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 Centerrichards@lsu.edurichards@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