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Tuesday, August 30, 2011

NIMS Incident Types

NIMS info from DHS
Today's post come in the form of an email question and answer on NIMS incident typing. The question comes from Ben Hazlerig, a Paramedic who has transitioned into Emergency Management. The answer from Alan Bubel, Assistant Chief of the Gates (NY) Fire District, an authority on NIMS, and frequent contributor to Mitigation Journal blog and podcast. 



NIMS Field Guide from Informed Publishing
 I love NIMS job aids and memory helpers. The best guides I've found have come from Informed Publishing. Informed offers a wide variety of field guides for the traditional and non-traditional responder. The NIMS ICS Field Guide puts all the needed information in your pocket...for any NIMS/ICS position. Available in electronic and hard-copy, it's a tremendous aid for any experience level. You can also stay current by reading the Mitigation Journal and listening to our podcast. The Mitigation Journal podcast App is also available on iTunes! 

Note: I endorse Informed Publishing products. Neither Ben nor Alan have any involvement with Informed.




Ben writes:
I’ve been a listener of your podcasts for some time now, especially during my days of Paramedic school.  I’ve now transitioned from EMS into an office Emergency Management job.  One thing I’m having a hard time grasping is the NIMS Incident typing.  The company I’m with uses the Incident Type 1 to 5 scale to classify events in the beginning stages.  I haven’t been able to find anything within the FEMA online materials that clearly defines who officially determines Incident Types as it relates to National disasters.  We are essentially mimicking the NIMS system within our own organization and putting the job of Incident Typing on our Senior Level Executives who have limited Emergency Management experience.  It seems to me that this classification is better implemented after the fact as a way to summarize what resources were used.   Do you have any thoughts on this subject or know of any reference material online I could refer to.  Thanks for any information you can provide.

Alan responds:

Here are some thoughts on the topic of Incident Typing:
One of the responsibilities of the Incident Commander (IC) is to analyze the complexity of the incident. This helps to identify resource requirements and manipulate the incident management structure appropriately. Complexity analysis factors include such things as safety, resources, size of the incident and impacts to life, property and the economy. More information on this can be found in the ICS200 curriculum.

Categorizing an incident by type, then, is based on the incident's complexity. You're aware of the 5 to 1 scale (Type 1 incidents being the most complex) so we don't need to get into that discussion. However, your question pertained to who officially determines incident type relative to a national disaster. With that being said, there are only two incident levels where Federal resources come into play - Type 2 and Type 1; of those two, only a Type 1 incident is considered an "Incident of National Significance". A national disaster would fit the criteria for an "Incident of National Significance", activating the National Response Framework (former National Response Plan) and likely resulting in Stafford Act declarations. But, WHO determines the incident type?

The answer is the IC, based on the whole complexity analysis thing. In addition to analyzing incident complexity, the IC has the responsibility to call for resources. The level from which those resources are requested (local, state, or Federal) also speaks to the incident type. Type 5 and Type 4 incidents normally require local resources; Type 3 incidents local and state resources; and Type 2 and Type 1 incidents all three levels. So, if incident complexity is not enough for an IC to base an incident type decision on, the resource requests can serve as an added guide.

Although incident typing is very useful for summarizing the size, scope and complexity of an incident after the fact, the determination of the incident type needs to be made real-time during the incident by the IC. If your executives have IC responsibilities, they should be afforded the training and education required to identify incident type. (Training through the ICS400 level would be my recommendation). If they do not function as an IC, but support an incident as Emergency Management personnel, they should still be aware of the incident typing process and the role it plays relative to resources and geo-political impact.

Monday, August 29, 2011

My opinions on Hospital Emergency Preparedness are nothing new

Click to download podcast
I've receieved reader emails asking if all this talk about hospital preparedness, accountability during crisis, and the after-the-fact accusations is a new outcome from recent legal decisions.

The quick answer is, no.

In fact, I've been talking about these and other hospital emergency preparedness topics in Rule of Outcomes fashion for a long time. Its nice to be ahead of the curve...

In response to those emails, I recalled discussion on the topic of Dr. Anna Pou and the allegations against her and other staff from Memorial Medical Center in the wake of Hurricane Katrina.

In this talk, from Mitigation Journal podcast (originally recorded in 2007) I discussed the issues that are now foremost on the minds of many in healthcare emergency management.

In this re-issue, we'll consider the implication of crisis decision making, triaging of limited medical resources, incident action planning, and standard of response versus sufficiency of response.

This clip will reiterate many of the points in from the recent Tenet Health/Katrina decision. It will also serve as a primer to get you thinking about the possibilities and adverse outcomes in crisis decision making.

Click the player below to listen on-line

Sunday, August 28, 2011

Interview with Ceciel County, MD County Emergency Services

Click for Podcast download

Welcome to a special interview with Mr. Richard Brooks, Director of Ceciel County Emergency Services, on the topic of winter storm activities. This is a re-issue of our podcast (#156). The planning and preparedness discussion in this segment remains one of the best on the web.

Although the topic is winter storms, the philosophy and actin-planning are universal to the current Hurricane Irene situation. This podcast episode is one of the most listened to and commented on by MJ followers.

For those of us thinking ahead to be ready for the next event, this podcast will be a great reminder of how to get things done.
 Click the player below to listen on-line:

Sitting on the edge of Irene: cautiously optimistic

Sitting here in Rochester, New York it's easy to be just a bit removed from the Hurricane Irene situation. Viewing the situation from a distance gives me the opportunity to reflect on the response of local governments, officials, and Federal agencies.

I'm cautiously optimistic that the actions taken by state and local government authorities will save lives. The forward thinking approach to evacuations and sheltering has been impressive up and down the East Coast. I am particularly pleased with the actions of New York City Mayor Bloomberg and the New York State office of emergency management. Although I have been critical of NYC in past storms; I'm encouraged to see that they are doing what I believe to be the best course of action possible.

Has the recent legal president from hurricane Katrina influenced emergency management decision making?

The decision to order a large-scale evacuation or shelter in place is never an easy one. Evacuations are not benign events and there are certainly risks associated with sheltering in place.  Major metropolitan areas such as those cities on the East Coast have to make this decision carefully and well in advance of a potential threat. I think they got it right this time.  Let's not forget that this is an area (the entire East Coast) that just suffered from one of the largest earthquakes in recent history.  A 5.8 magnitude earthquake struck the entire East Coast last week. There is untold and unseen damage to buildings and infrastructure. While this earthquake did not cause massive collapses and instruction, it certainly may have caused some buildings to be weakened. It certainly may have caused unseen damage to below ground utilities, sanitation, and transportation infrastructure. These same structures and pieces of infrastructure will now be impacted by hurricane Irene and thus raising the level of severity and the need for pro-activity on the part of local governments and responders.

There has been tough and honest talk from governmental leaders. The information has been blunt…  “if you don't evacuate we may not be able to rescue for several days…”. I think that's the reality of the situation and I think that demonstrates an understanding of when to switch from a standard of response to a sufficiency of response.

The physical damage to structures will be dependent upon the storm itself. The impact to life will be dependent upon the actions of local governments and local responders.

 So, what's going to happen next?

Well, if the storm turns out to be less severe than predicted there will certainly be accusations of overreaction. I've also anticipate that there will be those in the media who will accuse many in emergency management of crying wolf and scaring the public.

On the other hand, if hurricane Irene turns out to be as severe as predicted and to cause as much flooding and damage as predicted the ends will have justified the means. In either case I believe no other decisions could have been made by emergency managers the net to evacuate far in advance of the storm.   

 The only certain next step is recovery… and recovery is largely dependent upon preparation.

"I'm cautiously optimistic that the actions taken by state and local government authorities will save lives. Imagine the level of domestic preparedness that could be achieved with fully funded and staffed health departments and emergency management programs?"
Rick Russotti, Mitigation Journal
So far, the Irene has the flag barely moving...0900 8/28/11

Friday, August 26, 2011

North East Earthquake: The Real Hazards are Beneath Us

Top-5 list of issues responders and planners need to address

A magnitude 5.8 earthquake struck the East coast of the United States on August 24. The United States geological survey indicates that this quake was felt in 25 states reaching from the deep South to New England and possibly extending into Canada. Impacting more than 12 million people, this was the most powerful earthquake to be felt since 1944. It also happens to be the second earthquake felt in western New York in the last year. Its enough to make you ask: what if it did happen here?

NOAA photo
 E. L.Quarantelli (Disaster Research Center of the University of Delaware) warned us of the increasing impact of natural disasters. In his paper "Future Disasters in the United States: More and Worse" (1988),  he suggests that natural disasters will be more intense simply because they have more to impact in today's society. Again, this was written in 1988 and since that time we've seen our share of devastating natural events. We've also seen an increase in co-occurring natural events; earthquakes leading to tsunamis leaving to technological failures such as nuclear power plant failures. For more details, see Three Problems for Planning 2011. Related: They're going to get worse. (MJ July, 2010)
Critical Infrastructure:
the evidence of the quake was obvious in many buildings and while many monuments and tourist attractions were closed, the real concern is the impact the buildings of critical infrastructure… hospitals, for example.The recent decision from hurricane Katrina (Tenant Healthcare) has made us aware of the expectations for hospitals and healthcare facilities to be prepared for naturally occurring events. Furthermore, it seems the public has an expectation that hospitals will be in area refuge or shelter during crisis situations.

Co-occurring natural events:
Hurricane Irene is also projected to impact the East Coast of the United States within the next week. Changes in weather are often the most overlooked hazards in emergency response. With predicted sustained winds of over 85 miles an hour, hurricane Irene certainly has the potential for increased damage to structures weakened by the earthquake.

What lies beneath?
What we haven't seen (perhaps we haven't looked for yet) is what lies beneath…  under our feet, below ground is where we may find the true potential hazards from this earthquake. Quarantelli reminds us that natural disasters will simply be worse because they have more to impact. We have to keep in mind that there will be an increased impact on technology. Perhaps most importantly, is the impact to aging infrastructure. Natural gas lines,  power distribution systems, sanitation, bridges/tunnels and highway overpasses have all been cited as aging pieces of infrastructure. The impact of this earthquake may be harder to measure in this capacity as these items are mainly underground and problems may not be readily observable.

Communications:
Communications difficulties have to be considered a given in crisis situations. Even without widespread death and destruction cellular service was rapidly overwhelmed with the number of calls made  during and after the quake.  Social Media was also widely used to communicate and twitter was bombarded with “tweets” during and after the quake.

 Access to goods and services:
Many retail outlets including gas stations and supermarkets lost power making it impossible for people to purchase fuel and causing untold losses of frozen food and other consumables. While the inconvenience in this case appeared minor, consider the impact had a large scale evacuation been required… with limited availability of fuel for vehicles. Also consider the possibilities of prolonged sheltering without ready access to refrigeration.


Thursday, August 25, 2011

Forward thinking: Bringing the Katrina decision home

Ken Beers writes in this week with tremendous insight. He's asking questions that focus our attention on what will happen when the fallout from the recent Katrina decision comes home to our communities.

Concerning the Katrina/Tenet health settlement, Ken writes:

Let’s extend the thinking in this case to rural America. Can a small one ambulance town have a class action suit brought successfully when the tour bus goes off the cliff and 48 of the 55 patients die since their nearest mutual aid is an hour away?

What an interesting dilemma. How do we prepare for every contingency? When have we planned enough? How much should we spend on being prepared for the “big one”. How does Mother Nature figure in?

It would appear that in this case, the hospital didn’t plan on the levy breaking and taking out all their ability to continue providing services. If this hospital’s evacuation plan was similar to many others I’ve seen, they were all set to depend on ambulances for evacuation of the sickest patients. This doesn’t work when it is a community wide disaster since the ambulances will be tied up on other tasks. So how do you plan for community wide destruction and continuity of service?

In a way this is both very scary and fascinating at the same time.

Thanks, Ken, for writing in on this!

Tuesday, August 23, 2011

When is 25% preparedness acceptable?


 ...apparently, nearly ten-years into the "post 9/11 era"

"I would say Tampa is probably about 25 percent ready for a terrorist event. That's based on the training I've done throughout the State of Florida for the last five years. I think that there needs to be more funding and more education,”
                                                   Eric Dotten, Emergency Med. Learning & Resource Center Read more on this story from ABC

The above quote and the basis for this post comes from a story found over at ABC Action News. Please see the video below.

9/11/10 commentary
It caught me off guard. I expected to read about how the EMS providers were polishing their skills for dealing with a high profile event; an event that represented a high hazard, an event that held potential for an terrorist intentional attack with chemical or biologic weapons.

In my ignorance, I expected Florida to be a highly prepared state. Hurricanes, tropical storms, high heat, large special needs populations, big cities...Florida seemed to be a state that has prepared and practiced. Some of the best emergency management conferences I've been at have been hosted and presented by Florida. A state with solid Domestic Preparedness.

I seem to be wrong.

Tampa is Florida's third largest city with a population of 335,709 and Florida is the fourth largest state in the U.S. I think the Buccaneers still pay football there. But despite the size of the state and city, Tampa seems to be only 25% ready for a terrorist event. This after ten-years in the "post 9/11 era".

I've held the opinion that the current Homeland Security approach to preparedness is a failed model. If accurate, does Mr. Dottens quote reflect that failing? I've also held that we should not be (specifically) training for terrorism...we must integrate readiness for intentional events into an overall domestic preparedness program.

What, then should we expect...after all we're ten-years into the "post 9/11 era". Read my opinion from 9/11/2010. As one reader wrote in saying "25% is better than nothing".

And that may be the theme as we get ready to embrace 9/11/2011.

Effect of the recent Katrina ruling

I wanted to share a brief email from Michael Ehrman. Michael has been a long-time friend of Mitigation Journal and encountered a situation that reflected the impact of a recent legal decision from Hurricane Katrina. You can listen to Message from Katrina: Hospitals be ready part one and part two now.

You can contact Michael directly via Twitter @MichaelEhrman

Michael writes:

Just saw an effect caused by this ruling.

Went to Midwest City Regional Hospital for my Kiwanis Club bi-monthly meeting.  New signage on the revolving door and other doors stated "This hospital is not a shelter".  I had not seen this before and I asked security when did that go on the door but he did not know.  Could not understand it as the 8-story building is strong enough for current history of tornados including those that destroyed parts of the city years ago.  Now I know why it was put on the door.  Thank you judge.
Thanks, Michael. Make us wonder what could be next...

Sunday, August 21, 2011

Rochester, NY EMT has Stolen Trust

 While attempting to steal prescription medications, a Rochester, NY, EMT steals public trust.

“Shocked that somebody that is that close to helping people with medical conditions to be able to go in and invade your property."
                                                                   - Joseph Pula, 79 of Chili, NY
Sad but true. Here we are (once again) talking about a responder who defiles the public trust. Once again, we see that Rochester, NY is not immune from this behavior. Video below, full story here.

In this latest situation, Derek Carstairs (formerly an EMT with Monroe Ambulance) returned to the home of a respiratory patient and attempted burglarize the patients home for prescription medication. While the local media attention to this has been scant, it has rippled (but not shocked) the emergency response community here in Rochester.

Prescription medications are at the top of the list of abused drugs. Addictions drive otherwise good people to do terrible things; mostly impacting family and friends. In this case, the addiction/crime has cost many responders the trust of the public.

Its not the first time.

In November, 2005 I wrote about an EMS director who accused of using the internet to arrange sex from the girl who is actually an undercover Monroe County Sheriff's Deputy.

Also in November, 2005, we talked about California, not to be out done by NY, seems to have trouble with EMS providers and internet solicited, under-age sex crimes.


December, 2006 we found out about a forty-year-old volunteer firefighter has been arrested for sexual abuse of a minor.

More recently, in January, 2009, I got upset about six paid-on call firefighters have been setting fires to get work...at the rate of $10.00 an hour.

Its not just crimes that fail the public trust. January, 2006, a paramedic who has been fired as a result of her blogging activities, reminded us that public trust exists outside of the clinical arena. Just as the paramedics who responded to Jett Travolta defaulted on the public trust and gave the "inside scoop" about John Travolta's son to the media.

These are the cases I've written about...there have been many, many more. 

This is obviously not a problem unique to Rochester or to EMS. The damage to responders is also not limited to any one agency, service, or location.

Back to the Carstairs situation. The patient turned burglary victim makes a very poignant statement:

"I have to be very, very careful of the people that come and help me that they don't rob me."
Don't you forget that this statement will be going through the mind of each and every person you try to help. Think about this when your service lowers its standards because of a lack of personnel...just to get a warm body.


Saturday, August 20, 2011

MJ 216 Message from Katrina: Hospitals be ready. Part Two

Click for direct download
Special Early Release by popular demand
 
This may be the most influential decision in domestic preparedness that nobody is paying attention to. 
Join me, Jamie Davis (The MedicCast/The Nursing Show), and MJ Co-Host Matt Comer on this two-part podcast. In part one we discuss the general situation and organizational implications. Part two will address individual actions and decision making in disaster situations.

In part one we opened discussion on the situation with an overview and potential outcomes. The financial and precedence setting are on the top of the list. Also, we take a look at the impact on future planning and preparedness for healthcare in disaster situations. What will the impact be to health care costs? Should a community expect to shelter in a hospital during crisis?
In part two: public preparedness, the post 9/11 failing, preparedness pendulum, optimism bias and more!

Click the player below to listen to Mitigation Journal podcast on-line

Monday, August 15, 2011

MJ 215 A Message from Katrina: Hospitals be ready. Part One

Click for direct download
This may be the most influential decision in domestic preparedness that nobody is paying attention to. 

Join me, Jamie Davis (The MedicCast/The Nursing Show), and MJ Co-Host Matt Comer on this two-part podcast. In part one we discuss the general situation and organizational implications. Part two will address individual actions and decision making in disaster situations.

This will be an extended series on Mitigation Journal Blog and Podcast. Will be evaluating the pro's and con's of this important legal decision, implications for health care and traditional response. This podcast is important for hospital as well as non-hospital personnel.


Tenet Health owned Memorial Medical Center during Hurricane Katrina in 2005. Over one thousand civilians and patients sheltered in the hospital in the aftermath of the storm. The backup power had failed, there was no air conditioning, no power for ventilators, no running water or sanitation, and temperatures rose above 100 degrees.

But that's not all. Dr. Pou was accused of euthanasia "hastening" the deaths of some patients. Reports of inadequate triage processes for evacuation and lack or leadership quickly followed. Eventually, forty-five bodies were found in the devastated health center during recovery efforts.

A July, 2011 court decision requires Tenet Health to pay $25 million to those patients and civilians who took shelter at Memorial Health Center and died or suffered injury. The court ruling is based on the belief that the medical center failed to establish an evacuation plan and that by poor design, the backup power system was vulnerable to flooding...that is, they failed to plan, prepare, and implement adequate preparedness operations.

Part-Two available now. 

Click on the player below to listen now!

Tuesday, August 02, 2011

See Something Say Something goes to Wal-Mart

More than 230 Walmart stores nationwide launched the "If You See Something, Say Something" campaign today, with a total of 588 Walmart stores in 27 states joining in the coming weeks. A short video message will play at select checkout locations to remind shoppers to contact local law enforcement to report suspicious activity.

DHS Secretary Napolitano encourages you to say something to local police or a Walmart manager if you notice anything unusual while at Walmart. This is a continuation of the larger "See Something, Say Something" campaign designed to help report suspicious activity.

Although not an entirely bad idea, the statistics have yet to prove it worth.

I'm also a bit sceptical that running to the local Walmart manager is the best practice for reporting potential terrorist activity. Further, the campaign has yet to be proven as anything effective...check out this New York Times report.

Here's a quote from MJ Blog "See Something, Say Something" posted in September, 2010:
"Another problem is that people simply don't know what they are looking for. We, as emergency managers and planners have not done a good job at educating the public...or, is it that we simply don't want to share information? The result is failure for this See Something, Say Something campaign. Without an idea of what to look for, we'll get little if any useful information."

Let me add to that: Each report, while it may or may not result in useful information, will require law enforcement to expend resources to investigate.

We also discussed this topic on the podcast edition #202.
Click on the player below to hear my comments:



DHS video shown at Wal-Mart can be seen on the DHS Press Release (http://www.dhs.gov/ynews/releases/pr_1291648380371.shtm)