgent care centers, home health agencies, com-
munity health centers, clinics, ambulatory care
facilities, physicians’ offices, and long term care
and other health facilities. Doctors, nurses, home
health aides, social workers, retired health profes-
sionals, and all other medically trained profession-
als can help to meet medical surge personnel
needs. Other required surge needs include
decontamination facilities, laboratory capacity,
and immunization supplies, among many other
elements. As part of the planning process, and in
advance of an emergency, planning teams should
identify all community health resources and assess
the ability of each resource to contribute to
emergency prevention, preparedness, response,
and recovery.
Define critical capacities for each
health entity and link to state
databases.
Surge capacity for a hospital is different than surge
capacity for a long term care facility or a commu-
nity health center.The planning team should agree
on what role each organization will play in a large-
scale emergency and ensure that health facilities
are linked to any resource-coordinating databases
operated by the state or region. Figure 1 illustrates
a regional planning matrix of critical capabilities
for health care–related resources.
TOOLS:
? CNA Corporation: Medical Surge Capacity and
Capability: A Management System for Integrating
Medical and Health Resources During Large-Scale
Emergencies.http://www.cna.org/
documents/mscc_aug2004.pdf.
? School administrators: National
Clearinghouse for Educational Facilities.http://www.edfacilities.org/rl/disaster.cfm.
? Emergency physicians: American College of
Emergency Physicians.http://www.acep.org.
? Business owners: National Business Group on
Health.http://www.businessgrouphealth.org.
36
? Example:The Maryland Institute for Emergency
Medical Services Systems maintains a Web-based
Facility Resource Emergency Database to expedite
the flow of resources (including emergency depart
ment and pediatric bed availability, medications,
blood, medic unit availability, and emergency
response personnel and apparatus) to the scene of an
incident or to an emergency operations center.
Hospitals, public health, 911 centers, specialty refer-
ral centers, law enforcement agencies, and other com-
ponents of the emergency medical services system
monitor this Web page.
FIGURE 1. CONNECTICUT REGIONAL EMERGENCY AND PUBLIC HEALTH PREPAREDNESS: HEALTH CARE
AGENCY BIOTERRORISM ANNEX PLANNING CRITERIA.
Source: Connecticut Regional Emergency and Public Health Preparedness: Health Care Agency Bioterrorism Annex
Planning Criteria. Used by permission.
Standing Together: An Emergency Planning Guide for America’s Communities
Standing Together: An Emergency Planning Guide for America’s Communities
37
Know the federal government’s
definition of required surge capacity.
The Health Resources and Services
Administration’s (HRSA’s) capacity projections
in a mass casualty event are based on a population
of one million, which obviously exceeds the pop-
ulation of small, rural, and suburban communities
addressed in this planning guide. However, local
planners should be aware of HRSA guidance
related to surge capacity because it impacts the
ability of surrounding communities to handle
victims of mass casualty events. A critical bench-
mark identified by the HRSA for regional surge
capacity for the care of adult and pediatric vic-
tims of terrorism and other public health emer-
gencies is as follows:
Establish systems that, at a minimum, can provide
triage treatment and initial stabilization, above the
current daily staffed bed capacity, for the following
classes of adult and pediatric patients requiring
hospitalization within three hours in the wake of
a terrorism incident or other public health emer-
gency:
? 500 cases per million population for patients
with symptoms of acute infectious disease,
especially smallpox, anthrax, plague,
tularemia, and influenza
? 50 cases per million population for patients
with symptoms of acute botulinum intoxica-
tion or other acute chemical poisoning,
especially that resulting from nerve agent
exposure
? 50 cases per million population for patients
suffering burn or trauma
? 50 cases per million population for patients
manifesting the symptoms of radiation-
induced injury, especially bone marrow sup-
pression
31(p. 3)
For decontamination surge capacity related to the
numbers of patients indicated above, the critical
benchmark is as follows:
Insure that adequate portable or fixed decon-
tamination systems exist for managing adult and
pediatric patients, as well as health care person-
nel, who have been exposed during a chemical,
biological, radiological, or explosive incident in
accordance with the numbers associated with
CBM # 2-1 (those indicated above). As stated
in OSHA (Occupational Safety and Health
Agency) Best Practices for Hospital-Based First
Receivers of Victims from Mass Casualty Incidents
Involving the Release of Hazardous Substances: “All
participating hospitals shall be capable of pro-
viding decontamination to individual(s) with
potential or actual hazardous agents in or on
their body. It is essential that these facilities have
the capability to decontaminate more than one
patient at a time and be able to decontaminate
both ambulatory and stretcher bound patients.
The decontamination process must be integrat-
ed with local, regional and state planning.”All
decontamination assets must be based on how
many patients/providers can be decontaminated
on an hourly basis.The awardee should plan to
be able to decontaminate all patients and
providers within three hours of the onset of the
event.
31(p. 34)
? Example: Numerous states are considering or have
purchased deployable, mobile, military-type trailers to
meet some of the needs for surge capacity.These
trailers can offer extra bed and additional isolation
capacity. Although small communities are unlikely to
have the financial resources to purchase such trailers,
resource pooling may be a possibility.
Consider the issues involved with
standards of care during mass
casualty events.
Americans are hesitant to think about “austere
care”—defined as the level of medical care that is
provided when health care resources, medical
supplies, and medical personnel are limited or
unavailable for an extended response
period—and expect to obtain only the highest
level of care.This obviously may be difficult if not
impossible for small communities to provide in
Standing Together: An Emergency Planning Guide for America’s Communities
mass casualty events involving thousands of vic-
tims. As part of the planning process, planning
teams should wrestle with the issues involved
with standards of care in mass casualty events.
To assist in doing so, in May 2005, the Agency for
Healthcare Research and Quality (AHRQ) and
the Office of Public Health Emergency
Preparedness issued a report for officials on how
to plan for delivering health and medical care in
a mass casualty event.
32
The report recommends
that planners at all levels, including the commu-
nity level and health systems level, develop or
revise both triage guidelines for specific types of
events and allocation guidelines for the use of
scarce resources such as ventilators, burn beds, or
surgical suites. The report also addresses such
issues as what circumstances would trigger a call
for altered standards of care, who is authorized to
make that call, and the sources of relief available
to address concerns about financial resources and
reimbursement of medical care costs. Planning
teams should be alert for further reports on this
important topic.
Identify dual uses for existing or
emerging capabilities.
Finding dual uses for existing or emerging capa-
bilities is particularly critical for resource-
strapped small, rural, and suburban communities.
A reverse 911 call system established by a com-
munity for law enforcement emergencies, for
example, could also communicate other types of
emergencies. Investments made by local public
health departments in upgrading laboratory ser-
vices for smallpox, SARS, anthrax, and other spe-
cialized testing can benefit more routine labora-
tory services in the community as well.The plan-
ning team can identify businesses with call-center
capabilities, such as telemarketing and airline
operations, as potential emergency call centers
during disasters.
Identify alternative care and shelter
facilities.
Most individual health care facilities in small,
rural, suburban, and even urban communities
have limited, if any, surge supplies, personnel, and
equipment. Backup systems for critical assets are
often shared among community facilities. “This
double counting of resources diminishes the abil-
ity to meet individual projected surge demands
across multiple institutions during a medical
emergency,” notes one report.
15(pp. 3-5)
The planning team should identify supplemental
facilities, such as hotels, motels, college infir-
maries, dormitories, libraries, high schools, places
of worship, and other structures that could meet
health care and shelter surge needs. For example,
a small town in Texas identified its community
college as a facility that could be turned into a
surge hospital. However, the team should also
38
TOOLS:
? Agency for Healthcare Research and Quality:
Altered Standards of Care in Mass Casualty
Events.http://www.ahrq.gov/research/altstand.
Investments made by local public health departments in upgrading laboratory services for
smallpox, SARS, anthrax, and other specialized testing can benefit more routine laboratory
services offered to the community.
Standing Together: An Emergency Planning Guide for America’s Communities
remember that the facilities cannot function
without concurrent plans for additional staffing,
supplies, and equipment and that the alternative
facilities must be accessible to the disabled.
Checklists are available for assessing the adequacy
of facility accessibility (see Tools).
Identify federal resources in the
community.
Federal resources located in the community may
or may not be available to the community in the
event of a large-scale emergency. Communities
near military installations can consider military
assets that might be available as appropriate, such
as beds in Veterans Administration (VA) hospitals,
naval search and rescue capabilities, army heli-
copters, and so forth. The planning team deter-
mines who initiates contact with these assets to
help determine how their resources may be
incorporated in planning and response activities.
The planning team also needs to consider that
during a major emergency, as defined in the
Stafford Act, the president can direct federally
controlled resources located in the community,
such as VA hospitals, Bureau of Primary Health
Care facilities, military hospitals, and any other
medical or nonmedical federal assets, to respond
in ways directed by the president. As this directive
may or may not include assistance to the particu-
lar community in which such resources are per-
manently housed,
10
the planners need to prepare
for contingencies when such personnel, equip-
ment, supplies, facilities, and managerial,
technical, and advisory services might not be
available to the community.
Identify gaps in community assets.
The planning team then reviews the asset inven-
tory information so that gaps and areas of com-
monality can be identified. During development
of the integrated plan—the next activity
(addressed in Section 6)—the team begins to
identify strategies to close the gap between what
is needed and what is available for disaster pre-
paredness and response. “Shortfalls may require
negotiating agreements with private suppliers or
other jurisdictions. Determination of the
resource base also should include a consideration
of what facilities are vital to emergency opera-
tions and how they might be affected by hazards:
problems that cannot be mitigated should be
taken into account in the emergency operations
plan, not assumed away,” notes the FEMA plan-
ning guide.
7(pp. 2-10)
39
TOOLS:
? New York State Office of Advocate for
Persons with Disabilities: ADA Accessibility
Checklist for Existing Facilities.http://www.ghi.com/pdf/adachecklist.pdf
(accessed Jun. 20, 2005).
The integrated emergency management plan is
designed to meet the needs defined for the com-
munity based on its hazard vulnerability analysis
(HVA; Section 3), its goals for preparedness and
response planning (Section 4), and its current
capacities and capabilities (Section 5). Through
the HVA, goal setting, and capabilities identifica-
tion processes, the team determines what is being
planned for and what assets might be needed and
allocated.
Plans, of course, have both a political and strate-
gic value in their quantification and description
of available and needed resources. Small, rural,
and suburban communities must be realistic; the
planning and asset allocation process will
undoubtedly require trade-offs. The integrated
plan’s objectives include achieving a level of pre-
paredness and response that is sustainable and
building capabilities for the future as needs
evolve. It addresses the four phases of emergency
management described in Section 4—preven-
tion, preparation, response, and recovery.
The plan is a living document and must be
reviewed, updated, and tested as risks, goals, and
capabilities change over time (Section 12).
Transitions in team leadership and responsibility
must also be considered as the planning process
matures and moves into implementation and
maintenance phases.
The plan’s coverage of issues related to commu-
nication, mental health needs, and the needs of
special populations warrants in-depth descrip-
tion. Thus, these issues are covered in separate
sections in this planning guide: Section 7 address-
es communication, Section 8 addresses mental
health needs, and Section 9 addresses the needs of
special populations. Teams must ensure that these
topics are thoroughly covered in their final inte-
grated plan. A description of selected strategies
that can help teams to develop high-quality inte-
grated plans follows.
Maintain a collaborative effort;
broaden planning partnerships where
necessary.
All stakeholders, including the media and others
as identified in Section 2, are included as partners
in plan development.The value of a collaborative
planning process cannot be overemphasized.
Although a document is the tangible result at this
6. Develop the Integrated Plan
Standing Together: An Emergency Planning Guide for America’s Communities
40
Recommended Planning Strategies:
? Maintain a collaborative effort;
broaden planning partnerships where
necessary.
? Choose an approach to developing
the plan.
? Use available guidance and resources.
? Determine how the plan is to be
drafted and the expected time frame.
? Agree on meeting frequency.
? Review existing plans, laws, and
mutual aid agreements.
? Commit to the use of simple language.
? Clearly delineate roles and
responsibilities.
? Determine how the plan will be
organized.
? Address all types of events and cover
all defined goals.
? Specifically address health and medi-
cal facility emergency planning.
? Specifically address how to meet
needs for pharmaceuticals and medi-
cal supplies.
? Identify and address hazards and
resources that cross jurisdictions.
? Identify how preparedness and
response success will be measured.
? Consider the lessons learned from 9/11.
Standing Together: An Emergency Planning Guide for America’s Communities
41
stage, intangible results, such as new and
improved relationships, have significant positive
value above and beyond the document. Planning
conducted with a group over an extended period
of time builds and enhances partnerships and
communication that will be essential during an
actual emergency. Partnerships often also extend
to neighboring communities and the surround-
ing region. Subgroups or committees can be
formed to focus on particular areas of planning.
Communication, reporting, and decision-making
channels must be developed and maintained so
that the efforts of subset groups are integrated
into overall plans.
? Example: Arlington, Massachusetts (population
43,000), formed a subcommittee of the local emer-
gency planning committee to enhance the communi-
ty’s ability to respond to the threat of terrorism.
Subcommittee initiatives included targeted hardening
of critical infrastructure; specialized police training for
incident command; updating of mutual aid agree-
ments; acquisition of protective equipment and emer-
gency operations planning software; enhancement of
the town’s emergency management plan; develop-
ment of emergency plans for specific locations, such
as schools; and emergency operations exercises at a
high-profile institution.
33
Choose an approach to developing the
plan.
The planning team can take one or a combination
of four general approaches to creating an integrat-
ed plan based on the HVA. The team should note
that three of the four approaches involve adapting
existing plans, not adopting existing plans. The dis-
tinction between adapting and adopting is critical. If
the team chooses one of the adaptation options, it
will need to carefully review all elements of the
existing plan and revise plan elements to meet the
community’s unique needs and resources as identi-
fied through the team’s HVA. Adopting a plan and
transferring it “wholesale” from one community to
another, “cookie-cutter style,” is extremely risky
and ill-advised.The four approaches are as follows:
? Develop the plan from a blank sheet.
? Adapt a plan that already exists in one of the
community’s organizations (for example, fire
department, school system, local hospital).
? Adapt a plan obtained through the emergency
management literature.
? Adapt a county, regional, state, or national plan.
Again, whether starting from a blank sheet or
adapting an existing plan, the planning team must
tailor the plan to the risks, capabilities, and goals
defined for the specific community through its
HVA.
Use available guidance and resources.
The blank sheet approach may be more time-con-
suming than other approaches. Most states can pro-
vide valuable assistance to local jurisdictions. States
typically publish their own planning guides, con-
duct training, and may assign planners to work with
local community planners. Federal guidance, such
as the Public Health Emergency Response Guide for
State, Local, and Tribal Public Health Directors, pub-
lished by the Centers for Disease Control and
Prevention (CDC), can provide valuable planning
guidance and templates for documentation of con-
tacts and actions, leadership assignments, and inci-
dent-specific preparedness (see Tools).
Determine how the plan is to be drafted
and the expected time frame.
Decisions include Who will draft the plan and
prepare the needed graphics? To whom will the
draft plan be circulated? How will changes be
agreed upon and incorporated? Who will receive
a copy of the final plan? and What is the desired
time frame for the plan’s drafting, revision, and
finalization? Sidebar 12 provides selected sample
steps outlined by the Federal Emergency
Management Agency (FEMA).
Standing Together: An Emergency Planning Guide for America’s Communities
42
Agree on meeting frequency.
The planning team and its subcommittees or task
groups may meet weekly or monthly during differ-
ent phases of planning and implementation.
Meetings with neighboring, regional, state, or fed-
eral partners may occur on a monthly, quarterly, or
biannual basis after the relationships are established.
Review existing plans, laws, and
mutual aid agreements.
Local, state, and federal laws, rules, and regulations
may impact the plans that are developed.
Appropriate plans, laws, codes, and regulations
and existing agreements with neighboring com-
munities, private-sector organizations, and others
should be reviewed carefully by the team.
7
These
should include plans concerning command and
control and, in particular, the integration from an
incident command system structure to a unified
command system.
Commit to the use of simple language.
The emergency management plan should be
written in plain English. Team members can
define all terms at the beginning and avoid using
too many acronyms or abbreviations. A clearly
marked glossary at the end of the document may
define the acronyms or abbreviations that are
used.
TOOLS:
? Centers for Disease Control and Prevention
(CDC): Public Health Emergency Response
Guide for State, Local, and Tribal Public Health
Directors, Version 1.0.http://www.bt.cdc.gov/
planning/responseguide.asp.
? National Association of County & City Health
Officials: Bt PREP:A Bioterrorism Response Plan
Design Guide for Local Public Health Agencies, 1st
ed., 2003.http://www.naccho.org/pubs.
? Resources for local planning for pandemic dis-
ease, available through the CDC, include:
Pandemic Influenza Preparedness and Response:http://www.hhs.gov/nvpo; State and Local
Pandemic Planning Guide:http://www.hhs.gov/
nvpo/pubs/pandemicflu.htm.
? Northern New England Metropolitan Medical
Response System: Community Planning Guide:
Improving Local and State Agency Response to
Terrorist Incidents Involving Biological Weapons, Jun.
2003.http://www.nnemmrs.org/surge.html.
? Develop a rough draft of the basic plan to serve as
a point of departure for the planning team.
? Develop agendas and invitation lists for the first
cycle of planning meetings.
? Conduct a presentation meeting, establish com-
mittees for parts of the plan, appoint committee
chairs, and schedule a follow-up meeting.
? Work with committees on successive drafts.
? Prepare necessary graphics (for example, maps
and organizational charts).
? Produce a final draft and circulate the draft to the
planning team for review and comment.
? Hold a meeting to incorporate final changes, dis-
cuss an implementation strategy and necessary
distribution, and obtain informal commitments to
provide information that could necessitate revi-
sion.
? Obtain concurrence from organizations with
identified responsibilities for implementing the
plan.
? Obtain official promulgation of the plan by local
elected officials and advise the media of this in
advance.
? Print and distribute the plan, with a copy (or press
release) to local media. Maintain a record of the
organizations and persons that received a copy (or
copies) of the plan.
Source: Adapted from Federal Emergency Management
Agency: State and Local Guide (SLG) 101: Guide for All-
Hazard Emergency Operations Planning. 1996. pp. 2-11–2-
12.http://www.fema.gov/rrr/gaheop.shtm (accessed
Feb. 2005).
SIDEBAR 12. SAMPLE STEPS TOWARD CREATING A
WRITTEN EMERGENCY OPERATIONS PLAN
Standing Together: An Emergency Planning Guide for America’s Communities
Clearly delineate roles and
responsibilities.
The plan should clearly describe areas of respon-
sibility, the circumstances under which the plan is
to be activated, who is initially in charge, and
who is authorized to activate the plan. As men-
tioned earlier, coordinated emergency manage-
ment planning and decision making require com-
munity leaders and team players to play different
roles in different circumstances. The plan also
should outline alternative roles for personnel dur-
ing emergency situations, including who they
should report to within a command structure.
Roles and responsibilities must be determined in
advance because, during an emergency, turf bat-
tles or lack of clarity about who is to do what can
result in lost time, resources, and perhaps lives.
Operational duties and goals for key positions can
be provided in checklist format.
Determine how the plan will be
organized.
FEMA and other government agencies do not
mandate a particular format for emergency plans.
However, it is important that the plan be orga-
nized in a format that the team is comfortable
with and one that enables users to obtain with
ease the information they need. Additional issues
includes sequencing of the material (is it logical?),
consistency of sections, adaptability of material to
multiple situations, and compatibility with plans
of other jurisdictions.
7
A functional approach to the plan’s structure
enables communities to address the effects com-
mon to hazards without having to develop sepa-
rate plans for each hazard. For example, as men-
tioned earlier, the National Response Plan is orga-
nized around 15 emergency support functions,
such as transportation; mass care, housing, and
human services; and others (Sidebar 6). FEMA
provides the following list of core functions that
warrant attention and may require that specific
actions be taken during emergency response
operations:
? Direction and control
? Communications
? Warning
? Emergency public information
? Evacuation
? Mass care
? Health and medical services
? Resource management
7(p. 5-1)
Figure 2 illustrates how each core function can be
assigned to specific organizations or individuals.
Sidebar 13 outlines the components of an integrat-
ed plan that uses a functional structural approach.
Address all types of events and cover
all defined goals.
Plan contents should address all those elements
outlined as goals for preparedness and response in
Section 4. For example, the emergency manage-
ment plan should include a brief description of
the various activities the organization plans to
43
Roles and responsibilities must be determined in advance; during an emergency,
turf battles or lack of clarity about who is to do what can result in lost
time, resources, and perhaps lives.
Standing Together: An Emergency Planning Guide for America’s Communities
44
FIGURE 2. RESPONSIBILITIES FOR RESPONSE FUNCTIONS
Source: Federal Emergency Management Agency: State and Local Guide (SLG) 101: Guide for All-Hazard
Emergency Operations Planning, 1996.http://www.fema.gov/rrr/gaheop.shtm (accessed Feb. 2005).
The Basic Plan: The basic plan is an overview of the jurisdiction’s emergency response organization and policies. It
cites the legal authority for emergency operations, summarizes the situations addressed by the emergency opera-
tions plan (EOP), explains the general concept of operations, and assigns responsibilities for emergency planning
and operations.
continued
SIDEBAR 13. COMPONENTS OF A FUNCTIONALLY STRUCTURED EMERGENCY PLAN
Standing Together: An Emergency Planning Guide for America’s Communities
undertake in each of the four emergency man-
agement phases (prevention, preparation,
response, and recovery).
The plans also should include the following:
? Organizations and individuals responsible for
carrying out specific actions at projected times
and places in an emergency that exceeds the
capability or routine responsibility of any one
agency (for example, the fire department)
? Authority and organizational relationships, and
how all actions will be coordinated
? How people and property will be protected in
emergencies and disasters
? Personnel, equipment, facilities, supplies, and
other resources available—within the jurisdic-
tion or by agreement with other
jurisdictions—for use during response and
recovery operations
? Steps to address mitigation concerns during
response and recovery activities
7
However the plan is organized, the team should
ensure that the plan is flexible enough to respond
to different situations. Communities must be pre-
pared for natural disasters, unintentional disasters,
and intentional disasters.
Specifically address health and medical
facility emergency planning.
Local planners must take into account the ser-
vices required to support operations for health
care delivery during and after a disaster affecting
the community. For example, planners must con-
sider the following:
? Plans and decisions regarding water reservoirs,
tanks, or other sources can impact a health
care facility’s access to water essential for sani-
tation, sterilization, cooling of generators, and
other utility-related functions.
? Closure of or limited access to banks and
ATMs impacts a health care provider’s ability
to pay essential staff continuing to work
through the crisis.
45
Functional Annexes: Functional annexes are plans
organized around the performance of a broad task.
Each annex focuses on one of the critical emergen-
cy functions that the jurisdiction will perform in
response to an emergency. The number and type of
functional annexes included in the EOP may vary
from one jurisdiction to another, depending on
needs, capabilities, and organization. Because func-
tional annexes are oriented toward operations, their
primary audience consists of those who perform the
tasks. They do not repeat general information con-
tained in the basic plan.
Hazard-Specific Appendixes: Hazard-specific appendix-
es provide additional detailed information applicable
to the performance of a particular function in the
face of a particular hazard. They are prepared when
hazard characteristics and regulatory requirements
warrant and are attached to the relevant functional
annex(es).
SOPs and Checklists: Standard operating procedures
(SOPs) and checklists provide the detailed instruc-
tions that an organization or an individual needs to
fulfill responsibilities and perform tasks assigned in
the EOP. They may be attached to the EOP or ref-
erenced as deemed appropriate.
Source: Federal Emergency Management Agency: State
and Local Guide (SLG) 101: Guide for All-Hazard
Emergency Operations Planning. 1996, pp. 3-2–3-3.http://www.fema.gov/rrr/gaheop.shtm (accessed Feb.
2005).
SIDEBAR 13. COMPONENTS OF A FUNCTIONALLY
STRUCTURED EMERGENCY PLAN (CONTINUED)
TOOLS:
? A suggested format for a terrorist incident
appendix to a basic all-hazards emergency plan
can be found in Federal Emergency
Management Agency: State and Local Guide
(SLG) 101: Guide for All-Hazard Emergency
Operations Planning: Chapter 6, Attachment G.
Apr. 2001.http://www.fema.gov/pdf/rrr/
allhzpln.pdf.
Standing Together: An Emergency Planning Guide for America’s Communities
46
? The receipt, storage, and distribution sequence
of mass prophylaxis for first responders and
their families, first receivers and their families,
other health and public safety workers, and the
general public must be determined collabora-
tively and in advance to avoid confusion.
? Plans and decisions regarding curfew, road clo-
sures, or traffic routing can impact the ability
of health care professionals to get to and from
health care facilities and alternative care sites.
Health care organizations accredited by the Joint
Commission on Accreditation of Healthcare
Organizations must meet emergency manage-
ment planning and drill requirements as outlined
in Joint Commission accreditation manuals for
ambulatory care, behavioral health care, critical
access hospitals, health care staffing, home care,
hospitals, laboratory, long term care, and office-
based surgery facilities.The goal of these require-
ments is to ensure that health care organizations
prepare for and can respond to an emergency
within their organizations or in their communi-
ties that suddenly and significantly affects the
need for their services or their ability to provide
those services.
34
Health facility leaders on the community plan-
ning team, who represent Joint Commission-
accredited facilities, will be familiar with Joint
Commission emergency management require-
ments and can advise the team on their facilities’
ability to provide capacities and capabilities in the
areas outlined in this section. Not all health care
organizations are accredited by the Joint
Commission, however, so communities with
acute care and other health facilities should
address such facilities’ capacities and capabilities
to meet needs, including (but not limited to) the
following:
Ongoing risk assessment: A risk assessment process,
such as HVA, ensures that the health care organi-
zation identifies potential emergencies that could
affect the need for its services or its ability to pro-
vide those services.
Surge capacity: Surge capacity is not just a hospital
issue, but a community issue, as described in
Section 5. During disasters, surge capacity is per-
haps the most fundamental component of a
health care organization’s emergency prepared-
ness program. Surge capacity is the organization’s
ability to expand care capabilities in response to
sudden or more prolonged demand. It encom-
passes the following elements:
? Potential patient beds
? Available space in which patients may be
triaged, managed, treated, vaccinated, decon-
taminated, or simply located
? Available personnel of all types
? Necessary medications, supplies, and equipment
? Legal capacity to deliver health care services
under situations that exceed authorized capacity
Surge capacity has both a point-in-time aspect
(that is, the ability to accommodate patients for a
limited time period during the acute crisis) and a
longitudinal dimension (the ability to manage
longer-term care needs).
Plans and decisions regarding water reservoirs, tanks, or other sources can impact a health
care facility’s access to water essential for sanitation, sterilization, cooling of generators, and
other utility-related functions.
Standing Together: An Emergency Planning Guide for America’s Communities
Evacuation and alternative care sites: When a facili-
ty’s physical environment can no longer support
adequate care and treatment, the organization
must have plans for both horizontal (on the same
floor or level) and vertical (to a different floor)
evacuation. Procedures for horizontal evacuation
to areas of safety beyond closed smoke barriers
are written into every health care facility’s fire
plans and should be familiar to all staff. Even
though less common, vertical evacuation must
also be considered in the planning process. Other
evacuation planning considerations include Who
is responsible for the decision to evacuate? With
what company(ies) will transportation of patients
be arranged (for example, local paratransit or
ambulance services)? What evacuation routes will
be used? Where will these routes be posted? Who
is responsible for maintaining the medical and
medication profile sheet throughout the event
and after?
35
Hospitals and long term care organizations are
required by the Joint Commission to identify an
alternative care site(s) that has the capabilities to
meet the needs of patients when their own facil-
ities are not able to do so due to the effects of a
disaster. Consideration must be made for the type
of patients being relocated, with assurance that
the chosen alternative site can meet the clinical
needs of the individuals it receives.
Emergency communications and building utility systems:
Health facilities must ensure an appropriate back-
up for key internal and external communications
systems in the event of failure during emergen-
cies. Hospitals or other health care organizations
frequently consider multiple levels of communi-
cations systems redundancy, including backup
phone systems, additional radio licenses for
portable radios, cell phones, Ham radios, satellite
phones, personal digital assistants, e-mail, and so
forth.
Facilities must identify an alternative means of
meeting essential building utility needs when the
facility must provide continuous service during
an emergency. Electricity, water, ventilation, fuel
sources, and medical gas/vacuum systems may
each require special consideration. Key questions
related to utility failure include Does the organi-
zation’s emergency management plan address
how the organization would handle a utility fail-
ure caused by an interruption in service by a util-
ity provider? By a lightening strike? What effect
would a utility failure have on the organization?
How has the plan addressed such effects? What
backup systems are in place in the event of a util-
ity failure? Sidebar 14 provides Greater New York
Hospital Association’s planning categories related
to communication and power issues.
Emergency education and training of health care staff:
Orientation and education about potential emer-
gencies and their expected risks and conse-
quences, how to respond to each type of emer-
gency, and how to provide the best possible care
to disaster victims, as appropriate, should be pro-
47
The major information categories of the draft guidelines
in development at the Greater New York Hospital
Association include the following:
Communication considerations: internal phone switches, ana-
log phone lines, long-distance service provider trunks,
runner system, radios, walkie-talkies, cell phones, overhead
speaker and paging system, stand-alone computer and
Internet access, access to external information systems,
communications directories, and vendor contact numbers.
Power considerations: standards, fuel supplies, supplemental
emergency generators, operation of emergency generators,
placement and security of emergency generators, elevators,
radios, critical equipment, and contingency planning.
Source: Greater New York Hospital Association, New York. Used
with permission.
SIDEBAR 14. COMMUNICATION AND POWER
CONSIDERATIONS FOR HEALTH CARE FACILITIES
Standing Together: An Emergency Planning Guide for America’s Communities
vided to health care staff before a disaster occurs.
When a disaster or emergency occurs, there is lit-
tle or no time for staff training to be conducted.
An orientation and education program for all
personnel, including licensed independent practi-
tioners who participate in implementing the
emergency management plan, is required by the
Joint Commission for accreditation and is recom-
mended for all organizations. Education address-
es, as appropriate to the individual, the following:
? Specific roles and responsibilities during emer-
gencies
? How to recognize specific types of emergencies
? The information and skills required to per-
form assigned duties during emergencies
? The backup communication system used dur-
ing emergencies
? How supplies and equipment are obtained
during emergencies
Incident command system (ICS)/unified command:
The health care organization’s command struc-
ture must link with the community’s command
structure. The Hospital Emergency Incident
Command System (HEICS), used by many hos-
pitals nationwide, is based upon public safety’s
ICS all-hazards structure.
Isolation and decontamination: A community must
know what is available for radioactive, biological,
and chemical isolation and decontamination and
how to access such capabilities. Not all hospitals
have facilities for such decontamination, but cur-
rent belief is that it is advisable for hospitals to
work with the community to develop decontam-
ination plans and capabilities. The team should
also obtain information on hospital/health facili-
ty capacity to support ventilator-dependent indi-
viduals and to isolate and quarantine individuals
who require isolation and quarantine. According
to a recent study of hospital and community
emergency preparedness linkages,
14
only about
half of respondents from rural hospitals reported
that their community plan addresses the hospital’s
capacity to isolate individuals, as needed, and to
support ventilator-dependent patients.
Security/lockdown: According to some experts, a
plan to secure the facility within a few minutes of
an internal or known external biologic or chem-
ical incident in order to protect current care
recipients, the facility, and staff is appropriate, and
entry should be permitted only to noncontami-
nated staff and decontaminated care recipients.
36
Good perimeter control and access control points
around health facilities are often critical to pre-
vent the spread of infectious diseases and agents.
Security planning issues include What additional
security staff is required in the event of a com-
munitywide disaster? How might such staff be
obtained during an emergency? What “emergen-
cy lock-down” control procedures should be
implemented in the event of a disaster? How will
these occur? Who will implement them? What
role will local law enforcement agencies play in
assisting the organization during a community-
wide incident? How will the organization’s secu-
rity staff communicate with local agencies during
a communitywide incident?
? Example:To decrease the possibility of contamina-
tion of treatment areas, the Medical Center of
Central Georgia in Macon designed a physically
separate space for decontamination. If an individual
is or may be contaminated, staff posted at the emer-
gency medical services (EMS) entrance ramp ensures
that the person is directed from the private vehicle or
ambulance into a decontamination room prior to
entering the emergency department.
37
Surveillance and laboratory capacity: The team
should also work to ensure that hospitals and
public health agencies in the area have a collabo-
rative plan for timely and appropriate identifica-
tion and testing of suspected agents of bioterror-
ism, which include anthrax, smallpox, and others.
48
Standing Together: An Emergency Planning Guide for America’s Communities
Drills/exercises: Health care organizations must
give drills and exercises serious and comprehen-
sive attention.Testing of every aspect of an emer-
gency management plan includes all equipment
the organization will be using during an emer-
gency (for example, communications backups,
emergency generators), involving community
agencies, deploying the clinical staff, setting up
the incident command center, evacuating and
transporting the patient population, and request-
ing and receiving emergency supplies and equip-
ment from other organizations.
Emergency credentialing: Credentialing of disaster
volunteers in order to expand community capa-
bility warrants special focus. As described in
Sections 4 and 5, the team should consider the
range of potential volunteers, from local health
care professionals such as Medical Reserve Corps
and Community Emergency Response Team,
through Disaster Medical Response teams at the
federal level. The planning team or a subgroup
will need to establish appropriate credentialing
processes. Approximately one third of study
respondents from hospitals in rural communities
have no established mechanism for credentialing
volunteer staff during an emergency.
14
“This issue
has been a big problem in those communities that
have already experienced a variety of different
kinds of disasters, and deserves significant atten-
tion,” comments Jerod M. Loeb, Ph.D., executive
vice president of the Joint Commission’s Division
of Research.
Credentialing of disaster volunteers appears to be
lacking nationwide in both urban and rural areas
and should be examined by community planners.
Through a program called Emergency System for
Advance Registration of Volunteer Health Care
Personnel (ESAR-VHP), the Health Resources
and Services Administration (HRSA) is working
with states and jurisdictions to establish a com-
mon approach to credentialing licensed health
care professionals. “ESAR-VHP will be a nation-
al system in the sense that every state and juris-
diction will have developed their systems using
the ESAR-VHP national guidelines. States and
jurisdictions will be encouraged to enter into
agreements to create local and regional consor-
tia,” notes Marilyn Biviano, chief of HRSA’s
ESAR-VHP Branch.
38
With the assistance of state licensing boards and
medical staff offices at local hospitals, some com-
munities and community hospitals are establish-
ing databases that include information (and pho-
tos) of credentialed medical volunteers. Photo
identification cards facilitate the accurate identifi-
cation of credentialed volunteers.
Specifically address how to meet needs
for pharmaceuticals and medical
supplies.
Health care organizations and health departments
have routine medical and pharmaceutical suppli-
ers and often negotiate special supply arrange-
ments with these and other suppliers for emer-
gency situations. Supply arrangements must be
identified as part of the community planning
effort in order to ensure that all potential surge
supply sources are included in the community
plan and to prevent multiple organizations from
unknowingly relying on the same supplier, there-
by running the risk of an early depletion of sup-
plies with no alternative supply arrangements in
place.
Successful emergency management planning
includes identifying contingency suppliers that
can provide the resources that may be needed to
handle a patient surge. Resources include people,
equipment, food, and medical supplies, among
other items. Leaders should establish agreements
ahead of time with community agencies, other
49
Standing Together: An Emergency Planning Guide for America’s Communities
50
health care providers, and backup suppliers to
ensure that the organization’s resource needs can
be met during a dramatic patient surge. Having
adequate quantities of ventilators and personal
protective equipment is of particular concern
with a large influx of patients with severe respira-
tory problems.
In the event of major emergencies or disasters,
hospitals in local communities contact the local
health department or, in jurisdictions with no
local health department, hospitals call the state
health department to request state assistance in
meeting needs for drug and medical supplies that
exceed local resources. Sidebar 15 provides addi-
tional information on this process. The state’s
governor’s office can request federal assistance if
local needs exceed state resources. The CDC’s
Strategic National Stockpile (SNS), formerly
known as the National Pharmaceutical Stockpile
(NPS), can be made available to any community
in need of additional medicinal support in
response to an event involving a number of dif-
ferent threat agents. It consists of several tons of
needed pharmaceutical supplies and equipment,
strategically located throughout the United
States, which will be delivered to the local com-
munity within 12 hours of an event.The National
Response Plan does not need to be activated in
order for the stockpile to be requested by the
governor for use in a local community.
39
All communities, both large and small, must
address how they will procure and distribute
additional supplies from local stockpiles and the
national stockpile. Responsibility currently varies
widely by community and includes local health
care providers, public health officials, EMS, fire
services, law enforcement, and other services. In
testimony before a U.S. House of Representatives
subcommittee, a CDC official stated:“Local orga-
nizations at the city, county, and regional level
will be essential in the effort to reach all citizens
who need medical help after a terrorist incident.
However, these partners need to become fully
aware of the NPS to ensure that they are able to
most effectively plan for and use this valuable
resource.”
40
To meet this need, the CDC is now offering
extensive training to fully prepare state and local
partners. According to the CDC, “The prepared-
ness training and education program is for state
and local health care providers, first responders,
and governments (to include federal officials,
governors’ offices, state and local health depart-
ments, and emergency management agencies).
This training not only explains the SNS pro-
gram’s mission and operations, it alerts state and
local emergency response officials to the impor-
tant issues they must plan for in order to receive,
secure, and distribute SNS assets.”
41
Training
information is available at www.bt.cdc.gov/train-
ing.
Given the availability to hospitals of external
sources of drugs and related supplies from the
CDC’s SNS, the American Hospital Association
recommends that hospitals be prepared to sustain
a 24-hour supply of pharmaceutical products at
the most common dosage and that a standardized
formulary should be developed to adequately
determine stock requirements for medical/surgi-
cal supplies and equipment.
42
In its white paper,
the Joint Commission recommends ensuring a
48- to 72-hour stand-alone capability through the
appropriate stockpiling of necessary medications
and supplies.
30
Identify and address hazards and
resources that cross jurisdictions.
Disasters do not recognize jurisdictional lines (for
example, hurricanes affect multiple municipalities
and counties simultaneously); similarly, resources
Standing Together: An Emergency Planning Guide for America’s Communities
must cross jurisdictional lines to meet the needs
of communities affected by disasters (for example,
by transporting residents of one county without
an acute care facility to another county with such
a facility). The plan should address both realities.
Identify how preparedness and
response success will be measured.
Drills, exercises, and real events described in
Section 10 can shed light on the success (or lack
thereof) of preparedness and response efforts out-
lined in the plan. However, while developing the
plan, the team will want to consider parameters
or indicators that will be used to measure success.
Communities need realistic feedback regarding
the true level of preparedness.This helps to estab-
lish realistic expectations, ensure identification of
gaps, and enable these gaps to be filled in the best
possible way, given the community’s resources.
Consider the lessons learned from 9/11.
The Pentagon’s use of a unified command system
during the 9/11 attack was considered by many to
be a model of implementation in terms of coordi-
nating the roles of emergency responders, first
receivers (hospitals), public health, law enforce-
ment, the FBI, and others.The emergency response
at the World Trade Center was heroic, yet there
were significant lessons learned. Communities, no
matter how small, can learn from what went right
and what went wrong. The 9/11 Commission
Report
11
cited the following lessons:
? Avoid bureaucratic inertia.
? Simplify oversight and clarify accountability.
Too many parties dilute the effectiveness of
response and run the risk that no one assumes
responsibility.
? Challenge assumptions about what the likely
threats will be. Think outside the box.
? Assure joint operational planning. Give up turf
and collaborate for efficiency. Avoid duplica-
tion of effort.
51
During the occurrence of a major emergency or dis-
aster, a hospital in the local region may quickly need
additional support in the form of drugs and medical
supplies. The hospital will have activated its emer-
gency response plans using the Hospital Emergency
Incident Command System (HEICS) or another
incident command system (ICS).
The individual functioning as Incident Commander,
as specified under the ICS structure, or a person to
whom he or she has delegated this responsibility, will
initiate a request with the local public health depart-
ment (LHD) that serves the jurisdiction in which
the hospital is located. The Incident Commander
alerts the LHD to the fact that the hospital is expe-
riencing rapid depletion of certain medications or
supplies due, perhaps, to a widespread problem
affecting the area’s residents.
Before an emergency occurs, it therefore is critical
that the Incident Commander and other hospital
leaders know who the hospital’s public health offi-
cials are and how to contact them. Hospital leaders
must establish ongoing relationships with their pub-
lic health officials. In rural areas of the nation, where
there is no local public health department, the state
health department provides public health services to
local jurisdictions.
Local health departments can request further sup-
port from state health departments. State health
departments, through the governor, can request fed-
eral support, including pharmaceuticals and medical
supplies from the CDC’s Strategic National
Stockpile.
Source: Christine C. Bradshaw, D.O., M.P.H., M.B.A.,
medical officer, Centers for Disease Control and
Prevention, Coordinating Office of Terrorism
Preparedness and Emergency Response.
SIDEBAR 15. ASSURING DRUGS AND MEDICAL
SUPPLIES IN LOCAL COMMUNITIES
Standing Together: An Emergency Planning Guide for America’s Communities
52
? Provide layered preparedness and response
mechanisms.
? Designate who will be the communicator at
each response and operations entity.
? Technology is an asset but can also be a liability.
If power fails, is there a means for communica-
tion and other functions served by technology?
? Train people as backup for technology.
? Ensure detailed and effective transfer of
knowledge when new persons come into
important roles or during other transitions/
transfers of authority or responsibility.
? Develop standardized operating procedures
covering how different commands should
communicate during an incident.
? Make sure first responder civilians know what
to do.
? Assure that each participant of the unified
incident management system has command
and control of its own units and adequate
internal communications.
? Conduct regional drills in order to establish
professional relationships and trusts.
? Promote and reward information sharing.
? Match resources to responsibility and function.
Train people as backup for technology.
? Federal Emergency Management Agency (FEMA):
State and Local Guide (SLG) 101: Guide for All-Hazard
Emergency Operations Planning, 1996. http://
www.fema.gov/rrr/gaheop.shtm.
Published in 1996, this guide outlines the preparedness,
response, and short-term recovery planning components
that FEMA recommends be included in state and local
emergency operations plans. Attachment G, published in
April 2001, provides specific guidance for terrorism plan-
ning.http://www.fema.gov/pdf/rrr/allhzpln.pdf.
? State and Local Preparedness Guidance:http://www.fema.gov/preparedness/
state_local_prepare_guide.shtm.
Emergency Operations Planning Guidance is designed
to help state and local governments fine-tune their
EOPs and address critical planning considerations to
include a focus on weapons of mass destruction
(WMD) incidents, interstate and intrastate mutual aid
agreements, resource typing, resource standards, protec-
tion of critical infrastructure, inventory of critical
response equipment and teams, continuity of opera-
tions, and family and community preparedness.
? Managing the Emergency Consequences of Terrorist
Incidents—Interim Guidelines: http://
www.fema.gov/preparedness/managing.shtm.
This interim planning guide provides state and local
emergency management planners with a framework for
developing supplemental emergency operations plans
that address the consequences of a terrorist attack
involving WMD. It encourages the efficient integration
of state, local, and federal terrorism response activities
and provides current information regarding planning
and operational challenges faced by communities that
have dealt with terrorist events.
? National Capability Assurance:http://www.fema.gov/preparedness/nca.shtm.
FEMA’s Capability Assurance effort focuses on
resources and programs to help the state, tribal, and
local emergency management and response communi-
ties be better prepared to respond to disasters and inci-
dents of all kinds. These processes and resources focus
primarily on assessment and exercise-related programs,
processes, and systems.
TOOLS:
Two principal goals of communications planning in
emergency management are (1) to establish and
maintain a common operating picture and (2) to
ensure accessibility and interoperability across juris-
dictions and functional agencies.
27
Although
progress toward meeting these goals has been made,
much work remains to be done. During the 9/11
attacks, for example, the response efforts of the first
fire fighters to arrive at the World Trade Center
were hampered by radio communications prob-
lems. Those first responders thus actually had less
knowledge about what was happening inside the
buildings than those outside the buildings.
In any community, communication patterns devel-
op and change to fit the day-to-day needs of the
community. These communication patterns, both
internal and external, are influenced by equipment
use, procedures, and channels for collecting, orga-
nizing, and exchanging information among com-
munity agencies and organizations. Planning for the
provisions that should be available for communica-
tions during an emergency is difficult because
emergencies are by their very nature unpredictable,
and so are their effects on the community. Elements
of an emergency response plan for communications
that works for one community may not meet the
needs of other communities due to differing com-
munications infrastructure, equipment, channels of
communication, and dozens of other possible fac-
tors. Strategies that can help communities achieve
thorough communications planning follow.
Understand how communication is
transmitted.
An understanding of how communication meth-
ods work is critical to effectively planning for the
communications consequences of an emergency
because emergencies can interrupt established
communication systems (see section on “Plan for
alternative and backup communication links and
systems.”). Communications are usually transmit-
ted by wire line, radio, or a combination of the
two. Wire line communications, such as tele-
phone and telegraph, involve sending and receiv-
ing an electromagnetic signal by a closed con-
ducting path, such as a copper wire or fiber-optic
7. Ensure Thorough Communication Planning
Standing Together: An Emergency Planning Guide for America’s Communities
53
Recommended Planning Strategies:
? Understand how communication is
transmitted.
? Plan for alternative and backup com-
munications links and systems.
? Plan and provide for emergency back-
up power to communications systems.
? Ensure interoperability of communi-
cations systems.
? Use available communications plan-
ning resources.
? Review and build on existing com-
munications planning initiatives.
? Obtain/prepare information for crisis
communications.
? Define emergency communications
protocols or procedures.
? Establish communications credibility
with the public.
? Recognize and plan for the critical
role played by the media.
? Identify how every community mem-
ber can be reached in an emergency.
? Plan to provide decisional support.
? Ensure culturally sensitive communi-
cation.
? Use publicly available communica-
tions materials.
? Ensure integration of the local health
care organization’s communications
plans.
Standing Together: An Emergency Planning Guide for America’s Communities
cable. In radio communications, signals are sent
and received by electromagnetic radiation, gener-
ally through the atmosphere, without a connect-
ing wire. Combination communications systems,
such as cellular radio, use both wire line and radio
transmission paths. Sidebar 16 itemizes types of
communications equipment.
For effective emergency response, reliable commu-
nications must exist between specific fixed loca-
tions, between fixed and nonfixed (mobile) loca-
tions, and between two or more mobile locations.
Some of the communication paths that must be
planned for and established include local emergen-
cy medical services (EMS) radio dispatching, health
care organizations to each other and to ambulances,
ambulances to a medical communications control
center, fire and law enforcement to command cen-
ters and to each other, and so forth.
Plan for alternative and backup
communications links and systems.
Although many small communities may find it
challenging enough to establish and maintain need-
ed communications links and systems, backup links
and systems may be equally critical to effective
emergency response. (see Sidebar 17 on page 55.)
For example, the public telephone network can be
overloaded easily by increased traffic or become
physically disrupted during a major disaster.
Because radio and microwave systems can also be
damaged, communities should consider available
replacement supplies of antennas, coaxial cable, and
other hardware susceptible to damage. Make sure
that telephone lines coming into community com-
munications centers are buried (where feasible),
clearly marked, and protected from damage.
A designated radio frequency can be used for
point-to-point community disaster coordination.
Because a single frequency is often easily over-
loaded and abused during even minor emergen-
cies, incorporate into the system a method for
preventing overload. This might include a prac-
ticed system discipline (such as limitations on the
lengths of messages) and alternative communica-
tions paths (such as switching to cellular radio
telephone to handle a communications overload).
When possible, radio transmitter/receivers
equipped to operate on multiple frequencies
should be available.
? Example:The Huntington Beach (California) Fire
Department has a volunteer program called Radio
Amateur Civil Emergency Services (RACES), which
provides backup communications during disasters. In
54
SIDEBAR 16. COMMUNICATIONS EQUIPMENT
Radio
Equipment Wire Line Combination
Two-way
radio Telephone
Cellular
telephone
Pagers Fax machine
Satellite
telephone
Broadcast
radio
Computer
modem
Television
Public address
system
Satellite Intercom
For effective emergency response, reliable communications must exist between specific fixed loca-
tions, between fixed and nonfixed (mobile) locations, and between two or more mobile locations.
Standing Together: An Emergency Planning Guide for America’s Communities
2001 the fire department trained RACES to back up
its 800 MHz system. In September 2004, just two
weeks after an exercise to test preparedness, the fire
department’s 800MHz fire radio system went down
for the entire county.The fire department placed a
RACES member in the police dispatch where the
911 calls came in and one in each fire engine, truck,
and ambulance. RACES provided emergency commu-
nications for the city for several hours.
43
Plan and provide for emergency backup
power to communications systems.
Facilities with fixed communications systems
should have adequate standby power sources that
are independent (batteries or generators, for
example) to avoid dependence on commercial
power. Important locations in a service area, such
as health care organizations, should have more
55
The State of New Hampshire, as part of the Critical Benchmark expectations of the Cooperative Agreement Grant:
The National Bioterrorism Hospital Preparedness Program with the Health Resources and Services Administration
(HRSA), has developed a strategy to update ambulance-to-hospital (HEAR) radio equipment and provide for redun-
dant communications for the 26 acute care hospitals in New Hampshire.The benchmark in the grant is as follows:
Critical Benchmark #2-10: Surge Capacity: Communications and Information Technology
A survey of each hospital’s HEAR radio system was completed. It was discovered that some, but not all, hospitals had
a backup radio. Many of the hospitals had very old equipment, especially in small rural hospitals. Few if any hospitals
had digital capability. Concurrent with this effort has been an ongoing statewide radio interoperability project for police
and fire services.
The radio subcommittee of the New Hampshire Hospital Association’s Hospital Emergency Preparedness Working
Group developed the following simple objectives for the radio purchase project to ensure that each hospital:
? has APCO 25 compliant equipment (http://www.apcointl.org/frequency/project25/information.html)
? has digital capability (part of APCO 25 compliance)
? has redundant radio capability (by preserving their existing system)
? Another objective of the committee is to have the same equipment in hospitals throughout the State in order for it
to be familiar to personnel in the event they are called to respond to a mass casualty event where they are working
in another hospital, etc.
Based on these criteria, we decided to purchase a base station radio that has 16 channels and can work in either ana-
log or digital (some of our more rural and mountainous parts of the State cannot support digital). It is understood that
though a hospital may choose to use the new radio for their primary radio for continuous EMS monitoring/commu-
nication, having the built-in capability on the other channels is prudent and could be useful during a large scale emer-
gency.
Source: Personal communication from Jose’Their Montero, M.D., state epidemiologist of New Hampshire, Aug. 10, 2005.
SIDEBAR 17. BACKUP COMMUNICATIONS
Establish a secure and redundant communications system that ensures connectivity during a terror-
ist incident or other public health emergency between health care facilities and state and local health
departments, emergency medical services, emergency management agencies, public safety agencies,
neighboring jurisdictions and federal public health officials.
Standing Together: An Emergency Planning Guide for America’s Communities
56
than one radio site so that communications will
not be totally lost if one radio site fails. If possi-
ble, teams can consider whether it is possible to
install extra equipment at different geographic
locations throughout the community.
The system’s design should allow for enough
telephone lines, radio channel capacity, and oper-
ating positions, or rapid expansion capability to
handle the heavy communications traffic loads
generated by disasters. For example, health care
facilities can consider having several telephone
lines with unlisted numbers, which makes it eas-
ier to make outgoing telephone calls when there
is heavy incoming telephone traffic.
Ensure interoperability of
communications systems.
Interoperability of communications systems in
emergency planning involves primarily the abili-
ty of first responders and emergency coordinators
to communicate directly by radio with individu-
als from other agencies.The ability of computers,
mutual aid entities, and planning groups across
jurisdictions to participate in joint efforts is also
often considered part of interoperability.
Lack of interoperability is a significant problem
nationwide and was a well-publicized obstacle
faced by the New York City fire and police
departments during the 9/11 attacks. Local and
state first responders currently are spread across
10 different radio frequency bands and often can-
not communicate directly with each other.
Interoperability challenges result from spectrum
limitations, funding limitations, incompatible
technology, and lack of systems planning. In
response, the 9/11 Commission called for
Congress to support pending legislation for the
expedited and increased assignment of radio
spectrum for public safety purposes.
11
The Federal Emergency Management Agency
(FEMA) eGov Disaster Management Program
provides responders with a Web-based service
called the Disaster Management Interoperability
Services Interoperability Backbone, which offers
free communication tools that allow responders
to share information with other responder orga-
nizations. “Responder groups receive and trans-
mit information over the web, enabling them to
rapidly develop and exchange incident informa-
tion with other responder organizations. This
capability of sharing incident information gives
all responders greater knowledge of a particular
disaster event by leveraging technology to gain
efficiency,” notes the Web site
44
(see Tools).
? Example: Laurel, Maryland, a city of 22,000 locat-
ed near Washington, D.C., created a low-cost com-
mand center with used computers and donated soft-
ware from the federal government.The center pro-
vides interoperability with four counties surrounding
D.C. Its software includes instant messaging capa-
bilities that allow users to access and share docu-
ments over a private network.
33
Use available communications planning
resources.
Like other planning efforts, communications
planning need not involve reinventing the wheel.
Teams can consult available resources. For exam-
ple, a Web-based guide and toolkit provided by
TOOLS:
? The goals of the DMIS Interoperability
Backbone Web site are to improve disaster
response by enabling responders to share
information seamlessly between organizations,
and to provide new software tools at no cost
to responder organizations for increased disas-
ter response effectiveness. http://
www.cmi-services.org/dmishp_what_is_
dmis.html.
Standing Together: An Emergency Planning Guide for America’s Communities
the National Education Association for school
administrators includes tips, resources, ideas, and
examples for being prepared before a crisis, being
responsive during a crisis, being diligent in mov-
ing beyond a crisis, and for hands-on assistance
for educators (see Tools).
Local planners can consult federal Web sites that
provide free access to collaborative communica-
tion tools. One such Web site is http://
www.disasterhelp.gov (see Tools).
Review and build on existing
communications planning initiatives.
Communications planning may already have
occurred in numerous agencies within small
communities, such as law enforcement, fire, hos-
pitals, and school systems. These initiatives might
provide an appropriate starting point for overall
community communications planning. Plans
should be reviewed thoroughly and adapted as
needed.
? Example: Nuclear power plants are required by law
to facilitate and fund community-based emergency
planning and to engage in education, information,
preparedness, and drills with their community resi-
dents on a regular basis. Such relationships, which
cross jurisdictional lines, can serve as models for other
communities to engage in integrated communication
planning, coordination, and public education.
Obtain/prepare information for crisis
communications.
Lists of contacts, with addresses and phone num-
bers, should be established and maintained regu-
larly
45
to support timely access to critical individ-
uals, information and resources. The team can
prepare emergency proclamations, citizen alerts,
and other important documents in advance.
46
Much of the success of effective crisis communica-
tion, communication that occurs during an actu-
al crisis, is predicated on the effort that goes into
communications planning, information provision
prior to a crisis, and ongoing public education
often called risk communication.
Sidebar 18 provides the rules of risk communica-
tion recommended by the U.S. Environmental
Protection Agency.
57
TOOLS:
? Agency for Toxic Substances and Disease
Registry: A Primer on Health Risk
Communication Principles and Practices. http://
www.atsdr.cdc.gov/HEC/primer.html.
? American Red Cross: Talking About Disasters:
Guide for Standard Messages (2004). http://
www.redcross.org/disaster/safety/guide.html.
? National Education Association: Crisis
Communications Guide and Toolkit, 2003.http://www.nea.org/crisis.
? U.S. Department of Health and Human
Services (DHHS): Communicating in a Crisis:
Risk Communication Guidelines for Public Officials.
Washington, DC: DHHS, 2002. http://
www.riskcommunication.samhsa.gov/
index.htm.
? Wyatt W.: Be Prepared: Communicating in a Crisis.http://www.ncsl.org/programs/legman/nlssa/
402crisis.htm.
? DisasterHelp offers collaborative tools, includ-
ing instant messaging and chat, discussion
threads, and secured document sharing to the
responder community.http://www.diasterhelp.gov.
Standing Together: An Emergency Planning Guide for America’s Communities
Define emergency communications
protocols or procedures.
Disaster communications procedures should be
clearly defined, with an emphasis on interagency
coordination. These procedures should be a
straightforward expansion of day-to-day proce-
dures rather than a radical change in normal oper-
ating procedures.There should be established com-
munications paths with military, amateur, air, pub-
lic utility, and other radio operations outside the
Public Safety Radio Service. Communication
must be accurate and up-to-date and provide
information in “real time” so that messages will be
correct and consistent across all entities.
The planning team should ensure intact protocols
that allow law enforcement, fire, EMS, and hospi-
tals to communicate with each other during disas-
ter operations. A crisis communication protocol is
a key element of community plans; community
planners should be aware of protocol contents.
According to the study of hospital and communi-
ty emergency preparedness linkages,
14
the majority
of respondents from rural hospitals indicated that a
crisis communication protocol existed in their
community, but many still did not know whether
such a protocol was available.
Some communications techniques include using
common disaster channels and multichannel radios
and cross-banding or cross-patching of channels
through communication-center consoles.
Establish communications credibility
with the public.
Communication with the public during and fol-
lowing an emergency must be clear, credible, and
consistent. This requires thorough planning in
advance of any major occurrence. Residents of
small towns and rural communities often turn to
local leaders as the most direct source of informa-
tion in their towns and communities.
46
Identification of a spokesperson who is well
respected is key. In some communities, this might
be the mayor or other elected official, hospital
leader, religious leader, or others. Prior to any
emergency, this individual can be involved in edu-
cating and building trust with the community.
“People are more likely to follow official instruc-
tions when they have a lot of trust in what officials
tell them to do and are confident that their com-
munity is prepared to meet their needs,” notes one
study.
24
? Example: Poison control centers, nurse call lines, and
other types of medical contact systems can serve as a
conduit of credible information to the public. As part
58
1. Accept and involve the public as a partner. Your
goal is to produce an informed public, not to
defuse public concerns.
2. Plan carefully and evaluate your efforts. Different
goals, audiences, and media require different
actions.
3. Listen to the public’s specific concerns. People
often care more about trust, credibility, compe-
tence, fairness, and empathy than about statistics
and details.
4. Be honest, frank, and open. Trust and credibility
are difficult to obtain; once lost, they are almost
impossible to regain.
5. Work with other credible sources. Conflicts and
disagreements among organizations make com-
munication with the public much more difficult.
6. Meet the needs of the media.The media are usu-
ally more interested in politics than risk, simplic-
ity than complexity, danger than safety.
7. Speak clearly and with compassion. Never let
your efforts prevent your acknowledging the
tragedy of an illness, injury, or death.
Source: Covello V., Allen F.: Seven Cardinal Rules of Risk
Communication. Washington, DC: U.S. Environmental
Protection Agency, Office of Policy Analysis, 1988.
SIDEBAR 18. SEVEN CARDINAL RULES OF RISK
COMMUNICATION
Standing Together: An Emergency Planning Guide for America’s Communities
of their normal, day-to-day operations, they become a
familiar source of health and safety information for the
public. During an emergency, the public is likely to
seek information from these sources, which become an
important means of community response support. By
addressing questions on exposure, symptoms, and care
over the telephone, they can help reduce the demand
on acute care facilities.
? Example:To answer questions about how residents
can prepare for all types of emergencies and how their
city and county were preparing for emergencies,
Roseville, Minnesota (population 34,000), hosted a
community emergency readiness night.
46
The presenta-
tion and discussion were open to all residents.Topics
included how to prepare for all types of severe weather
and preparing for Y2K problems, which was an issue
of concern at that time.
Recognize and plan for the critical role
played by the media.
The media observe and report, but they also edu-
cate and warn. As indicated in Section 2, the plan-
ning team includes the media, but special effort
can be made to integrate the media’s two key
functions in planning.“In the first role (to observe
and report), the media acts as an outsider to the
community; in the second role (to educate and
warn), the media is an integral part of the emer-
gency preparedness system. Seldom are the two
roles well integrated, leading to a weaving back
and forth from one role to the other, and confus-
ing media users. News stories provide the opera-
tive ‘reality’ about the crisis period for almost
everyone,”notes E.L. Quarantelli, cofounder of the
Disaster Research Center at the University of
Delaware.
47
Identify how every community member
can be reached in an emergency.
Community preparedness requires a “locational”
system that can reach every person in a communi-
ty, from cradle to rocking chair. Communication
channels, including telephone, television, radio,
and computer (for Internet and e-mail, for exam-
ple), can be thoroughly considered by the plan-
ning team.According to a recent survey conduct-
ed for the U.S. Department of Homeland
Security’s (DHS’s) Office of Citizen Corps, there
is no one channel of communication that all
Americans prefer for receiving information.
26
? Example: Many communities have developed and
are using a “reverse 911” system to contact residents
in the event of an emergency and to provide ongoing
guidance during an emergency (for example, indicat-
ing that hospital X cannot take more patients, but to
go for care at hospital Y instead). Depending upon
the length of the message and system capabilities,
automated telephone calling systems can, within a
one-minute period, dial a dozen to hundreds of tele-
phone numbers and deliver a prerecorded message.
Targeted messages can be delivered to certain areas
and in different languages, as appropriate.Through
educational efforts, residents can be encouraged to
provide the reverse 911 agency with their unpub-
lished or cell phone numbers.
Plan to provide decisional support.
During an emergency, people want to know what
is happening, what they should do, and where to
get help. For events such as a terrorist attack, it is
not always possible to provide complete informa-
tion. However, it is imperative that communication
occurs and that the spokesperson plans to establish
an immediate presence and provide as much accu-
rate and timely information as possible.
46
“Although we live in an electronic age and a lot
of information is available through the Internet,
obtaining information or advice from another
human being appears to be critically important to
the American public in this situation. Both the
survey and our discussions with community resi-
dents around the country document that people
are looking for decision-making support, not just
59
Standing Together: An Emergency Planning Guide for America’s Communities
60
facts. People want to talk to someone to (1) con-
firm what they are hearing from government
officials or through the media, (2) get additional
information to answer their questions, and (3)
help them resolve difficult tradeoffs so they can
make the best decisions for themselves and their
families,” indicates the Redefining Readiness
study.
24(p. 19)
“Good communication is perceived differently
by the communicator, who wants public cooper-
ation and understanding in a time of crisis, and
the public, which wants inclusion, consideration,
respect, expert guidance, and proof that officials
have justly considered the public. (High quality)
risk communication bridges this gap by providing
individuals and communities with information
that allows them to make the best possible deci-
sions about their well-being,”notes an Institute of
Medicine (IOM) report.
48(p. S-38)
Ensure culturally sensitive
communication.
Consideration of the communication form and
language is critical. Given the large portion of
non-English-speaking residents in the United
States, cultural sensitivity must be assured.
Communities with significant cultural diversity
need to plan for communication in the appropri-
ate languages.
The planning team should consider if there are
cultural or linguistic groups not represented at
the planning table. These should be included or
consulted to assure that the most effective strate-
gies, messages, and modes of communication for
those groups are incorporated in the planning.
The anthrax attacks in 2001 illustrated the risk of
providing mixed messages to different communi-
ties. Ethnic groups who have experienced dispar-
ities in health care and/or social services may
look upon certain pronouncements with an atti-
tude of skepticism rather than cooperation, espe-
cially messages regarding, for example, the phased
distribution of prophylaxis or the need for isola-
tion or quarantine. Houses of worship, business
groups, and ethnic radio/TV and print media are
frequently trusted sources of information within
ethnic communities. Community-organized tele-
phone support networks can provide culturally
in-tune and accurate advice when integrated into
the planning process. Other “high-touch” meth-
ods, including in-person outreach, may be need-
ed in some communities.
“Unless public messages are tailored to gain the
attention of specific segments of our racially and
culturally diverse society, they are likely to be
ignored. (For example,) clear communication will
be essential to obtaining adherence to mass vac-
cination campaigns during a pandemic,” notes a
recent IOM report.
48(p. S-37)
? Example:The hurricanes of 2004 hit hard in por-
tions of DeSoto County, Florida, where migrant
farm workers lived and worked in the area’s citrus
groves.The local hospital, health department, and the
Centers for Disease Control and Prevention (CDC)
were concerned about the communitywide risks posed
Good communication is perceived differently by the communicator, who wants public cooperation
and understanding in a time of crisis, and the public, which wants inclusion, respect,
expert guidance, and proof that officials have justly considered their needs.
Standing Together: An Emergency Planning Guide for America’s Communities
by standing and contaminated water and other health
hazards. In the past, migrant workers typically used
the local hospital to meet their health care and infor-
mation needs. However, leery of contact with govern-
ment officials on the scene, many workers chose to stay
in the citrus groves rather than seek hospital care.The
hospital sent mobile care units, staffed by bilingual
individuals, into the citrus groves to identify and treat
injuries, provide information on safe water use, and try
to reestablish contact and trust.
Use publicly available communications
materials.
Small communities need not create their own
public awareness and readiness advertisements,
materials, and other communications vehicles
concerning certain standardized content. Such
information is available through numerous
sources, including the American Red Cross
(http://www.redcross.org/press/psa/psaPrint.html),
FEMA (http://www.fema.gov), and other agen-
cies. Resources offered by the American Red
Cross include preparedness print advertisements
devoted to specific emergencies (for example,
“Are you ready for an earthquake?”), and televi-
sion, radio, and Web banner public service
announcements in English and Spanish. FEMA
offers guides, educational materials for teachers,
fact sheets, and so forth.
? Example: A Midwestern town hung on its down-
town lamp posts two American Red Cross banners:
One banner read “Together We Prepare.”The sec-
ond banner listed five activities people could carry
out to get prepared: make a plan; build a kit; get
trained; volunteer; and give blood.
Ensure integration of the local health
care organization’s communications
plans.
Because many community residents will call or
come to the local health facility for care, for
information on their loved ones’ location or
health status, simply for general information on
disaster response, or as a safe haven, these facilities
must have a communications plan that includes a
triage communication procedure. The plan must
be integrated with the communitywide plan to
ensure consistency between the message deliv-
ered by the health facility’s administrator and the
communitywide spokesperson. “Hospitals need
to work with local emergency service organiza-
tions to provide clear, accurate information dur-
ing large-scale emergencies. To avoid disseminat-
ing conflicting information, hospitals that use
incident command systems provide for an indi-
vidual who will coordinate with other response
groups and communicate with the media and
other outside organizations,” notes an
Occupational Safety and Health Agency
report.
49(p. A-16)
A well-designed communication
plan can decrease the flood of individuals not
requiring care but coming to health facilities as a
preventive measure, as was experienced by many
New York health facilities on 9/11 and the days
following the attacks.
61
Standing Together: An Emergency Planning Guide for America’s Communities
62
Reactions to disasters may vary from one indi-
vidual to another, and stress reactions can occur
immediately following the disaster or many
months later.
50,51
These reactions may include
physiological symptoms (nausea, dizziness, chills),
cognitive/intellectual symptoms (distractibility,
difficulty communicating thoughts), emotional
symptoms (anxiety, grief, depression), behavioral
symptoms (insomnia, substance abuse), and spiri-
tual symptoms (challenges to faith beliefs, anger
and blaming, and so forth). These reactions may
be experienced by both victims of the disaster
and those who responded to help the victims.
Some of these reactions may be severe enough to
require an individual’s referral to behavioral
health services.
Mental health problems following natural or man-
made disasters impact communities of all sizes, but
rural and small communities may find it particu-
larly challenging to respond to the needs of their
residents. In the best of circumstances, such com-
munities lack a sufficient number of mental health
specialists. Moreover, their residents, whether due
to geographic, economic, cultural, ethnic, or other
impediments, may be unable or unwilling to
access mental health specialists. “Even more than
other areas of health and medicine, the mental-
health field is plagued by disparities in the avail-
ability of and access to its services. These dispari-
ties are viewed readily through the lenses of racial
and cultural diversity, age, and gender,” notes a
U.S. Surgeon General’s report.
52(p. vi)
Strategies teams can use to address mental health
needs follow.
Use available mental health disaster
planning resources.
Since publication in 2003 of the Mental Health
All-Hazards Disaster Planning Guidance by the
Center for Mental Health Services of the U.S.
Department of Health and Human Services,
53
state and local mental health leaders have had a
key resource for the creation or revision of all-
hazards mental health response plans (see Tools).
The publication outlines the planning process,
plan contents, and resources. An appendix out-
lines the discrete elements of an all-hazards state
disaster mental health plan.
Sidebar 19 lists numerous organizations that pro-
vide information on the behavioral consequences
of disasters.
Link to pastoral care resources.
In times of crisis and long after the crisis is over,
many people look to their familiar clergy and
other religious leaders in the community for
comfort and guidance. Planning teams should
consider community faith-based social support
systems and how to link to pastoral and spiritual
caregivers who can provide assistance to individ-
uals seeking spiritual and emotional support, reas-
surance, and guidance. National pastoral crisis
resources, including the American Red Cross, the
International Critical Incident Stress Foundation,
8. Ensure Thorough Mental Health Planning
Recommended Planning Strategies:
? Use available mental health disaster
planning resources.
? Link to pastoral care resources.
? Consider organizing self-help groups.
? Link to and know how to access fed-
eral and state disaster mental health
plans/resources.
? Recognize and plan for the emotion-
al effect of crises on rescue and
health care workers.
Standing Together: An Emergency Planning Guide for America’s Communities
Inc., and the Salvation Army, can also be consid-
ered. In a disaster relief operation, Salvation Army
volunteers offer emotional comfort and spiritual
comfort through a “ministry of presence.”
Recognition of the diversity of faith traditions
and belief systems is critical to the effectiveness of
pastoral services.
Consider organizing self-help groups.
Self-help groups or teams can be helpful in pro-
viding needed assistance following a disaster, par-
ticularly if mental health professionals are not avail-
able in or to the community. Emotional encour-
agement and practical support (working with
neighbors to board up windows and clean homes
after a catastrophic fire, escorting neighborhood
children to school past tornado-damaged homes,
63
TOOLS:
? Institute of Medicine: Preparing for the
Psychological Consequences of Terrorism: A Public
Health Strategy. Washington, DC: National
Academies Press, 2003.http://www.nap.edu/
openbook/0309089530/html.
? U.S. Department of Health and Human
Services (DHHS). Mental Health All-Hazards
Disaster Planning Guidance. DHHS Pub. No.
SMA 3829. Rockville, MD: Center for
Mental Health Services, Substance Abuse and
Mental Health Services Administration, 2003.http://www.mentalhealth.samhsa.gov/
publications/allpubs/SMA03-3829/default.asp.
? U.S. Department of Health and Human
Services (DHHS): Mental Health Response to
Mass Violence and Terrorism: A Training Manual.
DHHS Pub. No. SMA 3959. Rockville, MD:
Center for Mental Health Services, Substance
Abuse and Mental Health Services
Administration, 2004. http://
www.mentalhealth.samhsa.gov/publications/
allpubs/SMA-3959/default.asp.
The following list identifies a few of the numerous
organizations that provide information on the
behavioral consequences of disasters.
? American Academy of Child and Adolescent
Psychiatryhttp://www.aacap.org
? International Critical Incident Stress
Foundation, Inc.http://www.icisf.org
? American Academy of Experts in Traumatic Stresshttp://www.aaets.org
? National Alliance for the Mentally Illhttp://www.nami.org
? American Psychiatric Associationhttp://www.psych.org
? National Association of School Psychologistshttp://www.nasponline.org
? American Psychiatric Nurses Associationhttp://www.apna.org
? National Association of Social Workershttp://www.naswdc.org
? American Psychological Associationhttp://www.apa.org
? National Center for Post-Traumatic Stress Disorderhttp://www.ncptsd.org
? American Red Crosshttp://www.redcross.org
? National Depressive and Manic Depressive
Associationhttp://www.ndmda.org
? The Center for Mental Health Serviceshttp://www.mentalhealth.org
? National Institute of Mental Healthhttp://www.nimh.nih.gov
? Disaster Mental Health Institute at the University
of South Dakotahttp://www.usd.edu/dmh
? National Mental Health Associationhttp://www.nmha.org
? Federal Emergency Management Agencyhttp://www.fema.gov
SIDEBAR 19. BEHAVIORAL HEALTH INFORMATION
RESOURCES FOR DEALING WITH THE EFFECTS OF
DISASTERS
Standing Together: An Emergency Planning Guide for America’s Communities
and so forth) are invaluable during a disaster and
throughout the recovery phase as people try to
respond to the crisis and rebuild their lives.
? Example:Westport, Connecticut, developed a com-
munity support and counseling team to address the
mental health needs of its approximately 26,000
residents in times of crisis.The team is developing
training for mental health professionals, school and
community clinicians, home health care providers,
child care workers, and volunteers.
33
Link to and know how to access federal
and state disaster mental health
plans/resources.
When disasters strike, regional or state mental
health/substance abuse agencies and local service
providers may be suddenly thrust onto the front
line for response and recovery efforts because of
geographic proximity to the area affected by dis-
asters. Often they find themselves confronting
new or unknown problems for which no amount
of preplanning is possible.
54
The provision of
mental health services following a disaster will be
beyond the capability of many small, rural, and
suburban communities. Such communities must
link their plans to state disaster mental health
plans and must know how to access regional,
state, or federal services (Sidebar 20).
The state of New Hampshire has little experience
with terrorism, and the most rural areas lack the
resources to prepare for and respond to disasters.
Historically New Hampshire’s behavioral health
response to critical incidents came from two
areas: community mental health centers and the
Red Cross mental health branch. Following the
events of 9/11 it soon became apparent that New
Hampshire like many other states lacked the
capacity to respond to the behavioral health
needs of its citizens if a major disaster were to
occur. The Substance Abuse and Mental Health
Services Administration (SAMHSA) issued a
request for proposal to increase state behavioral
health response capacity. New Hampshire was
one of 35 states to receive a $200,000 grant from
SAMHSA for this purpose.The majority of these
funds have been used to identify behavioral
health professionals, encourage them to volun-
teer, and train them in the unique aspects of dis-
aster behavioral health response. In addition,
training has been provided to emergency medi-
cal, public health, and public safety organizations
to familiarize them with the psychosocial impact
of disasters and the existence of behavioral health
response in New Hampshire.
The New Hampshire Department of Safety’s
Bureau of Emergency Management (BEM) has
developed organized teams of behavioral health
providers to respond to the mental health needs
of New Hampshire residents following disasters.
Five regional disaster behavioral health response
teams (DBHRTs) totaling over 500 professionals
have been created and can be deployed immedi-
ately anywhere in the state. These teams would
respond to disasters or critical incidents when
local behavioral health resources have been
64
Planning teams should consider community faith-based social support systems and how to
link to pastoral and spiritual caregivers who can provide assistance to individuals seeking
spiritual and emotional support, reassurance, and guidance.
Standing Together: An Emergency Planning Guide for America’s Communities
65
depleted or are overwhelmed. The goal of the
DBHRTs is to provide an organized response to
individual victims, family members, survivors, or
the community affected by critical incidents or
disasters. Teams include individuals with experi-
ence in human services, psychology, mental
health, substance abuse, social work, psychiatry,
education, or spirituality. DBHRT members have
completed specialized training. Team members
operate under the supervision of BEM’s disaster
behavioral health coordinator, receive ongoing
training, and participate in communitywide drills.
Team members can provide interventions in
three distinct phases that may be delivered at a
disaster site, in an affected community, or
statewide. The phases and interventions include
the following:
Immediate Response: Behavioral health needs
assessment, psychological first aid, crisis interven-
tion, community outreach, public information,
and behavioral health consultation
Transition to Recovery: Brief supportive counsel-
ing, information dissemination, screening and
referral, support groups, and public education
Preparedness and Mitigation: Disaster behavioral
health planning and networking, prevention ser-
vices designed to strengthen community
resilience, specialized training initiatives for team
members and community partners, and research
Activation of the DBHRT is done through the
governor, or a designee at the BEM, during fed-
eral or state emergencies. If an emergency is not
declared, local municipalities or emergency
response systems may request assistance in order
to meet the behavioral health needs of commu-
nities in local crises by contacting the disaster
behavioral health coordinator located at the
BEM.
55
The American Red Cross (http://www.
redcross.org/services/disaster) also provides men-
tal health services to anyone in affected areas fol-
lowing any emergency and to families outside the
disaster area. Services, which are available on
average for a few days or a week following the
event, include counseling and referral by licensed
mental health professionals.
The Department of Justice’s Office for Victims of
Crime (http://www.ojp.usdoj.gov/ovc) provides
advocacy and other services, including support
for short- and long-term mental health services,
to victims of criminal acts (including terrorism).
SAMHSA DTAC
Established by the Substance Abuse and Mental
Health Services Administration (SAMHSA), the
Disaster Technical Assistance Center’s (DTAC’s) mis-
sion is to ensure that the United States is prepared
and able to respond rapidly when events increase the
need for trauma-related mental health and substance
abuse services. The agency performs the following
functions:
? Preparation: Assists states and territories with “all-
hazards” disaster response planning by providing
consultation to review disaster plans, conducting
literature reviews, and brokering knowledge and
support.
? Response: Assists in identifying suitable publica-
tions, psychoeducational materials, and expert
consultants, and organizes training events and
workshops to share the experiences of states that
have confronted certain types of disasters.
? Communication and resources: Maintains a contact
database of state/territory mental health commis-
sioners, substance abuse directors, and disaster
coordinators, and a roster of federal agencies and
nongovernmental organizations involved in disas-
ter and trauma research and/or service delivery.
Also maintains a collection of technical assistance
publications.
continued
SIDEBAR 20. FEDERAL MENTAL HEALTH
RESOURCES
Standing Together: An Emergency Planning Guide for America’s Communities
Recognize and plan for the emotional
effect of crises on rescue and health
care workers.
Numerous national crises have taught important
lessons about the extent of the emotional effect
of crises on rescue and health care workers. No
one who responds to a mass casualty incident is
untouched by it; training as a first responder or
caregiver does not provide such immunity. Stress
management assistance is often needed and
should be considered by community planning
teams. One form of assistance—psychological
debriefing—which usually occurs within days of
a critical event, aims to help first responders and
others exposed to a traumatic event to talk about
their feelings and reactions in order to reduce
traumatic stress.
56
Planning teams should consider
the possible range of staff support needs, match
the plans and potential interventions to those
needs, and prepare to solicit additional mental
health resources from local, state, or federal
sources should staff needs during response and
recovery exceed expectations and plans.
66
For more information:http://www.mentalhealth.samhsa.gov/dtac/default.asp
FEMA Crisis Counseling Program
The Federal Emergency Management Agency’s
(FEMA’s) Crisis Counseling Program provides
short-term services to eligible survivors of presiden-
tially declared major disasters who are experiencing
normal reactions to very abnormal situations. Its
mission is to help relieve any grieving, stress, or
mental health problems caused or aggravated by a
disaster or its aftermath. The confidential services,
typically lasting for about a year following a disaster,
are provided by FEMA as supplemental funds grant-
ed to state and local mental health agencies.
Individuals may contact FEMA’s toll-free helpline
number, 1-800-621-FEMA (TTY 1-800-462-
7585), to learn where these services can be obtained.
Crisis counselors are often on hand at disaster recov-
ery centers (when they are established). Crisis
Counseling grants are applied for by a State Mental
Health Authority when local resources cannot meet
local needs in a presidentially declared disaster.
For more information:http://www.fema.gov/rrr/inassist.shtm
SIDEBAR 20. FEDERAL MENTAL HEALTH
RESOURCES (CONTINUED)
The needs of vulnerable populations should be
considered by planning teams. These individuals
can easily suffer harm disproportionately during
or following an emergency because they may not
be able to seek help, care for themselves, or pur-
sue other survival and recovery strategies pursued
by nonvulnerable populations. Strategies teams
can use to address the needs of vulnerable popu-
lations follow.
Identify special-needs populations to
support effective communication,
outreach, and planning.
In disaster preparedness and response, the Centers
for Disease Control and Prevention (CDC) defines
special populations as “groups whose needs are not
fully addressed by traditional service providers or
who feel they cannot comfortably or safely access
and use the standard resources offered in disaster
preparedness, relief, and recovery.They include, but
are not limited to, those who are physically or
mentally disabled (blind, deaf, hard-of-hearing,
cognitive disorders, mobility limitations), limited
or non-English-speaking, geographically or cultur-
ally isolated, medically or chemically dependent,
homeless, frail/elderly, and children.”
57
They may
also include certain institutionalized populations,
such as those in foster care or nursing homes. A
number of resources from governmental agencies,
not-for-profit organizations, and commercial com-
panies are available to local planners preparing to
serve vulnerable populations. For example,
PrepareNow.org provides tools, expertise, and
access to resources to assist anyone engaged in dis-
aster planning for individuals with special needs.
Older and disabled people are particularly vul-
nerable during and following a disaster. Following
the 9/11 World Trade Center attacks, older peo-
ple and those with disabilities living near the dis-
aster area were trapped for days before being res-
cued.
58
Even in a city as large as New York, at that
time there was no effective way to identify vul-
nerable people who were not connected to a
community service agency. There also was no
means for community service providers to enter
the disaster area to provide critical assistance and
information to older and disabled people.
Identifying vulnerable individuals as part of the
emergency management plan and alerting, relo-
cating, or otherwise aiding them when disaster
appears imminent is essential in preventing harm.
For example, the National Organization on
Disability urges media outlets to follow closed-
captioning guidelines for persons with hearing
disabilities when broadcasting emergency infor-
mation to the general community.
Include a cross section of partners in
planning and response efforts related
to vulnerable populations.
The Disability Preparedness Center advises plan-
ners to include individuals and organizations with
disabilities not only as information resources, but
as active planning partners and in drills and exer-
cises so that responders can refine the necessary
skills in working with these populations.
9. Ensure Thorough Planning Related to Vulnerable Populations
Standing Together: An Emergency Planning Guide for America’s Communities
67
Recommended Planning Strategies:
? Identify special-needs populations to
support effective communication,
outreach, and planning.
? Include a cross section of partners in
planning and response efforts related
to vulnerable populations.
? Consider the unique needs of children.
? Involve the school nurse in emergency
preparedness and response.
The team might involve social workers and home
health care agencies in locating vulnerable indi-
viduals who will need special assistance. High
school and college students can also play a signif-
icant role in planning and response activities.
? Example: AmeriCorps Emergency Readiness teams
in California provide opportunities for students in
local community colleges to provide disaster/emergen-
cy preparedness services to vulnerable populations.
59
? Example:The Teen School Emergency Response
Training (SERT) program is an in-class curriculum-
based program that helps students make informed
decisions regarding emergency readiness and
response.
60
Pilot-tested for the nation at Pueblo West
High School in Colorado in November 2003, the
program is offered over a nine-week period for one
hour per day.
Consider the unique needs of children.
According to the National Center for Disaster
Preparedness (NCDP) at Columbia University’s
Mailman School of Public Health, the needs of
Standing Together: An Emergency Planning Guide for America’s Communities
68
In February 2005 the Disability Preparedness Center
conducted a needs assessment on disability preparedness,
which generated a number of valuable findings and rec-
ommendations regarding strategies for including people
with disabilities in emergency management planning
activities. Their specific recommendations were focused
on the National Capital Region (NCR), but many of the
recommendations are applicable to different types of
communities across the country:
1. Survey first responders and regional and local plan-
ners to assess (and raise awareness of) resources and
needs for disability preparedness in localities
throughout the region.
2. Provide technical assistance and skills development
to first responders to assist them in including per-
sons with disabilities in planning activities and in
response and recovery plans.
3. Identify people with disabilities living indepen-
dently, with family, or in residential facilities and
recruit them to participate in planning activities.
4. Plan and implement an information campaign to
inform the public about ways to better prepare in
the event of an emergency.
5. Establish an NCR Disability Advisory Committee
to be a visible public presence and oversee devel-
opment of inclusive emergency preparedness,
response, and recovery.
6. Hold a one-day regional conference on the roles
and responsibilities in emergency preparedness of
people with disabilities, advocates, agencies, and
service providers.
7. Develop a curriculum for persons with disabilities
to prepare them to participate effectively in plan-
ning and to pass on their skills to other people with
disabilities.
8. Develop a “planning participation course” for dis-
ability agency staff and service provider staff to help
prepare them to do effective emergency planning
and implementation.
9. Develop an enhanced emergency communication
network for persons with disabilities.
Source: Disability Preparedness Center (DPC): NCR Needs
Assessment on Disability Preparedness. Washington, DC: DPC,
2005.
SIDEBAR 21. NEEDS ASSESSMENT ON DISABILITY
PREPAREDNESS
TOOLS:
? Pennsylvania Department of Health: Special
Populations Emergency Preparedness Planning.http://www.dsf.health.state.pa.us/health/
cwp/view.asp?a=171&q=233957.
? Federal Emergency Management Agency’s
Emergency Management Institute offers a
course on emergency planning and special
needs populations (EMI - G197) that can be
downloaded from its Web site: http://
training.fema.gov/EMIWeb/pub/register.html.
? National Organization on Disabilityhttp://www.nod.org.
? Disability Preparedness Centerhttp://www.disabilitypreparedness.org.
Standing Together: An Emergency Planning Guide for America’s Communities
children have rarely been highlighted in disaster
planning and, hence, have rarely been planned
for.
61
Special pediatric considerations cited at the
2003 NCDP Pediatric Preparedness for Disasters
and Terrorism National Consensus Conference
include the following:
? Children are more vulnerable to chemical
agents that are absorbed through the skin or
inhaled, and are closer to the ground, thereby
more susceptible to gases that are heavier than
air.
? Children have special susceptibilities to dehy-
dration and shock from biological agents.
? Children require different dosages or different
antibiotics and antidotes to many agents.
? Children are more susceptible to the effects of
radiation exposure and require different
responses than adults.
? Children have unique psychological vulnera-
bilities, and special management plans are
needed in the event of mass casualties and
evacuation.
? Children’s developmental ability and cognitive
levels may impede their ability to escape dan-
ger.
? Emergency medical services, medical, and hos-
pital staff may not have pediatric training,
equipment, or facilities available.
The Program for Pediatric Preparedness is cur-
rently working on a Model Pediatric Component
for State Disaster Plans.
61
In addition, initiatives
are under way in a group of California hospitals
to enhance training of emergency department
staff in treatment, equipment, supplies, medica-
tions, and techniques required to treat pediatric
patients more effectively in a disaster situation.
The American Academy of Pediatrics sponsors a
Web page titled “Children, Terrorism &
Disasters,” which provides extensive information
not only for physicians and parents, but also for
teachers and community planners.
Involve the school nurse in emergency
preparedness and response.
The more than 60,000 school nurses in the
nation’s public and private elementary and sec-
ondary schools represent an important resource
for emergency preparedness and response for
children in small communities nationwide, par-
ticularly in the area of bioterrorism preparedness
and response. “School nurses have easier access to
large populations of people than most health pro-
fessionals and are, therefore, in positions to mon-
itor unusual symptoms or signs, recognize pat-
terns of symptom presentation, act to protect
against spread of communicable diseases, and pro-
vide immediate treatment and decontamination
for members of the school community,” notes the
National Association of School Nurses.
62
School
nurses are in a unique position to monitor school
absenteeism and to follow up with students and
the local public health department on any suspi-
cious patterns of symptoms.
69
TOOLS:
? Resources for planning, care, and treatment
concerning children in disasters is offered by
the American Academy of Pediatrics athttp://www.aap.org/terrorism/index.html.
Involve social workers and home health care agencies in locating vulnerable individuals who
will need special assistance.
Standing Together: An Emergency Planning Guide for America’s Communities
70
Many local governments are hard-pressed to pro-
vide basic services and, as a result, funds and
resources needed for “special activities,” including
emergency preparedness, often are sorely lacking.
Federal and state governments provide for fund-
ing at the local level for emergency preparedness
planning; however, many communities have
either not attained or not pursued the funding
that will enable them to develop and implement
emergency management plans.
In some states, fire, law enforcement, public
health, emergency medical services, or hospitals
may be designated to receive the lion’s share of
federal funding. However, collaborative planning
and preparedness require funding of and training
for all response partners. Commenting on fund-
ing disparities in the public health arena,
researchers involved in a study of public health
preparedness in 12 U.S. communities noted:
“Despite the large inflow of federal dollars to
some communities, the cost of implementing or
improving communications and surveillance sys-
tems, training, planning, and labs remains daunt-
ing.”
63
Because details pertaining to funding
sources and requirements can change rapidly, this
section focuses on broad strategies that can be
used to identify, cultivate, and sustain funding and
identifies a key resource for obtaining current
information on a range of funding sources.
Proactively pursue funding.
Many small communities for a variety of reasons
have not been proactive in providing states with
plans and initiatives eligible for federal funds
through the state. As a result, some state govern-
ments have not allocated all funds or have applied
funds to other projects. To gain access to federal
funding to which they are entitled, local planning
bodies must be proactive and persistent. A good
“one-stop shopping” source of information relat-
ed to available grants appears in the Tools box.
10. Identify, Cultivate, and Sustain Funding Sources
Recommended Planning Strategies:
? Proactively pursue funding.
? Include all planning partners in the
funding requests.
? Consider revenue-raising opportunities.
? Seek funding collaboratively and
regionally.
? Consider the impact of funding
reductions.
TOOLS:
? U.S. Department of Homeland Security (DHS)
grants Web site:http://www.dhs.gov/
dhspublic/display?theme=18.
This site provides information on homeland security
and public safety grant opportunities offered by agen-
cies across the federal government and is intended to
simplify access to these grants by placing information
in a single, easily accessible site. It includes grants
offered by the DHS, as well as other federal depart-
ments and agencies. Critical state and local missions
supported through these grants include the prepared-
ness of first responders and citizens, public health,
infrastructure security, and other public safety activi-
ties. Grants described can be awarded to a variety of
entities, including local governments, Native
American tribal government partners, and private
nonprofit organizations.
DHS grants listed include those administered by the
Office of Domestic Preparedness, the Federal
Emergency Management Agency, and the
Transportation Security Administration. Other feder-
al agency programs include public health prepared-
ness grants from the Department of Health and
Human Services, Department of Justice grants for
counterterrorism and general-purpose law enforce-
ment activities, and Environmental Protection
Agency grants for enhancing the security of the
nation’s water supplies.
Standing Together: An Emergency Planning Guide for America’s Communities
71
Include all planning partners in the
funding requests.
Many communities do not receive their full share
of funding because the role of all partners in the
emergency management plan is not represented
in the funding requests. Requests for funding
made to county, state, federal, and other entities
should present the full spectrum of participants
that require support.
Consider revenue-raising opportunities.
The chief executive of small communities can
support funding within his or her community,
region, or state by sponsoring or supporting tax
incentives, bonding bills, grants, and other mea-
sures. Such measures can either direct funding to
the community or incentivize planning partners
to participate more fully in planning and response
efforts.The incentives can be especially important
for increased access to response capabilities and
assets held by industrial and telecommunications
entities, hospitals, and other private businesses.
Seek funding collaboratively and
regionally.
Distribution of funds may be a bigger problem in
some states than the actual availability of funds.
Getting resources into the right hands often is
related to the availability of all key players at the
table.To increase leverage in funding negotiations
or to take advantage of economies of scale, chief
executives should foster collaboration within
their communities and across jurisdictions to
coordinate funding requests. Leaders of small,
rural, and suburban communities with a hospital
or hospitals can make special effort to partner
with hospital leaders in emergency preparedness
planning. Hospitals may have access to numerous
emergency preparedness funding streams, and
collaborative grant-seeking can be productive.
States often allocate federal funds on a regional
basis. Mayors and other leaders of small commu-
nities should consider participating in the plan-
ning and hazard mitigation efforts of multijuris-
dictional regional councils of government, for
example, in order to increase awareness of plan-
ning and funding initiatives. Through linkages to
regional and state planning efforts, elected and
other leaders of small communities can partici-
pate in funding requests, thereby securing the
necessary seat at the table and a voice to articu-
late the community’s full range of planning, train-
ing, response, and recovery needs.
Consider the impact of funding
reductions.
A risk that must be considered in the funding
strategy is that budgets at the state and federal
level change with fiscal and political pressures.
The planning team can prepare for potential
reductions in funding by identifying alternative
or creative sources and methods for sustaining
preparedness funding levels.
Through linkages to regional and state planning efforts, elected and other leaders of small
communities can participate in funding requests, thereby securing the necessary seat at the
table and a voice to articulate the community’s full range of planning, training, response, and
recovery needs.
Communitywide emergency preparedness and
response training, exercises, and drills allow com-
munities to test their plans, identify weaknesses,
and correct those to reduce the risk of process
failures during an actual emergency.The planning
and response partners are required to work col-
laboratively, many of them for the first time, to
test their communication and coordination sys-
tems designed to save lives, protect health and
property, and restore operability of essential com-
munity functions and services. Health care
providers, public health officials, first responders,
the general public, and all response partners
require training and practice in their intended
roles.
Identify who should be trained and the
training needs for each.
Individuals responsible for responding to a disas-
ter situation must be identified and trained. Not
everyone is capable of performing every func-
tion. For example, not all individuals working in
the health field may wish to participate or are
suited to enter a disaster environment; some staff
will require training in decontamination proce-
dures and others will not.
? Example: In various communities in Texas, selected
mental health workers, social workers, school coun-
selors, drug abuse counselors, faith-based counselors,
and others can attend a 16-hour training program in
emergency response. If the community or a neighbor-
ing community requires mental health support, these
individuals are activated to provide mental health
services through the emergency operation center.
64
Training sessions ideally are provided to represen-
tatives of the major organizations or agencies
involved in emergency response, including emer-
gency medical services (EMS) personnel, fire ser-
vice, law enforcement, emergency management
personnel, business leaders, local health care facil-
ity personnel, public health officials, and others as
appropriate.
In smaller communities, face-to-face training and
drills can be challenging, especially where one per-
son may wear several “hats.”To meet this challenge,
the planning team can identify a variety of training
methodologies and schedules as appropriate to
meet required competencies, roles and responsibil-
ities, and time and technology constraints. Some
11. Train, Exercise, and Drill Collaboratively
Standing Together: An Emergency Planning Guide for America’s Communities
72
Recommended Planning Strategies:
? Identify who should be trained and
the training needs for each.
? Ensure competency-based training
programs.
? Identify cross-training opportunities.
? Consider offering the CERT program.
? Access other training programs offered
through the federal government.
? Ensure incident command training
for appropriate personnel.
? Recognize drills or exercises as a
critical element of the emergency
preparedness process.
? Involve all players in exercises and
drills.
? Be sure to include local businesses in
training, exercises, and drills.
? Access available resources.
? Practice with other communities.
? Identify performance measures for
drills and exercises.
? Ensure the realism of drills and exer-
cises.
? Include alternative care sites and
shelters in disaster drills.
? Activate the emergency plan.
Standing Together: An Emergency Planning Guide for America’s Communities
73
preparedness partners (for example, an EMS agen-
cy) may be able to obtain extensive classroom
training for each staff member; others may need to
use Web-based training, CDs, or videos.
Ensure competency-based training
programs.
Education and training programs should be com-
petency based, with programming that is specific
to the individual’s role in emergency response.
Individuals responding to a disaster situation must
have the knowledge, skills, abilities, and behaviors
needed to perform tasks correctly and skillfully.
Some education and training will be appropriate
for both the general public and emergency
responders (for example, CPR), while other pro-
grams will be appropriate only for specialized
personnel (for example, decontamination).
Identify cross-training opportunities.
In small communities, cross training of first
responders increases the ability of individuals to
respond appropriately in different situations, such
as fire, rescue, hazardous materials, and weapons
of mass destruction. Cross training also extends
available skill sets during disasters involving dis-
placement of large numbers of people, evacuation
of hospitals, nursing homes, or other settings, and
emergencies of long duration.
? Example:Tyler,Texas (population 84,000), recently
purchased several hundred low-cost ventilators and
the training program to use these ventilators.
Emergency personnel are teaching disaster life support
very broadly among possible first responders, health
care personnel, and other citizens in the community.
Consider offering the CERT program.
Communities whose residents have not yet expe-
rienced the Community Emergency Response
Team (CERT) program
65
may wish to consider
offering the program. CERT is funded by
Congress through Citizen Corps program grants,
which may be available to local communities.
Citizen Corps is the community-based initiative
to engage citizens in homeland security and
community and family preparedness through
public education and outreach, training opportu-
nities, and volunteer service. A key component of
Citizen Corps, the CERT program trains citizens
to be better prepared to respond to emergency
situations in their communities. When emergen-
cies occur, CERT members can give critical sup-
port to first responders, provide immediate assis-
tance to victims, and organize volunteers at a dis-
aster site.
The CERT program is a 20-hour course, typical-
ly delivered over a seven-week period. Training
sessions cover disaster preparedness, disaster fire
suppression, basic disaster medical operations,
light search and rescue, and team operations. The
training also includes a disaster simulation in
which participants practice skills that they learned
throughout the course.
The CERT course is taught in the community by
a trained team that has completed a CERT Train-
Some preparedness partners (for example, an EMS agency) may be able to obtain extensive
classroom training for their team members; other partners may need to use
Web-based training, CDs, or videos.
Standing Together: An Emergency Planning Guide for America’s Communities
74
the-Trainer course conducted by their state train-
ing office for emergency management or by the
Federal Emergency Management Agency’s
(FEMA’s) Emergency Management Institute
(EMI). CERT programs currently serve in more
than 170 communities nationwide. A local gov-
ernment agency, such as the emergency manage-
ment agency, fire department, or police depart-
ment, typically provides the CERT classes.
CERTs are active in the community before a dis-
aster strikes, sponsoring events such as drills,
neighborhood cleanups, and disaster education
fairs. Trainers offer periodic refresher sessions to
CERT members to reinforce the basic training
and to keep participants involved and practiced in
their skills.
? Example: Iredell County in North Carolina (popu-
lation 130,000) applied and obtained a $10,000
grant through the state Citizen Corps to offer three
CERT training programs during 2003.The coun-
ty’s Board of Commissioners defined the programs’
purpose as follows: (1) enhance the overall prepared-
ness of Iredell County’s citizenry; (2) provide infor-
mation about the CERT program and improve pre-
paredness and safety; (3) use local agencies in the
training; (4) collaborate with local agencies to pro-
mote/support Neighborhood Watch/Community
Watch programs and Volunteers in Policing pro-
grams; and (5) obtain commitment from the Citizen
Corps council and local emergency planning commit-
tee to support the CERT efforts/programs.
66
Says
Tracy Jackson, the county’s Director of Emergency
Services, “An effective disaster preparedness program
must reach out to and educate all citizens and orga-
nizations within the community.The CERT pro-
gram is a great means to do just that.”
67
Access other training programs offered
through the federal government.
Training courses developed by numerous federal
agencies provide a broad curriculum and enable
local communities to tailor programs to their spe-
cific training needs. For example, FEMA’s EMI
offers independent-study training programs on
such topics as special-events contingency plan-
ning for public safety agencies, livestock in disas-
ters, radiological emergency management, devel-
oping and managing volunteers, community hur-
ricane preparedness, principles of emergency
management, multihazard emergency planning
for schools, and dozens of others (see Tools).
TOOLS:
? Federal Emergency Management Agency’s
Emergency Management Institute Web site
provides a resource center on best practices
for starting and maintaining a Community
Emergency Response Team program. http://
training.fema.gov/EMIWeb/CERT/
new_CERT/index.htm. Funding information
is available through State Citizen Corps
points of contact listed at http://
www.citizencorps.gov/citizenCorps/statepoc.do.
TOOLS:
? A complete list of training resources offered
through the Federal Emergency Management
Agency can be accessed at http://
training.fema.gov/EMIWeb.
? A complete list of training resources offered
through the U.S. Department of Homeland
Security is available athttp://www.dhs.gov/
dhspublic/display?theme=63.
? Training offered by the Centers for Disease
Control and Prevention’s Agency for Toxic
Substances and Disease Registry is available athttp://www.atsdr.cdc.gov/
hazmat-emergency-preparedness.html.
Emergency preparedness and response training
programs related to biological, nuclear, and
radiological terrorism are listed at http://
www.bt.cdc.gov/training.
Standing Together: An Emergency Planning Guide for America’s Communities
Ensure incident command training for
appropriate personnel.
The National Incident Management System (NIMS)
and the National Response Plan (NRP) require
incident management personnel to be appropri-
ately trained to improve all-hazards incident
management capability nationwide.
27
The EMI
offers training related to key elements of the
NIMS. The EMI also offers courses in prepared-
ness and resource management. Both the NIMS
and the NRP are being incorporated into virtu-
ally every course offered by the EMI. For more
information, accesshttp://training.fema.gov/
emiweb/emicourses/e449.asp.
Recognize drills or exercises as a
critical element of the emergency pre-
paredness process.
Drills are integral to the process of troubleshoot-
ing weaknesses in emergency management plans.
They are designed both to provide training exer-
cises and to identify weaknesses in the response
plan so that shortcomings can be addressed.
Communities should regularly test (at least annu-
ally) their emergency preparedness plans through
reality-based drills for the purpose of identifying
opportunities for improving and refining the
plan. Sidebar 22 provides the U.S. Department of
Homeland Security’s definitions for various types
of drills and exercises.
? Example: During a semiannual communitywide
emergency management plan drill in California, the
medical center that organized the drill discovered
some holes in its emergency management response
plan.
68
The scenario was a radioactive waste spill.
After scrambling to locate the appropriate personal
protective equipment, staff discovered that the decon-
tamination suits did not fit. Several even ripped
while the engineers tried to put them on.
Furthermore, several “paper patients” were lost in
transit.When investigating what went wrong, the
organization discovered that the lost paper patients
were actually transferred to an off-site location, but
there was no way to indicate this on the emergency
response patient transfer form.
75
Tabletop Exercises
Tabletop exercises focus on facilitating understand-
ing of concepts, identifying strengths and shortfalls,
and/or achieving a change in attitude. Exercises gen-
erally involve senior staff, middle management, and
other key personnel who are encouraged to discuss
issues in depth and develop decisions through slow-
paced problem solving rather than rapid, sponta-
neous decision making.
Games
A game is a simulation of emergency management
operations that often involves teams, usually in a
competitive environment, and does not involve the
use of actual resources. The goal is to explore
decision-making processes and the consequences of
those decisions. Players are commonly presented
with scenarios and asked to perform a task associat-
ed with the scenario episode.
Operations-Based Exercises
Operations-based exercises represent the next level
in the exercise cycle and are used to validate the
plans, policies, agreements, and procedures.
Operations-based exercises include drills, functional
exercises, and full-scale exercises and are character-
ized by mobilization of resources and commitment
of personnel over an extended period of time.
Drills
A drill is a coordinated test used to evaluate a spe-
cific operation or function in a single department or
nursing unit. Drills can be used to provide training
on new equipment, test new policies or procedures,
or practice skills.
continued
SIDEBAR 22. DEFINITIONS OF VARIOUS FORMS OF
DRILLS AND EXERCISES
Involve all players in exercises and
drills.
Full-scale exercises and drills, involving all the
major emergency response participants, provide
full-scale value in terms of lessons learned. Local
leaders, public health authorities, EMS, fire, law
enforcement, volunteers, the general public, and
all other appropriate parties should be involved in
communitywide drills.“The key to making prac-
tice pay off for your city or town is to seek out
opportunities to test your plan in as many ways as
possible, at all levels of your government.
Everyone who works for the city should at some
point be part of the testing, with a special focus
on first responders and managers of all city
departments,” advises the National League of
Cities.
46 (p. 14)
Health care organizations accredited by the Joint
Commission will be experienced partners
because they are required to conduct drills relat-
ed to their emergency management plan at least
twice yearly; one of these drills is expected to be
a communitywide one. However, not all health
care organizations are accredited, and, according
to a recent study of hospital and community
emergency preparedness linkages,
14
involvement
of key players in hospital-initiated community-
wide emergency drills in rural areas is inconsis-
tent. Local health departments and government
agencies were reported to be involved in fewer
than half of communitywide drills; traditional
first responders (fire, EMS, law enforcement)
were most commonly included in community-
wide drills.
? Example: Using FEMA’s Comprehensive Hazmat
Emergency Response - Capability Assessment
Program (CHER-CAP), Lake Havasu City,
Standing Together: An Emergency Planning Guide for America’s Communities
76
Functional Exercises
Functional exercises are designed to test multiple
functions, activities, and departments with a focus on
exercising the plans, policies, procedures, and staffs.
Functional exercises simulate the operations by pre-
senting realistic problems requiring responses.
Full-Scale Exercises
The full-scale exercise is the most comprehensive
level in the exercise cycle and usually includes mul-
tidepartment, multiorganization, multijurisdiction
agencies. The full-scale exercise simulates the reality
of operations in multiple functional areas through
the presentation of realistic problems requiring crit-
ical thinking, rapid problem solving, and effective
responses. Full-scale exercises are used to assess orga-
nizational and individual performance, demonstrate
interagency cooperation, review allocation of
resources and personnel, assess equipment capabili-
ties, activate personnel, assess interjurisdictional
cooperation, test public information and communi-
cation systems and analyze memoranda of under-
standing, standard operating procedures, plans, poli-
cies, and procedures.
Source: U.S. Department of Homeland Security, Office of
Domestic Preparedness: Homeland Security Exercise and
Evaluation Program,Vol. 1: Overview and Doctrine Revised. May
2004.http://www.ojp.usdoj.gov/odp/docs/HSEEPv1.pdf
(accessed Jun. 21, 2005).
SIDEBAR 22. DEFINITIONS OF VARIOUS FORMS OF
DRILLS AND EXERCISES (CONTINUED)
Local leaders, public health authorities, emergency medical services, fire, law enforcement,
volunteers, the general public, and all other appropriate parties should be involved in
communitywide drills.
Standing Together: An Emergency Planning Guide for America’s Communities
Arizona (population 50,000), conducted a full-scale
field exercise that was supported by 40 agencies.The
exercise provided weapons of mass destruction
(chemical bomb) training to emergency management
personnel. A follow-up tabletop exercise included
newly elected city officials and assisted the school
district and local hospital with their emergency
plans.The CHER-CAP exercise program is used
nationwide to increase response capabilities to tech-
nological hazards.
33
? Example: In December 2004, the Northern New
England Metropolitan Medical Response System, in
coordination with Dartmouth Hitchcock Medical
Center and community emergency planners, offered a
successful flu vaccination clinic in an indoor sports
arena at Dartmouth College. More than 1,900 pri-
marily high-risk patients were vaccinated.
Involvement of multiple agencies and organizations
in this type of “routine” care reinforced the concept
of working together but also provided valuable expe-
rience and insight into what may occur within that
community during an actual emergency.
? Example: Every U.S. nuclear plant is required by
law to develop and periodically test an on-site com-
prehensive emergency response plan and ensure that
off-site plans exist.These plans are approved by the
Nuclear Regulatory Commission (NRC) and
FEMA. Local, state, and national officials are
included in the plans and in periodic exercises.
Every two years, each nuclear plant conducts a full-
scale emergency exercise involving a confidential
emergency scenario to be handled by on-site and off-
site emergency response organizations, including
plant employees, local hospitals, county emergency
management agencies, and radiological monitoring
teams.The NRC evaluates performance and identi-
fies improvements of the on-site plan; FEMA evalu-
ates the off-site plan. In alternate years, plants con-
duct on-site training drills involving such key factors
as coordination; communications; assessment of emer-
gency, medical, and fire brigade response; and radia-
tion dose measurement. For example, a nuclear
plant sited on the Susquehanna River in
Pennsylvania has a large emergency response net-
work consisting of 27 municipalities, county and
state governments, school districts, hospitals, fire com-
panies, ambulance and EMS, and federal agencies.
The level of response to an event depends on the
potential threat to public health and safety.
69
Be sure to include local businesses in
training, exercises, and drills.
Involvement of local businesses in the training
and exercise process is very important. First
responders, fire, law enforcement, and other agen-
cies can provide basic training sessions in compa-
nies, covering such topics as what to do in an
emergency, what can be expected from local law
enforcement or fire personnel, where to obtain
information, and so forth.
? Example:Saco, Maine (population 16,000), held a
disaster recovery workshop and simulation exercise
focused on its information technology infrastructure.
The city tested its plan to safeguard data and sys-
tems in the event of a natural disaster, or even a
man-made technological disaster, such as computer
hacking. Representatives from all city agencies and
some local businesses participated in the simulation.
Backup computer storage, telecommunications, and
backup power generation were among the systems
tested.
46
Corporate America has become increasingly
involved in emergency preparedness. The
tragedies of 9/11 showed once again that many
disasters occur while individuals are at work.
Incidents result in significant interruption of
business operations, lost productivity, and
increased employee stress. In response, the
National Business Group on Health developed a
project with the Centers for Disease Control and
Prevention to explore ways that private-sector
employers and public health agencies can partner
to better prepare communities for bioterrorism
and other public health emergencies
12
(see Tools ).
77
Standing Together: An Emergency Planning Guide for America’s Communities
Access available resources.
Whenever possible, communities should use train-
ing programs and exercises, such as tabletop drills,
that are already in place and available through fed-
eral, state, professional associations, and other
sources. For example, the National Association of
County & City Health Officials offers customiz-
able bioterrorism tabletop exercises and a “bt tool-
box” with links to other available exercises and
programs (http://www.naccho.org/bttoolbox).
Practice with other communities.
It may be particularly cost- and time-effective for
small, rural, and suburban communities to conduct
joint exercises and drills with neighboring com-
munities. Because natural and man-made disasters
cross borders, and emergency response services are
likely to overlap in small and rural areas, joint exer-
cises are not only desirable, but necessary.
Identify performance measures for
drills and exercises.
The purpose of drills and exercises—to improve
performance—cannot be accomplished without
agreement about what constitutes success and
how indicators of success are to be measured.The
community’s emergency management team
should prospectively identify appropriate metrics
for drill/exercise evaluation.
Ensure the realism of drills and
exercises.
As the realism of drills and exercises increases, so
too do the learning and improvement opportuni-
ties.To achieve real value, a drill or exercise should
be planned to truly inconvenience the participants
and the community—as a real disaster would.
30
Communities should be encouraged to rigorous-
ly exercise and drill the system or function being
tested. An exercise that tests the limits of a plan or
its subparts can effectively identify weak spots and
opportunities for improvement.
? Example: Santa Monica, California (population
88,000), obtained a Federal Transit Administration
grant to conduct a full-scale functional exercise in
which armed terrorist role players, who claimed to
have a bomb, commandeered a city bus with 20
civilians on board.
33
Communities can consider conducting drills and
exercises involving the most likely disaster scenar-
ios, such as pandemic influenza in any communi-
ty, hurricanes in Florida, or earthquakes in
California, for example, and potentially the most
vulnerable function or system within the
response plan. For example, disaster communica-
tions systems and procedures should be tested
regularly, and the results of these tests should be
reviewed so that any failures can be corrected.
Critical backup systems should also be tested as
part of the drill or exercise.
Include alternative care sites and
shelters in disaster drills.
Although testing of current health care sheltering
capabilities is critical, it may be equally important
to include alternative health care sites and shelters
78
TOOLS:
? The National Business Group on Health
offers numerous resources, including an
employer toolkit on terrorism preparedness
and planning and an employer checklist on
forming business and public health prepared-
ness partnerships. These are available athttp://www.businessgrouphealth.org/
prevention/et_terrorismpreparedness.cfm.
? The Building Owners and Managers
Association offers numerous resources to help
building managers and owners fight terror-
ism.http://www.boma.org.
Standing Together: An Emergency Planning Guide for America’s Communities
in the exercises and drills. During drills and exer-
cises, the community can test the use of sites such
as ambulatory clinics, doctors’ offices, schools,
churches, and other facilities identified in the
emergency management plan. Such testing
increases communitywide awareness of the exis-
tence, location, strengths, and challenges of such
facilities.
Activate the emergency plan.
Activating the community’s emergency plan
provides a way of testing, reinforcing, and refin-
ing communication, technology, coordination,
decision making, and other issues. Even “non-
catastrophic emergencies,” such as when a hospi-
tal air conditioner malfunctions in August in the
South, can be used to test, stress, and improve
coordinated response before a catastrophic emer-
gency hits. Emergency plans should be activated
when smaller-scale emergencies occur. Regular
tests of communications systems and plans enable
response partners to become familiar with each
other’s roles and processes and will help to ensure
that people know what to do when a large-scale
disaster occurs.
79
Community emergency management plans can-
not be static documents; they must be evaluated
and revised on an ongoing basis through an inte-
grated, iterative, team-based process.The commu-
nity’s hazard vulnerability analysis (Section 3),
goals for preparedness and response (Section 4),
and current capacities and capabilities (Section 5)
require review on a regular basis in order to pro-
vide for changing environmental conditions, fed-
eral and state regulations, standards and require-
ments, community resources, and many other
factors. Use of a matrix that outlines key plan ele-
ments can help teams ensure a thorough
approach to plan review and improvement.
Conduct periodic review and
reprioritization of possible
emergency incidents.
Before 9/11, crashing a civilian airplane into a
high-rise building was unthinkable.Anthrax attacks
in fall 2001 also made the possibility of biological,
chemical, and radiation incidents all too real. The
majority of disaster scenarios identified by U.S.
Department of Homeland Security for planning
purposes (Sidebar 8) were, in fact, not on the radar
screens of most emergency preparedness planners.
SARS and recent outbreaks of avian influenza have
reinforced the “inevitability” of catastrophic pan-
demics. Every community should be redefining the
realm of possible disasters, community needs, and
preparedness and response mechanisms on an
ongoing basis. The priority issues identified in the
community’s hazard vulnerability analysis provide
the foundation for planning efforts. Building and
sustaining capabilities to address disasters in the
community and region are integral to the planning
goals, processes, and collaborative efforts with part-
ners across disciplines and organizations.
Review the emergency management
plan on an annual basis.
The community’s emergency plan should be
reviewed on at least an annual basis. Collaborative
and regular review keeps the plans current and
relevant, incorporates new partners or processes,
and retires obsolete content. “The emergency
operations plan is a living document. Problems
emerge, situations change, gaps become apparent,
requirements are altered—and the plan must be
adapted to remain useful and up-to-date,” notes
the Federal Emergency Management Agency’s
guide for local communities.
7(p. 2-12)
Base the review on an analysis of
performance.
Following an actual emergency, a community
identifies and analyzes data related to its imple-
mentation of the emergency management plan.
In the absence of an actual emergency, data from
plan drills, training, and exercises should be col-
lected and analyzed. Performance-monitoring
data form the backbone of regular evaluation.
Thus, it is appropriate that these data be present-
ed, trended, and analyzed. Documentation pro-
vided by drill observers, for example, can provide
relevant performance data on the adequacy of
12. Critique and Improve the Integrated Community Plan
Standing Together: An Emergency Planning Guide for America’s Communities
80
Recommended Planning Strategies:
? Conduct periodic review and reprior-
itization of possible emergency inci-
dents.
? Review the emergency management
plan on an annual basis.
? Base the review on an analysis of
performance.
? Discuss posttest problems and assign
remedial actions.
? Consider obtaining external feedback.
? Review the planning process.
Standing Together: An Emergency Planning Guide for America’s Communities
training, risks and needs, missing steps, and
opportunities for improvement.
Exercises and drills can be critiqued through an
“after-action” report, which summarizes the
event and the response, identifies strengths and
weaknesses in the response effort, and offers
explicit recommendations for improvement.
After-action reports should be based on predeter-
mined performance objectives.
? Example:The public health bio-defense team in
Montgomery County, Maryland, conducted a table-
top training exercise to test the system for accessing
the Strategic National Stockpile (SNS) and dissem-
inating the SNS supplies to public and private
points of distribution.The exercise involved 18 pub-
lic and private agencies. An after-action, “lessons
learned” report summarized problems encountered
and potential solutions as follows:
81
Notes: PHCC is Public Health Command Center; RSS is receipt, store, and stage; FLOP is finance, logistics, operations, and
planning. Full report available athttp://www.naccho.org/bttoolbox/index.cfm (accessed Jun. 24, 2005).
Discuss posttest problems and assign
remedial actions.
Information captured from tests, exercises, and
after-action reports must be used to improve cur-
rent preparedness and response plans.The planning
team meets to discuss problems that were evident
or that emerged during drills and exercises and to
objectively assess performance. The team identifies
and agrees on remedies and assigns to appropriate
individuals and organizations the responsibility for
corrective actions. Needed actions may involve
revision of planning goals, assumptions, training,
communication, or a myriad of other issues.
After corrective actions have been implemented, a
tabletop exercise can be scheduled as a follow-up
activity to ensure that the corrective actions did in
fact address the issues identified during the drill.
The critiques of the plan, the exercises, and the drill
after-action analyses must have the support of the
leadership of the planning team and of the indi-
vidual agencies and organizations involved, par-
Standing Together: An Emergency Planning Guide for America’s Communities
82
TOOLS:
The Federal Emergency Management Agency has
developed the Hazardous Materials Exercise
Evaluation Manual (HM-EEM), and its companion
guidance, the HM-EEM Evaluation Forms, as guid-
ance and technical assistance to assist state and
local governments, first responders, and industry in
the development, implementation, and evaluation
of their own realistic and challenging exercise pro-
grams.The evaluation form has many sections that
can be helpful to community emergency manage-
ment planning teams.The section evaluating alert
and notification of the public appears here, and
the whole document is available at http://
www.training.fema.gov/emiweb/downloads/
HMFormsEval%20forms.doc.
Standing Together: An Emergency Planning Guide for America’s Communities
ticularly in terms of accountability, follow-up, and
resources for improvement.
Consider obtaining external feedback.
Emergency planning teams can consider selecting
an external reviewer or an internal reviewer with
limited exposure to the plan to provide objective
feedback on a continuing basis. Neighboring
communities, the county, or the state can be asked
to review the community’s emergency plan to
suggest improvements based on their accumulat-
ed experience.
7
External feedback can be helpful
in identifying gaps and assumptions that need to
be filled or rethought. The top 10 weaknesses
often identified in emergency management plans
appear as Sidebar 23.
Review the planning process.
A community’s emergency management plan-
ning team would be well served to regularly
review not only the plan, but the planning pro-
cess used to create the plan. Sidebar 24 offers 10
possible assessment criteria.
83
1. Have a lack of critical information.
2. Are not flexible enough.
3. Do not address communication issues broadly or in
enough detail.
4. Do not contain enough multidisciplinary input.
5. Do not contain adaptable forms for managing
information.
6. Do not consider enough scenarios (or enough haz-
ard vulnerabilities).
7. Do not document incidents well.
8. Do not include troubleshooting tools.
9. Lack alarm points signaling that critical supplies are
running low.
10. Have not undergone a detailed review with all
appropriate local agencies and do not consider
community linkages or processes.
Source: Bruce C.: Troubleshooting your top ten weaknesses
in emergency preparedness plans. Environment of Care
®
News
3(2):11, 2000.
SIDEBAR 23. TOP TEN WEAKNESSES IN EMERGENCY
MANAGEMENT PLANS
High-quality local disaster planning is characterized
by the following:
1. Focuses on the planning process rather than the
production of a written document.
2. Recognizes that disasters are both quantitatively
and qualitatively different from minor emergen-
cies and everyday crises.
3. Is generic rather than agent specific.
4. Avoids the development of a “command and
control” model.
5. Focuses on general principles and not specific
details.
6. Is based on what is likely to happen.
7. Is vertically and horizontally integrated.
8. Strives to evoke appropriate actions by anticipat-
ing likely problems and possible solutions or
options.
9. Uses the best social science knowledge possible
and not myths and misconceptions.
10. Recognizes that crisis disaster planning and dis-
aster management are separate processes.
Source: E.L. Quarantelli, Disaster Research Center,
University of Delaware. Used with permission.
SIDEBAR 24. TEN CRITERIA FOR ASSESSING
COMMUNITY DISASTER PLANNING
The critiques of the plan, the exercises, and the drill after-action analyses must have the support of
the planning team leadership and of the individual organizations involved, particularly
in terms of accountability, follow-up, and resources for improvement.
The final activity described in this planning
guide—sustaining collaboration, communication,
and coordination—assures the continued viabili-
ty of community emergency preparedness and
response. The planning process and the plan that
results from this process are only as good as their
weakest link. Continued collaboration, coordina-
tion, and communication are critical to reinforc-
ing and maintaining established links, processes,
and plans. Strategies for sustaining the processes
and plans outlined in this publication follow.
Ensure proper documentation and
dissemination of plans and
supporting information.
As described in Section 11, policies, procedures,
contact information, and plans must be main-
tained and periodically reviewed to assure accura-
cy and relevance to community preparedness and
response. In addition to having a copy of the inte-
grated community plan, all partners must have
copies of each organization’s individual plans to
which they are a party, either as a recipient or as a
supplier. This facilitates a comprehensive under-
standing of roles and resources that should be
maintained and adjusted over time, as needed.
Ideally, the community emergency management
plan has elements that are integral to the normal
operations of some of the partners who support
communication and coordination as part of their
regular business or service functions within the
community. In other cases, contact between part-
ners will be limited to emergencies and disasters.
Establish mechanisms for receiving and
reviewing regional, state, and federal
plans.
Just as local community plans change and require
updating, so too do plans created by regional,
state, and federal agencies. Local communities
should establish a means to receive and review the
changes made to regional, state, and federal plans.
Such changes can have a significant impact on
community resources and preparedness and
response initiatives.
The National Response Plan (NRP) will be reviewed
and updated every four years but will have interim
13. Sustain Collaboration, Communication, and Coordination
Standing Together: An Emergency Planning Guide for America’s Communities
84
Recommended Planning Strategies:
? Ensure proper documentation and
dissemination of plans and support-
ing information.
? Establish mechanisms for receiving
and reviewing regional, state, and
federal plans.
? Collect and disseminate information
about effective models, practices, and
lessons learned.
? Build multilayered relationships and
prepare for transitions.
? Ensure ongoing communication with
the public.
Ideally, the community emergency management plan has elements that are integral to the
normal operations of some of the partners who support communication and coordination as
part of their regular business or service functions within the community.
Standing Together: An Emergency Planning Guide for America’s Communities
85
revisions as needed between full reviews. The U.S.
Department of Homeland Security is required to
distribute notices of changes to the NRP to all
regional offices and state emergency management
offices. Thus, local community planning teams can
access the information through these sources.
10
Collect and disseminate information
about effective models, practices, and
lessons learned.
All planning partners can benefit from receiving
information about effective models, practices, and
lessons learned in other communities and in the
region, state, and nation. Developing an “informa-
tion stockpile”to support educational and commu-
nications activities can be helpful. Such information
can be gathered from a variety of sources, including
local and regional meetings, Internet resources,
desktop exercises, and reviews of how other com-
munities are planning for or have responded to
emergencies and disasters. The Tools section pro-
vides a sampling of sources for best-practice and
lessons learned–related information.
Build multilayered relationships and
prepare for transitions.
Over time, individuals leave organizations or
change jobs, organizations change the scope or
nature of their services, planning partners drop
out of the planning process, and new partners
emerge.The planning team must prepare for tran-
sitions in roles and responsibilities. Relationship
building for long-term sustainability requires
multiple relationships within groups with differ-
ent levels and types of stakeholders.
Ensure ongoing communication with the
public.
An active and disciplined communication effort
will help to mitigate the impact of changes that
occur over time. Ongoing communication
should be provided to the multiple levels of
response partners and to the public and should
include information about the functions and
responsibilities of preparedness and response part-
ners. The media provide a primary means for
communicating with the public, as described in
Section 7.
TOOLS:
? The Medical Reserve Corps (MRC) Web site
includes information on “promising prac-
tices,” such as “Guidelines for Spiritual Care
Providers,”“Volunteerism Flyer,” and “Agency
Needs Assessment,” obtained from MRC
units:http://www.medicalreservecorps.gov/
resources/result.asp?subcategory_id=43.
? National Memorial Institute for the Prevention
of Terrorism (http://www.mipt.org) hosts
Lessons Learned Information Sharing, which
is a national network of lessons learned and
best practices for emergency response
providers and homeland security officials.http://www.llis.dhs.gov.
? The Federal Emergency Management Agency’s
Mitigation Division provides best practices and
case studies.http://www.fema.gov/fima/
bp.shtm.
? The National Governors Association’s Center
for Best Practices: Homeland Security &
Technology Section includes best practices
related to agroterrorism, bioterrorism prepared-
ness, critical infrastructure protection, energy
assurance, emergency management, information
sharing and technology, intelligence, interoper-
ability, nuclear and radiological terrorism, and
telecommunications and digital infrastructure.http://www.nga.org/center.
? The Rand Corporation makes available on its
Web site a publication titled Protecting
Emergency Responders: Lessons Learned from
Terrorist Attacks by Brian Jackson et al.http://www.rand.org/publications/CF/CF176.
Standing Together: An Emergency Planning Guide for America’s Communities
Ongoing communication with the community is
essential to managing concerns within the popula-
tion about risk, maintaining public interest in and
involvement with preparedness activities, and sus-
taining trust and dialogue that will be essential in
directing the public effectively during a disaster.
? Example:The Rocky Mountain Poison and Drug
Center (the Center) in Colorado worked with the
state health department to create a public emergency
information line.The Center had a long-standing and
well-recognized public role in providing accurate and
timely information. Following 9/11, its role expand-
ed to providing information to the public on a small-
pox vaccination program, providing clinical decision
support for vaccinees and their health care providers,
and collecting reported adverse reactions to smallpox
vaccinations.The demand for smallpox information
was very modest, but the emergence of outbreaks of
the West Nile virus in 2003 allowed the Center to
adapt its capabilities to include tracking virus occur-
rence in the state and providing the public with con-
sistent, accurate information about virus risks and dis-
ease management strategies. By asking people to
report on dead birds in their yards, the service involved
the public in the response effort, helped establish a
mechanism for information exchange, and resulted in
a meaningful role for the public in the process. Since
then the service has been expanded to monitor and
support other public health issues such as influenza,
mold, hantavirus, and plague.The Center’s capabilities
continue to expand based upon emerging public health
concerns and requests for information.
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88
Closing Comment
Standing Together: An Emergency Planning Guide for America’s Communities
Continued collaboration, coordination, and communication provide the glue needed for a truly strong and
interconnected community fabric. Returning to Melville’s quotation, “We cannot live for ourselves alone.
Our lives are connected by a thousand invisible threads, and along these sympathetic fibers, our actions run
as causes and return to us as results.”To achieve the results desired in a disaster situation—survival for two
or three days before help arrives—small, rural, and suburban communities must develop and sustain emer-
gency preparedness and response capabilities.The 13-step process outlined in this planning guide is offered
as one template for doing so. Whatever resources are used, small communities must prepare for disasters
that would inflict significant destruction in the form of lost lives, injured residents, and damage to critical
community infrastructure and property.The time for preparedness efforts—for weaving together thousands
of invisible threads—is now.
89
Acknowledgment of Roundtable Members
Standing Together: An Emergency Planning Guide for America’s Communities
Veronica Aberle, M.S.N., R.N.
Nurse Manager
Alexandria Health Department
Alexandria,VA
Ross Anthony, Ph.D.
Associate Director
Global Health RAND Health Security
Arlington,VA
Robert Bass, M.D.
Executive Director
Maryland Institute of Emergency Medical
Services Systems
Baltimore, MD
Commander Daniel S. Beck
Medical Readiness Manager
Office of Force Readiness and Deployment
Office of the Surgeon General
Rockville, MD
Gregory M. Bogdan, Ph.D.
Research Director & Medical Toxicology
Coordinator
Rocky Mountain Poison and Drug Center -
Denver Health
Denver, CO
Christine Bradshaw, D.O., M.P.H., M.B.A.
Medical Officer
Centers for Disease Control and Prevention
Coordinating Office of Terrorism Preparedness
and Emergency Response
Division of State and Local Readiness
Atlanta, GA
Commander Duane C. Caneva, M.C., U.S.N.R.
Head, Medical Plans and Policies
Navy Medicine Office of Homeland Security
Bureau of Medicine and Surgery
Washington, DC
Christopher Cannon, M.S.N., M.P.H., M.B.A.
System Director, Office of Emergency
Preparedness
Yale New Haven Health System
New Haven, CT
Paul K. Carlton, Jr., M.D., FACS (Roundtable
Moderator)
Lt. General, USAF (Ret.)
Director, Homeland Security
A&M System Health Science Center
College Station, TX
Ralph Conner
Former Mayor
City of Maywood
Maywood, IL
Charles Cook, L.C.S.W.
Project Officer
Emergency Services & Disaster Relief Branch
Center for Mental Health Services
Rockville, MD
Stephen Curren
Director, Public Health Security
Association of State and Territorial Health
Officials
Washington, DC
90
The Joint Commission sincerely thanks the roundtable members for providing their time
and expertise in the development of this planning guide.
Community-Based Emergency Management Roundtable Members
Standing Together: An Emergency Planning Guide for America’s Communities
Emily DeMers
Executive Director
Emergency Management Accreditation Program
Lexington, KY
Brett Ewig
Principal Director, Health Prevention and
Promotion Programs
Association of State and Territorial Health
Officials
Washington, DC
Michael R. Fraser, Ph.D.
Deputy Executive Director
National Association of County and City Health
Officials
Washington, DC
Robert Gougelet, M.D.
Medical Director for Emergency Response
Dartmouth Hitchcock Medical Center
Lebanon, New Hampshire
Kathy Hadlock, B.S.N., Nurse Consultant
Hospital Preparedness Program Manager
Center for Emergency Response and Terrorism
Missouri Dept. of Health and Senior Services
Springfield, MO
Ron Hilliard, R.N., L.P.
Manager, Bioterrorism Hospital Preparedness
Program
Center for Public Health Preparedness and
Response
Texas Department of Health
Austin, TX
Michael Hopmeier
Chief, Innovative and Unconventional Concepts
Unconventional Concepts, Inc.
Washington, DC
Dr. Ann R. Knebel, R.N., D.N.S.c, FAAN
Captain, U.S. Public Health Service
Commissioned Corps
Senior Program Manager, Preparedness and
Planning Team
Office of the Assistant Secretary for Public
Health Emergency Preparedness
Office of the Secretary, Depy. of Health and
Human Services
Washington, DC
Howard Levitin, M.D.
President
DQE, Inc., and Indiana University School of
Medicine
Indianapolis, IN
Patrick M. Libbey
Executive Director
National Association of County & City Health
Officials
Washington, DC
Scott Lillibridge, M.D.
Principal Investigator
University of Texas Health Science Center at
Houston School of Public Health
Academic Center for Public Health
Preparedness
Houston, TX
Rocky Lopes, Ph.D.
Former Manager, Public Education and
Outreach for Disasters
American Red Cross
Community Disaster Education
Washington, DC
91
Standing Together: An Emergency Planning Guide for America’s Communities
Mauricio Lynn, M.D.
Director for Mass Casualty Preparedness
Program
Medical Director, Trauma Resuscitation Unit,
Ryder Trauma Center, Jackson Memorial
Hospital
University of Miami
Miami, FL
Angela Martinelli, D.N.S.c, R.N., CNOR
Commander, USPHS
U.S. Public Health Service
Commissioned Corps Readiness Force
Office of the Surgeon General
Gaithersburg, MD
Commander Ludlow B. McKay
National Bioterrorism Hospital Preparedness
Program
Health Resources and Services Administration
Rockville, MD
Richard McCann
Principal
McCann & McCann Health Care Consultants
Chagrin Falls, OH
Gerald Murphy
Director, Homeland Security and Technology
Division
NGA Center for Best Practices
Washington, DC
James Pearson, Dr.P.H., B.C.L.D.
Committee Chairman
Emergency Preparedness and Response
Committee
Richmond,VA
Enrico L. Quarantelli, Ph.D.
Research Professor, Disaster Research Center
University of Delaware
Newark, DE
Irwin Redlener, M.D.
Associate Dean and Director
National Center for Disaster Preparedness
Columbia University Mailman School of Public
Health
New York, NY
Karen Roth
Senior Director
Office of Behavioral Health, New York City
Health and Hospitals Corporation
New York, NY
Gili Shenhar
Director
CERBERUS ENTERPRISES, LLC
Israel
Chief John Sinclair
Chairman, EMS Section
International Association of Fire Chiefs
Puyallup, WA
Sue Skidmore, R.N.
Product Manager, Consulting Services
DQE, Inc.
Arlington,VA
Rick Smith
Director, Division of Healthcare Emergency
Preparedness
Health Resources and Services Administration
Rockville, MD
92
Standing Together: An Emergency Planning Guide for America’s Communities
Terri Spear
National Bioterrorism Hospital Preparedness
Program
Health Resources and Services Administration
Rockville, MD
Leslee Stein-Spencer R.N., M.S.
Director, Health Systems Programs
Community Research Associates
Chicago, IL
Gina Swehla
Training Center Manager
Illinois Dept. of Public Health
Springfield, IL
Boaz Tadmore
CERBERUS ENTERPRISES, LLC
Israel
Joe Waeckerle
Chairman, Dept. of Emergency Medicine
Clinical Professor
University of Missouri Baptist Medical Center
Baptist Lutheran Medical Center
Leawood, KS
Mike Wahl, M.D.
Administrative Medical Director
Illinois Poison Center
Chicago, IL
93
Selected Resources
Standing Together: An Emergency Planning Guide for America’s Communities
Agency for Healthcare Research and Quality:
Altered Standards of Care in Mass Casualty Events.http://www.ahrq.gov/research/altstand.
Centers for Disease Control and Prevention:
Public Health Emergency Response Guide for State,
Local, and Tribal Public Health Directors, Version
1.0.http://www.bt.cdc.gov/planning/
responseguide.asp.
CNA Corporation: Medical Surge Capacity and
Capability: A Management System for Integrating
Medical and Health Resources During Large-Scale
Emergencies.http://www.cna.org/documents/
mscc_aug2004.pdf.
Columbia University Mailman School of Public
Health, National Center for Disaster
Preparedness: How Americans Feel About Terrorism
and Security:Two Years After 9/11, Aug. 2003.http://www.ncdp.mailman.columbia.edu/
How_Americans_Feel_About_Terrorism.pdf.
Columbia University Mailman School of Public
Health, National Center for Disaster Preparedness:
Pediatric Preparedness for Disasters and Terrorism:A
National Consensus Conference, Executive Summary,
2003.http://www.ncdp.mailman.columbia.edu/
pediatric.html.
Connecticut Department of Public Health:
Preparedness Planning Guidance for a Regional
Response to a Public Health Emergency, Apr. 2004.http://www.ct.gov/oem/lib/oem/
homelandsecurity/joint_dph_oem_regional_
planning_guidance.pdf.
FEMA: State and Local Guide (SLG) 101: Guide
for All-Hazard Emergency Operations Planning,
1996.http://www.fema.gov/rrr/gaheop.shtm.
FEMA: State and Local Guide (SLG) 101: Guide
for All-Hazard Emergency Operations Planning,
Chapter 6, Attachment G:Terrorism, Apr. 2001.http://www.fema.gov/pdf/rrr/allhzpln.pdf.
Institute of Medicine: Preparing for the
Psychological Consequences of Terrorism: A Public
Health Strategy. Washington, DC: National
Academies Press, 2003.http://www.nap.edu/
openbook/0309089530/html.
Institute of Medicine: The Threat of Pandemic
Influenza: Are We Ready? A Workshop Summary.
Washington, DC: National Academies Press,
Nov. 16, 2004.http://www.iom.edu/
report.asp?id=23639.
Joint Commission on Accreditation of
Healthcare Organizations (Joint Commission):
Health Care at the Crossroads: Strategies for Creating
and Sustaining Community-wide Emergency
Preparedness Systems. Oakbrook Terrace, IL: Joint
Commission, 2003.http://www.jcaho.org/
about+us/public+policy+initiatives/
emergency.htm.
Lasker R.D.: Redefining Readiness:Terrorism
Planning Through the Eyes of the Public. New York:
New York Academy of Medicine, 2004.http://www.cacsh.org.
Loeb J.M.: Assessing Hospital and Community
Emergency Preparedness Linkages. Oakbrook
Terrace, IL: Joint Commission on Accreditation
of Healthcare Organizations, Oct. 2004.
McHugh M., Staiti A.B., Felland L.E.: How pre-
pared are Americans for public health emergen-
cies? Twelve communities weigh in. Health
Affairs 23(3): 201–209.
94
Standing Together: An Emergency Planning Guide for America’s Communities
National Association of County & City Health
Officials (NACCHO): Local Public Health
Agencies Better Equipped to Handle Bioterrorist
Attacks. Washington, DC: NACCHO, Jan. 2003.
National Association of County & City Health
Officials (NACCHO): Bt PREP: A Bioterrorism
Response Plan Design Guide for Local Public Health
Agencies, 1st ed. Washington, DC: NACCHO,
2003.
National Business Group on Health (Terrorism
and Public Health Emergency Preparedness
Initiative): The Business Case:Why and How
Employers Need to Partner with Public Health, Jun.
2004.http://www.businessgrouphealth.org/
prevention/et_terrorismpreparedness.cfm.
National Commission on Terrorist Attacks Upon
the United States: The 9/11 Commission Report.
New York: W.W. Norton, 2004.
National League of Cities: Homeland Security:
Practical Tools for Local Governments, Nov. 2002.
Northern New England Metropolitan Medical
Response System: Community Planning Guide:
Improving Local and State Agency Response to
Terrorist Incidents Involving Biological Weapons, Jun.
2003.http://www.nnemmrs.org/surge.html.
Occupational Safety and Health Administration
(OSHA): OSHA Best Practices for Hospital-Based
First Receivers of Victims from Mass Casualty
Incidents Involving the Release of Hazardous
Substances. Washington, DC: OSHA, Dec. 2004.http://www.osha.gov/dts/osta/bestpractices/
html/hospital_firstreceivers.html.
Rural Health Resource Center (RHRC): An
Alternative Approach to Defining Rural for the
Purpose of Providing Emergency Medical Services.
Duluth, MN: RHRC, Jul. 2004. http://
tasc.ruralheatlh.hrsa.gov.
Texas Department of Health and the Texas
Institute for Health Policy Research: Disaster
Preparedness and Response in Texas Hospitals, Mar.
24, 2003.
U.S. Department of Health and Human Services
(DHHS): Communicating in a Crisis: Risk
Communication Guidelines for Public Officials.
Washington, DC: DHHS, 2002. http://
www.riskcommunication.samhsa.gov/index.htm.
U.S. Department of Health and Human
Services, Office of Rural Health Policy: Rural
Communities and Emergency Preparedness, Apr.
2002. ftp://ftp.hrsa.gov/ruralhealth/
RuralPreparedness.pdf.
U.S. Department of Health and Human Services
(DHHS): Mental Health All-Hazards Disaster
Planning Guidance. Washington, DC: DHHS,
2003.http://www.mentalhealth.org/
publications/allpubs/SMA03-3829/
introduction.asp.
U.S. Department of Homeland Security (DHS):
National Incident Management System.
Washington, DC: DHS, Mar. 1, 2004. http://
www.fema.gov/nims.
U.S. Department of Homeland Security (DHS):
National Response Plan. Washington, DC: DHS,
Dec. 2004.http://www.dhs.gov/interweb/
assetlibrary/NRPbaseplan.pdf.
95
Standing Together: An Emergency Planning Guide for America’s Communities
U.S. Department of Homeland Security, Office
of Citizen Corps: 2003 Citizen Corps Survey of
U.S. Households: Final Survey Report.
U.S. General Accounting Office (GAO):
Bioterrorism: Preparedness Varied across State and
Local Jurisdictions. Washington, DC: GAO, Apr.
2002.
U.S. General Accounting Office (GAO): Hospital
Preparedness: Most Urban Hospitals Have Emergency
Plans but Lack Capacities for Bioterrorism Response.
Washington, DC: GAO, Aug. 2003.
Washington State Emergency Management
Association: Elected Officials’ Guide to Emergency
Management, Feb. 2003. http://
www.emctaskforce.org/Resources/
ElectedOfficials/ElectedOfficialsGuide%20to%
20EM.pdf (accessed Feb. 17, 2005).
Washington University School of Medicine:
Department Emergency Planning Guidelines. St. Louis:
Washington U.,http://www.ehs.wustl.edu/
emergency/dptemplate.doc.
96
Index
Standing Together: An Emergency Planning Guide for America’s Communities
911 call system, 6, 28, 36, 38, 55, 59
A
Acute care hospitals, 36
Adapting emergency plans, 41
Adopting emergency plans, 41
After-action reports, 81
Agency for Toxic Substances and Disease Registry
A Primer on Health Risk Communication Principles and
Practices, 57
training programs, 74
Agricultural issues, 7, 18, 32, 86
Agriculture and natural resources, emergency support func-
tions, 12
AHRQ (Agency for Healthcare Research and Quality), Altered
Standards of Care in Mass Casualty Events, 38, 94
All-hazards approach, 15
Alternative care and shelter facilities, 38–39, 47, 78–79
Ambulatory care
emergency support functions, 11
medical surge capacity, 35
American Academy of Child and Adolescent Psychiatry, 63
American Academy of Experts in Traumatic Stress, 63
American Academy of Pediatrics, “Children, Terrorism &
Disasters”, 69
American College of Emergency Physicians, 35
American Hospital Association: Model Hospital Mutual Aid
Memorandum of Understanding, 30
American National Red Cross, 13–14
American Psychiatric Association, 63
American Psychiatric Nurses Association, 63
American Psychological Association, 63
American Red Cross
emergency response, 13
information resources, 63
mental health services, 65
pastoral care resources, 62–63
public awareness and readiness, 61
Talking About Disasters: Guide for Standard Messages,
57
AmeriCorps Emergency Readiness teams, 68
Animals, resources, 32
Anthrax, vi, 38, 60, 80
Antibiotic dispensing, 26
Asset allocation process, 40
Austere care, 37–38
Avian influenza, 80
Avocational special interest groups, 33–34
B
Backup communications, 54–55
Backup systems for critical assets, 38, 78
Bed capacity, 37
Behavioral health, 63. See also Mental health planning
Best Practices for Hospital-Based First Receivers of Victims
from Mass Casualty Incidents Involving the Release of
Hazardous Substances, 37
Bioterrorism annex planning criteria, 36
Bioterrorism preparedness, 69
Brainstorming sessions, compiling lists of potential hazards,
16–17
Building Owners and Managers Association, 78
Bureau of Emergency Management, 64–65
Bureau of Primary Health Care Facilities, 39
Business owners, 35
C
Capability Assurance effort, 52
Catastrophic events, potential for, 16
Census 2000 data, 8
Center for Infrastructure Expertise, 18
CARVER2 software, 18
State and Local Pandemic Planning Guide, 42
Strategic National Stockpile (SNS), 50
The Center for Mental Health Services
disaster planning resources, 62
information resources, 63
Center for the Advancement of Collaborative Strategies in
Health, 26
Centers for Disease Control and Prevention (CDC). See also
Agency for Toxic Substances and Disease Registry
definition of special populations, 67
Pandemic Influenza Preparedness and Response, 42
Public Health Emergency Response Guide for State,
Local, and Tribal Public Health Directors, 41–42, 94
Strategic National Stockpile (SNS), 51
training programs, 74
CERTs. See Community Emergency Response Teams
Checklists, 39, 43, 45
Chemical factory explosions, hazard analysis, 18
Chief executive, 4, 10, 14
Children
Pediatric Preparedness for Disasters and Terrorism: A
National Consensus Conference, Executive Summary, 94
school nurses and, 69
special needs, 68–69
Chlorine tank explosion, hazard analysis, 18
Citizen Corps. See also Community Emergency Response
Teams
2003 Citizen Corps Survey of U.S. Households: Final
Survey Report, 96
emergency planning, 13, 59
97
Standing Together: An Emergency Planning Guide for America’s Communities
managing volunteers, 26
training programs, v, 73
Civic responsibilities, emergency planning, 27
Civilian representation, emergency planning, 13
Clinics, 11, 25, 35
CNA Corporation, Medical Surge Capacity and Capability: A
Management System for Integrating Medical and Health
Resources During Large-Scale Emergencies, 35
Collaboration, 7–8, 40–41, 80, 84. See also Planning team
Colleges, critical resources, 11–12
Columbia University, Mailman School of Public Health,
68–69, 94
Communication. See also Documentation
alternative and backup links and systems, 54–55
building utility systems, 47
communicating with the public, 14
community locational system, 59
credibility with the public, 58–59
crisis communications, 57–58
culturally sensitive, 60–61
decisional support, 59–60
emergency backup power, 54–55
emergency communications, 36
emergency communications procedures, 58
emergency support functions, 11
equipment, 54
goals, 53
initiatives, 57
integration with local health care organizations, 61
interoperability of communications systems, 56
media’s role, 59
planning resources, 56–57
planning strategies, 53, 84
power considerations, 47
public awareness and readiness, 61
resources, 32
risk communication plan, 27, 36
rules of risk communication, 58
transmission, 53–54
Community awareness. See also Emergency management;
Funding; Integrated community plan; Risks and hazards
communication patterns, 53
education, 27, 36
existing relationships, v–vi, 9–10
federal resources, 39
gaps in community assets, 39
geopolitical and definitional factors, 8
“grass roots” level, v, 27
“intrusive reality” events, 1
planning strategies, 7, 9
readiness and, 61
roles and responsibilities, 43
stakeholders, 7–8
terrorism threats, 16
Community-based planning, 13
Community emergency preparedness
demand for services, 27
examples of emergencies, 17
funding, 15
HVA (hazard vulnerability analysis), 18
incident management, 29
initiatives linking to NIMS and NRP, 28
public’s involvement, 26–27
saving lives, 34
Community Emergency Response Teams (CERTs). See also
Emergency preparedness
emergency credentialing, 49
existing relationships, 10
funding through Citizen Corps, v
human resources, 24
program, 73–74
Community health resources, 35, 36
Community medical providers, 36
Community planning teams, 28–29
Community response plans, managing volunteers, 25
Competency-based training programs, 73
Complacency, 1–2
Connecticut Department of Public Health. Preparedness
Planning Guidance for a Regional Response to a Public
Health Emergency, 94
Connecticut regional emergency and public health prepared-
ness, 36
Contingency plans, 27
Convergent responders, 24–26
Cooperative Agreement Grant: The National Bioterrorism
Hospital Preparedness Program, 55
Coordination. See also Collaboration; Communication
Corporate America, 77
Corrective actions, 82
County planning initiatives, 29
Court system personnel, 26
Credentials
capabilities, 36
emergency credentialing, 49
medical volunteers, 26
Crisis communications, 57–58
Critical assets, backup systems, 38
Critical benchmark, HRSA, 37
Critical medical surge capacity, 35
Cross-training opportunities, 73
Cultural diversity, 62
98
Standing Together: An Emergency Planning Guide for America’s Communities
Current capacities and capabilities
alternative care and shelter facilities, 38–39
asset categories and target capabilities, 31–33
community health resources, 35
dual uses for existing or emerging capabilities, 38
federal resources in communities, 39
gaps in community assets, 39
geographic features and vulnerabilities, 34
groups involved in planning, 33–34
health care-related resources, 35–36
planning strategies, 31
public as an asset category, 33
surge capacity and consult-surge planning resources,
34–35, 37
D
Decontamination, 27, 35, 36, 37, 48
Department of Health and Senior Services, Missouri, 30
DHS. See U.S. Department of Homeland Security
Disability Preparedness Center, 67–68
Disabled population, 26, 39, 67
Disaster behavioral health response teams (DBHRT), 64–65
Disaster Management Interoperability Services (DMIS), 56
Disaster Medical Assistance Team (DMAT), 25, 35, 49
Disaster Mental Health Institute at the University of South
Dakota, 63
Disaster mental health plans/resources, 64–65
Disaster mutual aid, 30
Disaster planning, 27, 83. See also Preparedness and
response planning
Disaster Technical Assistance Centers (DTAC), 64
DisasterHelp, 57
Disasters
information resources, 63
stress reactions, 62
DMAT. See Disaster Medical Assistance Team
Doctors, medical surge capacity, 35
Documentation. See also Communication
community-level planning, 26
draft of emergency plan, 41–42
emergency operations plan, 42, 44, 80
guidance and resources, 41
information and planning, 32
integrated emergency management plan, 42–43
provided by drill observers, 80–81
Donated goods and services, 32
Drills, 36, 75, 80-81. See also Emergency preparedness
E
Earthquakes, hazard analysis, 18
Elderly population, 67
Emergency credentialing, 49
Emergency management. See also FEMA; Integrated emer-
gency management plan
developmental process, 3
emergency support functions, 12
funding, 2
in homes, v, 63
leadership, 4
phases, 22–23
planning partners, 10–14
planning process, 2–3, 6
planning strategies, 84–85
response functions, 44
strategies for managing volunteers, 25
weaknesses, 83
Emergency Management Institute (EMI), 75
Emergency medical services. See EMS
Emergency operations plan (EOP), 42, 44, 80
Emergency physicians, 35
Emergency preparedness. See also Community Emergency
Response Teams; Current capacities and capabilities;
Planning team; Preparedness and response planning;
Vulnerable populations
Assessing Hospital and Community Emergency
Preparedness Linkages, 94
communitywide training, exercises and drills
activating emergency plans, 79
alternative care sites and shelters, 38–39, 47, 78–79
competency-based programs, 73
cross-training opportunities, 73
emergency response personnel, 72–73
federal government programs, 74
incident command training, 75
involving local businesses, 77–78
participants, 76–77
performance measures, 78
planning strategies, 72
practice with other communities, 78
resources, 78
troubleshooting weaknesses, 75–76
Corporate America, 77
functionally structured emergency plan, 44–45
local planning, 4–5, 14
measuring, 51
planning group, 10
readiness barriers, 2
risk-based approach, 15
school nurses and, 69
teams, 27–28
Emergency supply kit, 27
99
Standing Together: An Emergency Planning Guide for America’s Communities
Emergency Support Function (ESF), 11, 35
Emergency System for Advance Registration of Volunteer
Health Care Personnel (ESAR-VHP), 49
Emotional support, 62–63
EMS (emergency medical services)
community relationships, vi
geopolitical and definitional factors, 8
medical surge capacity, 36
Energy
emergency support functions, 12
resources, 32
English Team members, 42–43
EPA. See U.S. Environmental Protection Agency
Equipment, planning criteria, 36
Evacuation planning criteria, 36, 47
Evacuation signs, 27
Exercises, 36
External affairs, emergency support functions, 12
F
Facility preparedness, 36
Federal Emergency Management Agency (FEMA), 10, 13
Federal government
asset categories and target capabilities, 31–33
definition of required surge capacity, 37
emergency preparedness programs, 74
encouraging the private sector, 13
guidance and resources, 41
mental health plans/resources, 64–66
Federal legislation, local planning initiatives, 29–30
FEMA (Federal Emergency Management Agency)
Capability Assurance effort, 52
Comprehensive Hazmat Emergency Response - Capability
Assessment Program (CHER-CAP), 76–77
Crisis Counseling Program, 66
educational materials, 61
eGov Disaster Management Program, 56
Emergency Management Institute, 68, 74
emergency operations plan, 42
grants offered, 70
Hazardous Materials Exercise Evaluation Manual (HM-
EEM), 82
independent study training programs, 74
information resources, 63
list of core functions, 43
Mitigation Division, 85
National Disaster Medical System, 35
nuclear plants, response plans, 77
planning guide, 39
potential areas of vulnerability, 34
resources, 18, 21, 29
State and Local Guide (SLG) 101: Guide for All-Hazard
Emergency Operations Planning, 19, 45, 52, 94
Firefighting
emergency support functions, 12
Life Safety Code, 23
resources, 32
First responders, 13–14, 29
Fliers, 27
Floods, hazard analysis, 18
Flu, pandemic outbreaks, 17
Food, 31
Full-scale exercises, 76
Functional annexes, 45
Functional exercises, 76
Funding
emergency management programs, 2
impact of funding reductions, 71
planning partners, 71
planning strategies, 70
proactive approaches, 70
regional resources, 71
revenue-raising opportunities, 71
G
Games, 75
Gap analysis, 19
Gas main break, hazard analysis, 18
Geographic Information Systems (GIS) mapping, 34
Geopolitical factors, 8
Grants, as funding sources, 70
Groundwater contamination, hazard analysis, 18
H
Hazard-specific appendixes, 45
Hazard vulnerability analysis (HVA), 15, 17–18, 41, 80
Hazardous materials
Best Practices for Hospital-Based First Receivers of
Victims from Mass Casualty Incidents Involving the
Release of Hazardous Substances, 37
interstate transit, 1
resources, 32
Hazards, compiling lists of, 16–17
Health Affairs, 95
Health and medical facilities, emergency planning, 45–49
Health Care at the Crossroads: Strategies for Creating and
Sustaining Community-wide Emergency Preparedness
Systems, 2
Health care organizations
bioterrorism annex planning criteria, 36
communications, 61
drills and exercises, 49
100
Standing Together: An Emergency Planning Guide for America’s Communities
emergency preparedness, 10–11
Health care staff, orientation and education, 48
Health department
communitywide training, exercises and drills, 76
emergency management, 4
emergency preparedness, 9–10, 69
laboratory services, 38
pharmaceuticals and medical supplies, 49–50
Health First Health System, Florida, 24
Health Resources and Services Administration (HRSA), 37,
55
High-touch methods, 60
Home health care
emergency support functions, 11
medical surge capacity, 35
Homeland Security Grants Web site, 70
Homeland Security Operations Center (HSOC), 28. See also
U.S. Department of Homeland Security
Hospital catchment areas, 8
Hospital Emergency Incident Command System (HEICS), 48,
51
Hospitals
Assessing Hospital and Community Emergency
Preparedness Linkages, 94
bed capacity, 37
communication procedures, 61
emergency preparedness, 10–11
funding efforts, 71
GIS locations of, 34
identifying alternative care sites, 47
medical surge capacity, 35
National Bioterrorism Hospital Preparedness Program, 55
planning initiatives, 30
Veteran’s hospitals, 39
Human resources requirements, 23–24
Humanitarian organizations, emergency response, 13
Hurricane plans, in Florida, v, 27
Hurricanes, hazard analysis, 17
HVA (hazard vulnerability analysis), 15, 17–18
I
ICS. See Incident Command System
Idaho Institute of Emergency Management, 30
Immunization supplies, 35, 36
Incident Command System (ICS), 27, 36, 48, 51
“Incident of National Significance”, 29
Industry-based planning, 113
Information and planning, 32
Initial stabilization, 37
Institute of Medicine (IOM)
culturally sensitive communication, 60-61
decisional support, 60
future pandemic, 1
mass vaccination campaigns, 60
Preparing for the Psychological Consequences of
Terrorism: A Public Health Strategy, 63, 94
Integrated community plan
annual emergency management review, 90
external feedback, 93
performance analysis, 90–92
planning process review, 93
planning strategies, 80
posttest problems and remedial actions, 92–93
Integrated emergency management plan
collaborative efforts, 40–41
documentation, 42–43
draft of emergency plan, 41–42
emergency planning, 41
goals, 45
guidance and resources, 41
health and medical facility emergency planning, 45–49
jurisdictional lines, 51
lessons learned from 9/11, 51–52
measuring preparedness and response success, 51
meetings, 42
organization, 43–45
pharmaceuticals and medical supplies, 49–51
planning strategies, 40
responsibilities, 43, 44
review of existing plans, laws, and mutual aid agree-
ments, 42
International Critical Incident Stress Foundation, 62–63
International Red Cross, 13
Interoperability Backbone, 56
Interstate mutual aid, 29
Isolation, 36, 37, 48
J
Joint Commission on Accreditation of Healthcare
Organizations
Division of Research, 49
emergency management planning and drill requirements,
46
Health Care at the Crossroads: Strategies for Creating and
Sustaining Community-wide Emergency Preparedness
Systems, 94
study on potential for catastrophic events, 16
Joint Field Office (JFO), 29
Joint Terrorism Task Forces (JTTFs), 28
Jurisdictional lines, 41, 51
101
Standing Together: An Emergency Planning Guide for America’s Communities
L
Laboratory services
capabilities, vi, 36
capacity, 48
medical surge capacity, 35
upgrading, 38
Law enforcement regions, 8, 26–27, 32, 42
Layered preparedness and response, 27
LEPC. See Local Emergency Planning Committee
Liaisons, local elected officials, 5
Local emergency planning. See also FEMA
communications, 57
large-scale emergencies, 26
planning process, 10
public education, 27
roles and responsibilities, 5
services required, 45–46
Local Emergency Planning Committee Database, 18
Local Emergency Planning Committee (LEPC), 29–30
Local Emergency Planning District, 29–30
Local governments, 70
Local health departments, 36
Local planner, 4, 14
Local public health department (LHD), 51
Lockdown, 36, 48
Loma Prieta earthquake, 24–25
Long term care
emergency support functions, 11
identifying alternative care sites, 47
medical surge capacity, 35
Long-term community recovery and management, emergen-
cy support functions, 12
M
Major construction projects, hazard analysis, 18
Man-made disasters, 78
Map sources, 18
Maryland Institute for Emergency Medical Services, 36
Mass care, housing, and human services, 12, 31
Mass casualty event, 37–38
Mass immunization campaigns, 26, 36
Mass prophylactic sites, 34
Mayoral Institute for WMD (Weapons of Mass Destruction)
and Terrorism Incident Preparedness, 30
Mayor’s office
credibility with the public, 58
existing relationships, 9
funding efforts, 71
geopolitical and definitional factors, 8
leadership, 14
“Mayors only” forum, 30
Media, 59. See also Communication
Medical equipment resources, 34
Medical Reserve Corps (MRC), 25, 26, 34–35, 85
Medical supplies, 49–51
Medical surge capacity, 34–35
Medical volunteers, 25
Meeting frequency, 42
Mental health planning
disaster planning resources, 62–64
emotional effect of crises on rescue and health care
workers, 66
federal and state disaster plans and resources, 64–66
Mental Health All-Hazards Disaster Planning Guidance,
62, 95
planning strategies, 62
Metropolitan Medical Response System (MMRS), 10. See
Medical Reserve Corps
Military assets, 39
Missouri Hospital Association (MHA), 30
Mitigation, 22–23, 85
Model Pediatric Component for State Disaster Plans, 69
MRC. See Medical Reserve Corps
Multi-Hazard Mapping Initiative, 18
Mutual aid agreements, 29, 30, 42
N
National Alliance for the Mentally Ill, 63
National Association of County & City Health Officials
Bt PREP: A Bioterrorism Response Plan Design Guide for
Local Public Health Agencies, 42, 95
Local Public Health Agencies Better Equipped to Handle
Bioterrorist Attacks, 95
National Association of School Nurses, 69
National Association of School Psychologists, 63
National Association of Social Workers, 63
National Bioterrorism Hospital Preparedness Program, 55
National Business Group, 35
National Business Group on Health, 77, 78, 95
National Center for Disaster Preparedness (NCDP), 20, 26,
68–69
National Center for Post-Traumatic Stress Disorder, 63
National Clearinghouse for Educational Facilities, 35
National Commission on Terrorist Attacks upon the United
States, The 9/11 Commission Report, 95
National Depressive and Manic Depressive Association, 63
National Disaster Medical System, 35
National Education Association, Crisis Communications
Guide and Toolkit, 56–57
National Fire Protection Association, Life Safety Code, 23
National Governors Association, Center for Best Practices:
102
Standing Together: An Emergency Planning Guide for America’s Communities
Homeland Security & Technology Section, 85
National Guard, human resources, 24
National Incident Management System (NIMS), 3, 28, 29,
31–33, 75, 96
National Infrastructure Institute, 18
National Institute of Mental Health, 63
National Institute of Standards and Technology, 18
National League of Cities, 21, 76, 95
National Memorial Institute for the Prevention of Terrorism,
85
National Mental Health Association, 63
National Organization on Disability, 67, 68
National Pharmaceutical Stockpile (NPS), 50
National Preparedness Plan, 15
National resource typing system, 31–32
National Response Plan (NRP). See also U.S. Department of
Homeland Security
all-hazards incidence management, 75
basic premise, 29
categories, 31–33
linking community’s plan to, 28
phases of emergency management, 22
reviewing and updating, 84–85
Strategic National Stockpile (SNS) and, 50
Web site, 96
National Weather Service, 18
Natural disasters, 78
NCDP. See National Center for Disaster Preparedness
Needs assessment on disability preparedness, 68
New Hampshire Department of Safety, Bureau of Emergency
Management (BEM), 64–65
New York State Office of Advocate for Persons with
Disabilities: ADA Accessibility Checklist for Existing Facilities,
39
NIMS. See National Incident Management System
NIST. See National Institute of Standards and Technology
Noncatastrophic emergencies, 79
Northern New England Metropolitan Medical Response
System, Community Planning Guide: Improving Local and
State Agency Response to Terrorist Incidents Involving
Biological Weapons, 42, 95
NRP. See National Response Plan
Nuclear detonations, hazard analysis, 18
Nuclear Regulatory Commission (NRC), 77
Nurses, medical surge capacity, 35
Nursing homes, 67, 73
O
Office of Citizen Corps, DHS, 27
Office of Domestic Preparedness (ODP), 70
Office of Public Health Emergency Preparedness, 38
Office of the Surgeon General, 26
Oil and hazardous materials, emergency support functions,
12
On-scene incident command, 25
Ongoing risk assessment, 36, 46
Operations-based exercises, 75
OSHA (Occupational Safety and Health Agency), 37, 61, 95
P
Pandemic influenza outbreaks, 17
Partnerships, 41. See also Collaboration
Pastoral care resources, 62-63, 64
Patient surge, 49–50
Pediatric patients, 37, 69, 94
Pennsylvania Department of Health, Special Populations
Emergency Preparedness Planning, 68
Pentagon, unified command system, 51
Peoria County Emergency Services, 30
Performance measures, for drills and exercises, 78
Performance-monitoring data, 80–81
Personnel processing point, managing volunteers, 25
Pharmaceutical resources, 34, 49–51
Physicians’ offices, medical surge capacity, 35
Planning partners, 10–14
Planning team. See also Communication; Current capacities
and capabilities
activating emergency plans, 79
advantages, 9
approaches, 41
leadership and responsibility, 40
participants, 11
responsibilities, 4
subgroups and committees, 41
Power failure
communications and, 47
hazard analysis, 18
Preparation, National Response Plan definition, 22–23
Preparedness and response planning. See also Emergency
management
basic societal functions, 20–21
community awareness, 27
compatibility with unified command functions and ICS,
27
convergent responders, 24–26
human resources requirements, 23–24
layered approach, 27
linking community’s plan to NIMS and NRP, 28
linking to county and state plans, 29
linking to Joint Field Office, 29
mutual aid agreements, 30
plan for layered preparedness and response, 27
103
Standing Together: An Emergency Planning Guide for America’s Communities
planning process, 21–22
planning strategies, 20
public’s involvement, 26–27
self-care, 27
Preparedness, National Response Plan definition, 22–23
PrepareNow.org, 67
Prevention, National Response Plan definition, 22
Private sector
emergency planning, 13
first responders, 13–14
Program for Pediatric Preparedness, 69
Protocols, 36
Psychological support, 62–63, 66
Public education, 26–27
Public Health and Medical Services
emergency support functions, 12
medical surge capacity, 35
resources, 31
Public information, 32, 41
Public involvement, community preparedness efforts, 26–27
Public safety and security, emergency support functions, 12
Public Safety Radio Service, 58
Public service announcements, 27
Public works and engineering
emergency support functions, 11
resources, 32
Q
Quarantine, 26–27, 36
R
Racial diversity, 62
Radio communications, 54
Rand Corporation, Protecting Emergency Responders:
Lessons Learned from Terrorist Attacks, 85
Readiness barriers, 2
Recovery, National Response Plan definition, 22–23
Redefining Readiness Study, 26
Redundant systems, 27
Regional agencies
funding efforts, 71
Homeland Security Coordinating Committee, 30
risk assessment resources, 18
Regional planning, 35–36
Representatives, local elected officials, 5
Rescue workers, emotional effect of crises, 66
Resource management, 32
Resource support, emergency support functions, 12
Resource typing, 31–32, 52
Response, National Response Plan definition, 22–23
Retired health professionals, 35
Revenue-raising opportunities, 71
Reverse 911 call system, vi, 38
Risk assessment
matrices, 18
ongoing, 36, 46
Risk-based approach, 15
Risk communication plan, 27
Risks and hazards
assessing and prioritizing hazards, 17–18
catastrophic events, 16
gap analysis, 19
planning strategies, all-hazards approach, 15
problems inherent in hazard lists, 17
Robert T. Stafford Disaster Relief and Emergency Assistance
Act, 13, 29, 39
Rocky Mountain Poison and Drug Center, 86
Rural areas
federal definition, 8
vulnerability to terrorist threats, 1
Rural Health Resource Center, An Alternative Approach to
Defining Rural for the Purpose of Providing Emergency
Medical Services, 95
S
Salvation Army, 63
SARS (severe acute respiratory syndrome), vi, 38, 80
School administrators, 35
School nurses, 69
Search and rescue, 31
Security, 32, 36, 48. See also Law enforcement regions
Security planning, 48
Self-care, 27
Self-help groups, 63–64
Severity, risk assessment, 18
Shelter
current capacities and capabilities, 38
disaster drills, 78–79
hurricane preparedness, 24
temporary, 33
Skilled nursing facilities, 36
Smallpox, vi, 38, 86
Snowstorms, hazard analysis, 18
Social support systems, 64
Social workers, medical surge capacity, 35
Societal functions, 7, 20–21
SOPs (standard operating procedures), 36, 45
“Special activities”, 70
Special Needs Population Task Force, 13
Special needs populations, vi, 67, 68–69
Spiritual support, 62–63, 64
Stafford Act. See Robert T. Stafford Disaster Relief and
104
Standing Together: An Emergency Planning Guide for America’s Communities
Emergency Assistance Act
Stakeholders, defining the community, 7–8
Standards of care, 37–38
State agencies. See also FEMA
funding efforts, 71
mental health plans/resources, 64–65
risk assessment resources, 18
State Emergency Response Commissions, 29
State planning initiatives, 29
State resources, 41
Stockpiling, 36
Strategic National Stockpile (SNS), 50, 51, 81
Stress reactions to disasters, 62, 66
Students, role in planning and response activities, 68
Substance Abuse and Mental Health Services Administration
(SAMHSA), 64
Supplemental facilities, 38
Surge capacity, 34–35, 36, 37, 46
Surge needs, 35
Surgical centers, emergency support functions, 11
Surveillance, 14, 36, 48
System wide failure, 27
T
Tabletop exercises, 75
Target Capabilities List (TCL), 32–33
Team. See Emergency preparedness; Planning team
Teen SERT (School Emergency Response Training) program,
68
Temporary shelter, 33
Terrorism National Consensus Conference, 69
Terrorism threats
assessing risks in communities, 16
How Americans Feel About Terrorism and Security: Two
Years After 9/11, 94
information resources, 63
Managing the Emergency Consequences of Terrorist
Incidents-Interim Guidelines, 52
National Memorial Institute for the Prevention of
Terrorism, 85
potential areas of vulnerability, 34
Redefining Readiness study, 60, 94
in rural areas, 1
Testing. See also Community awareness
communitywide, 76
of emergency management plan, 49
specialized, 38
Texas Department of Health and the Texas Institute for
Health Policy Research, Disaster Preparedness and
Response in Texas Hospitals, 95
Training. See Emergency preparedness
Transportation
emergency support functions, 11
resources, 32
Transportation Security Administration (TSA), 70
Triage treatment, 11, 37, 38
Tribal chief executives, 4, 28
Turf battles, 43
U
Unified command. See also Incident command system
all-hazards approach, 48
guidelines, 28
integration from an ICS to, 42
Pentagon’s use of, 51
Universal Task List (UTL), 21, 32
Universities, critical resources, 11–12
Urban areas, federal definition, 8
Urban hospitals, hazards, 16
Urban search and rescue, emergency support functions, 12
Urgent care centers, medical surge capacity, 35, 36
U.S. Citizen Corps. See Citizen Corps
U.S. Department of Commerce, 18
U.S. Department of Health and Human Services
Center for Mental Health Services, 62
Communicating in a Crisis: Risk Communication
Guidelines for Public Officials, 95
grants offered, 70
Mental Health All-Hazards Disaster Planning Guidance,
62, 63, 95
Mental Health Response to Mass Violence and Terrorism:
A Training Manual, 63
Rural Communities and Emergency Preparedness, 95
U.S. Department of Homeland Security. See also National
Incident Management System; National Response Plan
2003 Citizen Corps Survey of U.S. Households: Final
Survey Report, 96
emergency support functions, 10
grants offered, 70
incident management, 29
National Response Plan, 3, 20
Office of Citizen Corps, 27, 59
review and reprioritization of possible emergency inci-
dents, 80
risk-based approach, 15
spending priorities, 21–22
Target Capabilities List (TCL), 32–33
training programs, 74
Universal Task List, 21
Universal Task List (UTL), 32
U.S. Department of Justice
grants offered, 70
105
Standing Together: An Emergency Planning Guide for America’s Communities
Office for Victims of Crime, 64–65
U.S. Environmental Protection Agency
grants offered, 70
hazardous materials initiatives, 29
rules of risk communication, 57–58
U.S. General Accounting Office (GAO)
Bioterrorism: Preparedness Varied across State and Local
Jurisdictions, 96
Hospital Preparedness: Most Urban Hospitals Have
Emergency Plans but Lack Capacities for Bioterrorism
Response, 94
U.S. Geological Survey, 18
U.S. Surgeon General, mental health planning, 62
Utility-related functions, 46, 47
V
Vaccination
for high-risk patients, 77
mass vaccination campaigns, 60
smallpox vaccination program, 86
Veteran’s hospitals, 39
Vocational special interest groups, 33–34
Volunteers
credentialing, 49
managing, 25
resources, 32
Vulnerable populations
community preparedness, 26
needs assessment on disability preparedness, 68
partners in planning and response efforts, 67–68
planning strategies, 67
special needs populations, vi, 67
tools, 68
W
Washington State Emergency Management Association,
Elected Officials’ Guide to Emergency Management, 96
Washington University School of Medicine, Department
Emergency Planning Guidelines, 96
Water, 31
West Central Municipal Conference, Illinois, 30
Wire line communications, 53–54
World Trade Center attacks, lessons learned, 13, 51–52, 67
106
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