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4 pitfalls to avoid in your biologic planning

Think you'll have access to everything you'll need? Think again. 
This plan is your plan, this plan is my plan. Not.
Emergency service agencies and healthcare systems have spent countless hours and dollars on the planning process yet, few if any of these plans integrate with each other. There is little if any continuity between traditional response groups and healthcare systems. Failure of any agency or service to adopt or even recognize the existence of the national incident management system or NIMS will be the cornerstone of failure during a large scale event. Scant few services, either public or private, address planning needs or participate in any level of joint training. This unfortunate situation is perhaps the least expensive and easiest to implement, yet remains ignored. 

Four things you shouldn't count on in a biologic crisis
1. Communications
Each plan assumes that there’s going to be the ability to communicate and that communications will be undisturbed throughout any given event regardless of the length or scope of that event.  Case studies of numerous large scale events indicate the communications will be among the first piece of infrastructure to be compromised. When communication systems have failed or are compromised alternate means of communication will spring up; and it is these alternate means of communications that will lend a false sense of communications security and ultimately yield unreliable and inaccurate information unless they are planned and tested.

2. Power and Transportation

The reliance on public energy and public transportation are critical weak link in the disaster and emergency planning process. Power and transportation are linked together in the disaster planning setting. If we have and reliable and hardened power infrastructure capable of producing climate control, light, and maintaining critical operations in a given facility we can reasonably assume that facility will remain habitable and functional during crisis. If the power supply is threatened or lost we will no longer be capable of sheltering in place throughout the crisis and the decision will have to be made concerning evacuation or alternative sheltering. Should the need arise to evacuate a given facility, especially a healthcare facility, there will be our reliance on emergency medical service (EMS) and public transportation to make it happen. EMS transportation vehicles may or may not be available in such a situation. One must understand that all traditional response groups, including emergency medical services, will have their resources stretched to capacity and beyond. Air and ground transportation units will be subject to the same problems of fuel, power, and communications disruptions as fixed facilities. Alternate means for power supplies and shelter in-place needs must be addressed by fixed facilities in addition to hospital evacuation contingency and 96 hour planning.

3. Personnel
Another fatal flaw in emergency planning is the assumption that personnel will in fact report to work. This consideration must be taken without regard to the status of roadways and transportation. A survey study conducted by Columbia University in September, 2005 demonstrates possibility of personnel, who are otherwise unaffected by crisis, refusing to report to work. In this study, health care workers were asked to indicate if they would be able to report for work or willing to report for work in the event of a mass casualty incident. 81% said that they would be able to go to work if there was an environmental disaster, yet only 69% said they would be able to go to work during a small pox epidemic. The study goes on to note that the willingness to report for work would only be 48% of health care workers during a SARS outbreak. Further, only 57% of health care workers would return to work in the setting of a radiological event. The fallacy in this stage of planning is to assume that Healthcare workers who have a perceived obligation to respond will, in fact report to work. Numerous sources have noted that the willingness to report for work in any situation may be impacted by concerns for the safety of the responders family. It is important for employers of public and private organizations to understand that the family care can be as vital as responder care. Workers fears will impact their willingness to work and administrators and company leaders must talk to their workers about these concerns regarding exposure and contamination and reassure them by planning to assure family and dependent safety. An example of such contingency planning would be the setting of highly pathogenic flu or other biologic event. It is estimated in such a situation that nearly 30 to 40% of the American workforce would become stricken or ill and unable to report for work of any kind. That percentage includes persons engaged in critical infrastructure such as traditional responder and healthcare providers. 

4. Surge Capacity
Another important point to consider is that of the lack of surge capacity in the concept of ripple effect deaths. Surge capacity is a specter of imagination as many Healthcare systems operate above capacity every-day. Just as the traditional response groups will continue to respond to the routine calls for service during a large scale event, routine medical emergencies will continue to arrive at local hospitals. Lacking surge capacity will almost certainly cause some of these otherwise routine patients to destabilize and become critical or fatal. This can add to the death toll of any large scale event and further destabilize community infrastructure.

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