The National Research Council’s Disasters Roundtable and the Institute of Medicine’s Roundtable on Environmental Health Sciences, Research, and Medicine were formed to provide a neutral setting for individuals with different backgrounds and perspectives to discuss sensitive issues of mutual interest. Both groups bring together participants from the academic community, government, and the private sector who are actively engage in the disasters field (Disaster Roundtable) or environmental health sciences (Roundtable on Environmental Health Sciences, Research, and Medicine). Through their discussions, the Roundtables help to identify both current and potential problems, and consider approaches to solve them. The aim of these discussions is to share knowledge and ideas, but not proffer formal advice or recommendations.
This particular workshop provided an opportunity for the stakeholders in the two Roundtables to gather and consider issues related to health risks of disasters. To explore the capacity needs for addressing health risk during disasters, the speakers, participants, and Roundtable members considered how the United States will rise to meet these challenges and what research and training priorities were needed to strengthen its response to health-related risks.
INTERDISCIPLINARY PREPAREDNESS AND RESPONSE PLANS
Without a precise metric for preparedness, readiness can never be guaranteed. As a result, workshop participants stressed the need for enhanced collaboration and coordination among all stakeholders involved in disaster preparedness and response, in order to translate current policies into more concrete and effective
response strategies. Traditional response efforts have relied upon local, state, and federal resources. In addition to strengthening coordination at all levels of government, workshop participants advocated expanding preparation, mitigation, and response efforts to include hospitals, health care professionals from all fields of social and traditional medicine, non-governmental organizations, mass media, private businesses, academia, and the engineering and scientific communities.
Recognizing the need for a unified approach to preparedness, the Department of Homeland Security (DHS) has recently developed the National Response Plan to improve coordination between government agencies and local first responders, noted Lew Stringer, of the Department of Homeland Security. Although not fully implemented as of the time of the workshop, this all-hazards plan addresses prevention, preparedness, response, and recovery for all levels of domestic incident management. Under the National Response Plan, local jurisdictions will retain primary responsibility for response efforts, using locally available resources; however, in the event of a large-scale catastrophe, local and state resources are likely to be overwhelmed. The Catastrophic Incident Plan, a supplement to the National Response Plan, has also been drafted to be immediately implemented during crisis by the DHS Secretary. The major goal of the plan is to provide accelerated deployment of federal assets to disaster zones. Pharmaceuticals and medical supplies from the Strategic National Stockpile and personnel from the U.S. Public Health Service Commissioned Corps Readiness Force, the Department of Veterans Affairs, the Department of Defense, and the National Disaster Medical System can reach disaster zones within twelve hours following a decision to deploy. While those assets will certainly help to augment the local response, noted Stringer, there is a need for another 20,000 trained and credentialed response personnel, in addition to the existing VA, USPHS, Department of Defense, and National Disaster Medical System (NDMS) staffs, to stage an effective mass-casualty response.
Enhancing local response capabilities through federal assets is only one example of creating a multi-level response. The Department of Health and Human Services has taken this a step further by incorporating both hospital and public health preparedness standards into their emergency preparedness grants, thereby emphasizing the importance of integrating health care systems’ response plans with local jurisdictions’ plans. According to William Raub, of the Department of Health and Human Services, the goals of the preparedness grants are to improve the nation’s response capabilities in bioterrorism and other disasters, while correcting decades of neglect in the public health infrastructure.
In order to bring the full range of the nation’s preparedness capabilities to bear, Jack Azar, of the Xerox Corporation, advocated the value of including the private sector in emergency response planning. In the event that a disaster occurs during regular business hours, business and industry executives must have updated and well-exercised plans, including evacuation and shelter-in-place
protocols, for protecting America’s 100 million workers. According to Azar, the opportunity for government officials and private executives to share the successes and failures of emergency response, crisis management, and business continuity plans would be beneficial for all parties involved. That is especially true, considering the likelihood that private sector employees will be needed to assist in local response efforts. Following the September 11 attacks, engineers, iron workers, steamfitters, teamsters, electrical workers, and other building and construction trades unions collaborated with first responders throughout rescue, recovery, and cleanup efforts. While the National Institute of Environmental Health Sciences’ (NIEHS) Worker Education and Training Program made a considerable effort to educate and train over 4,000 workers at Ground Zero, many workers, unfortunately, suffer from residual respiratory problems brought on by hazardous fumes at the site. Samuel Wilson, of the NIEHS, stressed the need for the academic and scientific communities to develop a standardized occupational safety framework for emergency responders that addresses issues like training, medical surveillance, protective equipment, and decontamination.
While many workshop participants discussed the importance of creating interdisciplinary, multi-level plans to respond to disasters, Rae Zimmerman, of New York University, emphasized addressing health risks through changes in engineering and infrastructure. Because of technological advances and economic necessity, much of the nation’s infrastructure has become centralized and networked. For example, about 6.8 percent of all community water supply systems serve 45 percent of the population (Zimmerman, 2004:81, based on U.S. EPA, 2002). In addition, much of this infrastructure is interconnected, for example, according to U.S. Geological Survey data (2004), electric power and thermal electric power plants consume roughly half the total water used in the United States. Thus, it is plausible that a breakdown in one component of the physical infrastructure could lead to cascading and escalating effects in other sectors. According to Zimmerman, future government and industry decisions must involve decoupling structural infrastructure and introducing flexibility into systems when repairs or alterations are necessary.
COMMUNICATING PREVENTION AND PREPAREDNESS TO THE PUBLIC
Once developed, preparedness and response plans must be communicated to affected communities, the general public, the scientific community, and other stakeholders to provide the information necessary to make the best possible decisions concerning their survival. Empathetic, accurate, and rapid emergency risk communication to culturally diverse audiences with variable levels of scientific literacy is critical for any preparedness and response effort. According to Julie Gerberding of the Centers for Disease Control and Prevention, emergency com-
munication messages are judged by their timeliness, content, and credibility and must imply an understanding of the range of emotions that affected individuals may experience.
Federal agencies, the media, and non-governmental organizations all play integral roles in disseminating risk communication messages. Broadcast media are the fastest and most widespread method for circulating important public health information during crises; therefore, working effectively with the media is essential to successful communication and response. On the other hand, members of the media may lack the background knowledge to immediately understand the scientific or technical issues involved in many disasters; therefore, Gerberding noted the importance of educating journalists so as to avoid misinformation.
Although the media has an expedient emergency broadcast system, Rocky Lopes of the American Red Cross asserted that, during crises, individuals want consistent messages from a variety of sources. That is especially true in light of the varying degrees of public trust in the United States government. As a nongovernmental organization, the American Red Cross has noted that forty-eight percent of the public have said that they turn to the American Red Cross for disaster-related information. Through its collaborative efforts with the Federal Emergency Management Agency, the Department of Homeland Security, and the National Weather Service, the American Red Cross’ process of verification and repetition reinforces messages and inspires community action.
Effective risk communication messages can also mitigate the effects of disasters among those populations most vulnerable to their effects. During the 1995 Chicago heat wave, approximately 700 people, primarily elderly and poor residents, died in just three days. According to Eric Klinenberg of New York University, American society has assigned these populations less social importance, and this contributed to their isolation. As a result, their access to warnings, life-saving social interactions, and medical treatments was limited.
Following the Chicago heat wave, the Mayor’s office implemented automated telephone heat warnings, targeting the elderly population. In addition, the city government began to work with the National Weather Service, private meteorologists, and community organizations to improve early detection of extreme weather, and to determine a graded series of warnings to be issued on television, radio, and in newspapers. While those were notable improvements, Klinenberg emphasized the value of reversing the societal trends of isolation and deprivation, which not only intensify fatalities during heat waves, but can accelerate fatalities in other crises, as well.
Children are another special population that is especially vulnerable to the health effects of disasters. J. R. Thomas, of the Franklin County, Ohio, Emergency Management Office, described children’s different medical, legal, physical, and
psychological needs following a catastrophe. Medically, children need special supplies, such as pediatric drug doses and surgical instruments. In addition, emergency managers must plan for adequate shelter, transportation, and legal services to secure appropriate temporary placement for children who have been displaced from their families during the disaster. Even without parental separation, the traumatic experience of disasters alone is sufficient to produce psychological symptoms in children. Survivors of catastrophic events often have difficulty coherently verbalizing the effects of the disaster upon them. In young children, this is often compounded by an undeveloped language capacity. In addition, without a centralized mental health care system for children in the United States, treatment and services are currently scattered throughout numerous systems: schools, state and local health departments, child welfare services, and primary health care providers. As a result, the needs of this voiceless population are often underserved. To better prepare for future disasters, Thomas advocated including child health professionals from all fields of social and traditional medicine into response planning.
Recognizing vulnerable populations in disasters will help to ensure a more complete response; however, considering the unique nature of each disaster, different populations may be more vulnerable to specific disasters. Therefore, according to Carol Rubin, of the National Center for Environmental Health, a rapid community-needs assessment must be conducted following each disaster to ensure that the vital and specific needs of all affected community members are being met. A rapid needs assessment is a low cost, statistically sound, population-based epidemiological tool that can be used following a disaster to provide emergency managers with accurate and reliable information about the needs of an affected community. The results facilitate evidence-based decisions and interventions, providing a more effective disaster response through targeted allocation of scarce resources.
Since September 11, 2001, the federal government has undertaken significant initiatives to strengthen America’s state and local emergency preparedness and response systems. The improvements in the nation’s risk communication strategies, and its enhanced capabilities to acquire, store, and distribute pharmaceuticals and medical supplies to the public cannot be disputed; however, workshop participants stressed the importance of addressing the gaps and shortfalls in current emergency management policies. A number of challenges continue to exist as pointed out by many of the speakers and the participants, including:
The acknowledgment that disasters may destroy local health infrastructure when it is needed most (p. 23).
The concern that the public health workforce is nearing retirement age; thus, there is a critical need for training the next generation of responders (p. 11).
The capacity limitation of the NDMS, if deployed during a disaster, to be able to respond to treat 224 inpatients and 4500 outpatients per day (p. 39).
The need to engage the private sector in preparedness planning and communication channels for access to information in order to safeguard individuals at work (p. 49-52).
The need to plan for management of facilities and personnel during sustained crises (p. 47).