All disasters are local. Regardless of type, magnitude, or progression, disasters affect communities. Community responders will be the first on the scene and will remain for recovery operations well after supporting resources and organizations have departed.
Depending on the type of disaster, various government, public, and private organizations responsible for public safety, public security, and infrastructure maintenance will be tasked to save lives, preserve property, and identify and rebuild essential services for the population served. Prioritizing and coordinating these missions will require collaboration, cooperation, and understanding on the part of the leadership and membership of these response and recovery organizations.
In general, these services are organized in the United States within a jurisdictional framework, and overall coordination falls to the governing entity of the affected jurisdiction. Unfortunately, these government systems are not identically established throughout the United States. The general framework usually involves metropolitan areas (e.g., cities, towns) within a county, which is within a state. However, many “states” are in fact commonwealths, counties may be supplanted by parishes, and some states recognize townships or independent cities not subordinate to surrounding counties.
Thus no single description of local response can be provided that is applicable to all localities. Rather, this chapter will address functional entities and notional organizational structures, processes, and responsibilities; concepts, rather than specifics, will be emphasized.
Local governance
Protection, prevention, and response to emergencies and disasters are well-recognized government responsibilities. Depending on a number of factors, local jurisdictions either have systems in place for emergency response or band together with neighboring communities to provide overall emergency management to a larger constituency. Certainly, jurisdictions with substantial populations tend to establish discrete offices, referred to herein as emergency management offices, to provide coordination for prevention, mitigation, planning, and response functions.
However, even in those discrete jurisdictional areas, there might be multiple government entities involved that provide similar services. Law enforcement is but one example. Cities usually have a discrete police department, with the chief of police reporting to the city governing entity (e.g., mayor, city council). However, if that city is within a recognized county, certain law enforcement responsibilities, even within city limits, may fall to the county sheriff’s office, and state police might be tasked with other or overlapping duties. The city might also harbor a local Federal Bureau of Investigation (FBI) office with federal law enforcement and investigatory responsibilities, and should that community include ports of ingress, or abut an international border, other federal law enforcement entities, such as U.S. Customs and Border Protection or U.S. Citizenship and Immigration Services, may have certain authorities within the jurisdiction.
Responsibilities become even more confusing when applied to public health and medical services. All states have a division or department of public health that usually falls within the executive branch of the state government. A public health infrastructure, which may contain regional, county, district, and city public health offices, usually exists. Members of the public health organization are usually state employees. Medical care, on the other hand, may fall within the responsibilities of a variety of organizations. There are very few public health hospitals left in the United States, and most inpatient care is provided through private, for-profit and not-for-profit, hospitals that do not limit their services to discrete jurisdictional boundaries. There are, however, many veterans and military hospitals in communities throughout the country, and these facilities could be either affected by local disasters, or have resources that could, under the right circumstances, be available to assist in response. Physician offices and independent clinics outside of any one hospital’s organization are common in all communities. Increasingly, freestanding laboratories, diagnostic centers, and other health care services also exist that are not part of larger health care systems, but they do form part of the health care network. Emergency medical services (EMS) and emergency ambulance services may be provided by fire services, discrete government entities, hospitals, or contracted providers, and multiple EMS providers may support individual or multiple jurisdictions. EMS (and fire services) may be agencies with paid career staff, volunteer groups, or composites. Statewide, EMS may fall within the public health department, emergency management agency, or another state organizational construct. In addition to EMS, many jurisdictions also have private ambulance transport services with licensed or credentialed emergency medical technicians (EMTs).
Under the paradigm of the National Response Framework (NRF), there are 15 essential functions that potentially are required in the event of a disaster. In the case of federal support, a discrete federal agency or organization has been identified as the primary coordinating entity for providing each functional area support to state and local governments. (Note that several states have additional, state-level essential functions beyond these 15.) These 15 essential functions, with the usual local entity responsible for their provision, are outlined in Table 15-1 . What is most important is not the specific organization, because this may vary with the jurisdiction, but that, at the local level, some organization or entity has been (or should be) assigned the principal coordinating responsibility and has the necessary resources (material, manpower, and economic) to provide for the reestablishment and maintenance of these services under emergency conditions or has the processes and framework to request, acquire, and incorporate outside resources into this functional organization.
| Function | Responsible Organization |
|---|---|
| Transportation | Public works department |
| Communications | * |
| Public works | Public works department |
| Firefighting | Fire and emergency services department |
| Emergency management | Local emergency management agency |
| Mass care | * |
| Public health and medical | Jurisdictional public health department |
| Resource support | Various |
| Urban search and rescue | Fire and emergency services department |
| Oil spills and HazMat | Fire and emergency services department |
| Agriculture and natural resources | * |
| Energy | * |
| Public safety and security | Jurisdictional law enforcement organizations |
| Recovery and mitigation | Various |
| External communications | Area emergency warning agency |
* This function is not typically a responsibility of a local jurisdictional office or entity or is not provided by government.
Perusal of Table 15-1 will make it clear that not only are multiple, disparate local government agencies and organizations crucial to emergency management, but that participation may be necessary with nongovernment and industry organizations if the response is to be fully effective. Power, light, and natural gas resources and services are provided almost exclusively by private corporations. Crucial communications with the public will entail cooperation by local news media organizations and telecommunications corporations.
Supporting organizations and capabilities
It is clear from the discussion above that a full accounting of all local resources is imperative during preparation and planning for emergency response. The most common forum in which this occurs is through local emergency preparedness committees (LEPCs). LEPCs and state emergency response commissions (SERCs) are mandated by the Emergency Planning and Community Right-to-Know Act. The act requires each state to set up an SERC. All 50 states and the U.S. territories and possessions have established these commissions. Indian tribes have the option to function as an independent SERC or as part of the state SERC in the state in which the tribe is located. This can at times present complications, in that certain tribal lands fall within more than one state.
In some states, the SERCs have been formed from existing organizations, such as state environmental, emergency management, transportation, or public health agencies. In others, they are new organizations with representatives from public agencies and departments and various private groups and associations.
Duties of SERCs include the following:
- •
Establishing local emergency planning districts
- •
Coordinating activities of the LEPCs
- •
Reviewing local emergency response plans
- •
Monitoring legislation and information management concerning hazardous materials
- •
Maintaining situational awareness of locations of all major quantities of defined toxic industrial materials
- •
Establishing procedures for receiving and processing public requests for information collected under the Emergency Planning and Community Right-to-Know Act
- •
Taking civil action against facility owners or operators who fail to comply with reporting requirements
LEPCs normally include elected officials and representatives of law enforcement, civil defense, fire services, EMS, public health, local transportation agencies, communications and media organizations, facilities involved with the handling of toxic industrial materials, and the medical community. Others from the public at large may also be included. The primary responsibility of an LEPC is to plan, prepare for, and respond to chemical emergencies. LEPCs must identify and locate all hazardous materials, develop procedures for immediate response to a chemical accident, establish ways to notify the public about actions they must take, coordinate with corporations and plants that harbor toxic industrial materials, and schedule and test response plans. An LEPC also receives emergency releases and hazardous chemical inventory information submitted by local facilities and must make this information available to the public. An LEPC serves as a focal point in the community for information and discussions about hazardous substances, emergency planning, and health and environmental risks.
Local resources
The Metropolitan Medical Response System (MMRS) Program was established under federal auspices in the late 1990s. One of the many goals of the MMRS Program is to coalesce all potential public health and medical response capabilities into collaborative functional areas. In the case of health and medical support, this extends far beyond the traditional boundaries of EMS, hospital-based care, and local-jurisdiction public health. Under the MMRS paradigm, one or multiple jurisdictions could join together to optimize the use of resources along a more regional approach, to the benefit of all. The ability of all functional elements of response to surge capabilities and capacity in reaction to an emergency cannot be overemphasized. Failure of complementary surge in even one sector can result in bottlenecks and lack of optimal response across the spectrum.
In addition to traditional entities and organizations, there is a wealth of additional resources that could be brought to bear in the event of a public health emergency or other disaster with significant health effects. These range from private organizations, corporations, and other business ventures to the recruitment of appropriate volunteers, either from volunteer organizations or the public at large. A partial listing of these other medical or paramedical resources is included in Box 15-1 . Important in local planning are the recruiting, training, and cataloging of all potential participatory organizations, entities, and individuals; cooperative planning on best use of these resources; and the training of these individuals and organizations to produce a cohesive response organization. Convergent volunteerism is an important adjunct to area emergency managers, but planning for utilization of these resources is a necessity for their optimal use. Indeed, uncoordinated and uncontrolled convergent volunteerism can lead to casualties among the volunteers themselves.
Related posts:
Role of Emergency Medical Services in Disaster Management and Preparedness
Psychological Impact of Disaster on Displaced Populations and Refugees of Multiple Traumas
Selected Federal Disaster Response Agencies and Capabilities
Occupational Medicine: An Asset in Time of Crisis
Needs Assessment
Operations and Logistics
Full access? Get Clinical Tree
