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Experts Say U.S. Emergency Response Must Be Well Planned to Minimize Politics By David Ruppe WASHINGTON — Areas responding to mass casualty disasters need a prearranged plan and command structure for organizing resources and efforts to meet specific challenges — rather than allowing the politics of competing responders to govern the response, experts said yesterday (see related GSN story, today). All mass casualty disasters, whether the result of weapons of mass destruction, weather or other causes, have similar response needs, said Susan Briggs, an assistant professor of surgery at Harvard Medical School and an attending surgeon at Massachusetts General Hospital. Experience shows that for every such disaster, responders are called upon to provide water, food, shelter, sanitation, safety, transportation and communication and what differs is the degree to which they are needed for any particular case, Briggs said. What is needed, therefore, is a prearranged plan for organizing response resources that involves establishing “core competencies” for addressing those various needs, she said. Traditional organizational and command structures of various participating agencies should be set aside to organize an effort around a central, generic incident command structure that can determine the level of resources needed and direct them, she said. Briggs chaired a panel discussing lessons learned from previous disasters at Harvard University’s three-day BioSecurity Conference 2003 here. What is needed is a temporary, flexible command structure that can be adapted for different scenarios, that will establish objectives, set priorities, and assign resources, said panelist Richard Zane, from the Department of Emergency Medicine of Brigham and Women’s Hospital. Impact of Responder “Politics”The approach is intended to provide an alternative to allowing response resources and efforts to be organized by the “politics” of various responding agencies and groups, which have caused mismanagement during previous disasters, Briggs said. “Politics, more than lack of personnel, supplies and equipment, limits the effectiveness of disaster preparedness and response to today’s complex disasters,” she said. “It’s a hierarchy, it’s not the loudest voice wins,” Zane said. Solving the political problem, even prior to a disaster, is a tough question, however, according to Kathryn Brinsfield, a physician with the Department of Emergency Medicine of the Boston Medical Center. Previous experience has shown “politics really governs disaster medical response,” she said. Brinsfield said responder contributions might be driven by four factors: organizational loyalty; as a basis for future funding; personal reputation; and personal responsibility. “At its worst,” she said, organization loyalty and funding politics “fosters a sense of internal competition” whereby entities compete for deployments with hope of attracting recognition and funding. She recounted an example in which a hospital administrator of a large urban city was told that to respond to a terrorist incident, he could receive all available resources from area military hospitals, but for a natural crisis, such as a flu outbreak or a flood, “he was pretty much on his own with the civilian resources available.” “And the reason they gave for that is because it really wasn’t a public notice event,” she said. “It probably wasn’t something that would give them the press. And the press, for better or worse, leads to funding,” she said. Brinsfield said the construction workers who worked the site of the World Trade Center attacks were models for selfless response. “They came because they were needed. None of them got any personal credit. … There really was just a pureness of personal response,” she said. The way to resolve the impact of politics on disaster response and get various contributors to follow a predetermined plan, said Zane, is to “solve the money problem.” “The way we’re going to make that happen is all the medical assets get balanced, even funding,” Brinsfield said, and proposed creating a national medical system.
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