Plan Nationally, Respond Locally

The newly released National Response Framework (NRF) attempts to fill some of the readiness gaps exposed by Hurricane Katrina and other disasters that have taken place over the past several years. It starts by providing a structure for combining the efforts by the many agencies and levels of government during a catastrophe. And its first three chapters focus on three specific questions of the response equation: “How?”, “What?”, and, of particular importance, “Who?” 

Through initiatives such as Ready.Gov the Federal Emergency Management Agency (FEMA) has been emphasizing the importance of individual and household preparedness, taking the common-sense position that being prepared is first of all a personal responsibility. The NRF builds on the foundation of individual resilience postulated by FEMA by addressing the roles and responsibilities of the local, county, and state levels of government.

Special care has been taken to avoid dictating to state and local authorities, and allowing local structures to prevail. Nonetheless, the NRF does define the specific responsibilities of the agencies and officials most likely to be involved in response operations. This post-Katrina document also makes it clear, moreover, that the federal government will not always wait to be requested (as happened in the aftermath of Katrina) before responding.

An Equal-Opportunity Definition of Disasters

Unlike its predecessor, the original National Response Plan, the NRF does not draw a distinction between “Incidents of National Significance” and other events of seemingly lesser magnitude. For those involved in the on-the-scene efforts in the wake of a mass-casualty incident of any type this recognition that all events begin and end locally is a significant step forward.

One of the major failings of most if not all emergency-management and -response agencies has been that they group their policies and procedures into two separate heaps: (a) traditional day-to-day tasks and responsibilities; and (b) true disaster-response situations. The advantage of closing this previous divide is that on-the-scene operational staff are now no longer forced to switch between two sets of procedures but, rather, can follow the basics of more or less the same plan every day. By doing so, local and state decision makers still are able to introduce new plan elements or embellishments – but without having to shift gears into a disaster-plan format at the same time.

An important step in making the new system work is the requirement to break plans down into goal-oriented tools such as what are called PMAs (Pre-Scripted Mission Assignments). The PMAs break large plans down into smaller elements that can be used in a variety of situations. For example, rather than developing both a pandemic influenza plan and a smallpox plan, the working staff will have available a collection of basic PMAs that can be used in almost any type of hazard situation.

Thanks to the introduction of the new framework, a preparedness plan now might call for the typical county warehouse – which stores and delivers day-to-day supplies to county facilities – also to provide storage and delivery services for vaccines during an influenza pandemic. Under the framework, this component of the plan would be available for use as a more generic materials-distribution plan and, as such, could be used whether the supplies that have to be delivered are paper, vaccines, road flares, or any of a broad spectrum of the numerous other supplies and materials needed in most emergency situations. If nothing else, this fundamental change relieves local officials of having to create a separate distribution plan for each of the materials stored.

Three Sames, and a Helpful Bonus

By following the same materials-handling model, filling in the same paperwork, and using the same response personnel every day – and applying these common denominators to disaster-response situations – the warehouse staff becomes emergency-ready simply by showing up ready to work.

A bonus factor to be considered is that the working staff will also now have a solid basis for decision making during high-stress situations. As a result, when extra training is needed – for example, in observing the precautions mandated for the handling of smallpox vaccine – the staff is much less likely to be overwhelmed by examining anew the information that previously may have been used or discussed only once or twice a year in training sessions.

In short, the development and promulgation of the new National Response Foundation is not only a major step forward, but also a step in the right direction – one that encourages decision makers to adjust their thinking, both: (a) by creating tools that can be employed under any circumstance; and (b) by not changing certain events into unique incidents that require the development of special customized plans. However, this new tool-based model for planning does allow emergency planner to focus on what is truly unique about each hazard that might be encountered, rather than creating an entirely new scenario to deal with each separate incident.

Joseph Cahill
Joseph Cahill

Joseph Cahill is the director of medicolegal investigations for the Massachusetts Office of the Chief Medical Examiner. He previously served as exercise and training coordinator for the Massachusetts Department of Public Health and as emergency planner in the Westchester County (N.Y.) Office of Emergency Management. He also served for five years as citywide advanced life support (ALS) coordinator for the FDNY – Bureau of EMS. Before that, he was the department’s Division 6 ALS coordinator, covering the South Bronx and Harlem. He also served on the faculty of the Westchester County Community College’s paramedic program and has been a frequent guest lecturer for the U.S. Secret Service, the FDNY EMS Academy, and Montefiore Hospital.



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