DOMINO, NIKKI Y.

4ACN

EMERGENCY AND DISASTER MANAGEMENT JOURNAL

Two words, emergency, and disaster, are scary and send ripples down the spine of everyone. Though emergency is a situation of grave risk to health, life, or environment, and disaster is any phenomenon, natural or man made, that has the potential to cause a lot of destruction of life and property, the mere mention of either of these two words is enough to make people jittery. Yes, emergency and disaster are closely interrelated but there are differences between the two that will be highlighted in this article. Emergency refers to any situation that is threatening and requires quick response from you. When you see a risk to self, property, health or environment, you act hurriedly to prevent any worsening of the situation. However, there are situations that demand fleeing and no action on your part can help mitigate danger to life and property. Emergencies are of all scales and may affect a single individual to an entire population in area. For example, a person who has suffered a stroke may have to be taken to a hospital in time to get him medical care. This is a small-scale emergency as it involves a single individual and perhaps his family. On the other hand, an earthquake or a tsunami that strikes without prior warning is emergency that requires planning and preparedness to save lives and properties. When it comes to defining emergencies, most experts agree that all situations posing danger to human life are regarded as emergencies, while those posing danger to environment, though serious, do not require action as quickly and swiftly as an emergency. It is important to note that some authorities do not consider it an emergency when there is an immediate danger to the life of an animal population. On the other hand, fires, tornadoes, hurricanes that have the potential to sweep across properties are included in emergencies. There are agencies that are involved in management of emergencies and their action is divided into four categories starting from a state of preparedness to a quick response, recovery phase and then finally mitigation. There is another emergency that is called as state of emergency, which is what prompts governments to declare emergency in the state and curtail the rights of individuals. This is an extraordinary step to deal with civil unrest as peoples powers are usurped by the administration. Disaster refers to any man made or natural hazard having potential to cause widespread destruction of property and human lives is considered as a disaster. To common people, a disaster is a phenomenon or event that leaves behind a trail of destruction that also claims human lives. Landslides, earthquakes, fires, explosions, volcanoes, and floods are some of the well-known disasters though of late, terrorism and its related events have caused much more mayhem and destruction than natural disasters. Though, the intensity of a natural disaster may be the same, its after effects are felt more in developing countries than in advanced, developed nations. This is because of both higher density of populations and lesser preparedness in case of third world countries. An earthquake in a developed country causes much less destruction than a similar

DOMINO, NIKKI Y. 4ACN one in a poor country with higher density of population and with houses that have not been designed to face earthquakes. Emergency Management Journal Synthesis The Response to Hurricane Katrina by Donald P. Moynihan Hurricane Katrina was the largest natural disaster in the United States in living memory, affecting 92,000 square miles and destroying much of a major city. Over 1,800 people died and tens of thousands were left homeless and without basic supplies. Katrina evolved into a series of connected crises, with two basic causes. The primary cause was the hurricane itself, but no less important was the collapse of man-made levees meant to protect a city built below sea-level. Any consideration of Katrina must acknowledge that the impact of Katrina was great not primarily because of human failures, but because of the size and scope of the task. Good management might modify disasters, but cannot eliminate them. Nevertheless, it is clear that better coordination among the network of responders, a greater sense of urgency, and more successful management of related risk factors would have minimized some of the losses caused by Katrina. The type of risk deficits identified by this paper are relatively broad, and are likely to be relevant to many of the type of complex crises that Lagadec [2008] identifies as increasingly common. Many of the lessons that emerge from the case draw directly from the deficits identified. But there are some additional lessons. Katrina also occurred in the policy aftermath of 9/11, and illustrated how new policies and structures of crisis response that occurred after that event not only failed, but may have made the response to Katrina worse, causing confusion about roles and responsibilities, and limiting the ability of leaders to make sense or non-terrorist events. The paper also suggests the benefits of considering the collective set of crisis responders as a network, with varying degrees of connectivity [Moynihan, 2007; 2008]. Two additional observations arise from this perspective. The capacity of the overall network depends a great deal on the capacity of hub members. Since hubs such as FEMA have mandated responsibilities, they cannot be easily removed from the network if their performance falters. This implies that attention should be given to maintaining the capacity of hubs consistent with their disproportionate influence on the overall network. A network perspective also underlines how more emergent actors, typically voluntary actors from the private or non-profit sectors, are largely disconnected from network hubs, and therefore struggle to coordinate with other responders. But these players provide vital support and cannot be ignored. Crisis managers need to do more to incorporate these actors into the network before the disaster occurs.

DOMINO, NIKKI Y. 4ACN Disaster Management Journal Synthesis Disaster and Mass Casualty Management: A Commentary on the American College of Surgeons Position Statement by Eric R Frykberg, MD, FACS On September 11, 2001, the United States was dealt a body blow from which we are still recovering. Beyond the ruthlessness and evil of the attacks on the World Trade Center and the Pentagon, and the tragic loss of innocent lives, was our realization of how nave and unprepared we were for the consequences of terrorism that much of the rest of the world experiences regularly. We had developed complacency as to our invulnerability to such attacks, feeling that terrorist activity only affects others in faraway places. We felt no motivation to plan for such attacks or their prevention, as much of the rest of the world does with greater effectiveness. Certainly the American medical community recognized its disturbing lack of preparedness and experience in caring for the victims of mass casualty disasters after 9/11, as it did following the Oklahoma City bombing 6 years before and the World Trade Center bombing 8 years before. It is clear that managing large numbers of acutely injured victims who present all at once involves principles quite different from our everyday management of injured patients. These must be learned as a new and distinct skill set through an intense educational effort if we are to reach the proper levels of medical preparedness for terrorist events. The American College of Surgeons has adopted the accompanying position statement, as drafted by the Committee on Trauma, to emphasize and justify the importance of surgical involvement in all disaster efforts, and to assert its commitment to achieving this goal. The statement also makes the point that surgeons must work as part of a large multidisciplinary team if we are to succeed in disaster management. The College, through the Disaster and Mass Casualty subcommittee of the Committee on Trauma, has already made great headway in developing liaisons with a number of important organizations involved in disaster planning and management, including the National Disaster Medical System, the Centers for Disease Control and Prevention, the Oklahoma State Injury Prevention Office, the American Public Health Association, the American College of Emergency Physicians, the National Association of EMS Physicians, the U.S. military, and the Department of Homeland Security. Several educational products and programs arising from these relationships have already been developed or are in development, and are being made available through the American College of Surgeons Web site. We in the surgical community have a lot of catching up to do, but progress is being made. All surgeons are encouraged to become active in their own community disaster planning programs, and we invite all interested surgeons to participate in the Colleges activities to foster widespread understanding of disaster management. Mass casualties after disasters are characterized by such numbers, severity, and diversity of injuries that they can overwhelm the ability of local medical

DOMINO, NIKKI Y. 4ACN resources to de- liver comprehensive and definitive medical care to all victims. Surgeons traditionally have played an important role in disaster response. The training and skills of surgeons, and the resources and infrastructure of trauma centers and trauma systems, are especially suited to the logistical demands and rapid decision-making required by large casualty burdens following both natural disasters and man-made (biologic, nuclear, incendiary, chemical, and explosive [BNICE]) disasters. The American College of Surgeons believes that the surgical community has an obligation to participate actively in the multidisciplinary planning, triage, and medical management of mass casualties after all disasters. Surgeons should provide leadership at the community, regional, and national levels in disasters involving physical trauma to casualties that will likely require surgical intervention and management (ie, explosions, structural collapses, shootings, fires, and large-scale vehicular accidents). Disaster management poses challenges that are distinct from normal surgical practice. It requires a paradigm change from the application of unlimited re- sources for the greatest good of each individual patient, to the allocation of limited resources for the greatest good of the greatest number of casualties. This is achieved most effectively by planning and training for disasters, through both internal hospital drills and regional exercises involving all community resources. Res- cue, decontamination, triage, stabilization, evacuation, and definitive treatment of casualties all require the smooth integration of multidisciplinary local, state, and federal assets. This would include (but not be limited to) prehospital services, the media, emergency management and public health agencies, transportation and communication resources, the military, and health care delivery facilities and personnel. The medical management of mass casualties is only one of many critical functions involved in the overall response to a disaster. It is incumbent on all surgeons to attain an appropriate level of education and training in the unique principles and practices of disaster and mass casualty management, and to serve as role models in this field. The American College of Surgeons is committed to providing the leadership and resources necessary to achieve this goal.