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All Hazards Planning All Hazards Planning
Edward P. RichardsEdward P. RichardsDirector, Program in Law, Science, and Public HealthDirector, Program in Law, Science, and Public Health
Harvey A. Peltier Professor of LawHarvey A. Peltier Professor of LawLSU Law CenterLSU Law [email protected]@lsu.edu
http://http://biotech.law.lsu.edu/cphl/Talks.htmbiotech.law.lsu.edu/cphl/Talks.htm
TopicsTopics
What is an All Hazards plan?What is an All Hazards plan?What are the elements of an All Hazards What are the elements of an All Hazards
plan?plan?Why is All Hazards planning necessary?Why is All Hazards planning necessary?ExamplesExamples
Preparing for bird fluPreparing for bird fluEvacuation of New Orleans for KatrinaEvacuation of New Orleans for Katrina
Episode-based PlansEpisode-based PlansPlans to PlanPlans to Plan
Episode-based plansEpisode-based plansBird flu plansBird flu plansAnthrax plansAnthrax plansBomb plansBomb plans
Plans to planPlans to planWhat you need to think about, not what you What you need to think about, not what you
need to doneed to doNo operational detailNo operational detail
What is an All Hazards Plan?What is an All Hazards Plan?
A unified plan that, as much as possible, A unified plan that, as much as possible, uses common strategies for emergency uses common strategies for emergency responseresponse
Emergency response is built on day-to-day Emergency response is built on day-to-day procedures and resourcesprocedures and resources
All Hazards plans are operational plansAll Hazards plans are operational plansThey tell you what to do, not just what to planThey tell you what to do, not just what to plan
The public is fully informed and an integral The public is fully informed and an integral part of the emergency response part of the emergency response
Elements of an All Hazards PlanElements of an All Hazards Plan
Analysis of common factors in the different Analysis of common factors in the different types of emergenciestypes of emergencies
Relation of these common factors to Relation of these common factors to routine proceduresroutine procedures
Modification of existing procedures to Modification of existing procedures to incorporate elements that will be needed incorporate elements that will be needed in emergenciesin emergencies
Public information and educationPublic information and education
ExampleExample
Transforming a Bird Flu Transforming a Bird Flu Plan into an All Hazards Plan into an All Hazards
PlanPlan
Episode Planning: Bird FluEpisode Planning: Bird Flu
Plans for emergency quarantinePlans for emergency quarantinePlans for ethical guidelines on vaccine Plans for ethical guidelines on vaccine
allocationallocationPlans for stockpiles of PPEPlans for stockpiles of PPEPlans to work with public health, including Plans to work with public health, including
an MOU that says we will play nicelyan MOU that says we will play nicelyPlans for how to plan to handle the SNSPlans for how to plan to handle the SNSMaybe some training on how to put on a Maybe some training on how to put on a
maskmask
All Hazard Planning: Bird FluAll Hazard Planning: Bird Flu
What are core problems?What are core problems?Protecting staff from infectionProtecting staff from infectionAssuring adequate staff for operationsAssuring adequate staff for operations
What are related issues?What are related issues?Yearly flu pandemicYearly flu pandemicExposure to tuberculosis and other Exposure to tuberculosis and other
communicable diseases in the workplacecommunicable diseases in the workplace
All Hazards Recommendations:All Hazards Recommendations:VaccinationsVaccinations
Assure vaccination status of employeesAssure vaccination status of employeesMumps, measles, etc, which can disable a Mumps, measles, etc, which can disable a
forceforceYearly fluYearly flu
Benefits Benefits Reduction in lost time from workReduction in lost time from workReadiness if there is an outbreakReadiness if there is an outbreakResolves individual and union opposition to Resolves individual and union opposition to
vaccination before there is an emergencyvaccination before there is an emergency
All Hazards Recommendations:All Hazards Recommendations:Working SickWorking Sick
US culture and especially law enforcement US culture and especially law enforcement encourages people to work sickencourages people to work sickLimits on sick daysLimits on sick daysRules that you cannot be on special teamsRules that you cannot be on special teams Increases the spread of diseases such as the Increases the spread of diseases such as the
flu in the workplaceflu in the workplaceSet up criteria for exclusion of contagious Set up criteria for exclusion of contagious
workersworkersChange work rules to eliminate Change work rules to eliminate
punishment for being excluded so punishment for being excluded so employees will not hide illnessemployees will not hide illness
All Hazards Recommendations:All Hazards Recommendations:Personal ProtectionPersonal Protection
Key personal protectionKey personal protectionhand washinghand washingbehavior limitations - handshaking, etc.behavior limitations - handshaking, etc.goggles, masksgoggles, masks
RecommendationsRecommendationsTrain and equip all officersTrain and equip all officersUse these for regular flu and other possible Use these for regular flu and other possible
disease exposuresdisease exposuresMake behavioral modifications so these Make behavioral modifications so these
become routinebecome routine
All Hazards Recommendations:All Hazards Recommendations:Public InformationPublic Information
There maybe a need to limit travel or impose There maybe a need to limit travel or impose home quarantinehome quarantine
The public should be educated about all aspects The public should be educated about all aspects of these possible limitationsof these possible limitations What is their role?What is their role? Why is it important?Why is it important? How will essential services be provided?How will essential services be provided? How will you assure families will not be separated?How will you assure families will not be separated?
This will identify problematic areas and reduce This will identify problematic areas and reduce confusion in an emergencyconfusion in an emergency
All Hazards Planning:All Hazards Planning:GeneralizationGeneralization
Staffing in emergenciesStaffing in emergenciesAny emergency that threatens the general Any emergency that threatens the general
public will threaten the employees familiespublic will threaten the employees familiesYou have to provide for the families if you You have to provide for the families if you
want staff to show upwant staff to show upDevelop a general plan for family issuesDevelop a general plan for family issues
Evaluation: Evaluation: Episode Based PlanningEpisode Based Planning
Episode based plans are invisible until Episode based plans are invisible until there is an emergencythere is an emergencyThese are very low probability eventsThese are very low probability eventsThe only testing is by artificial exercisesThe only testing is by artificial exercises
Quality control theory (Demings, etc.)Quality control theory (Demings, etc.)You can only achieve quality through iterative You can only achieve quality through iterative
improvement based on data analysis and improvement based on data analysis and feedbackfeedback
This is impossible with an episode based planThis is impossible with an episode based plan
Evaluation: Evaluation: All Hazards PlanningAll Hazards Planning
All Hazards planning does fit the criteria All Hazards planning does fit the criteria for proper quality controlfor proper quality controlElements of the plan are in operation at all Elements of the plan are in operation at all
timestimesThis provides intermediate data, i.e., things to This provides intermediate data, i.e., things to
measure short of a disaster happeningmeasure short of a disaster happening Improves routine operationsImproves routine operations
There is almost no data on communicable There is almost no data on communicable diseases in the law enforcement workplacediseases in the law enforcement workplace
Assumptions Behind All Hazards Assumptions Behind All Hazards PlanningPlanning
Equipment and materiel that is not Equipment and materiel that is not routinely exercised will not be maintained routinely exercised will not be maintained and will not function when neededand will not function when needed
Emergencies are the worst time to change Emergencies are the worst time to change proceduresprocedures
Public cooperation depends on pre-event Public cooperation depends on pre-event education and buy-ineducation and buy-in
Political RealityPolitical Reality
The public (legislatures) have a short The public (legislatures) have a short attention span and will not support attention span and will not support emergency response once they move on emergency response once they move on to the next crisis de jureto the next crisis de jure
Reality Check:Reality Check:23 states, including most of the most 23 states, including most of the most
populous, have done away with mandatory populous, have done away with mandatory childhood vaccinationschildhood vaccinations
We are in the middle of a mumps epidemic in We are in the middle of a mumps epidemic in the Midwest - are your employees the Midwest - are your employees vaccinated?vaccinated?
Lessons from KatrinaLessons from Katrina
The Blind Men and the ElephantThe Blind Men and the Elephant
Why the Evacuation FailedWhy the Evacuation Failed
Transportation IssuesTransportation IssuesSurface CausesSurface Causes
Evacuation not triggered until too lateEvacuation not triggered until too lateNo provision for moving folks without No provision for moving folks without
transportationtransportationWhen transport was available - school When transport was available - school
busses - there was no provision for driversbusses - there was no provision for driversNo provisions for jails and hospitalsNo provisions for jails and hospitalsNo provision for secondary evacuation No provision for secondary evacuation
form the Superdome and other facilitiesform the Superdome and other facilities
Transportation Issues:Transportation Issues:Surface SolutionsSurface Solutions
Better plansBetter plansMore modes of transportationMore modes of transportationEarlier evacuationsEarlier evacuations "Manditory" evacuations"Manditory" evacuations
All sound, but all miss the pointAll sound, but all miss the point
Transportation Issues:Transportation Issues:Root CausesRoot Causes
New Orleans has flooded frequentlyNew Orleans has flooded frequentlyMost of the land that flooded is reclaimed Most of the land that flooded is reclaimed
bay and swamp that is up to 20 feet below bay and swamp that is up to 20 feet below sea level, not historic New Orleanssea level, not historic New Orleans
People lived next to levees with water 5 People lived next to levees with water 5 feet over street level every dayfeet over street level every day
Flood insurance was not required because Flood insurance was not required because it was assumed that the levees could not it was assumed that the levees could not breakbreak
The Implications of a Real The Implications of a Real EvacuationEvacuation
The only reason to really evacuate is if the The only reason to really evacuate is if the levees fail, which was ruled outlevees fail, which was ruled outThe Superdome and shelters of last resortThe Superdome and shelters of last resortDelaying the call for evacuationDelaying the call for evacuation
Why?Why?40 years of false alarms40 years of false alarmsAdmitting the levees could fail would destroy Admitting the levees could fail would destroy
the real estate values in New Orleansthe real estate values in New OrleansRoutine serious evacuations destroy businessRoutine serious evacuations destroy business
The Real Lessons from KatrinaThe Real Lessons from Katrina
Plans based on politically unacceptable Plans based on politically unacceptable actions will not be carried outactions will not be carried out
Long term prevention loses out to short Long term prevention loses out to short term economic and political considerationsterm economic and political considerationsDo not build in dangerous areasDo not build in dangerous areasRequire realistic risk analysis for insuranceRequire realistic risk analysis for insurance Do not downplay risks that cannot be Do not downplay risks that cannot be
managedmanaged
How Would All Hazards Planning How Would All Hazards Planning Have Changed the Outcome?Have Changed the Outcome?
Focus would have been on the risks of living Focus would have been on the risks of living below sea level, not just on the evacuationbelow sea level, not just on the evacuation
Planning would have explicitly included levee Planning would have explicitly included levee failurefailure Flood insuranceFlood insurance Business interruption insuranceBusiness interruption insurance Meeting appropriate life-safety codes for hospitalsMeeting appropriate life-safety codes for hospitals Personal evacuation planningPersonal evacuation planning
Addressing these would have changed the Addressing these would have changed the political dynamic, allowing a proper evacuationpolitical dynamic, allowing a proper evacuation