Planning for Recovery: The Public Health Perspective

Public health agencies at all levels have extensive experience recovering from disasters, mostly without the benefit of a pre-disaster recovery plan. Established guidance from a number of federal agencies coupled with an inclusive planning process can help public health agencies ensure that they and the critical services they provide are resilient after a disaster.

As the coordinating agencies for Emergency Support Function 8 (ESF-8) (Public Health and Medical Services), many state and local public health agencies have fought to determine their role in planning for recovery. With the variety of governmental and nongovernmental partners that generally support ESF-8, planning for recovery can be a daunting process. As a result, there is a vast range in the level of preparedness for recovery among health departments across the nation.

A Disaster Recovery Focus Group, convened by the National Association of County and City Health Officials, recently delved into the many ways in which local public health agencies across the country are tackling recovery planning. Although many have a good deal of real-world experience recovering from major disasters, a large number did so without the benefit of a detailed pre-disaster recovery plan. With the variety of guidance available, though, there is no shortage of information to help prepare for recovery.

Recovery Planning 101 Since its release in September 2011, the National Disaster Recovery Framework (NDRF) has sought to “promote effective recovery, particularly for those incidents that are large-scale or catastrophic” by defining principles, roles, and responsibilities, coordinating structures, and guidance for pre- and post-disaster recovery planning. The Centers for Disease Control and Prevention (CDC) Public Health Preparedness Capability 2: Community Recovery describes how public health emergency managers at all levels should collaborate with their partners to facilitate the rebuilding of public health systems after a disaster. This CDC capability also provides guidance on how best to ensure the provision of critical public health and medical services in the community.

Recovery for healthcare systems, a critical component of the local public health and healthcare infrastructure, is guided by the Office of the Assistant Secretary for Preparedness and Response’s (ASPR) Hospital Preparedness Program (HPP) in its version of Capability 2: Healthcare System Recovery. ASPR developed additional Healthcare COOP (Continuity of Operations) and Recovery Planning guidance in January 2015.

Planning Together for Recovery In many jurisdictions, recovery planning is guided by, and performed under, the auspices of the local emergency management agency. By being locally driven, the importance of developing a pre-disaster recovery plan rises and,eally, encourages emergency management agencies to use the existing guidance documents and develop comprehensive and inclusive plans. Local agencies can better link the pre-disaster recovery plan to the jurisdiction’s emergency operations plan, a document that is most-often maintained by the local emergency management agency. The emergency operations plans in most local jurisdictions are used to manage their responses to major emergencies, which facilitates a more seamless transition from response to recovery operations.

In addition, the use of ESFs and the integration of the Recovery Support Functions (RSFs) into the local pre-disaster recovery plan are best achieved through a collaborative planning process at the local level. Such collaboration ensures that the ESF coordinating and supporting agencies can be incorporated into the planning process for the pre-disaster recovery plan. The natural alignment of ESFs and RSFs is much easier to achieve when approached longitudinally. In other words, logical choices about who should be responsible for the various RSFs can be informed by who leads the closely related ESF. Since the transition from response to recovery can be a blurred line, with overlap inevitable, it is invaluable to effective recovery planning to understand the parallel nature of these efforts.

One Jurisdiction’s Experience In late 2009, Fairfax County, Virginia, which is part of the National Capital Region, became one of the first jurisdictions in the nation to embark on a pre-disaster recovery planning effort. A steering committee – representing governmental and nongovernmental stakeholders, including local elected officials and chambers of commerce – guided the project, which was overseen by the Fairfax County Office of Emergency Management (OEM) and supported by Witt Associates. The multiyear process resulted in a robust plan and a series of validation exercises that involved literally hundreds of stakeholders.

Fairfax modified the structure outlined in the NDRF by: (a) changing RSFs to recovery groups and using a branch structure to bring together analogous recovery groups; as well as (b) expanding the list of recovery groups to make the plan more robust and locally flavored. This modification has the Fairfax County Health Department – the county ESF-8 lead – coordinating two recovery groups and supporting five others. The creation of a recovery group to address the unique challenges of recovering from a biological or radiological incident – co-led by the fire and rescue and health departments – was one positive outcome of modifying the federal guidance. The other was the creation of a health and medical recovery group that focuses specifically on the complicated process of ensuring post-disaster public health service delivery, including the mobilization of service and information centers in affected communities.

The plan introduced the concept of a recovery agency – a temporary organization charged with recovery – accountable to an appointed recovery coordinator and recovery policy board. The composition of this recovery agency is dictated by the type of disaster and its impact on the county. The entire recovery organization reports to the county executive and the county board of supervisors, thus ensuring transparency and accountability.

The plan describes the process for how the response-phase incident command structure will transition to the recovery-phase organization, including the incorporation of recovery-phase command and general staff members into the response-phase organization to help ensure continuity and a more seamless transfer of command. It also allows for the gradual demobilization of response-phase leadership not being utilized in the recovery agency by allowing them to train the incoming recovery agency leadership before transitioning out of the response.

Further validation, including an upcoming operations-based exercise, and a subsequent review and revision of the plan based on the after-action review process, will help Fairfax County become better prepared to recover from disasters. Although the county has not had to operationalize recovery on a large-scale, several smaller-scale incidents – especially the 2012 Derecho storm, which impacted a number of healthcare facilities – provided a real-world opportunity for ESF-8 to collaborate in the response and recovery phase. These opportunities led to successful outcomes and additional planning to ensure that all ESF-8 partners are prepared to recover from emergencies large and small.

Marc Barbiere

Marc Barbiere has served as the emergency management coordinator for the Fairfax County Health Department since 2009, overseeing the agency’s emergency management program. Prior to that, he served close to 20 years in public safety, public health, and emergency management in New York City. He has a master’s degree in public health, and is both a Certified Emergency Manager (CEM) and a Virginia Professional Emergency Manager (VPEM).



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