US Response to Disasters and Public Health Emergencies

1. US Response to Disasters and Public Health Emergencies Medical Library Association Mary Moore, PhD Kimberly A. Loper, MLIS University of Miami Miller School of Medicine This project is funded by the National Library of Medicine under contract HHS-N-276-2010-00782-P

2. Disaster Information Specialization Program MLA website: http://www.mlanet.org/education/dis/

3. US Response to Disasters and Public Health Emergencies

4. Participant Introductions • Name • Institution • Job title • Brief experience with disaster/emergency response & what you wish to get out of this class

5. MLA link: http://www.mlanet.org/education/dis/us_response.html Instructor Introductions

6. Pretest

7. Prerequisites • FEMA classes on the Incident Command System (ICS) and the National Incident Management System (NIMS) are recommended, but not required, prerequisites for this class. • We will include a review of those concepts. Link to FEMA-ICS: http://www.fema.gov/emergency/nims/IncidentCommandSystem.shtm Link to training FEMA-ICS: http://training.fema.gov/EMIWeb/IS/IS100b.asp Link to FEMA-NIMS: http://www.fema.gov/emergency/nims/ Link to training FEMA-NIMS: http://training.fema.gov/EMIWeb/IS/IS700a.asp

8. Objectives. This class will: • Provide an introduction to disasters and public health emergencies as conducted in the United States with emphasis on medical response. • Describe efforts to provide framework and order before, during, and after emergencies and disasters. • Increase understanding and empathy with those affected: first responders, incident commanders, and administrators. • Increase knowledge of where information specialists might fit into the US framework for disaster/emergency response.

9. Course Outline • Participant Introductions • Pretest • Course Objectives • Prerequisites • Course Content • Basic Terminology • US Organizations and Reporting Structures • The US Framework and its development over time • History and Early Legislation • Example: 9-11 • ICS, NIMS, HICS, NRF • Example: Katrina • Post Katrina Legislation • Incident Communications • Volunteers & Humanitarian Response • US Response to International Incidents • Example: The Haiti Earthquake • Role of the Disaster Information Specialist • More Information • Posttest • Evaluation

10. Successful Course Completion and Courtesy • Participate in all activities and exercises • Complete pretests and posttests • Complete the end-of-course evaluation • This session is designed to be delivered through VOIP. Please set your microphones to mute. • If you have to telephone in for any reason, please set your phone to mute and please do not place it on hold (to avoid sending hold muzakto the entire conference).

11. Let’s get started!

12. Basic TerminologySee:http://disaster.nlm.nih.gov/dimrc/glossaries.html

13. What Is an Incident?An occurrence or event, natural or man-made, that requires a response to protect life or property. • Major disasters • Emergencies • Terrorist attacks • Terrorist threats • Civil unrest • Wildland and urban fires • Floods • Hazardous materials spills • Nuclear accidents Source: http://training.fema.gov/EMIWeb/IS/IS100b.asp • Aircraft accidents • Earthquakes, hurricanes • Tornadoes • Tropical storms • Tsunamis • War-related disasters • Public health and medical emergencies • Other occurrences requiring an emergency response

14. What Is a Catastrophe? • A catastrophe is “any natural or man-made incident, including terrorism, that results in extraordinary levels of mass casualties, damage, or disruption severely affecting the population, infrastructure, environment, economy, national morale, and/or government functions.” Source: http://www.fema.gov/pdf/emergency/nrf/nrf_CatastrophicIncidentAnnex.pdf

15. Basic Terminology 1 • Disasters • Terrorism • Natural disasters • Man-made disasters, i.e. industrial or transit accidents • Emergencies • All-hazards http://training.fema.gov/EMIWeb/edu/docs/terms%20and%20definitions/Terms%20and%20Definitions.pdf

16. Basic Terminology 2 • Disaster declaration http://www.fema.gov/news/disasters.fema • Public health emergencies http://www.phe.gov/Preparedness/legal/Pages/phedeclaration.aspx • Pandemic and declarations of pandemics http://flu.gov/ • Medical surge and surge capacity http://www.phe.gov/Preparedness/planning/mscc/handbook/chapter1/Pages/whatismedicalsurge.aspx

17. Common Phases of Emergency Management Guide for All-Hazard Emergency Operations Planning: http://www.fema.gov/pdf/plan/slg101.pdf; p17-18 Photo source: Wikipedia, Emergency Management

18. Audience Response Question 1 A/an ___________ is defined as “any natural or man-made incident, including terrorism, that results in extraordinary levels of mass casualties, damage, or disruption severely affecting the population, infrastructure, environment, economy, national morale, and/or government functions.” • Emergency • Disaster • Catastrophe • Incident

19. What questions do you have?

20. US Organizations and Reporting Structures

21. Selected US Government Agencies • Department of Homeland Security (DHS) (Operational Responsibility) • Federal Emergency Management Agency (FEMA) • Health Affairs (OHA) • Department of Health and Human Services (DHHS) (Medical Responsibility) • Assistant Secretary for Preparedness and Response (ASPR)/Office of Preparedness and Emergency Operations (OPEO) • National Disaster Medical System (NDMS) • Office of the Surgeon General • Medical Reserve Corps (MRC) • Health Resources and Services Administration (HRSA) • Centers for Disease Control (CDC) • National Institutes of Health (NIH) • National Library of Medicine (NLM) • Specialized Information Services (SIS) • Disaster Information Management Research Center (DIMRC) • Library Operations • National Network of Libraries of Medicine (NN/LM) See also: DIMRCSources of Emergency and Disaster Health Information from the US Government: http://sis.nlm.nih.gov/dimrc/federalresources.html

22. U.S. Department of Homeland Securityhttp://www.dhs.gov/xlibrary/assets/dhs-orgchart.pdf Health Affairs: http://www.dhs.gov/xabout/structure/editorial_0880.shtm

23. FEMA US Department of Homeland Security Organization Chart. http://www.fema.gov/pdf/about/org_chart.pdf

24. FEMA Regional Officeshttp://www.fema.gov/regional-operations

25. US Department of Health and Human Services http://www.hhs.gov/about/orgchart/

26. One Example of State Government Emergency Response

27. Second Example of State Government Emergency Response

28. What questions do you have?

29. History and Early US Legislation:Responding to Lessons Learned

30. Disaster Preparedness and Response Legislation • Before 1950: New law for each disaster. • Federal Disaster Relief Program of 1950: Supplemented state and local govts to alleviate suffering and damage from major disasters. Only for response. • Disaster Relief Act of 1966: Expanded federal assistance to recovery to help reestablish communities after disasters. http://training.fema.gov/emiweb/downloads/is7unit_3.pdf

31. Legislation 1 • 1970s: Series of wildland fires in California. • Collaborative study of lessons learned • Biggest problems: poor management, communications • Needed better system for all to work together (Incident Command System and National Incident Management System have early roots here.)

32. Legislation 2 • Federal Emergency Management Agency created by President Carter on March 31, 1979. Transferred all disaster-related statutory authority vested in the Presidency or other Federal agencies to FEMA. http://www.fema.gov/about/history.shtm • Stafford Act of 1988. Federal assistance only released if governor of state asks or event so catastrophic that federal government must take action. Major legislation under which FEMA operates today. Revised 2011 to include libraries as essential services. http://www.fema.gov/pdf/about/stafford_act.pdf

33. Audience Response Key aspects of the Stafford Act are: • Responsibility for an incident is handled at the most local level possible. • It authorizes the Federal Emergency Management Agency. • Libraries are essential services. • All of the above • A and B only

34. September 11, 2001 terrorist attacks change everything. Photo Credits: FEMA, Photographer: Andrea Booher. 9-11 Memorial Service, 2007

35. Consider as you watch the video… What observations you have about the 9-11 video on World Trade Center Building 5 from the perspective of disaster preparation, planning, response, recovery or mitigation. In other words, what did we learn from 9-11 for preparation and mitigation in the future?

36. Videos • Remembering 9/11: http://www.history.com/topics/9-11-attacks/interactives/witness-to-911 • After the interactive site opens, click WTC5 http://www.history.com/topics/9-11-attacks/interactives/witness-to-911# • When it finishes, click on the Interview with Evan Fairbanks: http://www.history.com/topics/9-11-attacks/interactives/witness-to-911#/wtc-building-5/

37. Discussion 1 What observations do you have about the 9-11 video on World Trade Center Building 5 from the perspective of disaster preparation, planning, response, recovery, or mitigation? What can/did we learn from 9-11 for preparation for and mitigation in the future?

38. What Did We Learn from 9-11? • Need to more actively prepare at all levels • Need scalable processes for response, even for incidents we cannot imagine or anticipate • Need standardized, interoperable communications • Need process for handling spontaneous onslaught of volunteers • Need strategies for homeland security and a framework for national response

39. Legislative and Federal Initiatives Homeland Security Act of 2002 restructured various aspects of the Federal government after September 11, 2001 terrorist attacks. Homeland Security Act of 2002: http://www.dhs.gov/xabout/laws/law_regulation_rule_0011.shtm

40. FEMA Over Time • Independent agency under President Carter in 1978, brought together many related agencies • Purpose: Coordinate response to incidents that overwhelm local and state resources • Governor must declare state of emergency and request FEMA and federal government response from the President • Organized as a regional response system • Moved to Department of Homeland Security after 9-11 for improved coordination with related agencies

41. But … was FEMA’s ability to respond to disasters and emergencies compromised when it went under DHS with mission to address domestic terrorism?

42. Homeland Security Act The primary mission of the Department of Homeland Security is to: • Prevent terrorist attacks within the US • Reduce the vulnerability of the US to terrorism • Minimize the damage and assist in the recovery from terrorist attacks that do occur in the US Triggered Homeland Security Presidential Directives: • HSPD-5: Mgmt of Domestic Incidents • HSPD-7: Critical Infrastructure • HSPD-8 (now PPD-8): National Preparedness • HSPD-21: Disaster Healthcare

43. Thought Question The US Coast Guard reports to: • The Department of Commerce • The Department of Defense • The Department of Homeland Security • The Department of Transportation • Someone else

44. Audience Response Question 2 FEMA reports to: • The US Department of Health and Human Services, OPEO • The US Department of Homeland Security • The US National Incident Management System • The US Department of Emergency Preparedness and Response • None of the above

45. What questions do you have?

46. The National Strategy for Homeland Security The Incident Command System The National Incident Management System The Hospital Incident Command System The National Response Framework

47. Incident Command System • A subcomponent of the National Incident Management System: http://www.fema.gov/emergency/nims/IncidentCommandSystem.shtm • ICS training: http://training.fema.gov/EMIWeb/IS/IS100b.asp

48. Incident Command System (ICS) 1 Why • Developed in 1970s by interagency cooperative task force working to combat wildland fires • Identified weaknesses in incident response When • For all events either planned or unplanned: • Natural disasters • Man-made disasters/hazards • Planned events

49. Incident Command System (ICS) 2 Key Features • Standardization • Common terminology • Command • Establishment of command • Transfer of command • Chain of command • Unity of command • Planning/Organizational Structure • Management by objectives • Modular organization • Incident action plan • Manageable span of control

50. Incident Command System (ICS) 3 Key Features • Facilities and Resources • Incident locations and facilities • Comprehensive resource management • Communications/Information Management • Integrated communications • Information and intelligence management • Professionalism • Dispatch/deployment • Check-in