Organizational Structures for Emergency Preparedness − Rakyat Biologi

There are many organizational structures that have been developed to support emergency response to environmental hazards. Three of the most important are the Metropolitan Medical Response System (MMRS), Urban Areas Security Initiative (UASI), and National Incident Management System (NIMS). MMRS and UASI are federally funded programs that support interjurisdictional collaboration. NIMS includes a standardized structure for emergency preparedness and response titled the Incident Command System (ICS) that must link effectively to the jurisdiction’s Emergency Operations Center (EOC). Each of these organizational structures is discussed below.

Metropolitan Medical Response System

The Metropolitan Medical Strike Team program was initiated in 1997 by the Department of Health and Human Services (DHHS), Office of the Assistant Secretary for Public Health Emergency Preparedness. The program quickly changed its designation to the Metropolitan Medical Response System to reflect both integration into local incident management systems and the extensive involvement of multiple governments, not just municipal agencies but also private sector organizations. Of the original 26 MMRS cities established before 1999, only two (Atlanta, Georgia, and Washington, D.C.) retained the strike team framework. In March, 2004, 124 city and regional MMRS programs had been established. These tend to be concentrated in high population density areas and other areas that are high probability terrorist targets, but 43 states have at least one MMRS program, yielding very broad geographic coverage and high levels of national population coverage.

The initial purpose of the MMRS program was to enhance local efforts to manage very large mass casualty incidents arising from terrorists’ use of weapons of mass destruction (Perry, 2003). In part the program mission was driven by the realization that, for local governments, specialized federal assets for terrorist attacks are 48-72 hours away even under the best of circumstances. The MMRS program goal is to ensure cities can operate independently until support arrives and develop a strong local incident management system that can effectively and efficiently integrate specialized extra community (especially federal) resources. Unlike many federal programs, the MMRS purpose statement has evolved over time, largely in ways that emergency managers consider constructive. The focus has come to include CBR agents as well as any other agent (natural or technological) that could produce large numbers of casualties; it has become firmly established as an all hazards program. Perhaps the two most distinctive features of the MMRS program from a local government perspective are funding and organization. DHHS allocated funds directly to cities, eliminating concerns about funding losses to intermediate government levels and increasing purchasing flexibility for municipalities. The organizational constraint is that focal cities must create programs that include broad participation by municipal departments (not just fire and police), as well as county and state agencies and the private sector (e.g., hospitals). Although the funding conditions are generally considered a blessing, the organizational issues have been treated as (and undoubtedly are) significant challenges.

The most significant feature of an MMRS is that it links multiple response systems. Horizontal linkages involve first responders (e.g., firefighters, hazmat technicians, technical rescue technicians, emergency medical personnel), public health, emergency management, law enforcement, and medical and behavioral health services. There also are vertical linkages; for example, public health participation involves city, county, and state agencies. Also, private sector organizations are included in the planning process to establish contact with hospital emergency departments, environmental cleanup companies, ambulance systems, funeral director associations, and similar organizations that provide critical services in mass casualty incidents. MMRS cities must also plan for receipt and integration of important federal assets by building a relationship with the National Disaster Medical System (NDMS) and developing a capacity to receive pharmaceuticals from the national stockpile, as well as other specialized assets from a variety of federal programs.

Whether by design or not, the MMRS program has imposed a comprehensive emergency management process on recipient cities. Municipalities are required to operate an incident management system; link it to a jurisdictional EOC; enhance mutual aid agreements with surrounding communities; integrate county and state agencies; and conduct joint planning, training, and exercises on a continuing basis. MMRS program requirements address some mitigation and recovery issues, but emphasize preparedness and response. As a condition of declaring an MMRS “fully operational”, each city must conduct a full scale exercise with federal evaluation. Achievement of operational status is treated at the federal level as only one milestone in the continuing development—through planning, training, and exercising—of an MMRS.

In March 2003, responsibility for the MMRS program passed from DHHS to DHS. Ultimately—except for the National Urban Search and Rescue Program—the MMRS program represents the only federally devised model for disaster operations that has been tested through repeated exercises and deployments. The challenge for the MMRS program is sustainability; to maintain “adequate funding and effective management of preparedness and efforts to keep domestic preparedness as a policy priority” (Grannis, 2003, p. 210). Through the years of DHHS oversight, funds to sustain established MMRS cities were made available, although on a highly variable basis. An indicator of the strength of the program and proof of serious local commitment is that cities kept their MMRS programs alive, even during years of small federal allocations, by making hard choices about the distribution of local resources. Funds to sustain the established MMRS programs have continued under DHS, but future federal support is no more guaranteed for MMRS than for any other program. No new MMRSs have been established since 2003, but this program appears to be one significant success in a long history of federal efforts to promote local emergency management where successes have been rare. Interestingly, the FY2005 allocation for the federal MMRS Program decreased to slightly more than $29 million, down from $50 million in FY2004. The 2005 allocation was also subject to retention of 20% at the state level, making the federal commitment to the successful MMRS cities even more tenuous.

Urban Areas Security Initiative (UASI)

In July of 2002, President Bush approved the National Strategy for Homeland Security as a framework for national efforts to prevent and respond to terrorist actions. Beginning in 2003, the DHS Office for Domestic Preparedness (ODP, formerly part of the Department of Justice) inaugurated the Urban Areas Security Initiative as part of the National Strategy for Homeland Security. In late 2003, President Bush approved the FY2004 Homeland Security Appropriations Act, which continued and expanded UASI at a funding level exceeding $4 billion. Seven urban areas were approved for funding in 2003, and that number grew to 50 in 2004. For 2005, DHS added seven new UASI jurisdictions while, without public explanation, discontinuing funding for seven urban areas that had been funded in 2004. The financial awards were substantial, ranging in FY2005 from a high of more than $207 million to New York City to a low of $5 million for Louisville, Kentucky. In addition to these grants, 25 mass transit systems (heavy rail and commuter rail systems) were funded in 2004 on the basis of ridership and total system miles.

Former DHS Secretary Tom Ridge (U. S. Department of Homeland Security, 2004d, p. iii) stated the purpose of UASI is to “create a sustainable national model program to enhance security and overall preparedness to prevent, respond to, and recover from acts of terrorism.” In launching UASI, technical vulnerability assessments were used to identify high threat, high population density areas to participate in the program. The level of funding assigned to urban areas has been based in part upon the vulnerability assessments and other needs assessments. UASI does not impose a generic response model on participating urban areas, but requires local governments located around a designated core city to cooperate in developing a strategic plan that either creates anew or supplements existing disaster plans for terrorist attacks anywhere in the urban area. UASI then authorizes program expenditures across five areas: planning, equipment acquisition, training, exercises, and management and administration (the latter is limited to 3% of the total allocation). The funding mechanism is intergovernmental, with federal money being allocated to states (which can retain up to 20%) that, in turn, distribute funds to local governments. Local governments receive funds based on the area’s strategic plan as well as agreements among the core city’s Urban Area Administrator, participating municipal governments, and county and state emergency management agencies. All expenditures are subject to federal review.

These general funding rules for UASI continued through the FY2005 allocations, although DHS has changed its approach to funding local government programs. The DHS Office of State and Local Government Coordination and Preparedness (SLGCP) Office for Domestic Preparedness has created a program that combines the application process for six major federal programs and delegates the responsibility for that process to state governments. The programs brought under this umbrella application process are UASI, the MMRS Program, the State Homeland Security Program, the Law Enforcement Terrorism Prevention Program, the Citizen Corps Program, and Emergency Management Performance Grants. Some of the budget allocations appear to have increased, whereas others decreased from previous years. It is clear that this new process gives states additional resources (programs like MMRS which were previously immune to the 20% funds retention by the state under UASI are now subject to the retention), but also a considerably greater administrative role and burden. It is not clear how effectively this consolidation of programs will be implemented by the federal government and states, nor how well it will be received by local governments.

For the most part, emergency managers view UASI as promising. It provides substantial funding for local needs (rarely accomplished by previous federal programs) and allows a degree of local choice in planning, administration, and funding. Another positive point is that 47 core cities of the 50 UASI urban areas already had existing MMRS programs. This means they had already engaged in substantial emergency planning and, therefore, possessed an existing structure on which to build further capability. Complaints include concern that federal authorities tightly define authorized expenditures within each predetermined budget category and that local governments bear a substantial financial accounting load. There is also concern that the pass-through mechanism from federal to state and then to local agencies is complex and administratively demanding, thus risking the diversion of funds from emergency preparedness to other uses. Finally, if UASI is to succeed in creating a functioning local emergency management capability, there must be high levels of continuing cooperation among federal, state, county, and municipal governments—and particularly among the municipal governments within each urban area. Sylves’ (1991) work on the inherent difficulties with intergovernmental relations indicates the required agreements on operational plans and budget allocations will prove to be serious challenges.

At the present time, there is little basis for judging the success of the UASI program. Not only is the program new, but plans must be kept secure to avoid divulging their contents to potential adversaries. When combined with the usual administrative and operational hurdles to data collection, these obstacles inhibit the amount of information available in the open literature that can be used to evaluate the program. Most urban areas funded in the FY03 budget cycle obtained federal approval of strategic plans, but implementation requiring such intense intergovernmental collaboration and massive equipment purchases can be expected to be slow under even the best of circumstances. There has simply not been time to establish a capability that could be evaluated in functional or full scale exercises. Although many of these urban areas have MMRS programs that provide emergency management system models, it is not clear if the UASI strategic plans build upon these capabilities, revise them, or change them entirely.

The National Incident Management System

The concept of incident management systems is neither new nor confined to traditional emergency management. Incident management has military origins and law enforcement agencies have long used the Incident Command System (ICS) for large scale incident response. Both ICS and IMS (Incident Management System, Brunacini, 1985) are preplanned organizational structures for emergency response that will be treated here as interchangeable, although there are small differences that will be discussed in the next section. In fact, an important issue regarding IMS/ICS is the confusion about meaning; different professions, different professionals, and different times have embraced different meanings. Municipal fire departments use IMS and the National Fire Protection Association adopted a standard (NFPA 1561) on emergency services IMSs in 2000. Similarly, the Law Enforcement Incident Command System (LEICS) was systematized and endorsed by the Police Officers Standards and Testing organization (Bartosh, 2003). The Hospital Emergency Incident Command System (HEICS), used in public health organizations, originated with the Orange County, California, Emergency Medical Services Agency and has diffused widely through the medical community.

In addition to the myriad systems currently available for incident management, the federal government has now required NIMS. Homeland Security Presidential Directive Number 5 (HSPD-5), a direct response to multijurisdictional, multiorganizational problems arising in the response to the September 11^th attacks, established NIMS as part of the US National Response Plan. The Department of Homeland Security (2004b) issued the documentation for NIMS on March 1, 2004. HSPD-5 required all federal agencies to adopt NIMS immediately and all state and local organizations to adopt NIMS as a condition for federal preparedness funding by FY2005. The State of California negotiated with DHS to retain SEMS (a standardized emergency management system it had developed before NIMS), but the overall reception of the NIMS among other emergency responders is currently unknown.

While all IMSs focus on the operational response to an incident, NIMS addresses this issue and also many others that are considered to be emergency preparedness rather than emergency response activities. There are six components to NIMS (US Department of Homeland Security, 2004b). The first, labeled command and management, includes the traditional component of ICS (NIMS here uses ICS rather than the more conventional IMS term), plus a definition of “multiagency coordination systems” and “public information systems”. The ICS described here appears to be almost identical to California’s SEMS (which also is more comprehensive than a simple ICS) and similar to a traditional fire service IMS. What DHS identifies separately as multiagency coordination systems and public information systems overlap the structure of traditional fire services incident management. The conventional version of IMS structurally accommodates the need to link with incident management systems operated by different classes of agencies and governments (e.g., public works, EMS, law enforcement, hospitals) and includes joint information systems to disseminate incident information to the public (Brunacini, 2002). These same features also characterize all municipal MMRS programs.

The second component of NIMS is labeled preparedness and “involves an integrated combination of planning, training, exercises, personnel qualification and certification standards, equipment acquisition and certification standards, and publication management processes and activities” (US Department of Homeland Security, 2004b, p. 4). Much of this component appears to be conventional guidance that, to maintain any ICS (or IMS), one needs to engage in planning, training, and exercising, as well as develop mutual aid pacts. The parts that are both different and confining include the notion that DHS will issue standards and test personnel to certify their ability to perform “NIMS-related functions.” This certification process also will be applied to equipment. Finally, this component specifies that forms used in ICS—including the incident action plan, organization assignment list, and many others—be standardized by federal fiat. Indeed Appendix A, Tab 9 of the National Incident Management System reproduces facsimiles of appropriate form formats (US Department of Homeland Security, 2004b, p. 105-120).

The resource management component of NIMS is complex and extensive. There is a requirement for inventorying resources, along with a DHS supplied “resource typing system”, that provides specific definitions of each type of resource and how it is to be categorized. There are also rules for determining what resources are needed for an incident, as well as how they are to be ordered, mobilized, tracked, reported, and recovered. Finally, there is a section requiring certification and credentials for personnel, but it is unclear from the description whether this means resource management personnel must be certified or whether they are charged with ensuring incident command personnel and equipment are properly certified.

The final three components of NIMS are less well defined than those just discussed. The “communication and information management” component develops standards for communications (including interoperability between responder organizations) at an incident and specifies processes for managing incident information. The supporting technologies component exhorts locals to acquire and continually review the availability of new technology for incident management. The ongoing management and maintenance component “establishes an activity to provide strategic direction for and oversight of the NIMS, supporting both routine review and the continuous refinement of the system and its components over the long term” (US Department of Homeland Security, 2004b, p. 6)

It is difficult to evaluate NIMS at this stage of implementation. With regard to its origins, “Both NRP [National Response Plan] and NIMS have been developed in a top down manner, centrally coordinated by DHS… [and] [v]iews differ on the scope and intent of stakeholder involvement in developing NRP and NIMS.” (Hess & Harrald, 2004, p. 2). It appears that disaster research was minimally considered, if at all, in the process of generating NIMS. It is unclear how other guidance was solicited by DHS, from whom, or how it was incorporated. Drafts of the NRP were widely distributed via electronic mail along with requests for comment and many of these messages reached municipal emergency managers. What appears to be an even greater concern to municipal emergency management and response agencies is the detail in which processes and protocols are specified within NIMS. In what could be regarded as a significant understatement, Christen (2004, p. 96) states that, in the fire service, “not everyone is happy with national standards and protocols that supersede local preferences.” More important is the question of whether such detailed specification promotes or retards the effective and efficient management of emergencies and disasters.

On a practical level, the likelihood of successful NIMS implementation is difficult to estimate. There is no doubt DHS can impose a requirement for agencies accepting federal disaster preparedness funding to adopt NIMS. However, effective implementation is quite a different matter from official adoption. A veneer of nominal adoption sometimes substitutes for the reality of an executable capability at the local level. The ICS component is similar to the IMS that is used by most large fire services agencies in the United States, although implementation by public works, hospitals, and law enforcement agencies is difficult to estimate. To effectively operate an IMS, an agency must address the planning, training, and exercising issues contained in other NIMS components. There are serious practical challenges—including a reliance on intergovernmental relationships that has plagued implementation efforts for other federal programs. As another example, immense resources will be required for DHS to produce standards and annually test and certify every command officer in the United States. If equipment must also be certified, the task will be even more daunting, especially when one remembers NIMS is designed for federal, state, local, and tribal governments (Ridge, 2004). The Phoenix Fire Department operates a Command Training Center for certifying its own command officers (and others from the surrounding region), but the simulation models, props, computers, and software require a financial investment far beyond the resources of most fire departments. Hence, even if the certification and testing were passed to local jurisdictions, many would be overwhelmed and would likely see the process as another “unfunded federal mandate”. For local agencies that do not routinely use some ICS or IMS or use it infrequently, the additional resources required to comply with NIMS will be substantial. DHS has created a “NIMS Integration Center” (with a Web site at www.fema.gov/nims) as part of the federal effort to manage NIMS and answer questions regarding system adoption. In addition, the DHS/FEMA Emergency Management Institute offers multiple online classes that address both NIMS and basic ICS.