Mitigating and Preparing for H1N1

Frye Regional Medical Center in Hickory, N.C., where I serve as emergency preparedness coordinator, held a press conference regarding the H1N1 flu outbreak on May 1. We did so to educate and reassure the public by explaining the steps we are taking internally and in concert with community public health and health care providers. Though these remarks – which include expert insight from our chief of staff and infectious disease physician – are offered especially to the people of the Hickory Metro area, we hope you may find them of value as we all strive to learn more about mitigating and preparing for the various scenarios that could occur with this outbreak.

The remarks are published in the order in which they were shared at the news conference.

Michael Barrick, Emergency Preparedness Coordinator

Good morning. Frye Regional Medical Center has been closely monitoring the H1N1 flu outbreak for more than a week, as we take very seriously the health and safety of our staff and the people we serve.

For several years, Frye has placed a firm focus on emergency preparedness. As a result, we have a strong team of doctors, clinicians, administrators and support staff in place to respond to various emergencies, including this outbreak. Every day, we are working on our emergency response plans. We have extensive training, drills, analysis and reviews of all of our plans, including those for this outbreak.

However, we wish to take this opportunity to caution the public to remain calm. While this outbreak is serious, this flu is treatable.

There are several steps we have undertaken to prepare for an outbreak in our area. We have been meeting daily with public health officials and other health care providers. We wish to thank the Catawba County Health Department and the North Carolina Department of Public Health for their active, robust response to this development.

Additionally, our team has been meeting daily throughout this week. Medical staff, administrators and clinicians representing various disciplines have participated in these daily meetings to review our plans and to consider contingencies and develop responses for them.

We have already taken several steps in various areas of the hospital to mitigate the impact of the outbreak and to prepare and respond should confirmed cases occur in the Hickory Metro area. We have assessed our inventory of medications and personal protective equipment to ensure supplies are adequate and will continue to do so.

Should you have flu symptoms, which our Chief of Staff will detail momentarily, it is important that you see your family doctor. Should you need to report to our Emergency Department, you may see staff wearing masks, gloves, goggles and gowns. This should not alarm you; rather it should comfort you, as these steps are taken to minimize the risk of spreading the disease.

Frye Regional Medical Center stands ready to serve the people of the Hickory Metro area. Providing them with top-quality healthcare is our objective. Keeping them educated and informed is an important part of that mission.

Kevin R. Clark, D.O., Frye Regional Medical Center Chief of Staff

Good morning. As Chief of Staff of Frye, I take seriously our responsibility to our community – as do all of our employees. Our goal is to provide the level of care that we would expect for any of our family members. Part of that care includes education. So, with a serious disease outbreak facing us, we are taking this opportunity to put this situation in perspective.

There is no doubt this is a serious matter. The World Health Organization would not have placed the Pandemic Alert at its next to highest level if that was not the case. That is why numerous steps are being taken to quickly identify individuals coming to Frye who present with flu symptoms.

We are closely monitoring every patient that enters our emergency department and are taking the proper precautions should a person complain of flu symptoms, which include a fever, lethargy, lack of appetite, and coughing. Additional symptoms could include a runny nose, a sore throat, nausea, vomiting and diarrhea. Also, it is important to remember that we are in the height of the spring allergy season. And, these symptoms could also be signs of an illness that isn’t the flu.

Additionally, it is important to remember that we are still in the annual flu season. So, just because someone complains of the flu or even has the flu, does not mean they have the H1N1 virus. Indeed, it is common for us to diagnose people with the flu this time of year. To date, though, there have been no confirmed cases of the H1N1 flu at Frye.

We simply do not know how this will unfold. It is too early to tell. But whatever the outcome, it is critically important to remember that to date, the disease is treatable. Indeed, we have adequate supplies to treat confirmed cases of the flu, so long as other providers do not prescribe and dispense medicines unnecessarily, causing stockpiles to be depleted. Frye, then, is ready to care for those who seek treatment, but we also wish to emphasize that it is generally best to first visit your family doctor, who is familiar with your medical history.

Our staff’s health is very important to us. They must remain healthy to care for you. So, don’t be alarmed by any protective gear they may be wearing, and please comply with their directions. We deal daily with infectious diseases and do have plans for dealing with an outbreak.

It is important to understand that while we are prepared to provide whatever level of care is needed for this outbreak should it reach the Hickory Metro area, it is also important to remember that should you become ill, you will quite likely be able to recover at home if you follow your doctor’s directions closely.

Grace Auton, M.D., Infectious Disease Physician

Good morning. We are aware that the people of our community are concerned – if not alarmed – by the H1N1 flu outbreak. While people certainly should have a heightened awareness, we do not want them unduly alarmed. So, there are a few details regarding this outbreak I wish to share.

Numerous steps are being taken to track the disease in our county, state, the nation and the world.

Key objectives at the moment include early detection of outbreaks, ensuring rapid intervention, and mitigating further complications. Additionally, teams have been sent to impacted communities, and investigating the causes of the deaths in Mexico is a top priority. The county and state public health agencies are in constant communication with one another, and are in direct contact with the CDC.

Frye Regional Medical Center, through its collaboration with community partners, is aware of vulnerable populations for disease outbreaks. Responding to their needs is part of our preparedness plans.

While the significance of this outbreak should not be underestimated, it is important for the public to understand that hospital and public health workers are monitoring every patient entering our doors.

Most encouraging, there are steps we, as individuals, can take to mitigate the impact of this outbreak upon ourselves, our families, our neighbors, and our communities. First, wash your hands regularly with soap and water, or use alcohol-based sanitizers. Always cover your mouth when you cough or sneeze. Avoid touching your eye, nose or mouth. Try to avoid close contact with sick individuals. If you are a caregiver for a person who is ill, take precautions. There are guidelines on the CDC website. If you are sick, after you are treated, follow the doctor’s directions and stay home.

Every day we practice standard infection prevention procedures to limit the spread of diseases. We are taking seriously the need to be ready. We encourage our neighbors to do so also. In doing so, we can sensibly and calmly prepare for whatever the next weeks and months hold.

Read coverage by the Hickory Daily Record here.

Read coverage by the Newton Observer-News-Enterprise here.

Other key resources:

FAQ on the H1N1 virus
North Carolina Department of Public Health
Centers for Disease Control and Prevention
World Health Organization

Balancing the National Guard’s Role in Disasters

By Michael Barrick

With a new administration in the White House reviewing our nation’s plans for responding to man-made or natural disasters, the role of the U.S. National Guard will undoubtedly be reviewed. While the 2006 congressional study of Hurricane Katrina – A Failure of Initiative: The Final Report of the Select Bipartisan Committee to Investigate the Preparation for and Response to Hurricane Katrina – revealed a startling lack of collaboration and leadership at all levels, it also revealed the readiness of the U.S. National Guard to be a bright spot. However, readiness does not ensure a proper response. Though that ended up being the case during Katrina, the National Guard clearly has a role to play in natural disasters. However, its role must be balanced against the nation’s historical principle that “all disasters begin and end locally.” In short, the Guard must be put to its highest and best use, but not be asked or allowed to cross the line of civilian control of disaster response and recovery.

The greatest strength of the Guard – its disciplined methods and force – turned to be its greatest liability during the response to Hurricane Katrina. However, the blame does not rest with the National Guard or its leaders, for it was ready to deploy; rather civilian authorities charged with understanding its role within the National Response Plan (now the National Response Framework) and with the responsibility for activating the National Guard simply failed to utilize this tremendous asset in a timely manner.

There is no question that the National Guard’s primary mission is to be ready to deploy to combat theaters. “The current heavy reliance on the Army National Guard for oversees operations represents a fundamental change from the Guard’s planned role as a strategic reserve force whose principle role was to deploy in the later stages of a major conflict, if needed” (GAO report, 2005). Yet, despite this primary mission, and even with civil authorities seemingly making questionable decisions regarding the legitimate and legal use of military assets, the National Guard eventually fulfilled its role in the greatest natural catastrophe of our time. In short, the systems were ostensibly in place that would have allowed for a quick, coordinated response by the National Guard – whether operating under the orders of the President or Gulf Coast Governors – if civilian leadership would have been more proactive in calling upon these resources.

While Katrina is but one natural disaster, its scope was so significant as to allow ample opportunities for learning lessons and applying them. First, though, a review of what the National Guard did right in responding to Hurricane Katrina points to the assets that it – and it alone – brings to the tool box of disaster preparedness and response. The Air National Guard rescued 85 civilians from Gulfport, Mississippi in what Lt. Gen. Daniel James III, the Director of the Air National Guard called, “the largest military airlift operation supporting disaster relief in the United States” (A Failure of Initiative, 2006). Additionally, National Guard units provided search and rescue operations, hauled cargo such as sand bags, provided emergency medical treatment and supplied assistance for trauma surgeries. It also patrolled areas subject to looting or unrest, manned checkpoints, supported local law enforcement, provided assistance to those with special needs, and provided security at the Superdome (A Failure of Initiative, 2006).  It also provided logistical support to FEMA and provided high-clearance vehicles and helicopters to aid evacuation efforts.

Still, the ill-coordinated response to Hurricane Katrina by all levels of government has forced a reexamination of the role of the National Guard in disaster response within the United States. Before considering the conclusions from the untold number of assessments of the response to Hurricane Katrina, it is instructive to look at a recent event – Hurricane Ike. Evidence suggests that lessons have been learned. According to the U.S. Northern Command website, the response to Ike included dozens of search and rescue missions, the deployment of the USS Nassau to Galveston, the coordination of relief supplies, pre-positioning of equipment and supplies, and logistical support (USNORTHCOM News). Indeed, the effective use of pre-positioned supplies is a tremendous improvement from the response to Hurricane Katrina. “By the time Katrina made landfall on August 29, 2005, the military was positioned to response with both National Guard and federal forces” (GAO Katrina report, 2006). Yet, DHS Secretary Michael Chertoff and others who could and should have asked for those resources did not do so until well after landfall. The failure to use these resources effectively during Hurricane Katrina is just one example of the challenges facing the National Guard when it is called upon to provide disaster assistance. Because they were deployed but not utilized, commanders lacked situational awareness and were hence hampered in identifying the most critical assets requiring deployment. Another challenge is that a large percentage of National Guardsmen are presently deployed oversees. The draw-down of equipment being utilized in the battle fronts in Iraq and Afghanistan is also having a negative effect. “…states are concerned about the Guard’s ability to perform future domestic missions given its declining equipment status” (GAO Katrina report, 2006).

Also, as Banks has noted, the Department of Defense does not wish to have an expanded role in domestic disaster relief. Echoing this sentiment is Assistant Secretary of Defense Paul McHale, who wrote, “…striking the appropriate balance between the military’s primary warfighting role overseas and the need to support civilian authorities at home is a difficult, but fundamental issue” (GAO Katrina report, 2006).

Conclusion
One finding in “A Failure of Initiative” is debatable. In it, the authors stated, “The most important limit to the military’s ability to manage domestic disaster response is the nation’s traditional reliance on local control to handle incident response.” Essentially, the authors are stating that the problem is systematic. However, none of the other reports supports this conclusion. What they do support is that the people responsible for implementing the systems failed to exercise their roles. Communications breakdowns, bureaucratic layering, turf battles, political considerations, and flat-out incompetence ruled the day. Until each and every system that failed is tested in a manner to allow it to function as intended, it is premature to abandon our firmly-held principle of local and civilian control even while we still utilize the Guard as only it can be. Ultimately, the failures during Hurricane Katrina were caused by responsible parties failing to do what was required of them – to imagine the worst and to prepare for it.

© The Barrick Report, 2009. Direct comments or questions to mbarrick@charter.net

Infrastructure Report Card Demands Action by Congress

By Michael Barrick

In a column posted yesterday, I argued that some stimulus funds appropriated by Congress to fight the recession should be earmarked to integrate community planning and disaster preparedness. The recent 2009 Report Card for America’s Infrastructure by the American Society of Engineers, in which all of our infrastructure sectors received nearly failing grades, serves to underscore the benefits of this proposal.

The Report Card graded the following infrastructure sectors accordingly:
·    Aviation = D
·    Bridges = C
·    Dams = D
·    Drinking Water = D-
·    Energy = D+
·    Hazardous Waste = D
·    Levees = D-
·    Inland Waterways = D-
·    Public Parks and Recreation = C-
·    Rail = C-
·    Roads = D-
·    Schools = D
·    Solid Waste = C+
·    Transit = D
·    Wastewater = D-

Clearly, these grades point to a crumbling, aging infrastructure neglected for far too long. Not only is our infrastructure essential for economic development, social welfare and public health, it is also more susceptible to destruction from natural hazards or terrorist attacks while it is in such disrepair. Hence, response and recovery costs – not to mention morbidity and mortality – are made worse each day we neglect the findings of this report.

Much of the funding for these systems comes from local or state tax coffers. Hence, the debate about the stimulus package must include a robust discussion about the distribution of money to local and state communities to assist them in fixing our crumbling roadways, bridges, schools, water treatment plants and other vital systems. Money allocated to these needs must include provisions for integrating disaster planning and community development, meaning simply that zoning and land use laws, building codes, density regulations and similar planning cannot occur without considering the impact upon the community when disaster strikes.

When one considers the failures associated with Hurricane Katrina and the new direction chosen by the voters in November, it seems rather clear that the American public is not in the mood for business as usual. Inaction is not an option. That is how we got here in the first place.

© The Barrick Report, 2009. Direct questions or comments to mbarrick@charter.net

Use Stimulus Funds to Integrate Community and Disaster Planning

By Michael Barrick

With billions likely to be allocated for infrastructure renovations and improvements over the next several years, we have an obligation to acknowledge and account for the increasing costs and volume of natural disasters as well as the ongoing threat of terrorism. The costs of upgrading our public works and critical infrastructure will be significant.

Still, the costs associated with disaster preparedness continue to increase. This is because the dramatically increasing costs of disaster response, relief and recovery in the United States are the result of people settling in areas that are prone to natural hazards. Therefore, stimulus funds earmarked for infrastructure improvements should include requirements that disaster mitigation be integrated into community planning. In “Disaster Management and Community Planning, and Public Participation: How to Achieve Sustainable Hazard Mitigation,” Laurie Pearce accurately identifies a needed transformation – the integration of community planning and disaster management principles, in particular the never-ceasing mitigation activities. This implies a local effort, though collaboration with state and federal officials is essential.

This means that a transformational change must first occur in the coordination of emergency management and land use planning within those communities located where natural hazard pose a significant threat. Perhaps the first issue to address is experience (or rather the lack of it). Many communities have been fortunate to escape catastrophic natural disasters. Even fewer have experienced terrorist attacks. The solution is disclosure and discourse. “In order for community members to influence politicians, they need to have access to the information essential to rational decision making” (Pearce, 217). Such information is a right. It is also vital on a practical level. “When the public is not involved in the disaster management process, it often, not surprisingly, challenges the decisions and actions of those in command” (ibid.). The last several years offer too many examples of the consequences of poor mitigation efforts. These should be discussed among political and agency leadership, as well as based on input from the community. The fundamental philosophy of disaster management – all disasters begin and end locally – must be conveyed. This will help answer the two implicit questions on the minds of citizens: Why is disaster planning important to me?; and, Why is disaster planning important to me now? Successfully answering these questions for the public will be a significant step in achieving the goal of local self-reliance.

The Federal Emergency Management Agency (FEMA) is of little consequence in advance mitigation. “Federal agencies such as FEMA often are limited to little more than encouraging wise land use and mitigation of recognized hazards and to making funds available for improving existing government-owned facilities” (Markle). Even the 404 program and 409 requirement of the Stafford Act are mitigation-focused only post-disaster. The response to FEMA’s limitations is simply for the community to be aware and ensure that the gaps are addressed through its own disaster management plan. Political advocacy, of course, is always an option.

Cultural opposition is also a challenge. “…disaster managers and community planners come from very different backgrounds” (Pearce, 215). Perrow observes that organizational culture in federal agencies discourage collaboration and critical thinking, meaning the organization “…just fosters errors and produces interpretation of errors that will not lead to corrective measures” (154). This underscores the danger of inflexible organizational cultures. Adds Pearce, “Petak notes, ‘public administration, as a discipline, has generally neglected to consider emergency management within the mainstream of its activities” (211). The first role of public administrators, emergency managers and planning and development managers, then, is to make emergency management part of its mainstream of activities. That is because, “…some people will want the community to return to pre-disaster conditions, while others will want to take the opportunity to pursue various other planning goals” (Pearce, 220).Leaders, then, must make it very clear to the public – even before disasters – that no community returns to its pre-disaster status. This is an opportunity to transform thinking, planning and development activities. This can be communicated through meetings, workshops and seminars at the neighborhood level. There, “Experts, community officials, and elected representatives have to ensure that community planning processes are designed to ‘allow the integration of specialized technical and abstract knowledge with local concrete knowledge and feelings…’” (Pearce, 220). Such a process will ensure community confidence and communication among residents.

A fierce debate about property rights can be expected as well. While eminent domain should not be abused, responsible communities can reasonably conclude that since natural hazards are not only inevitable but beyond humanity’s control, the only questions remaining are how restrictive land use laws will be. Shall building codes be changed? Should zoning be looked at anew? How should density be addressed? Will existing structures be “grandfathered” while new development is prohibited or limited? These and other questions must be addressed if mitigation efforts are to succeed and our tax dollars used wisely. The times require no less.

© The Barrick Report, 2009. Direct questions or comments to mbarrick@charter.net.

Lessons from Hurricane Evacuations

By Michael Barrick

Following the wave of hurricanes that overwhelmed the United States Gulf Coast during the late summer of 2005, and out of concern for the need to have effective plans in place to evacuate urban populations in the event of a terrorist attack, the U.S. Department of Transportation, in collaboration with the U.S. Department of Homeland Security, conducted an assessment of the hurricane evacuation plans in the five Gulf Coast states – Alabama, Florida, Louisiana, Mississippi and Texas.

While evacuating urban areas is a real possibility as long as the nation remains at war, it is the Gulf Coast states that have the actual experience of evacuating entire cities, counties and regions. While many mistakes have been exposed during these evacuations, so too have many lessons been learned. However, before a community can apply these lessons to improve their own plans, it is imperative that we first have an understanding of who is responsible for the decisions leading to an evacuation, and what agencies and organizations are essential for support of the operations developed and implemented by the decision-makers.

Primary Responsibility

As with virtually any natural disaster in the United States, the decision to evacuate a community during a disaster is made by emergency management officials at the local level. However, because of the size and scope – not to mention the unpredictable nature of hurricanes – it is folly to think that only local officials could make such a decision. They can not operate independently of adjacent communities that would be impacted by the storm, nor can they act independently of communities that would be receiving evacuees or have them moving through their communities on to safer venues. So, while it is a local decision, it is one that involves more than one locality, and requires input from multiple levels of government, functions, private entities and non-government organizations (NGOs). Ultimately, however, it is up to the emergency manager in each community who, by state statute is the appropriate designee, to make the final decision.

Support for Decision Making

The official that must ultimately be the one person accountable for making the decision to evacuate in face of an approaching hurricane is well-served to call upon as many resources as possible before he or she reaches the “Hurricane Evacuation Decision Time” (Patterson, Tutorial 1.3). Some key partners that the emergency manager will want to call upon include meteorologists with the National Weather Service; transportation officials; emergency response agencies, in particular police because of the need for safety and control; the American Red Cross and other NGOs; and peers in neighboring communities. However, others – while not involved in the initial phases of an evacuation – must also be consulted.

The clearest proof of this are the Emergency Support Functions (ESFs) established under the National Response Framework (NRF). A listing of those functions guides the emergency manager. In short, virtually every one of these 15 functions would be involved in some stage of the evacuation, whether it is preparedness, mitigation, response or recovery. So, the emergency manager should keep in close contact with officials at the local, state and federal level which contribute to each of these functions so that the manager will have a greater level of situational awareness regarding how his or her decision to evacuate will impact not only the population evacuating, but also the agencies providing those functions. In short, are these agencies fully informed and prepared to support the evacuating population?

Top Improvements

Choosing which improvements are the “top two” is difficult because while the plans have been assessed, the implementation of them have not been (though the After Action Reports that are presently being generated in response to the hurricane season of 2008 should soon provide such insight). So, in considering the top improvements in hurricane evacuations discovered through this congressional study, I considered two primary measures. First, which areas have the greatest impact upon morbidity and mortality? Second, which areas allowed for the greatest room for improvement? Considering the five areas that the report identified as the weakest areas of evacuation plans and processes – public communications, serving special needs populations, planning, operations, and sheltering – I considered the subsets in each category as they related to the two measures noted above. The greatest weakness under operations and planning – contraflow (getting people back home after the event) was eliminated as a potential top improvement because it simply does not have a high potential for impacting morbidity and mortality. Under sheltering, the main problem was with animals. Again, this is not a primary concern under that first measure.

Consequently, improvements in public communications and meeting the needs of special populations are the two areas I have identified as why these are the areas which must show – and have shown – the most improvement. That is because improvements in these areas have the greatest potential to reduce morbidity and mortality.

Evidence

So, if assessments are incomplete, how can one state that public communications and meeting special needs populations are the two areas showing the greatest improvement?

First, the “Findings and Recommendations” (Congressional Report) support my conclusions regarding the areas impacting morbidity and mortality. Second, as a result, these two areas have current corrective actions in place, some of which I have personal experience with in my position as an emergency manager. The study reports that “three crosscutting issues…emerged from the study” (page 5-1). First mentioned is the lack of local coordination. This is a communications issue. Second is that evacuation plans do “not adequately address…those with special needs” (page 5-1). Finally, the two intersect in the third finding. “…plans for communicating essential information to those who do not have…special needs generally are not well developed” (page 5-1).

Still, how can one claim that these deficiencies are areas of greatest improvement? First, one can presume that the areas identified as the greatest weaknesses and threats will receive the most attention. Second, corrective actions are in place for these areas. On August 1, 2008, our facility participated in a regional DHS Full Scale Exercise which tested, as key objectives, evacuation plans and responding to special needs populations. Furthermore, The Joint Commission, DHS and other regulatory bodies have made these two areas key focal points for current assessments of emergency management plans for communities and hospitals. Unquestionably, such scrutiny will lead to rapid and measurable improvements in these areas.

Conclusion

Until these plans are more fully tested, and until comprehensive After Action Reports from the 2008 hurricane season (which is not yet over at the time of this writing) are completed, we can speculate that the two areas identified – communications and meeting special needs – are showing the most improvements based on the evidence above. However, further assessments must be conducted and ongoing to validate these claims. Finally, it is arguable that whatever steps are taken will be incomplete, because coastal communities and the nation seem reluctant at this point to take the most obviously beneficial mitigation step – regulating and limiting further coastal development.

References

“Catastrophic Hurricane Evacuation Plan Evaluation: A Report to Congress.” U.S. Department of Transportation, 1 June, 2006.

Patterson, Chip. “Hurricane Evacuation Decision Making” lectures. University of North Carolina. HPM 423.

© Michael Barrick, 2008. Direct questions or comments to mbarrick@charter.net

Hospital and Health Care Preparedness Report Requires Heeding

Hospital Week a Good Time to Apply Lessons Learned

By Michael Barrick

National Hospital Week is next week, May 11-17. Though the valuable work of the millions of hospital clinicians, physicians, administrators and support staff is certainly worthy of celebration, it is also an opportunity to reflect upon the state of hospital and health care system preparedness for our ever-changing world.

This is not a question I raise. It was raised last week in numerous news reports. On May 5, numerous national news outlets reported that hospitals are simply not prepared to meet the demands of a pandemic or other potential risks such as catastrophic natural hazards or terrorist attacks. The sources of those reports were none other than doctors, researchers and academicians from the Department of Homeland Security, the Centers for Disease Control and Prevention, and the Department of Health and Human Services.

Recognizing that hospitals would be overwhelmed in certain scenarios, these health care leaders issued a wake up call to the public. In speaking with family members and friends as this news was being reported, it was clear that the message had been heard. As a result, people are concerned. That’s good. From concern is born a deeper awareness. That awareness could lead the public to demand that the federal government take a fresh look at disaster statutes like The Stafford Act and other revenue streams for local responders and receivers.

Meanwhile, with this group of health care leaders offering very specific – and startling – recommendations such as not providing care for people over 85 or with severe chronic disabilities should systems be overwhelmed – it is perhaps fitting that hospitals not only celebrate next week; it is also an opportunity to study history in order to defy the predictions of these leading health care experts.

One such way is to examine the sarin nerve gas attacks in Japan in 1995. While terrorist attacks obviously represent different threats than other hazards, this event so overwhelmed local hospitals that its lessons apply to multiple scenarios.

In March of that year, residents of Tokyo using the subway system were victimized by a sarin nerve gas terrorism attack. Perpetrated by the Aum Shinrikyo cult under the leadership of Chizuo Matsumoto (AKA Shoko Asathara), this attack offers the United States health care system numerous lessons to be learned in the event of an attack by terrorists using Weapons of Mass Destruction (WMDs) or other mass-casualty events.

Terrorists are willing to kill thousands, kill indiscriminately, and use WMDs. Only small amounts of WMDs are needed to cause mass casualties. Symptoms are difficult to recognize because medical staff are unfamiliar with them. And, health care institutions will be quickly overwhelmed because of the huge patient surge and because victims and the “worried-wounded” will self-transport. First responders and receivers may be contaminated, depleting valuable human resources. Also, a large percentage of “victims” may not actually be infected, but will, in a panic, respond to the nearest health care facility, making it difficult for caregivers to discern between those actually afflicted and those who are psychosomatic.

Consequently, there are a number of steps that communities must take to mitigate, prepare for and respond to mass casualty events caused by WMDs or other mass casualty events. Medical staff must be thoroughly trained to recognize symptoms of WMDs, including nerve agents, smallpox, anthrax and other potential weapons. Hospitals, health departments and first responders must dramatically improve cooperation, and, as U.S. Army Major James Hanlon has said in lectures delivered to students of the University of North Carolina, “We must begin planning for the most catastrophic events now…We need to develop and integrate detection and surveillance capabilities….Equipment such as decon apparatus and personal protective equipment must be addressed (and) issues such as heating ventilation and air conditioning systems and the ability to quarantine large sections or entire hospitals will have to be addressed.”

Again, while this is a terrorist attack from which we draw lessons, many of the structures developed in response to this lesson are also essential for planning for and responding to a pandemic, natural disasters or other man-made events such as mass shootings or infrastructure failings, such as the bridge collapse in Minnesota.

My sense is that hospitals are responding. With new stringent standards from the Joint Commission for hospital emergency management plans and other upcoming changes, along with the adoption of the National Incident Management System and Hospital Incident Command System, hospitals are planning for disasters as never before. Still, the wake-up call has been issued and the public stirred. In response, hospitals would be well-served to give notice to the public they serve that they, health departments and first responders are committed to working together to ensure interoperability and adequate preparedness through funding, ongoing training and other measures.

© The Barrick Report, 2008. Direct questions or comments to mbarrick@charter.net

‘Hope is on the Way’

Medical Teams International models faithful, effective and rapid response and restoration

By Michael Barrick

(Note: Please see the related articles, “A Transformational Experience: The role of volunteers in Medical Teams International” and “Step-by-Step to Success: Why Medical Teams International is so effective and efficient”)

On its website, Medical Teams International (MTI) declares, “Hope is on the Way.” It is hope provided through thoughtful, purposeful outreach programs – in which people are the center. The hope is revealed in MTI’s mission statement, “The mission of Medical Teams International is to demonstrate the love of Christ to people affected by disaster, conflict and poverty around the world.”

It has been at it for nearly 30 years. Its experience is evident, as it is widely recognized as among the most efficient Christian Relief & Development ministries, providing its services with less than five percent of its budget going to operating overhead. Such efficiencies – recognized by the likes of MinistryWatch, Charity Navigator and Forbes magazine – help ensure program effectiveness as well. It also holds memberships in the Evangelical Council for Financial Accountability (ECFA) and the Better Business Bureau (BBB). So, even as the Oregon-based ministry meets basic human needs while sharing the hope of Jesus, they are being exemplary stewards, giving confidence to donors that money or supplies given to MTI are helping those who are among the world’s most impoverished and desperate.

MTI is working in more than 30 nations in five regions of the world, providing medical services and training, community health and development, emergency medical services, disaster response, humanitarian aid, mobile dental clinics and care for those suffering with HIV/AIDS. The ministry’s budget for 2007 was approximately $90 million. MIT President Bas Vanderzalm noted that such a huge outreach could not be accomplished without several key principles guide the ministry.

The role of volunteers underscores the fundamental objective of MTI to ensure all the ministry does is rooted in biblical principles. Mr. Vanderzalm shared, “Volunteers are key. We provide everyone who wants to serve with an opportunity to make a difference for the Kingdom by caring for the poor.” So, by utilizing volunteers to help fulfill its mission, MTI is helping to unify the Body of Christ and also provides opportunities for believers to use their talents while being blessed by those whom they serve. “Some plant, some water, and others see the harvest. Those of us in relief and development are doing that land clearing and cultivation that will result in the harvest,” he offered.

In short, even though these volunteer teams are composed of professionals who generally have time only for a “short-term” mission experience, the objective is to ensure a long-term impact. “Our teams are volunteer professionals,” noted Mr. Vanderzalm. “We recruit professional medical, dental and work teams who volunteer their time. Development teams cover their expenses and sometimes gather donated supplies for the hospitals and clinics where they serve.”

He acknowledged, “It is fair to ask, ‘What difference for the Kingdom can people make if they only go for a very short period of time, not knowing the language or culture?’ Well, our objective is to ensure that people have a long term impact. We have to design programs that engage local partners in a way consistent with their calling. For example, after Hurricane Katrina, we’ve worked within existing church structures. If it doesn’t occur within the context of a long-term commitment to a community, you can question the impact. Our task is to make sure that people who have a heart and have the call are effective. It’s a good thing to have a commitment, to go and see who gets the help. It is a transformational experience for all involved to pray together, to cry together. These experiences have great value in changing lives, in the individual, in the church that sends them, and the community they serve. It’s a personal connection between the person who is helping and the person who is being served.”

He noted also the establishment of a youth center in Uganda that is reaching out to youths using drama, sports and music to help combat HIV and AIDS.

He pointed to the development of Emergency Medical Services programs as evidence that the ministry is constantly learning. “We have established EMS programs in Sri Lanka, Uzbekistan and Cambodia. For many developing countries, the lack of basic emergency medical services – no trained paramedics, ambulances or 911 systems – has meant millions of premature deaths annually.” He added, “Immediately following the tsunami in December 2004, Medical Teams International deployed medical volunteers to both Sri Lanka and Indonesia. From that disaster response more than three years ago, Medical Teams International has developed a country-wide emergency medical services program that is being adopted by the Sri Lankan government, its Ministry of Health and the World Health Organization/Sri Lanka. We’ve put a focus on the EMS infrastructure, including training for EMS first responders and providing resources such as books.”

So, he said, the ministry and all working with it must always be learning – and sharing the credit properly. “I don’t really care if people see our name or logo. I do care if they see God in action, through people who love Jesus and cared for them in His name.”

Quick Take on Medical Teams International

• Has a 5-star Ministry Efficiency Ranking from MinistryWatch
• Has received an Transparency Grade of “A” from MinistryWatch
• Received the 4-star Ranking from Charity Navigator for the fifth year in a row
• Provides free dental care annually valued at more than $5.3 million
• Has a ten-vehicle fleet of converted Winnebagos that provide dental care in Washington and Oregon through schools, social service agencies and churches
• Is using more than $100 million in donated medicines worldwide
• Is presently working in the U.S., Sri Lanka, Cambodia, Bolivia, Honduras, Romania, Sudan, Vietnam and other nations
• Partners internationally to develop sustainable relief and development programs
• Is accepting volunteers through its website

© The Barrick Report, 2008. Questions or comments? Write mbarrick@charter.net

The Role of the Church in Disaster Management

Good intentions are not enough

 By Michael Barrick 

Note: Before getting to the subject matter, a brief note to emergency managers/responders who don’t necessarily think of the Church as an Emergency Support Function – please read this anyway. There are two reasons: churches, denominations and ministries have and can play a critical role in Disaster Management activities; and, the challenges I’ve outlined below to the Church are applicable also to the entire field of Emergency Management.

The lessons learned from Hurricane Katrina continue to fill volumes of After Action Reports. In reviewing the activities of local, state and federal government disaster management agencies and hospitals, it is clear that “mistakes were made.” Yes, heroic efforts by individuals, responders and receivers saved many lives and comforted the afflicted. Still, as emergency managers and congressional committees have reviewed the response to this national disaster, it is clear that many of those responsible for protecting the lives and property of citizens could have done a better job. 

The same is true for the Church. 

Responding out of the compassion that is natural for Christianity, churches and ministries rushed to the Gulf Coast region in response to the suffering caused by Hurricane Katrina. It is true that some of the more experienced ministries were of tremendous benefit to the people devastated by the storm. However, many were also in the way. In short, good intentions were not enough. 

The Church can – and must – do better. We are in an age of increasing mass casualty incidents. Some are caused by shifting of populations into areas where natural hazards are common. Others are the result of man-made events, such as mass murders on college campuses. And, of course, the threat of terrorism looms ever-present. So, there is no question that the Church – whether through parachurch ministries, denominational response groups, or individual congregations – will continue to have more opportunities than any of us would wish for to offer assistance to those affected by disasters. Consequently, it is time for the Church to honor Christ by committing itself to improving its knowledge of Disaster Management. In doing so, it will be more effective in not only providing appropriate care, but will also earn the right to share the love – and everlasting hope – of Jesus. 

First, the Church must understand the basics of disaster management – Mitigation, Preparedness, Response and Recovery. Mitigation is taking steps to prevent disasters or reducing their impact. Preparedness is identifying the tactics and tools that will be needed to respond to disasters and making sure the resources and people are trained and in place to implement them. Response is the dispatching and application of resources and people during a disaster. Recovery is the process of rebuilding and mending people and communities following a disaster. It is essential to remember that this is a cycle that is constantly evaluated and is not necessarily perfectly chronological. In short, some or all four phases can be in process at one time. 

For mitigation, the Church should start with learning and applying the all-hazards approach to its planning. This way, ministries could identify how their mission fits with potential threats and hazards so that they could work with other non-governmental organizations (NGOs), as well as community responders and receivers in looking for ways to prevent or mitigate the impact of natural hazards, terrorism or man-made events. For instance, a ministry that operates on college campuses could play a vital role in working with university officials to develop methods for identifying students who might present a threat to the university community and offer counseling or other appropriate services. 

Regarding preparedness, the first step that a ministry can take is learning the National Incident Management System (NIMS) and applying it as its Command and Control philosophy and structure. By completing at least four NIMS courses (ICS 100, ICS 200, ICS 700 and ICS 800) offered by the Federal Emergency Management Agency (FEMA), ministry leadership would be familiar with the Incident Command System (ICS) being used by first responders with whom they will be working. This would include specific training for each position in the Command Staff – Incident Commander, Safety Officer, Liaison and Public Information Officer. It would also allow ministries to begin organizing themselves according to the General Staff structure – Planning, Logistics, Operations and Finance/Administration. By taking these steps, ministries would not only be much more versed in how others operate, they would be implementing a system that has been tested and proven through time and countless disasters. 

Having completed these first two steps, ministries will have established the necessary relationships and knowledge to effectively and appropriately respond to disasters. For instance, during Katrina, many churches self-dispatched, having no idea how they would help; so, they were in the way and actually ended up reflecting poorly upon the Church. Most of us have also heard of the well-intended but poorly-planned sheltering activities which resulted in churches and homes receiving people without giving any thought to the consequences. Understanding response would also force ministries to identify their mission within the context of a disaster. It also means participating in “hot washes” (After Action Reviews) to identify mistakes, strengths, weaknesses, opportunities and threats, as well as developing Corrective Action Plans to improve future response efforts. It would also include extensive training and drills. 

Recovery is the area where the Church is probably at its best right now, as this is generally where the Church is used to having a role. And it should. But until a ministry truly understands the first three areas of disaster management, it will not know its role in recovery. Too many churches rush to an area to “witness.” Well, disaster victims need physical, financial and emotional needs addressed before they will ever listen to a “sermon.” 

Additionally, ministries should also become familiar with the National Response Framework. As such, they could understand the interoperability of different levels of government, as well as the various agencies and functions. As a volunteer agency, a ministry can play a role as an Emergency Support Function (ESF). By understanding its role within this framework, it is much more likely to be welcomed by the person(s) managing a disaster. 

It has been said that mediocrity and complacency are twin brothers. As we review the response to Hurricane Katrina, it is evident that these twins were present. While that is unacceptable in any area of disaster management, it is certainly not reflective of the excellence for which the Church should be known. So, it is time for ministries to adopt a teachable spirit and seek those who can help them become trained in these four critical areas of disaster management. In doing so, it will not only reflect favorably upon the one for whom its faith is named, but it will be playing a key role in improving and saving lives. I can think of no greater mission for the Church. 

© The Barrick Report, 2008. Send questions or comments to mbarrick@charter.net

An Initiative of Leadership Required

Hospitals must take a lead in emergency preparedness as population shifts to areas prone to natural hazards

By Michael Barrick

This week, the United States Census Bureau reported that 47 of the 50 fastest-growing areas in the United States were in the South and West. This is significant news for hospitals serving those growing populations, for these are the same areas that are among the most likely to experience natural hazards.

What this means is that hospital administrators and emergency managers must exercise an initiative of leadership in planning for the increased mortality, morbidity and financial costs sure to arise from these dangerously merging trends.

This year, the Joint Commission – the independent organization that accredits and certifies hospitals and other health care organizations – has dramatically increased its scrutiny of hospital emergency management plans. And, for 2009, it will likely focus even greater attention on those plans, as it is proposing to take emergency management out of the Environment of Care Chapter and make Emergency Management its own chapter, meaning a hospital’s plans for emergency plans and operations will be on par with the other seven chapters that cover major aspects of hospital clinical and support activities.

These increasingly stringent standards are overdue and should be welcomed. Yet, it may still not be enough if hospitals do not assert leadership roles for disaster planning within these rapidly growing regions. According to the Census Bureau report, communities in Florida, North Carolina, Georgia, Texas, Arizona, California, Louisiana and Nevada were among the nation’s ten fastest growing locations.

So, regions that are prone to natural hazards such as hurricanes, earthquakes, tornadoes, wildfires, and droughts are seeing the greatest population growth. As natural hazards impact these areas, hospitals will be overrun with victims from mass casualty incidents; and, financial losses (property damage, health care delivery costs, and the cost of response and recovery) will increase.

These are hazards that hospitals cannot afford to ignore. Recent disasters caused by naturally-occurring events have proven that “all roads lead to the hospital.” In other words, disaster victims often bypass first responders and transport themselves to the hospital. Yet, for even those that are transported by ambulance, how they get there is ultimately irrelevant – they will get there. So, while other community responders and agencies may be entering the recovery (or final) phase of a disaster, the hospital will find itself in the middle of the response phase – and may for an extended period of time.

It is true that laws in many states mandate that counties or municipalities serve as the primary entity responsible for disaster planning and response. These statutory requirements, however, cannot be used by hospitals as an excuse for not taking an aggressive, leading role in collaborative community planning for natural hazards. Hospitals must be active partners in developing community all-hazards plans that account for population growth – which includes not only more people, but more structures that pose risks in severe weather. They must also take into consideration historical climate data, the identification of available resources, and plans for finding funding streams to meet the shortfalls in needed resources for the inevitable risks caused by these migration patterns.

Obstacles to effective disaster planning, preparedness and response must also be identified, acknowledged and overcome. Much of government funding – especially since the terrorist attacks of September 11, 2001 – has been directed to response agencies. There remains a reluctance among responders and receivers to establish, cultivate and maintain the necessary relationships to understand and work together to complement each others’ roles. Also, the hospital industry is growing increasingly competitive. So, a culture of mistrust between hospitals filters into areas where it should not, such as emergency preparedness. These political, cultural and economic factors must not be allowed to stand in the way of hospitals fulfilling their ethical responsibilities.

Too often, they do. Yet, this is not because of a lack of regulation. In addition to the Joint Commission, the Federal Emergency Management Agency (FEMA) now requires that hospitals demonstrate that they are preparing for and managing disasters utilizing a proven and standardized command structure and system – the Hospital Incident Command System (HICS).

So, while systems are in place that should foster interoperability and standardized approaches for emergency planning and response, their success is dependent upon the people responsible for implementing them. Consequently, those running hospitals must exert an initiative of leadership to account for increasing populations in areas prone to natural hazards. Anything less is a recipe for disaster.

© The Barrick Report, 2008. Michael Barrick works in a hospital in the field of emergency preparedness.

Responding to Needs with an ‘Army of Compassion’

Convoy of Hope equipping believers, reaching the needy

Note: This is the main article in a three-part series on Convoy of Hope. Convoy of Hope mobilizes, resources, and trains churches and other groups to conduct community outreaches, respond to disasters, and direct other compassion initiatives in the United States and around the world. To read the other two articles, visit the ‘Ministry & Missions’ category of The Barrick Report.

By Michael Barrick 

There is only one thing about Convoy of Hope that could be clearer than its simply stated Mission and Vision statements – its success in meeting those ideals. Its mission is simply stated – “Convoy of Hope is a Christian compassion organization that meets physical and spiritual needs.” Of course, that’s not a unique objective – many Christian ministries exist for the same reasons. What makes Convoy of Hope stand above most other ministries, however, is how it accomplishes its objectives – its highly effective and efficient use of gifts-in-kind and its successful determination to bring entire communities together in accomplishing its mission, as expressed in its Vision Statement – a determination to empower and equip the Church, combined with collaboration with multiple agencies, organizations and corporations (see sidebar). It is based in Springfield, Mo.

Convoy of Hope, founded in 1994, works through three service divisions. It coordinates community outreach efforts in the United States designed to help communities meet the needs of the poor, it responds to disasters in the United States with truckloads of donated goods and supplies utilizing local volunteers, and offers community assistance and disaster response in foreign nations. It is also in the process of developing an initiative as part of its disaster response, HOPE (Helping Others Prepare for Emergencies), designed to help community churches, agencies and businesses prepare for and respond to disasters. 

Each of these efforts can only be accomplished through what Founder, CEO and President Hal Donaldson calls “an army of compassion.” The use of the phrase does indeed seem apt, as it has a huge central location – a 300,000 square foot distribution center; it establishes staging areas when threats – such as impending hurricanes – are identified; it operates as a first responder to the victims of disaster; it works with hundreds of thousands of volunteers; and has mobilized more than 15,000 churches and other organizations. 

Though the community outreaches are essential to the success of its vision, the most visible aspect of Convoy of Hope is the well- planned and organized response efforts, driven home by its name – its convoys of trucks and volunteers responding to disasters with the aim of delivering physical and spiritual hope in the name of Jesus. 

Mr. Donaldson acknowledges that the highly visible fleet of semi-trucks rushing to the scene of a disaster, as well as the scores of trained volunteers distributing the food, medicine and supplies at disaster scenes is what defines Convoy of Hope. He notes, however, “Our fleet of trucks serves all three divisions. The procurement department (those charged with securing gifts-in-kind from corporations) serves all three as well.” 

Convoy of Hope responded to more than 70 communities impacted by hurricanes during the past several years, deploying millions of dollars of food, water, medical supplies and other essentials, all while employing a volunteer force of roughly 200,000 people and 15,000 organizations. It partners with local churches, the Federal Emergency Management Agency (FEMA), congregational response teams, the Salvation Army, the Southern Baptist’s North American Mission Board, and local organizations. 

It held Outreach efforts in more than 50 U.S. cities (see sidebar) designed to bring churches, community agencies and businesses together to help the poor. 

Through its international efforts, it holds similar but scaled-down events and also responds to disasters with food and supplies, just as it does in the United States. 

All serve to meet the ministry’s mission, explained Mr. Donaldson. “Our motivation is to mobilize the churches and let them see what they can do locally. Internationally, it’s the same thing with missionaries and pastors. Though the ministry operated in more than 40 nations last year, totaling 100 during the life of the ministry, it is feeding as many as 12,000 people a day in El Salvador, Haiti and Kenya, combined. Mr. Donaldson noted that a primary focus in foreign nations is feeding children. “It’s usually done through a school initiative. When kids come to school, we can make sure that they get at least one meal a day.” Food, water and vitamins are distributed, often in partnership with USAID, which provides some funds through grants. 

Still, the ministry’s disaster response remains its most visible aspect, largely because of changing conditions in the last few years. Mr. Donaldson noted, “Disaster response has really changed in recent years. When we started there wasn’t a lot of cooperation and collaboration.” Now, though, agencies such as FEMA “…have done a really good job of bringing a group like ours into the mix.” He continued, “As a result, we’ve become a lot more sophisticated. We’re part of a well-coordinated response.” 

The ministry’s outlook is essential also, said Mr. Donaldson. “When we go in as partners, we ask, ‘How can we help you.’” As a result, in response to Hurricane Katrina, the ministry was able to mobilize 10,000 volunteers to repair about 3,000 homes. He revealed that the ministry initially distributed $35 million worth of wholesale goods with 700 truckloads. He added, “To date, we’ve distributed over $100 million worth of goods from corporate America and helped over 20 million people.” 

He continued, “We did it across denominational lines. Within the church, there are tremendous resources. Within weeks of Katrina, we had mobilized tens of thousands of people. Convoy of Hope was near the top in terms of mobilizing people.” Indeed, the overwhelming needs of Hurricane Katrina led the ministry to develop the H.O.P.E. Begins Here campaign (Helping Other Prepare for Emergencies), which will be launched this spring. Mr. Donaldson explained, “When we went to the Gulf, we spent a great deal of time developing relationships We asked what they needed rather than saying, ‘This is what we’re going to do.’ We asked how we could help in the long-term.” The need for disaster preparedness topped the list, so modeling this new program after their Community Outreach programs, the ministry is working with churches, civic groups, agencies, and corporations to prepare communities for the next disaster. 

Meanwhile, in war-torn Kenya, the ministry has partnered with a husband and wife team that began a school and is helping to clothe and feed 400 to 500 children a day. “It’s just devastated,” said Mr. Donaldson. “There is no sewer system, no water. I’ve been in 60 countries. It’s just one of the poorest places I’ve been. It’s on par with Calcutta.” 

All of these experiences provide learning opportunities, acknowledged Mr. Donaldson. “You learn something every time you do it. We’ve just taken the adage you don’t stop learning.” He pointed to crowd control as one experience from Katrina and the value of combining education and feeding programs as a lesson learned from ministering in other nations “Those are things you learn quickly. We’re learners. We haven’t arrived.” 

While managing volunteers has always proven to be a challenge in ministry, it’s a core mission of Convoy of Hope. He noted that the Community Outreaches provide opportunities for providing training, but acknowledged also that on-the-job training is also necessary, especially in disaster response. He offered, “The results far outweigh the challenges. Anyone can pass out ice or water or a bag of groceries. Just come, we’ll find a way to use you.” 

Mr. Donaldson, who himself was a beneficiary of the generosity of others after his father was killed by a drunk driver in 1969, said that even after so many years of helping people, he still remains motivated, largely from an encounter he had with Mother Teresa in Calcutta. “She challenged me to do something.” In response, he decided to walk streets in eight of the largest cities in the United States. He recalled, “What I saw was incredible need. I saw that the church can play a part in meeting the needs of the cities, but can also partner with others. We can bring hope, we can bring peace to our cities that need fixing. The government should not fear the church and the church should not fear the government. We need to work together to make America a better place.” 

He concluded, “When I met Mother Teresa, I said she was a special woman. She said, ‘No, there are many who do what I do.’ We’ve been privileged to meet them. It has been part of my own personal transformation.” 

© The Barrick Report, 2008. To learn more, email mbarrick@charter.net