Emergency Management Primer for EMS

Since hurricanes Katrina and Sandy, emergency management has become more of a known entity to the emergency services sector and to the general public with programs such as Ready.gov. But what do emergency managers really do and how does it affect EMS?

Like police, fire and EMS, emergency management is an essential role of government. The Constitution tasks states with responsibility for public health and safety”•hence, they are responsible for public risks–while the federal government’s ultimate obligation is to help when state, local or individual entities are overwhelmed.

The overarching goals of emergency management at all levels are:

  • First, to reduce the loss of life;
  • Then, to minimize property loss and damage to the environment;
  • And finally, to protect the jurisdiction from all threats and hazards.

Brief History

Emergency management is not a new field. In December 1802, fire engulfed the city of Portsmouth, N.H. This disaster exceeded local capabilities and had a severe impact on commerce for the entire nation. Congress quickly passed the Congressional Relief Act of 1803, which enabled the federal government to be involved in local disasters. This act is commonly regarded as the first piece of national disaster legislation.

The Federal Civil Defense Act of 1950 established a nationwide system of civil defense agencies and programs, such as air raid warning and emergency shelter systems, to protect the civilian population. Duck-and-cover drills became routine in schools, government agencies and other organizations. This was the first recognized face of modern emergency management. In 1952, President Truman ordered that federal disaster assistance was intended to supplement, not supplant, the resources of state, local, tribal and private-sector organizations. Today’s emergency management system supports the notion that all disasters are local and should be managed at the lowest level until response capabilities are exceeded.

During the 1960s and 1970s, the U.S. experienced many devastating natural disasters, including the Alaskan earthquake and hurricanes Betsy and Camille, which identified a need for a well-coordinated federal response and recovery operations during major events. Congress passed several disaster relief acts, which ultimately established the process for presidential disaster declarations.

In 1979, President Carter’s executive order merged many of the separate disaster-related responsibilities into a new Federal Emergency Management Agency, or FEMA.

Jumping ahead into the 21st century, emergency management saw dramatic changes at the federal level. FEMA was merged into the Department of Homeland Security and saw a shift in priorities, moving away from disaster preparedness and toward an emphasis on national security.  However, we are still subject to natural disasters, such as hurricanes Katrina and Sandy, which continue to direct the scope of emergency management at the state and federal levels.

One of the most important pieces of legislation for emergency management procedures is the Stafford Disaster Relief and Emergency Assistance Act, which created the system in place today through which a presidential disaster declaration triggers financial and physical assistance through FEMA. The Stafford Act covers all human intentional hazards (terrorism), and unintentional and natural disasters.

Key Components

As with EMS, emergency managers use terms that we should have a clear understanding of. A hazard is a potentially damaging physical event, phenomenon or human activity that may cause the loss of life or injury, property damage, social and economic disruption or environmental degradation. A threat is the presence of a hazard and an exposure pathway. The hazard must have accessibility to an individual, community or entity for a threat to exist. For example, there is currently no threat to Montana from an active volcano. The susceptibility of life, property or the environment to damage and destruction if a hazard occurs is called vulnerability. For our purposes, vulnerability is the absence of resiliency, which is the ability to absorb stress and maintain certain basic functions or recover after a hazard has been realized. Risk is defined as the possibility of suffering harm from a hazard. The mere presence of a hazard is not sufficient to establish that a risk exists.

There are four main phases to emergency management:  

Prevention focuses on preventing human hazards, primarily from potential natural disasters or terrorist attacks (both physical and biological). The risk of loss can be limited with plans, training and design standards.

Mitigation activities are those necessary to reduce or eliminate risk to people, property or lessen the effects of an incident. This may include building resilient systems, communities and infrastructure to reduce vulnerability to incidents. This may also involve hardening or fortifying our communications centers, ensuring redundant power sources and supply chains.

Preparedness includes a range of deliberate, critical tasks and activities necessary to build, sustain and improve the operational capability to prevent, protect against, mitigate, respond to and recover from incidents. It is a continuous process to identify threats, determine vulnerabilities, determine impacts on capabilities and identify required resources.

Response is the reaction to the occurrence of a catastrophic disaster or emergency. It is comprised of the coordination and management of resources (including personnel, equipment and supplies) utilizing the incident command system in an all-hazards approach; and actions to save lives and minimize damage in a disaster or emergency situation. This phase includes:

  • Providing transportation for response priorities, including evacuation of people and animals, and delivery of response resources.
  • Providing fatality management services.
  • Minimizing health and safety threats.
  • Providing life-sustaining services with a focus on hydration, food, shelter, and reunifying families.
  • Delivering search and rescue services.
  • Ensuring a safe and secure environment for affected communities.
  • Ensuring timely communications.
  • Providing essential services including emergency power, fuel, access to community staples, and fire and first response services.
  • Providing lifesaving and medical treatment.

Recovery consists of those activities which the agency must perform that continue beyond the emergency period to restore critical functions and initiate stabilization efforts. The goal of the recovery phase is to return our organization to normal operations.

Do you know how your EMS system fits into these four phases? Do you know who your local emergency manager is and how to contact them 24/7? 

Each community is required to have an emergency operations plan (EOP). This document establishes the overall authority, roles and functions performed during incidents, and assigns responsibility to organizations and individuals. Do you know what is expected of your organization? Typically, the EOP will address several functional areas that impact EMS, including mass care, public health and medical services.

EMS is often written into these plans with no input from the EMS agencies themselves, resulting in unrealized expectations. For example, many plans call for EMS to provide services whenever an emergency shelter or relocation center is opened. The plan may also call for EMS to perform support functions at hazmat incidents or rehab at search-and-rescue functions. If you are not aware of what is written in the EOP, you may find yourself in a difficult situation. The plan may also be outdated, and your organization has since made changes in communications, equipment and staffing that may not be properly reflected.

Preparing for the Real Deal

The EOP needs to be tested to ensure the validity of the assumptions that exist. There is a specific formula that needs to be followed and it should involve all stakeholders. There are several ways of testing the plan, grouped into discussion-based and operations-based exercises.

Discussion-based exercises include seminars, workshops, tabletop exercises (TTXs) and games. These types of exercises can be used to familiarize players with current plans, policies, agreements and procedures, or to develop new plans, policies, agreements and procedures. Discussion-based exercises focus on strategic, policy-oriented issues. TTXs are aimed at facilitating conceptual understanding, identifying strengths and areas for improvement, and/or achieving changes in perceptions.

Operations-based exercises are more complex and include drills, functional exercises (FEs) and full-scale exercises (FSEs). These exercises are used to validate plans, policies, agreements and procedures; clarify roles and responsibilities; and identify resource gaps. Operations-based exercises are characterized by actual implementation of response activities in reaction to an exercise scenario.

FEs are traditionally used to evaluate coordination of command and control functions and focus on exercising plans, policies, procedures and staff members involved in management, direction, command and control of the various ICS branches or multiagency coordination centers. There is no actual deployment of assets.

FSEs are the most complex and resource-intensive type of exercise. They are conducted in a real-time, stressful environment intended to mirror a real incident where many activities occur simultaneously throughout the duration of the exercise. Assets are deployed and kept within strict time tables.

Continuing ‘Business’ Ops

For the sector of emergency management, there are valuable lessons to be learned from the field of business crisis and continuity management. We may not always view our agencies as a business, but think about how we keep units in service during a disaster. What does our manpower pool look like? How resilient is our supply chain? Do we have a back-up communications plan? How long can we keep the wheels turning if we do not have fuel, people, supplies and the ability to respond?  

A top document for all emergency responders to obtain is a copy of the NFPA 1600: Standard on Disaster/Emergency Management and Business Continuity/Continuity of Operations Programs. This document addresses methodologies for defining and identifying risks and vulnerabilities, and provides planning guidelines that address stabilization of your physical infrastructure and protecting the health and safety of your personnel. It also provides guidance on crisis communications procedures and discusses strategies for both short-term recovery and ongoing long-term continuity of operations.

It has been said before, but it bears repeating: During a disaster is not the time to introduce yourself for the first time.

Peter Dworsky, MPH, EMT-P is President-Elect of the International Association of EMS Chiefs (www.IAEMSC.org), Corporate Director of MONOC EMS in New Jersey, and a Deputy OEM-EMS Coordinator for Monmouth County (N.J.) Sherriff’s Office. 

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