a systems analysis of special-needs population evacuation ... · this “special-needs...

© Copyright 2007 ASysT Institute

In partial fulfillment of a Graduate Certificate in Systems Engineering and Architecting Stevens Institute of Technology

A Systems Analysis of Special-Needs Population Evacuation during Catastrophic Events Robert Edson Larry John Patrick Webb Advisor: Dr. Dinesh Verma February 2007

© Copyright 2007 ASysT Institute i

ABSTRACT

Disasters and large-scale events can have profound effects upon a subset of the population that has special medical and care-giving needs. This “special-needs population” includes people in hospitals, nursing homes, mental-care facilities, and assisted-care complexes, as well as those in private residences who receive daily living or medical assistance. Evacuation of this particularly vulnerable population in the event of a disaster is both difficult and challenging. It requires special planning and resources that cut across multiple organizations—federal, state, local, industry, and non-governmental/volunteer, and can be implemented in multiple ways depending on the type and severity of the event. By viewing the evacuation process as a system of systems—complete with significant interoperability and communication requirements and complex, distributed governance—researchers and decision-makers can gain insight into performance issues and opportunities for improvement.

The project seeks to understand the current form of the multidimensional special needs population evacuation system. It describes the system’s complexity, strengths, and weaknesses. It contrasts the results of a detailed review of policy and regulatory documents on the one hand (the “As Designed” system), and their application on the other (the “As Is” system), by examining the case study of Hurricanes Katrina and Rita. It uses soft system methods and applies systemigrams and layered CONOPS analysis to develop a coherent understanding and description of the system, assess its performance, and identify key shortfalls and opportunities.

The study identifies significant shortfalls in six key areas: statutory authority; organization, roles and missions; communications policy; operational and enabling processes; preparation (especially training and exercises); and resources. It makes six operational-level priority recommendations and discusses several general system-level considerations to address the deficiencies.

Special Needs Evacuation System, ANSER, 14Feb07

© Copyright 2007 ASysT Institute ii

TABLE OF CONTENTS ABSTRACT.................................................................................................................................... i 1. Introduction............................................................................................................................... 1

1.1. Special-Needs Evacuation ................................................................................................. 2 1.2. Problem Discussion ............................................................................................................ 3 1.3. Research Motivation .......................................................................................................... 4 1.4. Project Goal ........................................................................................................................ 4 1.5. Definitions ........................................................................................................................... 5

2. Methodology .............................................................................................................................. 7 3. Data Collection .......................................................................................................................... 8

3.1. General Documentation..................................................................................................... 8 3.2. Formative Documents: NIMS and NRP .......................................................................... 9

4. Current System Description and Assessment....................................................................... 10 4.1. Methodology ..................................................................................................................... 10 4.2. Critical System Requirement.......................................................................................... 11 4.3. System Overview .............................................................................................................. 12 4.4. Event Management Phases and The Special Needs Evacuation System .................... 13 4.5. The Federal Evacuation System and the National Disaster Medical System............. 14 4.6. SNES “As Designed” Federal Planning and Preparation System............................... 15 4.7. SNES “As Designed” Federal Response System ........................................................... 17 4.8. SNES “As Is” Federal Response System........................................................................ 18 4.9. SNES “As Designed” Texas System ............................................................................... 20

5. System Issues Analysis............................................................................................................ 23 5.1. Methodology ..................................................................................................................... 23

5.1.1. Categories .................................................................................................................. 23 5.1.2. Priority ....................................................................................................................... 24 5.1.3. Stakeholders .............................................................................................................. 24 5.1.4. Issues .......................................................................................................................... 26 5.1.5. Analysis ...................................................................................................................... 27

5.2. Issues Analysis Results .................................................................................................... 27 5.2.1. Statutes....................................................................................................................... 28 5.2.2. Doctrine and Policy................................................................................................... 28 5.2.3. Organization .............................................................................................................. 30 5.2.4. Training and Education ........................................................................................... 30 5.2.5. Materiel ...................................................................................................................... 30 5.2.6. Leadership ................................................................................................................. 31 5.2.7. Personnel.................................................................................................................... 31 5.2.8. Facilities ..................................................................................................................... 31 5.2.9. Processes .................................................................................................................... 32 5.2.10. Resources ................................................................................................................. 33

6. Case Studies and Comparative Analysis............................................................................... 34 6.1. Methodology ..................................................................................................................... 34 6.2. Incident Command System (ICS)................................................................................... 34 6.3. National Response Center ............................................................................................... 35 6.4. Suffolk County New York- Joint Emergency Evacuation Program (JEEP).............. 37 6.5. Washington State WebEOC............................................................................................ 38


© Copyright 2007 ASysT Institute iii

6.6. FIRESCOPE..................................................................................................................... 39 6.7. Israeli Disaster Response................................................................................................. 41 6.8. Japan Tsunami System.................................................................................................... 45 6.9. System Attributes............................................................................................................. 46

7. Conclusions .............................................................................................................................. 48 8. Recommendations ................................................................................................................... 49

8.1. SNES Level Recommendations....................................................................................... 49 8.2. Higher-Level System Recommendations ....................................................................... 51

9. Recent Changes ....................................................................................................................... 52 10. Acknowledgments ................................................................................................................. 53 References .....................................................................................................................................55


© Copyright 2007 ASysT Institute 1

1. Introduction

Large- scale disastrous events are inevitable. Throughout history, populations have suffered from catastrophic natural events, from the volcanic eruptions of Pompeii to the ravages of the plague in Europe. Technological advances have also made inevitable more-complex man-made disasters, such as the nuclear events of Chernobyl and Union Carbide’s chemical gas release in Bhopal, India. More recently, the Tokyo subway Sarin gas attack, the September 11th jetliner attacks, and the London subway bombing have shown that man is more than capable of adding to his own vulnerability through the calculated use of technology to create large-scale disasters. Given the historical record, it is reasonable to conclude that mankind will have a continuing requirement to design and employ robust systems to help populations protect and respond to catastrophic events for the foreseeable future.

Within the general population affected by any disaster is a group with even greater vulnerabilities and risks—individuals with special needs. The “special-needs” population can generally be described as those who are cognitively and/or physically disabled or frail to the point that they require routine, professional help to complete daily-life tasks. This group is made up of patients and residents of hospitals, nursing homes, and mental-health facilities that need additional specialized care during a disaster or evacuation activity. Much of this group is made up of the elderly who need assistance in daily-living activities in addition to medical care. The special-needs group is particularly vulnerable during a disaster and special plans and resources must be in place to address this at risk population.

Eric Roethlisberger, Vice-President of the International Committee of the Red Cross, identified the primary challenge of his organization as “victims of natural and man-made disasters” and identified the “most vulnerable” groups as children, women, elderly, and the disabled. These populations are often disproportionately affected and make up a significant number of the victims in disaster events. Services directed to these demographics will be required in order to reduce the impact of disasters (Roethlisberger, 1996). The International Red Cross and Red Crescent Movement have “always acknowledged the elderly among vulnerable populations in their policies and programs, but the unprecedented growth in numbers of elderly people on earth creates a different order of vulnerable people” (Seabrook, 2000).

Reports from the Government Accountability Office (e.g., Bascetta, 2006; GAO, 2006a, 2006b; Walker, 2006), American Association of Retired People (Gibson & Hayunga, 2006) and other organizations (e.g., Bea 2005) indicate that evacuation and sheltering of people with special needs cannot be carried out reliably by the same mechanisms used for able-bodied persons. People with special needs may require immediate or full-time access to medical and psychological care, medicines, equipment, even service animals. Regular cars, buses, aircraft, and shelters may be inaccessible to them because of the need for wheelchairs and other equipment. Physical environments should be controlled to the maximum extent possible, as their physical strength, speed, and stamina may be limited, and they can often be highly vulnerable to confusion and disorientation, especially in crowded, noisy environments.

The consequences of insufficient planning and resources are clearly seen in the disasters of 2005. On 29 August 2005, Hurricane Katrina slammed into the Gulf Coast of Louisiana, Mississippi, and Alabama as a Category 4 storm, making it the most costly and destructive natural disaster in United States history. Its storm surge rolled inland along the Gulf Coast causing widespread devastation, but perhaps most notably overflowing the New Orleans levee system and flooding 80% of the city with water from Lake Pontchartrain.1 According to the National Association of Realtors, total housing, commercial and public property loss by Katrina were in the range of U.S. $100 billion (NAR, 2005). The U.S. Congress

1 “Floodwaters, tensions rise in New Orleans,” CNN, 31 August 2005, http://www.cnn.com/2005/WEATHER/08/30/katrina.neworleans/index.html, accessed 11 January 2007.



appropriated $62.3 billion for hurricane relief to assist the approximately one million people who were displaced by the hurricane, half of those from Louisiana. As of 13 August 2006 the death toll in Louisiana stood at 1,056 with the total loss of life along the Gulf Coast at 1,302 (LFAC, 2006b).

The cataclysmic damage to property and human life took on shocking proportions with media scenes of roughly 150,000 desperate people who were not able to evacuate New Orleans. Images of the tragedy from the New Orleans Superdome and Convention Center not only shocked the nation but also underscored that the magnitude of damage from Hurricane Katrina proved overwhelming to local, state, and federal authorities.

1.1. Special-Needs Evacuation

Within the special needs population, the reports are just as devastating. There were more than 30,000 elderly and disabled people in 400 nursing homes across Texas and Louisiana when these hurricanes hit.2 Only one-third of the nursing homes in New Orleans were even evacuated.3 Although the total number is difficult to determine, approximately 129 nursing home residents died during the Hurricane Katrina disaster, either through drowning or heat and related complications.4 St. Rita’s Nursing Home had a reported 34 drowning deaths when the one-story building was filled with water.5 Twenty-two heat-related deaths were reported at the Lafon Nursing Home of the Holy Family.6 Hurricane Rita provided similar evidence of a problem of life-threatening proportions with 23 residents dying in a bus fire while they were being evacuated from the city.7

It is clear that the problem of evacuating and caring for the special-needs population during the time of a disaster is an issue of life and death consequence. The current system must be assessed and improvements made to address this need and provide aid to this vulnerable subset of the population.

This study develops a foundation for improving the evacuation response systems that specifically addresses the special needs demographic in large-scale disaster events. Addressing the requirements of this specific population will reduce the overall impact of disasters and improve the safety and security of the nation.

2 “Fleeing the storms was just the start of troubles for the elderly, as many are isolated from their families and have no home left,” Houston Chronicle, 28 November 2005, http://www.chron.com/disp/story.mpl/special/05/rita/3487244.html, accessed on 11 January 2007. 3 Ibid. 4“New Details Surface in Hurricane Katrina Nursing Home Deaths,” Inclusion Daily Press, 20 November 2005, http://www.inclusiondaily.com/archives/05/11/30/113005lakatrina.htm, accessed on 11 January 2007. 5 “Pair charged in 34 deaths,” USA Today,14 September 2005, http://www.usatoday.com/news/nation/2005-09-13-katrina-new-orleans_x.htm, accessed on 11 January 2007. 6 “Class-Action Lawsuit Filed Over Katrina Nursing Home Deaths,” Nursing Home Abuse Resource, 14 September 2005, http://www.nursing-home-abuse-resource.com/news/la-katrina-deaths.html, accessed on 11 January 2007. 7 “Fleeing the storms was just the start of troubles for the elderly, as many are isolated from their families and have no home left,” Houston Chronicle, 28 November 2005, http://www.chron.com/disp/story.mpl/special/05/rita/3487244.html, accessed on 11 January 2007.



1.2. Problem Discussion

The elderly population in the U.S. (persons 65 years or older) numbered 36.3 million in 2004 (the latest year for which data is available). They represented 12.4% of the U.S. population, about one in every eight Americans. By 2030, there will be about 71.5 million older persons, more than twice the number in 2000. People age 65 and older represented 12.4% of the population in the year 2000; that figure is expected to grow to 20% of the population by 2030 (Administration on Aging, 2005).

In 2002, the U.S. Census Bureau determined that 51.2 million people (18.1% of the population) had some level of disability and 32.5 million (11.5% of the population) had a severe disability (unable to perform one or more activities or roles). More than 10 million individuals over the age of six needed assistance in one or more activities of daily living. These statistics represent the civilian noninstitutionalized population living in the U.S. Individuals with disabilities in an institute such as a nursing home are not included (Steinmetz, 2006).

The scope of the potential vulnerable population and the concomitant problem is also seen in a number of residents and total number of beds in high hurricane impact regions care facilities in (Table 1).

Table 1 - Available beds and special needs population in Gulf and East Coast care facilities. These facilities are at risk from hurricanes.

153,47196,160346,371419,807

24814916387470121548Texas

881145712915138397Louisiana

809100061605718149Mississippi

2451464657198782546Florida

1153144032356426369Alabama

2916179863637239998Georgia

99398461622018306South Carolina

1989189043793643022North Carolina

1674148162761431472Virginia

Population in Mental Care FacilitiesHospital Beds AvailablePopulation in Nursing

HomesNursing Home Beds AvailableState

153,47196,160346,371419,807

24814916387470121548Texas

881145712915138397Louisiana

809100061605718149Mississippi

2451464657198782546Florida

1153144032356426369Alabama

2916179863637239998Georgia

99398461622018306South Carolina

1989189043793643022North Carolina

1674148162761431472Virginia

Population in Mental Care FacilitiesHospital Beds AvailablePopulation in Nursing

HomesNursing Home Beds AvailableState

A significant event in any of the states in Table 1 would represent a nearly overwhelming special-needs population in need of evacuation and care. The problem would be compounded significantly if the event area covered more than one state. These numbers should be added to the noninsitutionalized statistics previously noted to gain an understanding of the magnitude of the total problem.

However, it is within the context of the Hurricane Katrina disaster that the true magnitude and reality of the problem of special-needs population evacuation becomes apparent (Gibson & Hayunga, 2006).

• An estimated 88,000 persons age 65 and older were displaced by Hurricane Katrina • Forty-eight percent of all persons age 65 or older living in flooded or damage-affected areas reported

having a disability • Among households with people age 65 or older, more than one-quarter (26%) were without a vehicle,

and among those were age 75 or older, one-third (33%) • In Louisiana, roughly 71% of the victims (estimated 1,330 people) were older than age 60, and 47%

of those were over age 75



• Most of these elderly victims died in their homes and communities; at least 68—some of whom were allegedly abandoned by their caretakers—were found in nursing homes

• For the older people who survived, the emergency response problems often resulted in inappropriate displacements, deterioration in health and functioning, or other harms (DHHS Office of Inspector General, 2006).

It is clear that a significant special-needs population exists and can suffer from increased morbidity and mortality during large-scale events.

1.3. Research Motivation

The special-needs population is clearly large and growing, and can be at considerable risk during large scale events and disasters. Recent events have validated this risk; people in this population have died during and after disaster events. The question remains, however, whether the risks (and the resulting deaths) are the result of an adequate evacuation system poorly executed or a poorly designed system. Evidence from an interdepartmental assessment (DHS/DOT, 2006) shows that, in many cases, it is the latter—the system is clearly broken in important ways. Specifically, in 2006, the Department of Homeland Security (DHS) and the Department of Transportation (DOT) conducted a joint review of emergency action plans on the metropolitan, state, and federal levels. The conclusions clearly stated that special-needs evacuation planning was not adequate.

• Assessment of the status of catastrophic planning for states and 75 of the nation’s largest urban areas: • Five of 15 state and urban area conclusions dealt with evacuation and special-needs individuals • None of the functional annexes adequately address special needs populations • Capabilities to track patients under emergency or disaster conditions and licensed out-of-state

medical personnel are limited. • Federal conclusions:

• The federal government should develop a consistent definition of the term “special needs.” • The federal government should provide guidance to states and local governments on

incorporation of disability-related demographic analysis into emergency planning.

This lack of preparedness highlights the need for a rigorous assessment of the special-needs response capability. A Department of Health and Human Services report (Bascetta, 2006; DHHS Office of Inspector General, 2006) reached similar conclusions.

1.4. Project Goal

The goal of this project is to develop an integrated operational concept for evacuation and support of special-needs populations displaced as a result of a large-scale, open event (an event with no clearly defined population or impact region). The project will evaluate the current system for evacuation of the special-needs population during a major event (e.g., terrorist event, natural or technological disasters), developing an “As Designed” and “As Is” concept of operations. Gaps and deficiencies in the system will be identified and further studies proposed. The steps necessary for the development of a more robust “To Be” concept of operations will be discussed. The concept of operations and study evaluation will cover all aspects of special-needs evacuation from initial planning through evacuation and delivery of a victim to a suitable facility, and return of the victim to a permanent facility after the event.

This study will assess the entire system for special-needs populations, but it should be understood that each state and locality will approach this problem differently. Although there is some effort to



provide guidelines and common planning across all levels (DHS, 2004, 2005), the system is still comprised of 50 different manifestations at the state level and thousands of variations at the municipalities and local level. As the system is studied, common and extensible areas will be identified.

It is important to note that healthy individuals with no personal transportation, characterized in the literature as “transportation disadvantaged,” are not included within the scope of this study (see GAO, 2006c for more details on this issue).

1.5. Definitions

This section provides definitions for the key concepts and terms utilized within this report. Where possible, the definitions were derived from established federal planning and guidance documentation (Bea, 2005; DHS, 2004). It is interesting to note, however, that the most important term “special-needs population” has no official definition. This lack of clarity is illustrative of the overall problem these populations face. An additional complication with the established definitions is that they reflect the orientation of the definer, and thus have a legalistic or limiting aspect rather than an inclusive one. The definitions listed next capture the intent as utilized in this study:

• Special-needs population—Any individual falling into several groups as noted next: o Inpatient and resident populations of hospitals, nursing homes, and mental health-care

facilities o Elderly/disabled populations living outside institutional care facilities, but that require

professional care in daily-life activities or for medical care o Elderly/disabled persons in assisted living communities o Elderly/disabled persons in home residences who receive regular care/assistance from family

or through informal channels o Elderly/disabled persons either self-identified or identified by a third party through some

formal effort. • Event—

o Natural disasters o Technological disasters o Major transportation accidents o Acts of terrorism including weapons of mass destruction events.

• Technological disaster—A disaster that is a result of an accident at a major industrial, commercial, or other technological facility or operation.

• Scale of an event—The geographic size and devastation of the event coupled with the impact on the population in the affected area (Figure 1).



Figure 1 - Event scale with examples and major characteristics.

• Open event—Extremely large in scale; number and identities of victims unknown; extensive damage to infrastructure; large-scale evacuation or population displacement

• Closed event—Extremely limited in scale; number and identities of victims easily known; insult primarily limited to injuries and fatalities; no evacuation or population displacement.

• Evacuation—Safe movement of special-needs individuals from their home facility to a medically appropriate and secure facility outside the area of event impact. This includes safe transport and appropriate medical care en route.

• Shelter-in-place—Safe refuge provided in the original facility or in another facility within the event impact area.

• Resources—All activities and services associated with the care and movement of the special-needs population. This may include personnel, equipment, supplies, and facilities available or potentially available for use in the response activity.

2004 Tsunami

Commercial Plane Crash

9/11 Hurricane Katrina

Large Tornado

Open Event • Extremely large in scale

• Number and identities of victims unknown

• Extensive damage to infrastructure

Closed Event • Extremely limited in scale

• Number and identities of victims easily known

• Insult primarily limited to injuries and fatalities

System concentrating in this area



2. Methodology

The overarching goal of this project was to establish a baseline of the existing special needs evacuation and management system. Ring (2006) described a very methodical and comprehensive process for the development of a true concept of operations for any system or problem solution. This process is particularly robust in its approach to stakeholder involvement and preferred solution definition. Given the nature of this particular project, however, direct stakeholder involvement was limited; it was predominantly derived from authoritative summaries of conferences, workshops and after-action debriefs. As this project and analysis moves forward, it may be beneficial to “backfill” some of the steps Ring (2006) outlined for the complete development of the preferred solution.

As Figure 2 illustrates, the project was separated into four main tasks: (1) data collection (Section 3), (2) current system description (Section 4), (3) system issues analysis (Section 5), and (4) case studies and comparative system analyses (Section 6). Each of these tasks is described in the appropriate section. Together, the tasks served to generate the “As Designed” and “As Is” description of the system and to provide significant insight into high-priority problem areas and desirable system characteristics for a future “To Be” system.

1. CollectData

2. Describe& Assess Current

System

3. AnalyzeIssues

4. AnalyzeCase Studies &Other Systems

Reported Issues

System Intent & Design Info

“As Designed” & “As Is” SystemCharacteristics

PrioritizedRecommendations

Other Systems’ Intent & Design Info

Attributes ofSuccessfulSystems

“To Be”System

Figure 2 – Study tasks, inputs, and outputs.



3. Data Collection

Tasks two, three, and four each required significant data collection and analysis. Data collection was conducted along two lines: a thorough review of the vast set of general documentation on the special needs evacuation problem, and a specific in-depth review of the two primary formative documents on emergency response in the U.S., the National Incident Management System (NIMS), and the National Response Plan (NRP).

3.1. General Documentation

General documentation and data were collected from a wide variety of sources including the following:

• Stakeholder discussions • Academic, industry and government reports • Government policy, plans, and guidance documents • After-action reports from government and nongovernmental agencies • Peer-reviewed journal articles • Interviews with response and planning practitioners.

The Internet was also used extensively as a data source, though in general, data collection through this media was limited to established, authoritative sources. The major Internet Websites reviewed are as follows:

• Department of Homeland Security (DHS) (http://www.dhs.gov) • Government Accountability Office (GAO) (http://www.gao.gov) • Veterans Administration (VA) (http://www.va.gov/) • National Disaster Medical System (NDMS) (http://www.oep-ndms.dhhs.gov/) • Centers for Medicare and Medicaid Services (CMS) (http://www.cms.hhs.gov/) • American Association for the Advancement of Retired Persons (AARP) (http://www.aarp.org/) • Joint Commission on Accreditation of Heath Care Organizations (JCAHO)

(http://www.jcaho.org) • American Red Cross (http://www.redcross.org/) • National Citizens’ Coalition for Nursing Home Reform (NCCHR) (http://www.nccnhr.org/) • Center for Medicare Advocacy (http://www.medicareadvocacy.org/) • National Center on Elder Abuse (http://www.elderabusecenter.org/) • American College of Health Care Administrators (ACHA) (http://www.achca.org/) • American College of Health Care Executives (ACHE) (http://www.ache.org/) • George Washington University’s Institute for Crisis, Disaster and Risk Management

(http://www.gwu.edu/~icdrm/).

In addition to the these sources, the project also benefited from an affiliation with the Louisiana Family Assistance Center (LFAC). ANSER, the investigators’ home institute, was responsible for managing the LFAC and for developing a variety of guidance and planning documents for post-disaster victim assistance (LFAC, 2006a, 2006b, 2006c). This activity provided valuable hands-on experience to supplement the more academic analysis previously noted.



3.2. Formative Documents: NIMS and NRP

A thorough understanding of the existing special needs evacuation system requires a review of the establishing and guiding policy documentation. Principal among these are the National Incident Management System (NIMS) and the National Response Plan (NRP).

NIMS, released by DHS on 1 March 2004, was written in response to the Homeland Security Presidential Directive-5 (HSPD-5). HSPD-5 states that the Secretary of Homeland Security must “develop a national incident management system to provide a consistent nationwide approach for federal, state, tribal, and local governments to work together to prepare for, prevent, respond to and recover from domestic incidents, regardless of cause, size or complexity.”8 NIMS, therefore, is a national-level document that integrates existing best practices into a single approach to domestic incident management.

Domestic incidents such as severe natural disasters or terrorist acts may require multi-jurisdictional emergency resources to mitigate the consequences of the incident. These resources could include emergency response personnel and equipment from local, state, and federal sources. The resources must be employed by an organizational framework that is understood by all participants under a common plan that is specified through a process of incident action planning. NIMS provides a coordination management structure to manage these diverse resources efficiently and effectively, including the Incident Command System (ICS), Multi-Agency Coordination Systems, and public information systems. Additionally, NIMS supplies requirements for processes, procedures, and systems to further interoperability among local, state, and federal jurisdictions. ICS is “a standard, on-scene, all-hazards incident management system already in use by firefighters, hazardous materials teams, rescuers and emergency medical teams. The ICS has been established by the NIMS as the standardized incident organizational structure for the management of all incidents…HSPD-5 requires state and local adoption of NIMS as a condition for receiving federal preparedness funding.” 9

The NRP was released in December, 2004, in response to the Homeland Security Presidential Directive-5 (HSPD-5).10 The NRP, an all-hazards response plan, is framed upon the NIMS template. “The NRP, using the NIMS, provides the structure and mechanisms for national-level policy and operational direction for domestic incident management.” The NRP is intended to be a scalable response plan that can be fully or partially implemented based on the type of threat, anticipation of a significant event, or in response to an incident requiring a coordinated federal response. “Selective implementation through the activation of one or more of the NRP elements allows maximum flexibility to meet the unique operational and information-sharing requirements of any situation and enables effective interaction among various federal, state, local, tribal, private-sector, and other nongovernmental entities.”11 The NRP is built upon the assumption that incidents are typically handled at the lowest level of jurisdiction; however, it is applicable to all incidents that require a coordinated federal response in conjunction with a mixture of local, state, federal, private-sector, and NGO agencies.

8 “Homeland Security Presidential Directive 5 (HSPD-5),” The White House. http://www.whitehouse.gov/news/releases/2003/02/20030228-9.html, accessed on 14 August 2006. 9 “NIMS and the Incident Command System,” FEMA: National Incident Management System. http://www.fema.gov/txt/emergency/nims/nims_ics_position_paper.txt, accessed on 14 August 2006. 10 “Homeland Security Presidential Directive 5 (HSPD-5),” The White House. http://www.whitehouse.gov/news/releases/2003/02/20030228-9.html, accessed on 14 August 2006. 11 Quick Reference Guide for the National Response Plan, Version 4, Department of Homeland Security, 26 May 26, 2006, http://www.fema.gov/pdf/emergency/nims/ref_guide_nrp.pdf, accessed on 14 August 2006.



4. Current System Description and Assessment

The most difficult part of any system design or assessment is the development of a clear understanding of the current system or problem state. This section deals with the analysis and characterization of the current system.

4.1. Methodology

Figure 3 illustrates the process utilized for the characterization of the overarching system. The left side of the figure illustrates the analytical approach; in this case the broad categories of documentation used to develop the “As Designed” and “As Is” system description. Data collection and analysis were completed through an assessment of the primary and secondary sources previously noted. Documentation was reviewed to discover details on the structure and procedures of the designed and picture of the system, to identify weaknesses, and to discover gaps in the system operation and resources actual current special needs evacuation system. These details were synthesized to present a coherent.

System MaturitySystem Maturity Timeline/EventsTimeline/Events

“As Designed”“As Designed”

“As Is”“As Is”

“To Be”“To Be”

NDMS DocsNDMS Docs

NIMS/NRPNIMS/NRP

State Emerg. Action Plans


NGO StudiesNGO Studies

Lessons Learned/ After Action Report


Case StudiesCase Studies

Govt. Reports(GAO, CRS)


Version 0Version 0

Version 1Version 1

Version 2Version 2

Analysis ApproachAnalysis Approach

NDMS Established within HHS


NDMS move to DHS

NDMS move to DHS

1984

2004

2007

2005

2003

2006

Four Hurricanes Season


Hurricane KatrinaFirst NDMS Evac.


NDMS move back to HHS?


Hurricane RitaHurricane Rita

Test and EvaluationTest and

Evaluation

System MaturitySystem Maturity Timeline/EventsTimeline/Events

“As Designed”“As Designed”

“As Is”“As Is”

“To Be”“To Be”

NDMS DocsNDMS Docs

NIMS/NRPNIMS/NRP



NDMS DocsNDMS Docs

NIMS/NRPNIMS/NRP















Version 0Version 0

Version 1Version 1

Version 2Version 2

Analysis ApproachAnalysis Approach



NDMS move to DHS

NDMS move to DHS

1984

2004

2007

2005

2003

2006







Hurricane RitaHurricane Rita

Test and EvaluationTest and

Evaluation

Figure 3 – Analytic approach with system maturity and related timeline and major events.

Two systems analysis tools were used to accomplish the information synthesis: systemigrams and hierarchical operational concept analysis. Developed by Boardman (1994; Boardman & Cole, 1996), systemigrams provide a powerful tool for the analysis of systems described in written form. One first takes lengthy documentation and distills it down to “concentrated” prose covering all the salient points of the system. A visual systemigram is then constructed, decomposing the prose into the individual, but related, points, showing the flow of information, resources, and actions. Systemigrams are powerful constructs to facilitate complete understanding of a system and to provide a common foundation for group discussions on the system.



This study employed a modified systemigram approach. Rather than distilling one descriptive or policy document down to its primary points and then building the systemigram, the systemigram was built from information derived from many documents. This modified approach brings potentially disparate information into one coherent picture. The systemigram became an organizing tool for the information, and was used iteratively to build the underlying story.

The second tool, the hierarchical operational concept analysis (HOCA), is an analytical technique with a lengthy history in various system analyses. It is named here for convenience. HOCA groups system components of a similar nature into layers. These layers are then ordered and stacked based on a hierarchical ordering of layer activities. Relationships between various components within and between the layers are illustrated using arrows. This analytical technique is particularly useful for identifying missing components and connections within the system. It also allows for analysis and comparison of system components of a similar sort. For this project, the system was broken into seven layers: primary agencies; statutes, regulations, and directives; policies and plans; agencies and organizations; implementing unit; facilities; and resources. More on this will be discussed in the results section.

Visually similar to the lexicon and taxonomical representation of DeLaurentis, Fry, Sindiy, and Ayyalasomayajula (2006), the HOCA methodology does not have any representation of hierarchy within the layer. Should such a division become obvious, an additional layer would be depicted and incorporated into the analysis. In other words, there is no pyramidal structure to the HOCA construct. It is a layered cake of components, rather then the pyramid of DeLaurentis et al. Relationships cross component types and connect simple components as well as system components.

Also illustrated in Figure 3 are the various stages of the existing system. These stages or iterations of the special-needs evacuation systems (SNES) can also be characterized as version 0 (“As Designed”) and version 1 (“As Is”). Version 0 represented the designed evacuation system prior to the 2004 hurricane season. The four hurricanes in 2004 coupled with Hurricanes Katrina and Rita in 2005 acted as a lengthy test and evaluation of the designed system, and were used to construct the “As Is,” or version 1 of the system. Although not covered in this study, the same test and evaluation data and results could be utilized in follow-on work to develop a more effective and successful SNES (the “To Be” system).

The system assessment task included the development of the system context diagram and “As Designed” and “As Is” system descriptions for both the federal system and a representative state system (Texas).

4.2. Critical System Requirement

A simple system requirement or description was necessary to help guide data collection and analysis. This description evolved through several iterations as the study continued; it represents a synthesis of literature and stakeholder comments. The system description ultimately took the form of one critical requirement: maintain health and reduce deaths in the special needs population through a “system” that must do the following:

• Move the patient/resident out of the affected area • Utilizing safe and appropriate transport • While providing required medical care • Deliver them to safety at an appropriate facility outside the impact zone • Repatriate them after the event is complete and impacted area recovery is sufficiently advanced.



Though not developed with the necessary rigor, one could view this requirement as the “intervention system” as defined by Ring (2006) in his discussion of the development of a concept of operations. It represents the “black-box” system which, in the simplest form, represents a conceptual solution to the problem.

4.3. System Overview

An initial assessment of the special-needs evacuation system provides the impression that the system should be relatively simple in concept and execution. Essentially, it must take an individual with medical or assistance needs from a facility in an affected area and deliver the person to a facility in a safe area. However, even at the most abstract, a special needs evacuation system is extremely complex. Figure 4 provides a context diagram of the simplified special-needs evacuation system.

First, there are several originating facilities including hospitals, nursing homes, mental-health facilities, assisted-living homes, and private residences—all with different capabilities, needs, requirements, planning, preparation, and oversight. More importantly, these facilities have different entry points and access to the existing system. There are both federal and non-federal transportation mechanisms for moving this population. Regardless of the sponsor, the transporter must identify safe and appropriate transportation vehicles/methods. For example, a school bus may be insufficient; it may need to be a bus with a wheelchair lift and medical care capability. The entire transportation process must be coordinated with medical care providers and resources. The destination facilities must be identified and surveyed for specialized equipment and doctors. Through this whole process, appropriate records must be kept of patient movement and treatment. Families and friends separated from the affected population must be able to track their loved ones and have sufficient information to rejoin them later. Patient/victim medical records must also be maintained in an appropriate, secure manner. Finally, once the impacted area is secured and recovery sufficiently advanced, the patients/victims must be repatriated to their original homes or facilities, or some other new residence that meets their needs. Even when simplified, this is a complex system.

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Figure 4 - Special needs evacuation context diagram. The blue lines represent transport from the impacted area to safe facilities. The red lines represent the path back to appropriate facilities after event recovery.



Another complicating factor in the management and operation of the special-needs evacuation system is the complexity and number of organizations involved. The evacuation system itself actually represents a system-of-systems comprised of the individual systems of the care industry, local agencies, state agencies, disaster response NGOs, and federal departments (Figure 5). Each of these organizations or systems has its own mission and mandate, exists on its own, and normally operates independently outside the evacuation system. The interaction of these systems, in terms of both number and scale of involvement, depends on the magnitude and type of disaster event. As the event escalates in intensity and/or extent, the overall evacuation system spirals outward to involve more and more of these systems and their resources. Transition from one

form or state of the evacuation system to another as the system progresses through the response scale is a major event and represents a potential problem area.

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Figure 5 - Special needs evacuation system-of-systems.

Overall, the evacuation system-of-systems suffers from complications and issues endemic to all enterprise service systems of a similar sort: difficult distributed/variable governance, poorly understood roles and responsibilities, ineffective interfaces between the systems, and nearly infinite forms of response.

4.4. Event Management Phases and the Special-Needs Evacuation System

Assessment of the special needs evacuation system must be conducted in the context of the four basic phases of emergency or event management: planning, mitigation, response, and recovery (Figure 6).

Pre-impact EvacuationPre-impact Evacuation

Post-impact Evacuation

Post-impact Evacuation

RepatriationRepatriationPlanningPlanning

Population IdentificationPopulation

Identification

Figure 6 - Phases of emergency management with associated special needs evacuation activities.

The special-needs evacuation system has components that touch each of the emergency management phases. The system activities and organizational structure differ depending on the phase. Thus, when assessing the system for this project, the two major evacuation phases, planning and response, were looked at separately.



4.5. The Federal Evacuation System and the National Disaster Medical System

Within the guidelines provided by the NIMS and NRP, as well as other federal policy documents, the federal evacuation system is executed through the National Disaster Medical System (NDMS) and a number of cooperating agencies. (This evacuation is only supported for hospital patients, not the entire special needs population.) NDMS supports federal agencies in the management and coordination of the federal medical response to major emergencies and federally declared disasters. The NDMS organization12 is shown in Figure 713.

NDMS is under the FEMA, Response Division, Operations Branch. NDMS is comprised of several units as shown in the figure. The principal units for special needs evacuation are the Disaster Medical Assistance Team (DMAT), the Federal Coordinating Center, and the ad-hoc Management Support Team. DMAT provides the on-site medical care during an event. MST assists in the management of the care delivery, resources, and evacuation. FCC works to identify hospital beds and care resources both prior to and during an emergency or disaster.

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Figure 7 - NDMS organization and components.

There are two significant consequences for NDMS. First, NDMS lies deep within FEMA, reducing its visibility and budget clout. This positioning is in marked contrast to the high organizational position it maintained while part of DHHS prior to the Homeland Security restructuring of 2003. Secondly, as the chart indicates, there are a large number of agencies involved in the system, specifically DOD, DHHS, and VA. The lead role in several of the major components of the SNES system varies among the agencies, as do ownership and management of resources and infrastructure. This organizational complexity results in significant coordination and ownership issues. The special-needs evacuation system is a system that has either multiple owners, or none, depending on one’s perspective.

12 “National Disaster Medical System,” DHHS, www.oep-ndms.dhhs.gov, accessed 09 January 2007. 13 Since the study was completed the FEMA director been elevated to an Under Secretary position and FEMA is now a separate agency within DHS. NDMS has also been returned to DHHS as of 01 January 2007. Both actions were a result of the FY07 Homeland Security Appropriations Act.



There are several important operational aspects of NDMS that should be noted. First, the hospital beds are provided through a voluntary agreement with NDMS. They are identified during non-emergency periods, but availability must be validated during the actual event, as it varies with conditions and the hospitals are not bound to the original agreement. Second, the DMAT teams are made up of volunteer, non-dedicated individuals. These individuals must leave regular occupations on short notice and travel to the disaster location. Third, the NDMS system and related evacuation deals only with hospitals and medial emergencies. Nursing homes, mental-health facilities, and elderly or disabled in home care and assisted-living are specifically not covered. Destination nursing or long-term care facilities are not identified prior to events. Finally, NDMS evacuation is a complex process—a “human activity system” supported by a variety of IT and mechanical systems. It is subject to all of the variability and internal conflicts inherent in the former.

4.6. SNES “As Designed” Federal Planning and Preparation System

The current “As Designed” federal special-needs evacuation system was assessed using the modified systemigram and HOCA analysis (Figures 8 and 9). The NRP (DHS, 2004) provides overall policy guidance on disaster response. Emergency Support Function (ESF) 6, an annex to the NRP, provides mass care, housing, and human services guidance and specifies DHS as the lead agency for these functions. ESF 8 provides public health and medical services guidance, including evacuation. ESF 8 designated DHHS as the lead agency for these services.

The NDMS is comprised of four federal agencies: DHS, DHHS, DOD, and VA, with DHS as the lead to administer, fund, and activate the system. NDMS has three mission areas: medical response, evacuation, and definitive care. DHS has the lead for the medial response, DOD leads the evacuation component, and DOD and VA together lead the definitive care.

NDMS is comprised of several units, including the Federal Coordinating Centers (FCCs) that recruit non-federal hospitals to provide patient beds. FCCs also coordinate preparedness activities (e.g., emergency plans and exercise development) with local authorities and hospitals to develop patient plans for reception, transportation, and communication.

Each state also interfaces into this system. Activities vary by state and are dealt with only generally here (see the Texas case study later in the paper for a more in-depth discussion). State authorities and agencies license both nursing homes and hospitals. They also conduct preparedness activities with local authorities and care facilities, both hospitals and nursing homes, and assist in developing patient plans.

Finally, oversight agencies such as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and the Center for Medicaid and Medicare Services (CMS) require emergency plans to accredit the care facilities.

The nursing homes, which are not part of the federal system, prepare for disasters by contracting with local transportation to provide patient evacuation. Unfortunately, as was shown in recent events, local transportation assets are often inappropriate, over-subscribed, unavailable, or rerouted by a higher authority when needed the most.



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Figure 8 - Systemigram of the “As Design” federal planning and preparation phase for the special needs evacuation system.

Figure 9 - HOCA diagram of the layers of organization in the “As Designed” planning and preparation phase federal special needs evacuation system.



4.7. SNES “As Designed” Federal Response System

The previous discussion dealt with only the planning and preparedness phase of an event. Once an event occurs, the system manifests a new configuration as the response stage is initiated (Figure 10). During a response, NDMS provides DMATs to staff NDMS mobilization areas. These areas are within the affected area and act as “train stations” for incoming patients. NDMS also provides management support teams (MSTs) to support the DMATs and manage the mobilization areas.

The U.S. Transportation Command (TRANSOM, a unit within the DOD) initiates the Global Patient Movement Requirements Center (GPMRC) and deploys the Immediate Response Assessment Team (IRAT). The IRAT coordinates with MSTs and others within the mobilization area to identify patient medical and movement requirements. The GPMRC communicates with the FCC to obtain receiving facility information. The GPMRC also coordinates the Aeromedical Evacuation System (AES), the air assets that medivac patients from the mobilization areas.

FCCs continue their previous functions by coordinating with non-federal hospitals and resources and local authorities in the receiving area. Through this coordination, they are able to identify hospital beds and specialized care available for the evacuees. FCC coordination is with hospitals only, and does not include nursing homes or long-term care facilities.

Hospitals in the disaster region care for the patients and assist in transporting the patients via contracted and emergency local transportation to the mobilization area. State and local agencies assist in this transport. It is important to note that the federal transport and medical assistance does not occur until the patient reaches the mobilization center. Once at the mobilization centers, the patients are medivaced to NDMS reception facilities for receiving area local transportation to the identified hospital beds.



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Figure 10 - Systemigram of the “As Designed” federal response phase for the special needs evacuation system.

The previous discussion does not include nursing homes or mental-health facilities, which, as noted, are not part of the federal system. Nursing homes and mental-health facilities use contract and emergency transportation with state and local assistance to transport residents to receiving facilities outside the impacted area.

As assessed, the “As Designed” response system provides for an end-to-end transport and care of hospital patients through a federally assisted process. The system does not deal with nursing homes, mental-health facilities, or others in the extended community. This system also does not identify or plan for a mechanism to return the patients/residents to their community or an appropriate facility.

4.8. SNES “As Is” Federal Response System

A large number of documents were reviewed to obtain data on the actual performance of the federal response system. As previously noted, the 2004 and 2005 seasons represented the test and evaluation of the “As Designed” (version 0) system.

In particular, after-action reports generated after each deployment of NDMS teams represent an invaluable source of information on both the positives and the negatives of the NDMS system. In areas of interest to this study, the NDMS after action-report (NDMS, 2006) concluded the following:

• Mission assignments were not always communicated in a timely manner



• Patient movement operations out of the disaster area, particularly at the New Orleans Airport, were initially under-resourced and chaotic

• Medical record-keeping, patient movement requests, patient accounting, and tracking were meager throughout the operations

• Air and ground evacuation operations conducted by TRANSOM, the USCG, the Navy, the National Guard, the state, and other authorities not well coordinated

• Patient reception team resources were limited • Metropolitan reception areas were not prepared to efficiently manage the full range and large

volume of victims’ medical and sheltering needs • There was no mechanism to ensure reimbursement of NDMS hospitals, nursing homes, and

others • No mechanism to repatriate evacuees who required en route to medical care and/or continuing

medical care.

Beyond these criticisms, NDMS suffers from one specific deficiency that is of paramount importance to this study: NDMS does not address needs of nursing home or mental-health facility residents or those in other long-care environments.

This information and data was used to reassess the response system; the results are shown in Figure 11. Deficiencies in the system are highlighted in the call-out boxes with missing components “grayed out” in the diagram. It is readily apparent that NDMS is significantly understaffed and, in some cases, the personnel were inexperienced. Coordination and management were poor at the mobilization facilities and reception areas. Several examples were documented of hospitals preparing to receive patients only to receive few or none. Air medivac was also poorly coordinated, especially once the event escalated and nontraditional assets were used.

Local transportation from the impacted facility to the mobilization area was one of the most significant deficiencies in the system. Local transportation was often simply not available. The contracted resources were destroyed, over-subscribed, or the federal or state governments had commandeered the vehicles. Often the local transportation was impacted significantly as the facility was simply no longer a viable resource. Unaffected transport from outside the impacted area could not enter to assist in the evacuation. The link between the impacted facility and the mobilization area is a major weakness in the existing system.



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Figure 11 - Systemigram of the “As Is” federal response phase for special needs evacuation. The comments in the blue boxes highlight deficiencies in the system. The grayed out text and links represent portions of the system that were not available.

4.9. SNES “As Designed” Texas System

Though the federal system provides guidance on the state and local medical support and evacuation system, the specific organizational structure of the system is left to each state. This results in 50 state SNES designs and thousands of systems at the local level. For this study, Texas was chosen to illustrate the complexity and operation of the state-level SNES. Texas was chosen as this example for two reasons: the Texas system is relatively advanced and Hurricane Rita tested the “As Designed” system extensively, validating the system and illustrating significant weaknesses (Litaker Group, 2006). Systemigrams were again used to gain a better understanding of the system (Figure 12). Note that this entire figure, with its considerable complexity, would replace the single “state agencies” bubble on the previous diagrams.

The Texas Governor’s Division of Emergency Management (GDEM) operates the State Operations Center (SOC). The SOC coordinates emergency services through district disaster committees and down through local emergency operations centers. The GDEM also coordinates a 211 initiative to identify special-needs populations that need evacuation during an emergency (TEMD, 2006). (The 211 initiative is a relatively new addition to the system.)



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Figure 12 - Systemigram of the Texas “As Designed” special-needs evacuation and medical support system.

The Texas Department of State Health Services (DSHS) is responsible for Emergency Action Plan Annex H for health and medical services. Prior to an emergency, DSHS reviews state emergency plans and nursing home and hospital emergency plans for adequate coverage of evacuation and medical needs during an emergency. During an actual event, DSHS also operates an Emergency Support Center (ESC) to provide support to the SOC. DSHS also monitors local medical capabilities and manages medical volunteers. The Texas Medical Association and Texas Nursing Association also coordinate and verify medical volunteers during an event.

In principle, this seems to be a fairly robust evacuation system. However, during the “testing” in the 2005 hurricane season, several flaws surfaced. These issues were summarized from the extensive after-action documentation developed for the state (Litaker Group, 2006).

Information flow: During the evacuation, the inability to identify and track special-needs patients created difficulties in providing medical treatment and in repatriating evacuees after the hurricane passed.

Roles and responsibilities: DSHS created the ESC as an adjunct to the SOC to support health and medical requests from the SOC. However, the role of the ESC in relation to the SOC was not always clear, thus resulting in duplicated tasks being performed by both the ESC and SOC.

Resources: Local responders and DSHS had a difficult time managing and coordinating the large numbers of volunteers.

Resources: DSHS did not have a clear understanding of all the capabilities of sister agencies or federal partners.

Resources: DSHS was not initially prepared to monitor local medical capabilities. Preparedness: DSHS should define medical special needs and determine agency responsibilities

for special-needs patients. Other issues specific to special needs:

Identification and tracking became both a logistics and medical issue: Lack of identification (e.g., name, age)



Lack of family member contact details (e.g., whom to contact) Inadequate information on where a resident or patient originated (e.g., from

which nursing home or hospital) Lack of medical information (e.g., medical history, current illnesses, current

medications, etc.). Poor patient tracking made it difficult to repatriate patients after the disaster. Inaccurate and/or incomplete information was provided to localities regarding arriving

evacuees: Information on the number, types, and injuries or medical needs of patients

evacuating to local, inland communities was not clear. Greater and more accurate detail about arriving evacuees would have freed up

resources for use elsewhere.

Both the federal government and Texas, a fairly capable state, have evacuation systems that need some additional overhaul and tuning.



5. System Issues Analysis

The system issue analysis encompassed the cataloging and analysis of the issues and problems identified during the data collection phase.

5.1. Methodology

The analysis methodology included the development of category, prioritization, stakeholder, issue, and analysis schemes that helped maximize the potential utility of the resultant database.

5.1.1. Categories

The categorization scheme needed to cover all types of issues, without regard to whether an issue would be best addressed by material or non-material solutions. The successful scheme would also enable government decision-makers to ensure that they do not prematurely adopt a costly or complex solution without having first ascertained that the problem could not be addressed by other, less-expensive or time-consuming methods. The categorization system also needed to offer a clear way to structure the presentation of sets of issues for discussion and prioritization.

The project leveraged a scheme that has long been used by the U.S. military—”DOTMLPF”—doctrine, organization, training, materiel, leadership and education, personnel, and facilities (DOD 2006). The analysis expanded upon this construct to include areas not normally within the military’s purview (specifically “statutes” and “policy”) and to offer finer resolution into problems in execution (“process” and “resources”). Table 2 contains the final construct—“SDPOTMLPFPR”—and the definitions adapted for ease of use and clarity.

Table 2 - SNES Issue Categorization Schema

CATEGORY DEFINITION

Statutes A federal or state written law enacted by the Congress or state legislature, respectively. Local statutes or laws are usually called “ordinances.” Regulations, rulings, opinions, executive orders, and proclamations are policies, not statutes.

Doctrine Fundamental principles by which organizations or elements thereof guide their actions in support of stated objectives. Doctrine is authoritative but requires judgment in application. Doctrine tends to be persistent and slow to change.

Policy A guiding principle designed to influence decisions, actions, etc. Typically, a policy designates a required process or procedure within an organization. Policies can typically change much more quickly than doctrine.

Organization The structure of groups of people, materiel, and facilities (and their attendant responsibilities and authorities).

Training and Education

The systematic process of developing knowledge, skills, and attitudes for current or future jobs. Education encompasses teaching and learning specific skills, and also something less tangible but more profound: the imparting of knowledge, good judgment and wisdom. All members of an organization require training and education to meet their responsibilities.

Materiel All items (including “front line” equipment, related spares, repair parts, and support equipment, but excluding real property, installations, and utilities) necessary to equip, operate, maintain, and support activities without distinction as to its application for administrative or operational purposes.

Leadership The practice of influencing and directing the performance of group members toward the achievement of organizational goals.

Personnel Those individuals required to accomplish assigned missions or achieve stated goals.



Facility A real property entity consisting of one or more of the following: a building, a structure, a utility system, pavement, and underlying land.

Process A generalizable method of doing a specific set of work, generally involving steps or operations that are usually ordered and/or interdependent.

Resources The monies and information required to plan and execute operations to meet a goal.

As an issue was identified during data collection, it was assigned to one or more of these categories. Multiple assignments were often unavoidable because of the nature of the issue’s root causes and the types of solutions that would have to be enacted to address it. For example, issues assigned to the “statutes” category were typically also assigned to the “doctrine” and “policy” categories, because any change in law would automatically require implementing changes in doctrine and policy.

5.1.2. Priority

The development of the prioritization scheme was difficult. Experience has shown that the development of a deterministic prioritization scheme for similar “issue constellations” is both time-consuming and methodologically problematic. Perceived failures of orthogonality, unsatisfactory comparisons, or inappropriate weighting are often difficult to overcome. Therefore, a subjective rating scheme (high, medium, and low) was utilized for the initial assessment. This rate rating scheme reflected the combined assessment of the following:

• Severity of the issue’s impact • The time frame within which useful action could reasonably be accomplished: “near” term

(current year), “mid” term (1–3 years), and “long” term (more than three years) • The likelihood of the potential course of action (COA) coming to a successful completion.

High-impact issues with a low likelihood of corrective COA (for example, a major change to the Stafford Act), and a “long” time frame may have been assigned a “medium” or even “low” priority, while medium impact issues with highly “doable,” COAs that could reasonably be expected to come to fruition in the near term may have been rated “high.” This subjective assignment of prioritization represents a zero order analysis and a more rigorous evaluation should be completed in future work under this project.

5.1.3. Stakeholders

Most public systems have very large sets of direct and indirect stakeholders, some of which may play multiple roles. Initially, stakeholders were classified into broad categories based on need and value sought by the group. This classification assisted in the issue identification and categorization. As Table 3 illustrates, 12 stakeholder classes were identified, each of which originally contained many subtypes. Even if subtypes had been eliminated, assignment using such a complex scheme would fail to meet decision-maker needs— it would be cumbersome, time-consuming, and could lack the clarity essential to sound system engineering. Role-based issue assignment was further complicated by the fact that the special needs evacuation system is, in effect, a multi-level system within which “SDPOTMLPFPR” are each managed, influenced, operated, and, most importantly, funded simultaneously by ascending levels of stakeholders from many of the subtypes.

Therefore, for simplicity’s sake, the stakeholder groups were reduced to five levels (local, regional, state, multi-state, and national). The issues identified were assigned to one or more of these



levels, with assignment to multiple levels more the rule than exception, because of the layered nature of the “As Designed” and “As Is” systems.

As Table 3 indicates, the common threads of the value propositions for all stakeholders are provision and receipt of needed services. Potential evacuees, decision-makers, system participants, advocacy groups, and overseers all seek assurance that the system will marshal people, dollars, information, tools, and processes such that special needs populations involved in a mass evacuation event will meet the critical system requirement or “black-box” intervention system as outlined in a previous section.

Table 3 - Stakeholder Classification, General Capability Needs and SNES Value Proposition.

Stakeholder Class Members Capability Need

Value Proposition—SNES will marshal people, dollars, info, tools, and processes to

provide the following: Special-Needs Evacuees

Hospital Inpatients, Nursing Home Patients, Disabled Populations Requiring Daily-Living Assistance, Elderly Citizens Requiring Daily-Living Assistance

Assured, timely, orderly, and medically safe evacuation to physically safe care facilities with timely access to suitable capabilities and supplies

Care in mass evacuation events

Federal Decision-Makers

OPOTUS; Homeland Security Council; Interagency Incident Management Group (IIMG); Executives and Managers from DHS, FEMA, HHS, VA, DOT, DOD, USNORTHCOM, all five Uniformed Services, Federal Law Enforcement Agencies, NOAA, FCC, Interagency Coordinating Committee on Emergency Preparedness and Individuals with Disabilities

Timely, assured access to the info they need to make critical oversight decisions (resource allocation, planning, activation mobilization)

Timely, assured access to the information and resources they need to successfully prepare for and support mass evacuations

State Decision-Makers

Governors’ Offices, Executives and Managers from the State Homeland Security, Health, Emergency Management, Transportation, National Guard, Law Enforcement, Certifying Boards, Federal Interagency Coordinating Council on Access and Mobility

Timely, assured access to the info they need to make critical oversight decisions (resource allocation, planning, activation/mobilization)

Timely, assured access to the information and resources they need to successfully prepare for and support mass evacuations

Disaster and Health-Related NGOs

American Red Cross, Salvation Army, Faith-Based Charities and Ministries, Council of Churches, Area Agencies on Aging

Timely, assured access to the info they need to provide required assistance to special needs populations

Timely, assured access to the information and resources they need to successfully plan, support, and execute mass evacuations

Care Facilities Federal, State, Tribal, Local, Public, and Private Hospitals, Nursing Homes and Assisted-Living Facilities

Optimum utilization and protection of available real property assets

Use of their capabilities will be maximized, but not over-saturated

Transportation Providers

Transportation-providing military commands, airlines and air freight services, cruise ship companies, railroads, vehicle rental, and chartering services, citizen volunteers

Optimum utilization and protection of available transportation assets, especially expensive, high demand/low density assets


Care Givers and Administrators

Administrators and technical and nontechnical staff from Hospitals, Nursing Homes and Assisted-Living Facilities; Health-Care Providers

Assured, timely access to comprehensive, accurate, secure medical data

Opportunity, information and assets required to provide the best possible medical care available to special-needs patients during and after mass evacuation events

Evacuation Planners and Managers

Federal Response Coordination Centers; Infrastructure Support Integration Center; Army Corps of Engineers; Disaster Medical Assistance Teams; enters for Medicare and Medicaid Services; Sate, Tribal, Local and NGO Emergency Management Centers and Organizations; Insurance Companies (property, casualty, health, business); State, Tribal, and Local Law Enforcement Organizations; Formal and Informal Volunteer Organizations

Timely, assured access to the info and resources they need to make and execute critical special-needs evacuation planning and execution decisions and actions

Timely, assured access to the information and resources they need to successfully plan and execute mass evacuations



Stakeholder Class Members Capability Need

Value Proposition—SNES will marshal people, dollars, info, tools, and processes to

provide the following: SNES Data System Maintainers

Maintainers of SNES hardware, software, support systems, and infrastructure

Timely, assured access to the info and resources they need to maintain special-needs evacuation data systems


External Federal, State, Regional, Tribal and Local Systems and Data Stores

Data Record Systems for patients, residents, charities, government activities at each level, communications systems, churches, families, insurance, military command and control (GCCS and affiliates)

Timely, assured, secure collection, storage and interchange of critical data required to support the planning, execution and reporting of mass evacuation events

Use of their capabilities will be maximized, but not over saturated—adequate information will be maintained in a responsible manner.

Advocacy Groups

Business and Trade Associations (Hospital, Healthcare, Nursing Home, Medical); Commissions (JCAHO, etc.); American Association of Retired Persons (AARP); American Association of People with Disabilities (AAPD); Disabled American Veterans (DAV); American Association of the Deaf-Blind (AADB); American Council of the Blind (ACB); National Organization on Disability (NOD) Emergency Preparedness Institute; Through the Looking Glass; Missions and Shelters; National Council on Disability; National Citizens’ Coalition for Nursing Home Reform (NCCNHR); Alzheimer’s Association; Association of State and Territorial Health Officials (ASTHO)

Timely, assured, secure access to data required to assess mass evacuation event planning and conduct for the purpose of advocating for special-needs populations

Required advocacy data will be available when and where needed

Researchers and Educators

Federal, State, Private, Industry and Charitable research agencies; public and private colleges and universities

Timely, assured, secure access to data required to study, improve and educate people on mass evacuation event planning

Required education and research data will be available when and where needed

5.1.4. Issues

Issues highlight specific portions of the special-needs evacuation system (written large) that failed to perform “adequately” in the eyes of customers, overseers, or participants. In general, field research was not conducted to ascertain performance, nor were definitive measures of adequacy readily available. Although this may be disappointing to classical systems engineers accustom to focusing on “hard” systems with precise, detailed performance requirements, it is common in policy-related issues, and did not present any unanticipated challenges. The 152 discrete issues identified in this research came directly from papers, Websites, and after-action reports produced by government offices, public service groups, advocacy organizations, professional organizations, and academic institutions. Figure 3 illustrates the five-step analysis process used in this study.

Figure 13 - Issues analysis process.



5.1.5. Analysis

The information provided through the primary and secondary literature was considered as generally accurate and provided in good faith. Both the explicit and implicit messages within the material were evaluated. Reasoned “systems thinking” judgment based on operational and bureaucratic experience was applied to the information to assess how each issue and element affects the others in both planned and unplanned ways, and to “screen out” or balance any of the reporters’ agenda-based biases that could serve to distort the true picture.

The value propositions detailed in Table 3, along with generally accepted principles of “good government,” were used as a baseline to represent an acceptable standard of performance for the system and the courses of action evaluated. This standard focused analysis on developing actionable, fact-based recommendations that offer a reasonable probability of improving the system. In some cases, the COAs proposed and evaluated were offered within the source documentation; in others, COAs were proposed.

The analysis process sought to identify the complex system of “SDPOTMLPFPR” elements, to recognize their operative properties and interrelationships, and to exploit this understanding to synthesize representations of the system’s internal and external trains of logic and causality. In this case, effects of the system’s elements in operation were observed, “patterns of effects” inferred, and likely contributors to both successes and failures were attributed. The process could perhaps be best described as a crucible, where minor issues were subsumed or supplanted by those with more impact, and proposed courses of action were evaluated with resource and bureaucratic constraints firmly in mind.

5.2. Issues Analysis Results

This section summarizes the significant issues identified and presents them by category: statutes, doctrine and policy, organization, training and education, material, leadership, personnel, facilities, processes, and resources. Summaries of the issues are contained in Tables 4 through 8.

Table 4 - Total issues by category. Statutes Doctrine Policy Organization T & E Materiel Leadership Personnel Facilities Processes Resources

32 56 80 24 25 30 14 13 12 83 19

Table 5 - Total issues by time frame.

Time Frame

Near Mid Long 103 39 10

Table 6 - Total issues by stakeholder level.

Action Stakeholder(s) Level

Federal Multi-State State Regional Local 134 47 85 50 85

Table 7 - Total issues assigned to ONLY the indicated level.

Action Stakeholder(s) Level

Federal Multi-State State Regional Local 55 0 0 0 1

Table 8 - Total issues by priority level. H M L None Total

84 33 16 17 150



5.2.1. Statutes

Of the 31 issues listed in the statues category, the following high-priority issues were identified in the area of legal authorities. Specifically, there is a critical need for legislation that authorizes and enables the following:

• Integration of the planning and operations of volunteer groups like the Red Cross, Salvation Army, local churches and service organizations, and the response plans of companies and other “private” entities with federal, state, and local government activities. This will help ensure maximum leverage of the capabilities each can bring to bear while minimizing waste, confusion, and needless duplication of efforts (GAO, 2006a).

• Creation and enforcement of multi-jurisdictional partnerships that can assess requirements, obtain resources, support education and training, and conduct the required planning and operations.

• Identification, registration, and tracking of special needs populations both before and during evacuations (Gibson & Hayunga, 2006). This must also include enabling the following:

o Access to and protection of private data (as specified in the Privacy Act and Health Care Information Privacy Act, as well as related state legislation)

o Leverage of data, especially registry-type data, collected by other organizations like the IRS, Social Security, hospitals, nursing homes, care givers and advocacy organizations

o Establishment and enforcement of both administrative standards and standards for a variety of records (especially electronic health records), planning and operational procedures, and data systems.

• Reconciliation of the requirement for sound evacuation planning with insurers’ requirement that receiving facilities must meet declared standards of care, equipment and staffing, and must have adequate business operations insurance.14

• Federal or multi-state shelter licensing and equipage (staff, supplies, equipment, communications capabilities, etc.), and the establishment and enforcement of planning standards for long-term care facilities to be used during evacuation operations, especially in multi-state operations (Gibson & Hayunga, 2006).

• Timely, assured reimbursement of care providers (NDMS, 2006). • Credentialing of care givers, especially those operating outside their home jurisdictions and those in a

“reserve” role (Gibson & Hayunga, 2006). • Codification of government roles and responsibilities, including the designation of the “lead Federal

Agency” for transportation (GAO, 2006a). • Coordination of transportation planning for both evacuees and required medical and support staff

(GAO, 2006b; Gibson & Hayunga, 2006; NDMS, 2006).

5.2.2. Doctrine and Policy

Successful resolution of most or all of the high-priority statute issues will create a requirement for enabling doctrine and policy, so it is reasonable to assume that they are automatically included as high-priority doctrine and policy issues as well. Additional high-priority doctrine and policy issues that do not appear to require significant statutory action include doctrine and policy that enables the following:

• Development of useful criteria to assist in the “evacuate or shelter in place” decision. • Determination of the value of naming a single manager for all government-ordered evacuations or a

separate manager for special-needs populations. If the latter, establishing a framework for coordinating the special-needs evacuation with the general evacuation.

14 American College of Health Care Administrators, http://www.achca.org, accessed on 06 Dec 2006.



• Pre-registration and tracking of special-needs populations. About 13 million people age 50 or older in the U.S. say they will need help to evacuate, and about half of these individuals will require help from someone outside of their household. This proportion increases with advancing age (Gibson & Hayunga, 2006).

• Insurers to permit (and reimburse providers and patients for) the issue of extra quantities of medications and supplies.15

• The identification, regulation, and tracking of special-needs shelters, including the requirements for different classes of shelters and ensuring that they are available when needed (Gibson & Hayunga, 2006).

• Incorporation of standards for the transfer of residents into the facility accreditation process (Gibson & Hayunga, 2006).

• Creation of public education programs that close the expectation gap between popular ideas and government capabilities and responsibilities (Gibson & Hayunga, 2006).

• Ensuring that an appropriate number of shelters can accommodate the presence of service animals that may be required by special-needs populations.16

• Integrated planning among all levels of government and special-needs populations and caregivers, including (GAO, 2006a; Gibson & Hayunga, 2006) the following:

o Resolving problems associated with NRP roles and responsibilities and ambiguities on the definition of “incidents of national significance” and “catastrophic incidents” required to trigger action under the NRP’s Catastrophic Incident Annex. For example, the September 2005 draft Catastrophic Incident Supplement to the NRP, which is intended to be used with the Catastrophic Incident Annex when a catastrophic incident almost immediately overwhelms the capabilities of state and local governments, states that collecting and transporting patients from health-care facilities to mobilization centers is the responsibility of state and local authorities. The draft supplement does not describe what, if any, role the federal government may play in coordinating with state and local authorities for this kind of transportation.

o The resolution of NDMS design limitations: specifically the lack of federally supplied short-distance transportation assets and a coordination policy for them, and the fact that NDMS does not incorporate facilities other than voluntarily participating hospitals (i.e., it fails to address the needs of people who do not need medical care, especially those in nursing homes).

o Completion of implementation plans in the absence of the NRP’s Catastrophic Incident Annex.

o Requiring responsible authorities at all levels to establish and execute realistic planning and exercises and to determine the requirement for and qualities of required leadership training.

o Incorporation of military lessons learned from past catastrophes to fully delineate required military capabilities.

o Defining and developing the capabilities required to address special-needs evacuation requirements during catastrophic open events.

o Tracking the resources and staff of volunteer groups like the Red Cross, Salvation Army, local churches and service groups, and private companies.

o Improving coordination between federal, state, and local agencies responsible for providing transportation to mobilization points.

o Providing an adequate mechanism to repatriate evacuees who required en route medical care and/or continuing medical care.

15 National Citizens’ Coalition for Nursing Home Reform, http://www.nccnhr.org, accessed on 06 Dec 2006. 16 Ibid.



o Creation of government emergency planning information and processes at each level—federal, state, and local—that address the fact that older persons and persons with disabilities, whose needs may overlap, face special risks during disasters.

o Deconflicting the use of shelter facilities, especially to ensure that special-needs populations are housed only in shelters that meet their unique needs.

o Integration of the needs of vulnerable populations into existing emergency planning efforts at federal, state, and local levels. These plans encompass all phases of preparedness and response, including plans for evacuation and recovery, especially in terms of coordination and communication among various agencies at each level.

5.2.3. Organization

Although many organizational issues were identified, all of the high-priority issues were addressed in the Statutes section, except one: the determination of the lead agency for the integration of volunteer organizations’ capabilities.

5.2.4. Training and Education

Personnel at all levels need individual and group training in the specific skills, processes, and systems required to conduct complex operations like the evacuation of special-needs populations. The following high-priority issues were identified in this area:

• Testing the plans and participants’ operational understanding of their roles and responsibilities through robust training and exercise programs (GAO, 2006a).

• Setting and enforcing training standards for personnel at all levels, including the following (Gibson & Hayunga, 2006):

o Ensuring that training and exercises realistically test required capabilities, identify problems and lessons learned, and address them in partnership with other federal, state, and local stakeholders.

o Assessing the need for and providing leadership training specifically focused on resolving the issues of preparedness indicated by the differences in response between Hurricane Katrina and Hurricane Rita.

o Preparing personnel to deal with the special needs of patients with Alzheimer’s. o Rehearsing realistic key processes and tasks by the people expected to execute them.

• “Metropolitan reception areas were not prepared to efficiently manage the full range and large volume of victims’ medical and sheltering needs. FCCs were not optimally prepared to manage the sheltering, special medical needs, or nursing home requirements of people not admitted to NDMS hospitals. Many non-NDMS patients arrived at metropolitan reception areas on ESF-1 flights with special medical needs or nursing home needs ... FCCs were not always well integrated into these non-NDMS reception plans and operations” (NDMS, 2006).

• Establishing robust public education on the subject of emergency preparedness (Gibson & Hayunga, 2006).

5.2.5. Materiel

Successful special-needs operations require a variety of materiel assets—hardware, software, medicines, equipment. The high-priority materiel issues include the following:

• Determining the requirement for logistics systems that provide adequate capability to identify, prepare, dispatch, track (readiness, status, and location), mobilize, and demobilize available critical



resources throughout all incident management phases. GAO investigators determined that critical resources were not available, properly distributed, or provided in a timely manner. The result was duplication of deliveries, lost supplies, or supplies never being ordered (GAO, 2006a).

• Improving transportation and logistics planning by (GAO, 2006a; Gibson & Hayunga, 2006): o Emplacing contracts prior to a disaster that could be activated to lean forward and

provide surge capacity for critical supplies and services o Ensuring that there are enough shelters with enough of the right types of equipment and

supplies (including generators for powered medical equipment) to meet the needs of special-needs populations

o Ensuring the availability of sufficient, properly equipped vehicles for transporting special needs populations both locally and out of the evacuation zone

o Deconflicting facility operators’ contracts for transportation services to ensure that specific assets are not tasked beyond their availability

o Creating plans to provide assured communications capability in the absence of local infrastructure

o Adopting standardized needs assessment tools o Assessing the need and accomplishing planning for the transportation of required

emergency supplies and equipment. • Assessing the need for and functional requirements of interoperable systems for patient tracking,

medical record-keeping, patient movement requests, patient accounting, and tracking to replace the multiple, stovepiped systems in use during Hurricane Katrina (Gibson & Hayunga, 2006).

• Adopting evacuation notification systems (and associated processes) that meet the needs of the various segments of the special needs population (Gibson and Hayunga 2006).

5.2.6. Leadership

In addition to the leadership issues already identified, the importance of two issues raised by GAO investigators was recognized as follows:

• The need to determine the requirement and methodologies to improve the training of leaders at all levels in the improvisation skills required to manage fluid, fast changing situations, including the ability to (GAO, 2006a):

o Adequately anticipate requirements for needed goods and services o Clearly communicate responsibilities across agencies and jurisdictions o Deploy sufficient numbers of personnel to provide contractor oversight.

• The requirement to improve command and control, especially for patient movement operations out of the disaster area (NDMS, 2006).

5.2.7. Personnel

All of the high-priority personnel issues, including the provision of adequate medical staff during transportation, sheltering and return, operations require precursor changes already detailed in statutory, doctrine, and policy issues.

5.2.8. Facilities

The team identified high-priority needs to establish the requirements for the following:



• Accomplishing licensing of the various classes of shelters (with appropriate staff, equipment, and supplies) and their specific capabilities (Administration on Aging, 2005; GAO, 2006a; Gibson & Hayunga, 2006)

• Expanding NDMS to include nursing home and assisted-living facilities (GAO, 2006a, 2006b).

5.2.9. Processes

Many important process issues cannot be adequately addressed until the required statutory, doctrine, policy, training, and materiel issues have been identified and resolved. Those high-priority issues that may be addressed more directly include the following:

• Establishing a process for pre-registration and tracking of special needs populations, as well as processes and associated tools for assessing needs, recording and tracking patient movement information and medical data (patient records, medications, etc.) (Gibson & Hayunga, 2006)

• Creating processes (and associated systems) to maintain up-to-date data on the readiness of people, equipment and supplies

• Establishing evacuation notification processes (and associated systems) that meet the needs of the various segments of the special needs population (Gibson & Hayunga, 2006)

• Developing an objective evaluation method for assessing the integration, coordination, substance and effectiveness of federal, state, and local plans (emergency preparedness, transportation, shelter staff, medical staff, medications, supplies, equipment, etc.) and the actual readiness of all organizations and caregivers to manage disasters (GAO, 2006a)

• Ensuring the adoption of robust, all-agency disaster management lessons learned programs at each level of government to ensure that all players are aware of the specific capabilities required of them (GAO, 2006a)

• Establishing contracting processes that will enable required contracts to be in place prior to the disaster that could be activated to lean forward and provide surge capacity for critical supplies and services (GAO,2006a, 2006b)

• Improving processes (and associated systems like TRAC2ES) that support timely communication of NDMS mission assignments, patient manifests and patient tracking information to GPMRC (Gibson & Hayunga, 2006; NDMS, 2006).

• Improving the coordination of air and ground evacuation operations conducted by TRANSCOM, the USCG, the Navy, the National Guard, the U.S. and other authorities by assessing the need for the following (NDMS, 2006):

o A single NDMS movement manager o Coordination of aeromedical missions with ground evacuations conducted by the U.S. o Integrating NDMS patient movement operations with operations to evacuate non-patient

victims under ESF-1. • Improving the integration of FCCs into non-NMDS plans and operations to enable efficient

management of the full range and large volume of victims’ medical and sheltering needs (NDMS, 2006).

• Creating mechanisms to repatriate evacuees who require en route and/or continuing medical care (Gibson & Hayunga, 2006; NDMS, 2006).

• Addressing in detail the overlapping needs of older persons, those in nursing homes, and those with disabilities in government emergency planning documents, especially evacuation plans, and processes at all levels (Gibson & Hayunga, 2006).



5.2.10. Resources

Decision-makers must make resource allocation decisions in the face of continuing constraints and the knowledge that they will likely never be able to satisfy all needs. Although many critical resource issues require the resolution of associated statutory, doctrine and policy issues, a few can be addressed more immediately:

• Establishing target funding levels for needed training and exercises (GAO, 2006a) • Assessing the requirement for pre-positioning resources, especially federally controlled resources

well before a catastrophic event (GAO, 2006a) • Ensuring that individual resource pools are not over-committed (GAO, 2006a, 2006b).



6. Case Studies and Comparative Analysis

This analysis of examples of existing disaster response systems is intended to identify those common elements or “best practices” that, if incorporated in the special needs evacuation systems, could enhance performance and value to stakeholders. The analysis does this by developing a clear understanding of the current operational environment of similar systems and the characteristics that help them succeed. The subject systems were developed to support evacuation and emergency response, and have been deemed “successful” in their current missions.

6.1. Methodology

To identify best practices and common system attributes, research was conducted through assessment of organizations that are known to commonly work in a disaster environment. As the special need evacuation system is not intended to address any one particular type of disaster event (i.e., fire, flood, or war), the evaluation included several types of systems. A majority of the systems represented were developed by the US entities. The Japan Tsunami and Israeli disaster response systems were considered due to their unique experience with particular disaster environments. When possible, information regarding the system was derived directly from the organization overseeing the system operation. News reports, as well as official leaflets, and informational material have been used to derive the current operational status of the system. Seven systems were evaluated:

• Incident Command System • National Response Center • Joint Emergency Management Program (JEEP) • WebEOC • Firescope • Israel • Japan Tsunami.

The operational and essential characteristics of each system were summarized and a matrix was developed summarizing system attributes and comparing the systems.

6.2. Incident Command System (ICS)

The Incident Command System (ICS) was developed in California by an interagency taskforce working in a cooperative local, state, and federal interagency effort called FIRESCOPE (Firefighting Resources of California Organized for Potential Emergencies). ICS resulted from the need for a new approach to the problem of managing rapidly moving wildfires in the early 1970s. Issues highlighted by local fire departments identified the need for better management of evacuations from wildfires. Some items that were addressed included too many people reporting to one supervisor, different emergency response organizational structures, lack of reliable incident information, inadequate and incompatible communications, and lack of a structure for coordinated planning between agencies. A standardized emergency management system took several years and extensive field testing to develop. The group identified four key items to be incorporated into the system: flexible management structure, scalable, sufficiently standardized, and low cost. These principal requirements identified by FIRESCOPE are continuously readdressed by organizations.17

17 Incident Command Center, e-tools, http://www.osha.gov/SLTC/etools/ics/index.html, accessed 8 November 2006.



The ICS was incorporated into FEMA’s National Response Plan and more recently into the National Incident Management System (NIMS). The ICS is designed to be a flexible management system to meet a verity of possible threats. The system, which consists of incident management teams, is indented to address events both large and small. The ICS is not a physical system but a command management concept.18

The key element of the ICS is the 17 instructional modules in the training development program. Each of the training modules endorsed by the ICS has been submitted for review to more than 200 public safety agencies. The modules serve to address the needs of federal, state, and local government agencies as well as private-sector users in multi-hazard and planned event applications throughout the U.S. There are no skill requirements for training and no specific threat that is addressed in the training.

The value of the system is that it allows organizations with uneven resources to communicate effectively. The system does not levy any requirements nor is its use mandated. The system allows for the organizations to interoperate without requiring existing plans to be in place. The system can operate in various environments and address most disastrous events. ICS allows for the immediate response by organizations with no preplanned operational commitments.

6.3. National Response Center

The National Response Center (NRC) is the federal government’s national communications center. It is staffed 24 hours a day by U.S. Coast Guard officers and marine science technicians. The NRC receives all reports of releases involving hazardous substances and oil that trigger the federal notification requirements under federal laws. Incident reports to the NRC activate the National Contingency Plan and the federal government’s response capabilities. It is the responsibility of the NRC staff to notify a predesignated on-scene coordinator (OSC) assigned to the area of the incident and to collect available

18 Federal Emergency Management Agency, training.fema.gov/emiweb/downloads/FEMA_IS100_Distiller.pdf, accessed 4 November 2006.

Table 9 - ICS Characteristics Summary

Issue Positive Negative

Resources Organizations are not required to commit resources

Resources must be requested; local organizations may keep needed resources in reserve

Scalability Management structure allows the system to address both large and small events

No pre-existing plan on how to best address an event; all plans are reactive

Interoperability Allows responders to address a variety of threats Unknown result to any specific threats

Command Control Allows management to expand control to effected areas

Managements ability incorporate resources outside effected area limited



information on the size and nature of the release, the facility or vessel involved, and the party(ies) responsible for the release. The NRC maintains reports of all releases and spills in a national database.19

The primary function of the NRC is to serve as a national point of contact for reporting all oil, chemical, radiological, biological, and etiological discharges into the environment anywhere in the United States and its territories. The NRC gathers and distributes spill data for use by federal OSCs and serves as the communications and operations center for the National Response Team. The NRC maintains agreements with a variety of federal entities to make additional notifications regarding incidents meeting established trigger criteria.

The Federal Water Pollution Control Act (FWPCA) or “Clean Water Act” was enacted in 1972 to protect the public and environment from discharges involving U.S. waters and their adjacent shorelines. The bill was amended in 1973 to provide for a federal spill response mechanism to meet the challenge of responding to national incidents. The regulation provides for a National Contingency Plan to provide an efficient, coordinated and, effective disaster response. The plan is intended to minimize damage from discharges of oil and hazardous substances, including containment, dispersal, and removal of oil and hazardous substances.20

In August of 1973, Executive Order 11735 delegated the authority and responsibility for establishing a response plan to the Council on Environmental Quality. As a result, the National Oil and Hazardous Substances Pollution Contingency Plan was developed and implemented later that year. This plan established what is now known as the NRC, which became operational in August of 1974 at the U.S. Coast Guard headquarters in Washington, DC. The center provides the reporting and coordination of responses to pollution by oil and hazardous substances.

The NRC is charged with receiving reports of discharges of oil and hazardous substances in accordance with the FWPCA, including those that occur in connection with the activities regulated under the Outer Continental Shelf Lands Act and the Deepwater Port Act, as well as those that affect resources under the jurisdiction of the Fishery Conservation Management Act. The NRC disseminates this information to the appropriate federally predesignated OSC. The criteria for reporting such incidents are set forth in 40 CFR 110 for oil discharges and 40 CFR 116 for hazardous substance discharges. They include definitions for the type of spill and reporting actions required.

In 1980 Congress passed the Comprehensive Environmental Response Compensation and Liability Act (CERCLA) also known as “Superfund.” The act taxed companies and expanded operational responsibility to hazardous waste sites and materials regulated by the FWPCA, the Toxic Substance Control Act, and the Resource Conservation and Recovery Act. The NRC receives incident notification and is responsible for the notification of appropriate official agencies.21

In 2002, Congress passed the Maritime Transportation Security Act, which requires the NRC to be notified when foreign vessels enter U.S. ports, reports of any suspicious activities, breaches of security, and transportation security incidents. The NRC disseminates this information to local law enforcement authorities.22

19 National Response Center, http://www.nrc.uscg.mil/nrchp.html, accessed 7 November 2006. 20 National Response Center Background, http://www.nrc.uscg.mil/nrcback.html, accessed 7 November 2006. 21 CERCLA Overview, EPA, http://www.epa.gov/superfund/action/law/cercla.htm, accessed 5 November 2006. 22 Maritime Transportation Security Act of 2002, U.S. Coast Guard, http://www.uscg.mil/hq/g-cp/comrel/factfile/Factcards/MTSA2002.htm, accessed 16 November 2006.



The NRC reporting responsibility extends to an almost unlimited list of disaster events. The NRC does not employ resources to disaster areas; however, it does coordinate with appropriate organizations to ensure notification is provided.

The NRC system enables responses to various disasters. The system allows for the notification of the proper authorities to deal with an event or situation. It works on a national scale, providing information as to the type and extent of an event. Although the NRC acts as the central collection point for information regarding the disaster, the system does not provide resources directly to the event. The center acts as a facilitator between departments and agencies allowing them to take the appropriate actions.

6.4. Suffolk County, New York, Joint Emergency Evacuation Program (JEEP)

JEEP is a database of individuals who require emergency evacuation assistance during disasters. The database is maintained by Suffolk County Fire, Rescue, and Emergency Services (FRES) and is activated prior to an impending disaster. The program is open to eligible disabled or frail persons who are unable to leave their residence without emergency assistance. Application to the program is conducted on a continuous basis before a disaster by the county’s Office of Handicapped Services (OHS). Applications are reviewed to ensure the applicant meets predetermined criteria for disabled status. Approved applicants are assigned to an appropriate shelter in case of emergency and annual reviews of applicants are conducted. Emergency services are not guaranteed; however, it is suggested that all eligible persons apply to ensure appropriate care facilities can make preparations. Likewise, the program does not ensure transportation to shelters. Transport for applicants is arranged on an availability basis; persons are encouraged to arrange their own transportation when possible. Transportation to hospitals and centers may require payment by the individual depending on patient conditions. The ongoing specialized care for the applicant is not within the scope of this program. Applicants are also still responsible for personal medications and equipment (i.e., walkers, canes, glasses) as well as personal blankets, sheets, and pillows. Specific instructions are provided for people with ongoing life-support equipment to ensure power is provided in emergencies.23

Although medical facilities are provided for critical-needs applicants, Suffolk County also provides special-needs shelters for victims who do not require hospitalization. These shelters provide services beyond those provided by general population shelters. Only basic care and assistance is available

23 Joint Emergency Evacuation Program, Suffolk County, http://www.co.suffolk.ny.us/Fire%20Rescue%20Emergency/JEEP.pdf, accessed 13 December 2006.

Table 10 - NRC characteristics summary.


Scalability Central nationwide collection point for events and disasters

Responsibility is limited to strict congressional definitions of events

Interoperability Assists in the coordination of activities between a variety of national and local organizations

Cannot command resources or direct actions

Responsibly Reactive measures in collection of events

Relies on the resident authorities to properly notify the NRC



at these locations; medication, 24-hour skilled nursing care, and life-support equipment are not available in evacuation centers, and electricity is not guaranteed. The attendance of healthy, able-bodied persons during an event is highly discouraged and a limit of one person is allowed to assist applicants at these facilities. Accepted applicants to the program are given priority for access to transportation and facilities. Hospitals, nursing homes, adult homes, and assisted-living facilities are responsible for the safe evacuation of their patients/residents in an emergency.24

A registry of all accepted applicants is maintained by the county and the registry adheres to applicable privacy rules. The registry is used only during emergencies requiring evacuation, such as flooding, hurricanes, or hazardous materials (such as a gas leak). Applicants are notified via public radio and television to begin evacuation procedures. Applicants are expected to be “ready to travel” upon arrival of evacuation teams; return trips for unprepared persons are not permitted.

The Suffolk JEEP program is designed for local response to disaster events. There is no training required to enter the program and registration in the program is voluntary. Applicants are screened and assessments of individual needs are conducted via local handicapped services. The system allows for a “good” assessment of special needs population prior to an event. The program is implemented and executed through the coordination and participation of local first responders.

6.5. Washington State WebEOC

WebEOC is software designed to bring real-time crisis information management to the Washington State Emergency Operations Center (EOC) as well as to other local, state, and federal EOCs. The Web-based technology was developed by Emergency Services integrators, Incorporated (ESi) and provides a low-cost integrated crisis information management system. The system requires minimal investment in equipment, hardware, and software making the system a viable option for small

24 Huntington, NY, Citizen Services, Senior Citizens, http://town.huntington.ny.us/department_details.cfm?ID=52, accessed 13 December 2006.

Table 11 – JEEP characteristics summary.


Responsibility Proactive measure to maintain listings of persons in need

No promise that transportation resources will be on hand; unknown number of unregistered persons

Target Population Non-inclusion of hospital and elderly facilities

Notification Attempts made to contact individuals through public media

No ability to contact individuals; individuals are expected to be prepared to travel

Resources Best effort made to acquire adequate medical facilities

No guarantee registered members will receive adequate medical facilities

Scalability System works with local responders and organizations

Ability to manage large-scale events are uncertain



jurisdictions.25 The product provides a secure real-time access to operational details in the local and neighboring jurisdictions WebEOC provides organizations with unlimited user access, customer tools, easy customization, and low acquisition and on-going maintenance costs. Currently, WebEOC provides rights to the state of Washington to conduct disaster planning and execution. WebEOC helps facilitates decision-making by on-scene commanders in emergency situations. Access to the system is controlled and only authorized users can gain access. The number of users is virtually unlimited and any number of users can log in to a jurisdiction’s WebEOC. The system displays text-based lists, reports, and checkpoints in conjunction with graphics, maps, video, live TV cameras, contact lists, and other information needed in an emergency situation.26

The Washington State Military Department, Emergency Management Division (EMD) provides a WebEOC Crisis Information Management system with development and implementation advice, support, and training materials for Washington State, county and municipal emergency management agencies. The system is also employed by the Kennedy Space Center, the Jet Propulsion Laboratories (NASA), Cape Canaveral Air Station, U.S. Department of Energy sites, and Delta Airlines. The Webmaster provides the division with Internet and intranet Website development, design, implementation, support, and maintenance during normal periods as well as during emergencies and disasters.27

WebEOC facilitates the coordination of organizations during disaster events. The extent of participation by organizations in the program is dictated by local interest. WebEOC does not dictate command control of the event, however, it does provide all participants with a common operational picture with which to work from. The accuracy of the data provided “assumes” participants are actively and correctly updating information. Use of the program is not mandatory, which may neglect possible resources.

6.6. FIRESCOPE

The FIRESCOPE program originated in Southern California, organized under the acronym, “FIrefighting REsources of Southern California Organized for Potential Emergencies” in 1972. Through state legislative action, the FIRESCOPE Board of Directors and the Office of Emergency Services (OES) Fire and Rescue Service Advisory Committee were consolidated into a working partnership on September 10, 1986. This consolidation represented local, rural, and metropolitan fire departments, the California Department of Forestry and Fire Protection, and federal fire agencies. FIRESCOPE played a critical role

25 King County, Emergency Services, http://www.metrokc.gov/prepare/, accessed 18 November 2006. 26 WebEOC in Washington State, Washington Military Department, Emergency Management Division, http://emd.wa.gov/1-dir/com/webeoc/webeoc-idx.htm, accessed 14 November 2006. 27 FAQs, Washington Military Department, Emergency Management Division, http://emd.wa.gov/site-general/faq.htm, accessed 14 November 2006.

Table 12 - WebEOC Characteristics Summary


Scalability Ability to coordinate an infinite number of organizations

Use of the program is not mandatory; nor is participation

Cost Nominal cost Participation is inconsistent for federal, state, and local organizations

Interoperability Can be used in various disaster events

No precoordination of activities or prior training in events



in the development of the Incident Command System (ICS). The ICS has been implemented nationwide as a best practice for responding to disasters.28

Today, FIRESCOPE has been mandated as California’s program to manage fire service issues. It provides recommendations and technical assistance to various disaster agencies. FIRESCOPE aims to “provide a common voice for California’s fire service” and “develop risk management and multi-agency coordination systems.” The program continues to receive national attention for work dealing with mutual aid, cooperative agreements, and fire/rescue regional policy issues.

All the agencies involved in the program are required designate members to serve in one of four positions. Members at the following levels work to develop emergency planning procedures.29

• The Board of Directors is made up of agency directors and sets goals and policies. • The Operations Team is composed of the agency operations chiefs and implements Board

decisions and recommends new proposals for consideration or review. • The Task Force is composed of supervisory operations-level officers and provides most of the

general staff work and basic analysis. • Specialist Groups are composed of agency specialists and perform technical staff work in their

areas of expertise.

The FIRESCOPE planning process is designed so that the jurisdictional authority and responsibilities of the participating agencies are not compromised. The planning group attempts to clarify each member agency’s roles and how they will interact with other member agencies. Planning by the users assures that the resulting plan will be known and accepted by those who are supposed to put it into action. If an issue should arise in which consensus cannot be achieved, the unresolved issue will be forwarded to the next organizational level for review and resolution with an explanation as to the reason for non-consensus.30

Due to the consensus format for disaster planning, specific comprehensive standards for evacuation are nonexistent. Although the need for effective evacuation plans receives strong recommendation by various FIRESCOPE agencies, no regional evacuation plan exists.

The FIRESCOPE system provides extensive opportunity for local jurisdictions to collaborate during disaster events. Participation by the locality may be determined by the participating agency and does not require undesired commitment of resources. Localities may prepare for event through planning groups. The system allows local governments to best address and serve the needs of their local populations.

28 FIRESCOPE, About Us, http://www.firescope.org/about-us.htm, accessed 22 November 2006. 29 FIRESCOPE Organization Chart, http://www.firescope.org/firescope-org-chart/firescope-org-chart-big.pdf, accessed 7 November 2006. 30 FIRESCOPE, http://www.firescope.org/, accessed 14 November 2006.



6.7. Israeli Disaster Response

There is arguably no better representation of a governments’ capability to respond to an event on a national scale than Israel. The country’s violent history and the homogeneous region in which the Israeli government exists require it to become adept at responding to emergencies. The Israeli model of disaster preparedness represents the use of a complicated system model to address large-scale national-level evacuation procedures in response to large-scale disasters and terrorist events. The system represents a successful working model that mirrors many of the requirements and challenges in the evacuation of special-needs victims identified by the SNES system. Although there are clear differences in the social, political, and regional challenges represented in the Israeli model, the focus and logistical issues in both systems remains the same.

Israel operates using a plan referred to as the “5 Ps”: preparedness, performance, psychosocial, practice, and predictions. Preparedness and performance deal with the readiness and response of the hospitals and their staff. As regional conflict has defined Israeli history, so too has it defined their disaster preparedness.31 In 1974, the Israeli government charged police with responsibility for handling terrorist incidents within Israel’s borders. It also made the Israeli Defense Forces (IDF) responsible for managing incidents up to five kilometers from the borders, in the Negev Desert, which encompasses the southern half of the country (with the exception of cities and towns there), and in the territories. All media outlets, including television, radio stations, and newspapers, are required by law to provide the military immediate access to their broadcasting and publication outlets in an emergency. The IDF is also responsible for allocation of victims to hospitals in a state of emergency. This allows the IDF command control over extensive civilian resources like the civilian police. The Home Front Command (HFC) coordinates IDF Air Force helicopters to transport victims and mobilizes hospitals to accept victims. The Israeli police are responsible for maintaining security at the disaster sites, opening up restricted access to hospitals for ambulances until all victims have been removed, and for keeping anxious family members a distance from the hospital following a disaster. The HFC has comprehensive responsibility to be prepared for and manage states of emergency within Israel’s borders. Although HFC is part of the IDF, most of its budget comes directly from the Israeli treasury.32

31 “Seeing through the eyes of Israel,” Virginia Department of Health, Virginia Health Beat Spring 2005, http://www.vdh.state.va.us/news/VAHealthBeat/0505/index.htm, accessed 16 November 2006. 32 Ariel Merari. “Israel’s Preparedness for High Consequence Terrorism,”BCSIA Discussion Paper 2000-30, ESDP Discussion Paper ESDP-2000-02, John F. Kennedy School of Government, Harvard University, October 2000, http://bcsia.ksg.harvard.edu/BCSIA_content/documents/Israels_Preparedness_for_High_Consequence_Terrorism.pdf, accessed 23 November 2006.

Table 13 – FIRESCOPE characteristics summary.


Scalability Extensive capability to adapt to various event scales Limited predetermined response planning

Interoperability Allows for organizations of varied size and capability to operate

Participation is not mandatory and may limit maximum resource capability

Cost Local jurisdictions control cost levels Unequal distribution of resources and training



The HFC has a national command and three regional commands—north, center, and south—that report to the national command. In performing its duties, the HFC relies, by and large, on Israel’s extensive system of readiness for war, rather than on its own standing force. This gives the HFC access to Israel’s manpower and equipment reserves. Like other components in the Israeli army, the HFC is comprised mostly of reserve soldiers, who can be called up immediately in a state of emergency. The same rule applies to certain kinds of equipment. For example, in Israel all heavy mechanical equipment (e.g., tractors, bulldozers, cranes, etc.) is registered with the military and may be requisitioned for service in an emergency. In addition, bus companies must maintain a predetermined number of buses to evacuate victims of a mass-casualty attack and to transport forces to the site of the incident. For research and development, the HFC relies on the special means branch of the ministry of defense, which is responsible for developing the means to deal with unconventional warfare for both the IDF and the civilian population.33

The HFC is responsible for establishing operating procedures, planning and supervising exercises, and monitoring the preparedness of organizations that respond to high-consequence attacks, including the medical system, municipalities, transportation, and electricity. The procedures set forth by the HFC are very specific. With regard to medical treatment, for example, the HFC issues binding directives for treating individuals exposed to any number of chemical substances.34

The HFC preparedness has three main organizational goals:

• It seeks to create a common terminology among all of the agencies that would be called upon in the event of high-consequence attack. This step is essential for ensuring rapid, mistake-free mutual understanding of people coming from different organizations. This objective is achieved primarily through the HFC’s development of standard operating procedures that are issued to all organizations responding to an incident, and through the use of joint exercises.

• The HFC is responsible for establishing a central command post to control all resources and ensuring that it functions smoothly.

• It must establish a clear delineation of responsibility at every stage of crisis management. The HFC is in charge of communicating with the public in the event of an attack and maintains a unit for this purpose.

The minister of defense may declare a “limited state of emergency,” thereby transferring comprehensive responsibility for managing any incident to the military. The declaration of a state of emergency allows military authorities to take actions to ensure public security and the uninterrupted supply of vital services. It allows the military to force people to stay in bomb shelters, to obtain means of defense as determined by the military, and to shut down schools and other public services and workplaces. By law, the declaration must be made public through radio, television, and newspapers as soon as possible. It can remain in effect for a maximum of five days. After that, it must be endorsed by the Knesset.35

33 “Israel: Caterpillar Should Suspend Bulldozer Sales,” Human Rights News, http://www.hrw.org/english/docs/2004/11/22/isrlpa9711.htm, date accessed 22 November 2006. 34 “The Establishment of the Home Front Command,” IDF, http://www1.idf.il/oref/site/en/oref.asp?pi=25176, accessed 14 November 2006. 35 Ariel Merari, “Israel’s Preparedness for High Consequence Terrorism,” BCSIA Discussion Paper 2000-30, ESDP Discussion Paper ESDP-2000-02, John F. Kennedy School of Government, Harvard University, October 2000, http://bcsia.ksg.harvard.edu/BCSIA_content/documents/Israels_Preparedness_for_High_Consequence_Terrorism.pdf, accessed 23 November 2006.



In conventional terrorist incidents, the police are capable, in principle, of assuming comprehensive responsibility. However, this is not the case in unconventional incidents such as terrorist Weapons of Mass Destruction (WMD) events. At present, the police are unable and unequipped to manage an unconventional incident. For instance, they are neither trained nor equipped to detect and identify chemical substances. The army’s HFC is the only organization that can manage an unconventional incident and would be in charge in a case of this kind. In the event of an incident, management of a WMD incident would not belong solely to the HFC and would have to rely heavily on other IDF resources. The chief of staff and general headquarters would be directly involved in managing the event. In peacetime, the IDF can afford to allocate these resources, but there is debate whether or not resources could be deployed during wartime.

Israel’s health ministry maintains a rotation list of hospitals for an event involving mass casualties. In a declared state of emergency the HFC has authority over hospitals and other medical facilities. In consultation with the ministry of health and the IDF’s medical corps, the HFC would also determine the distribution of casualties to hospitals. In the event of an attack, the hospital next on the rotation list receives notification. It is also notified if a chemical agent is suspected, even before detection and identification have been performed. The hospital then sets in motion its emergency procedures. The police make sure that evacuation routes to the hospitals have been cleared. Upon reaching the hospital’s entrance, the casualties are assessed by the medical staff. Additionally, Israel is probably the only country in which every citizen, including infants, is required to have a chemical defense kit at home.

Pragmatic disaster planning is a uniquely Israeli trait due to the routine nature of disaster events of the country. Focus is on scenarios and exact numbers when executing planned exercises. Because Israelis consider themselves at constant war, disaster requires a different emphasis than the U.S. preparedness. Israeli preparedness is conducted frequently and in full coordination with active military units. The civilian communications infrastructure in Israel is also designed with the integration of emergency organizations in mind; emergency channels and frequencies have been allocated for use in events. All hospitals are required to conduct drills, which are executed in three-year cycles. One year they practice response to a chemical attack; in the second they conduct a drill that is in response to a toxicological, radiological, or biological event. The third year drill is tailored to the particular needs and or weaknesses of the hospital or may be modified to a particular situation facing the country or a particular region. The IDF requires these drills and works closely with the hospitals and the Ministry of Health in planning, conducting, and assessing each drill.

Israel has a unified emergency medical system, the “Magen David Adom” (MDA). There are 11 regional dispatch centers for the whole system, as well as a national dispatch center located in Tel Aviv. The MDA has also led efforts to develop a common vocabulary among medical EMS. They have worked to simplify concepts and operational procedures to avoid misunderstandings by emergency units. By way of example, MDA EMS workers follow a clear set of instructions when they come upon a disaster site. The first ambulance to arrive takes a command position, and is not to provide any treatment. First responders immediately report to the HFC on the scope of the incident and the approximate number of casualties so that resources can be directed to the site. Victims are categorized into two groups: lying and sitting/standing. The sitting/standing victims are likely to be loudest, and emergency response workers would most likely to be drawn to them. However, those people can be transported by private car or bus and should not occupy the limited number of ambulances required for the more seriously wounded people. Except for dismembered bodies, all victims are removed from the scene, dead or alive. MDA personnel are to use a “scoop and run” approach to their work. Life-saving procedures are generally done in the ambulance during evacuation, reducing the risk of further injuries if a second device is detonated at the scene. Once the victims arrive at the nearest hospital, they are most likely transferred by air evacuation to a hospital in a different location for advanced treatment. In peacetime, the hospital closest



to the incident is primarily responsible for triage services and treatment of lightly and moderately wounded victims.36

The strategy used by MDA in a chemical or biological attack is to get people out of the hot zone and care for them once they are removed. This minimizes the need to deploy suits inside the hot zone. Atropine is carried for active life-support protocols, and organophosphorous is carried in case of a nerve gas attack. As it pertains to general strategies for preparedness and treatment, there is a distinction made between war and non-war operations. Supplies for nerve gas intervention as well as advanced gear are stored at dispatch stations for deployment in the event of an incident. All personnel are trained in the use of this equipment and how to protect themselves. MDA also maintains a supply of level 3 protective gear, including boots and gloves, as well as positive pressure devices with one kit per unit. The MDA also values training for civilian populations. The organization provides extensive training courses for citizens including a pre-war course designed to give Israelis knowledge of organizational responsibilities and how to respond in national disasters.

Israel provides several examples of elements that enable the successful evacuation and care in a crisis. The use of common language among first responders is one of the most significant elements of the Israeli plan. This common language allows for the first responders to communicate effectively and concentrate efforts on life-saving procedures as opposed to logistical efforts. Having a language in place precludes the need for additional reevaluations of victims once they reach a staging point. This streamlines the evacuation process and enables victims to receive proper treatment immediately. This also ensures correct allocation of resources, which maximizes facilities capabilities.

The clear direction within the Israeli government over responsibility during events further maximizes response time. There are no competing organizations taking action in the disaster area. Utilization of all equipment and resources is maximized by the government’s top-down command structure. Unlike the U.S., where local, state, and federal governments as well as private organizations “own” their resources, only one organization in the Israeli government determines the risk and allocation of resources. The top-down function of the Israeli system enables the government to act quickly and more effectively.

The requirements levied by the government on private individuals and companies also enable the effectiveness of the system. Requirements levied on hospitals to perform at determined standards ensure the resources are available during disasters. The registration of heavy equipment by private individuals and companies brings a clear advantage to the system. The government has the capability to know the number and status of available resources before disaster occurs.

Training and experience probably best define what makes the system work. The Israelis expend considerable time practicing for events at a national level. Training combined with the experience of several wars and constant bombings keep the system up to date. Through constant trials the faults in the system can be recognized and addressed. As medical procedures evolve and threats change, the use of training is critical to ensuring the system works when it is enacted.

The final element that enables the Israeli system to function effectively is its people. A common language, culture, and life experience make it work effectively. A common bond among the people to do what is right brings an additional level of support to the system. Many Israelis do not have the same level

36 American Friends of Magen David Adom, http://www.afmda.org/site/PageServer?pagename=On_Going_Needs, accessed 30 November 2006.



of mistrust in their government as people in the U.S. Partly due to religion and mandatory service in the armed forces, the Israeli people bring a unique and positive aspect to the system.

6.8. Japan Tsunami System

Tsunamis have historically threatened the population of Japan; as a result, the local population is well-rehearsed in tsunami preparedness. The tsunami threat has translated into the Tsunami Warning Service established in 1952. The service is ran by Japan’s Meteorological Society (JMA) and consists of six regional centers connected to up to 300 sensors located across Japan’s islands. The system also includes 80 water-borne sensors to monitor seismic activity offshore. The regional centers aims to give people in the path of the wave at least 10 minutes’ warning to evacuate the area. Local authorities, central government, and disaster-relief organizations receive tsunami warnings via special communication channels to enable staff to respond to the disaster swiftly. The tsunami center network can predict the height, speed, destination, and arrival time of tsunamis destined for Japanese shores. The general population receives alerts for effected areas via broadcast on all radio and TV channels as well as local sirens. The cost of the Tsunami warning system is an estimated U.S. $20 million a year.37

The high-tech tsunami warning system is coupled with a walled defense, along with extensive general building requirements. Japan has developed a 13.5 ft costal tsunami defense to minimize potential destruction. The walls are intended minimize a tsunami event but are not capable of preventing a disaster. In as recently as 1993, Kokkaido was swamped by a 100 ft tall wave that dwarfed the costal defenses. In addition to the outer sea walls, flood gates in tributaries have been designed to limit inland flooding. 38

Education is a critical part of Japanese culture; many grade-school children receive education on what to do in the event of a threat. Evacuation routes are clearly marked in many coastal towns as well as flyers and pamphlets distributed in hotels. The JMA also produces educational videos, sends experts to give lectures in schools, and includes information about what to do in the event of a tsunami on its Website. As part of an educational program, the earthquake preparedness center in Shizuoka includes a banner depicting the actual height of past tsunamis and a wave basin where the 50,000 visitors who attend 37 “How Japan handles tsunami threat,” BBC News, http://news.bbc.co.uk/1/hi/world/asia-pacific/4149009.stm, accessed 16 November 2006. 38 TSUNAMI Warning System, Japanese Meteorological Society, in Japan http://www.jma.go.jp/jma/en/Topics/lists/tsunamisystem2006mar.pdf, accessed 19 November 2006.

Table 14 - Israeli system characteristics summary Issue Positive Negative

Terms and Language Common first responder language/terms

Requires an organizational leader to develop terms

Command Control Top Down response with clear definition of responsibilities

Does not allow for local governments to address their populations needs

Regulations Expansive requirements in the registration of personal property and equipment

Limits private property ownership rights

Training/Experience Mandatory training and near constant practice at a national level

Cost to perform education and training exercises is expensive

Culture Common culture, government is trusted to do the best thing



each year can witness a simulated tsunami striking model houses. Japan also sponsors a Disaster Prevention Education Challenge Plan, picking the year’s top 20 local disaster prevention programs.39

Although traditionally education has been a priority, there remains some complacency. There is no national evacuation plan and some costal cities have no published evacuation routes or hazard maps. Local departments are responsible for evacuation planning; evacuation procedures vary by locality. A survey conducted by Japan’s federal Office of Fire and Disaster Management showed only about 14% of localities in coastal areas have designated buildings where people can take shelter in a tsunami, and 40% lack emergency broadcasting systems. Recently there have been cases where victims have been drawn to the coast to witness the waves rather than evacuate, and local governments that did not issue evacuation orders. 40

Japan’s tsunami system provides primarily disaster preparedness activities. In order to limit evacuation of large-scale populations, planning is designed to limit casualties. Strict building and zoning requirements address the need for large-scale movement of special-needs persons prior to a tsunami event. National-level planning places an emphasis on warning capabilities, allowing local authorities to execute individual evacuation plans. Due to limited response time, local plans often are limited “footpath” evacuation routes. Education of local evacuation plans is performed early in formal educational institutions as part of the national plan.

6.9. System Attributes

In conducting the case studies, an attempt was made to identify significant attributes or characteristics across all the systems assessed. How these attributes manifested varied depending on the type and purpose of the system. The goal of this portion of the study was to identify favorable attributes for a particular type of disaster management/evacuation system. This system “DNA” would then allow the system designer to design or modify an evacuation system more efficiently and effectively in the future.

39“Japanese pupils first in prevention,” UNESCO.org, http://portal.unesco.org/en/ev.php-URL_ID=26872&URL_DO=DO_TOPIC&URL_SECTION=201.html, accessed 30 November 2006. 40 Tsunami Tips, Embassy of the United States – Japan, http://tokyo.usembassy.gov/e/acs/tacs-tsunami.html, accessed 9 November 2006.

Table 15 - Japanese Tsunami System characteristics summary.


Scalability Nationwide pre-event planning and warning

Emphasis is on prevention with few standard processes for post-event evacuation

Cost Extensive planning and funding is required

Responsibility National-level (large-scale) planning and prevention management

Local municipalities can be inadequately prepared relying on federal programs

Regulations Heavily regulated construction and building codes High building costs and oversight



The list of attributes, and how they manifested, is contained in Table 16. This initial review rated the attributes as high/medium/low for each of the systems. Because favorable attributes vary depending on the type of system, there is no direct correlation between rating and success. One must correlate the attributes to the specific form of the system desired.

This area of the research was strictly preliminary. More investigation should be conducted and a more finely resolved attribute scale developed.

Evacuation System

Attributes Israe

lIncid

ent C

ommand

System

(ICS)

National

Response

Center

(NRC)

Joint E

mergen

cy

Manag

emen

t Pro

gram

(JEEP)

Web-bas

ed Emerg

ency

Operatio

ns C

enter

(Web

EOC)

FIRESCOPE

Japa

n Tsunam

i

Central Command Control H H L H L M LInteroperable L H M M H H LAdaptable Command Control L H L L H H LExisting Policy Directive H L H H L H LDefinitive Accountability H L H M L H MMulti Threat Cabablity H H M H H M MSpecialized Capabilty M L H L H H HResource Allocation H L L H L M MRegistration H L L H H M LGuaranteed Funding H L M M M H HPersistant Cost H L L H L L MSurge Cost H L L M L M LEvacuation Notification H M L M L M HTime to Execute L M L L L L LComprehensive H H H L H H HMobilization Time L M M L L L LScalable (large & small events) H H M L H H MCommon Terminology H M H L L M LTransportation Services H M L M L M LDedicated Training H L L L L M LDedicated Resources H L L M L L LReliability H H M H M H MPopular Support H H M M H H H

Table 16: Evacuation system attribute matrix.



7. Conclusions

This project sought to identify the current state of the special-needs evacuation system within the U.S. This was accomplished through several tasks, system reviews, issues reviews, and comparative analysis. Both the “As Designed” and “As Is” systems were assessed and a database of significant system issues was developed. These views and analysis provided significant insight into the problems within the existing system.

Key shortfalls in six major areas prevent the special-needs evacuation system from delivering the services that the stakeholders need:

• Statutory authority • Organization, roles and missions, and integration among government departments and with the

volunteer sector • Communications policy, assets, and infrastructure • Operational and enabling processes, personnel, facilities, and materiel • Preparation, especially training and exercises at all levels • Resources, especially funding.

Significant change and improvement is necessary in all these areas if the special-needs evacuation system is to become an effective and successful system, preventing morbidity and mortality within this vulnerable population. This study serves as a baseline for the status of the existing system and provides a significant compilation of issues and faults. Going forward with new design and change, this study provides a means for assessing proposed changes and determining the optimal course of action.



8. Recommendations

Synthesis of the information and results from the study produced two sets of recommendations. The first set deals with issues of immediate importance and impact to the SNES system itself. The second set of recommendations covers systems of a similar nature more broadly. Both sets of recommendations are discussed next.

8.1. SNES Level Recommendations

Although there are clearly many efforts that federal, state, and local authorities could undertake to address the issues identified, resolution of several issues would offer the most immediate impact. Table 17 summarizes six operational recommendations for immediate action to begin the process of improving the special-needs evacuation system’s performance.

Table 17 - Special-needs evacuation system study recommendations.

Evacuation System Recommendation 1: Conduct assessment of data requirements and availability necessary for thorough planning and response.

To succeed, authorities responsible for planning and conducting complex tasks must have a deep knowledge of the particulars of the task they are planning. In the team’s view, one of the best ways to gain this level of knowledge is to understand the nature and content of the data flows that support the task. In other words, planners must know what each set of actors needs to know to execute their portion of the overall mission. In concept, a successful study will produce a logically structured list of the operational and enabling data elements required, and required to be produced by, each role filled by actors in the process. When completed, this study will open the way for more production of other systems engineering products, including detailed concepts of operation, use cases, process architectures, and stakeholder and system requirements.

Issue Recommendation Suggested Sponsors

Critical Data for SNE Planning Conduct assessment of data requirements and availability necessary for thorough planning and response

DHS/HHS/ State/Special Interest/

Foundation

Special-Needs Population Identification

Study to assess requirements and models for, and identification and tracking of, the special-needs population


Foundation

SNE Core Training and Exercises Program

Study to assess core requirements and exercise types for special-needs evacuation training and exercises


Foundation

SNE Transportation Planning Systems engineering study to assess special-needs evacuation requirements for evacuation transportation planning system

DHS, DOT/ TRANSCOM/

State

SNE Patient Tracking Systems engineering study to assess special-needs evacuation requirements for tracking individuals and records during an evacuation


Foundation

SNE Shelter Management Systems engineering study to assess special-needs population shelter requirements with development of shelter management system


Foundation

Program Management Establish an “honest broker” to coordinate studies and development efforts on this subject among government and non-governmental entities DHS/S&T



Evacuation System Recommendation 2: Study to assess requirements and models for, and identification and tracking of, the special-needs population.

Evacuation operations are likely to be more effective and efficient if planners know in advance where to send specific types of evacuation, support, and medical assets, and how many of each type will be required at each location. This drives a need for a concerted effort to identify and track the status of potential evacuees. In fact, some jurisdictions already have such programs in place. The recommended study will analyze the data requirements, document the known legal and societal constraints, review the existing programs to identify strengths and weaknesses, and postulate additional models if none of the existing models proves suitable.

Evacuation System Recommendation 3: Study to assess core requirements and exercise types for special-needs evacuation training and exercises.

It is reasonable to assume that the performance of special-needs evacuations could be improved by well-constructed, high-fidelity training and exercises. The real issue is, which type(s) of training and exercises, at what level(s) of fidelity, and for which collection(s) of actors will produce the desired level of improvement at an affordable cost. The recommended study will establish a framework for the required cost-benefit-risk analysis, review the types and scales of training and exercises that could be made available, and determine the optimal mix and frequency of training and exercise events to achieve the desired level of performance.

Evacuation System Recommendation 4: Systems engineering study to assess special-needs evacuation requirements for evacuation transportation planning system.

Although the provision of safe and appropriate transport is fundamental to the conduct of evacuation operations, a number of reports highlighted conduct and coordination of transportation planning, both local and “long haul,” as a significant issue especially for individuals with special needs. The recommended study will establish the stakeholder, system, and functional requirements for a system (or federation of systems) that can support the planning and execution of both exercise and actual evacuation transportation operations.

Evacuation System Recommendation 5: Systems engineering study to assess special-needs evacuation requirements for tracking individuals and records during an evacuation.

Many reports also highlighted patient tracking and medical records creation, capture and tracking as significant issues especially for individuals with special needs. Treatment was delayed, inappropriate medications prescribed, and medical and psychological conditions aggravated by the failure to have the right patient information on hand when needed. The recommended study will establish the stakeholder, system, and functional requirements for a system (or federation of systems) that can support the tracking of patient status and movement, as well as the creation, capture, and tracking of evacuee medical records.

Evacuation System Recommendation 6: Systems engineering study to assess special-needs population shelter requirements with development of shelter management system.

Individuals with special needs were sometimes placed in shelter environments that were wholly inappropriate to their needs—they lacked the medicine, equipment, and staff required to ensure that the sheltering experience did not contribute to even poorer mental and physical health than the individual had prior to the evacuation event. The recommended study will create a framework for the cost-benefit-risk analysis, evaluate the need for specific shelter capabilities, and investigate possible shelter configurations.



8.2. Higher-Level System Recommendations

In addition to the evacuation system-level recommendations previously noted, several more generic central questions were identified. These questions reflect issues with large enterprise systems-of-systems, particularly service-oriented systems with a major human factors component. The issues are captured in the recommendations listed next and each represents another area of research that should be further investigated.

General System Recommendation 1: Investigate efficient governance within a distributed set of systems.

In large distributed system-of-systems, governance becomes a central issue. Who is in charge and what procedures need to be followed? Time is short and life and death decisions must be made. Should the system be a “spider” or a “starfish” (Brafman & Beckstrom, 2006)? Should it operate with a highly centralized command structure or decentralize to the greatest extent possible? This investigation will study possible governance models to seek to determine the most appropriate model for use in large, distributed system-of-systems, particularly those with critical time-sensitive decision requirements.

General System Recommendation 2: Study management of the transitions through the various possible “states” of the system as the event escalates.

When a system takes on many forms due to a variable response to outside stimuli, the transition between these different forms becomes a primary system characteristic and a major source of success or failure. This dependence becomes even stronger in the case of a system-of-systems, where the transition may represent the addition of new systems to the mix. The recommended study would look at the requirements for system state transition, identifying patterns and possible templates for more efficient transitions.

General System Recommendation 3: Develop architecture for an effective system-of-systems considering the extreme heterogeneity of possible component systems (states/local/etc.).

All systems are not created equal, nor do they operate in the same manner, or in the case of human-based systems, have the same culture and value system. Given this, how can systems of extremely different cultures and goals work together in an integrated system-of-systems? This study will look for patterns in systems-of-systems similar to the special-needs evacuation and will develop a generalized architecture as a template for future system development.

General System Recommendation 4: Investigate effective interfaces between the systems—communication and interoperability in the broadest sense.

“Ninety-eight percent of system problems occur at the interface” and nowhere is this more true than in large distributed system-of-systems. Communication and interoperability at the interface should be studied to more fully understand best practices and patterns. It is possible that rather than improving communications, these system-of-systems should reduce communication, therein reducing confusion, clutter, and layers of management. Push responsibility to a lower or more distributed level. These and other alternatives for interface management should be investigated.



9. Recent Changes

Since the completion of this study, several changes have been made within the U.S. emergency response community. Modifications to the Stafford Act have confirmed FEMA as the lead agency for evacuation coordination. As a result of the FY07 Homeland Security Appropriation Act, NDMS has been shifted back to DHHS effective 01 January 2007. FEMA has also been elevated to be a stand-alone agency within DHS and the FEMA Director is now the Under Secretary of Federal Emergency Management. Other changes at the organizational level as well as simpler process changes are occurring. The NRP and the NIMS are current under review and revision. The Target Capabilities List is being enhanced and a new version is due for release soon. The implications of all these changes, both big and small, are currently unknown. These changes do not diminish the value of this study, but rather reinforce the need for a strong baseline to evaluate changes as they occur, or more importantly, as they are proposed.



10. Acknowledgments

This project was completed in partial fulfillment of the Stevens Graduate Certificate in Systems Engineering. Thanks are provided to Analytic Services Inc., which sponsored the investigators’ participation in this program, and to the Analytic Services Executive Leadership Team, who provided significant comments on the direction and utility of the study. Additional thanks are provided to the Stevens Institute review team: Jack Ring, Rick Dove, Mike Pennotti, Ralph Giffin, and Tony Barrese, who sat through several seemingly endless reviews, always with good cheer, and provided countless invaluable comments. Thanks also to John Boardman who provided the insight to think outside the proverbial “ATM” box and to apply new applications of systems thinking. And finally, a special thanks to Dinesh Verma, who acted as advisor for this study. He had the unenviable job of providing the interface between the widget engineers and the policy wonks, which he did with true skill, diplomacy, and wisdom.



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