All Hazards Planning

2. All Hazards Planning Edward P. Richards Director, Program in Law, Science, and Public Health Harvey A. Peltier Professor of Law LSU Law Center richards@lsu.edu http://biotech.law.lsu.edu/cphl/Talks.htm

3. Topics • What is an All Hazards plan? • What are the elements of an All Hazards plan? • Why is All Hazards planning necessary? • Examples • Preparing for bird flu • Evacuation of New Orleans for Katrina

4. Episode-based PlansPlans to Plan • Episode-based plans • Bird flu plans • Anthrax plans • Bomb plans • Plans to plan • What you need to think about, not what you need to do • No operational detail

5. What is an All Hazards Plan? • A unified plan that, as much as possible, uses common strategies for emergency response • Emergency response is built on day-to-day procedures and resources • All Hazards plans are operational plans • They tell you what to do, not just what to plan • The public is fully informed and an integral part of the emergency response

6. Elements of an All Hazards Plan • Analysis of common factors in the different types of emergencies • Relation of these common factors to routine procedures • Modification of existing procedures to incorporate elements that will be needed in emergencies • Public information and education

7. Example Transforming a Bird Flu Plan into an All Hazards Plan

8. Episode Planning: Bird Flu • Plans for emergency quarantine • Plans for ethical guidelines on vaccine allocation • Plans for stockpiles of PPE • Plans to work with public health, including an MOU that says we will play nicely • Plans for how to plan to handle the SNS • Maybe some training on how to put on a mask

9. All Hazard Planning: Bird Flu • What are core problems? • Protecting staff from infection • Assuring adequate staff for operations • What are related issues? • Yearly flu pandemic • Exposure to tuberculosis and other communicable diseases in the workplace

10. All Hazards Recommendations:Vaccinations • Assure vaccination status of employees • Mumps, measles, etc, which can disable a force • Yearly flu • Benefits • Reduction in lost time from work • Readiness if there is an outbreak • Resolves individual and union opposition to vaccination before there is an emergency

11. All Hazards Recommendations:Working Sick • US culture and especially law enforcement encourages people to work sick • Limits on sick days • Rules that you cannot be on special teams • Increases the spread of diseases such as the flu in the workplace • Set up criteria for exclusion of contagious workers • Change work rules to eliminate punishment for being excluded so employees will not hide illness

12. All Hazards Recommendations:Personal Protection • Key personal protection • hand washing • behavior limitations - handshaking, etc. • goggles, masks • Recommendations • Train and equip all officers • Use these for regular flu and other possible disease exposures • Make behavioral modifications so these become routine

13. All Hazards Recommendations:Public Information • There maybe a need to limit travel or impose home quarantine • The public should be educated about all aspects of these possible limitations • What is their role? • Why is it important? • How will essential services be provided? • How will you assure families will not be separated? • This will identify problematic areas and reduce confusion in an emergency

14. All Hazards Planning:Generalization • Staffing in emergencies • Any emergency that threatens the general public will threaten the employees families • You have to provide for the families if you want staff to show up • Develop a general plan for family issues

15. Evaluation: Episode Based Planning • Episode based plans are invisible until there is an emergency • These are very low probability events • The only testing is by artificial exercises • Quality control theory (Demings, etc.) • You can only achieve quality through iterative improvement based on data analysis and feedback • This is impossible with an episode based plan

16. Evaluation: All Hazards Planning • All Hazards planning does fit the criteria for proper quality control • Elements of the plan are in operation at all times • This provides intermediate data, i.e., things to measure short of a disaster happening • Improves routine operations • There is almost no data on communicable diseases in the law enforcement workplace

17. Assumptions Behind All Hazards Planning • Equipment and materiel that is not routinely exercised will not be maintained and will not function when needed • Emergencies are the worst time to change procedures • Public cooperation depends on pre-event education and buy-in

18. Political Reality • The public (legislatures) have a short attention span and will not support emergency response once they move on to the next crisis de jure • Reality Check: • 23 states, including most of the most populous, have done away with mandatory childhood vaccinations • We are in the middle of a mumps epidemic in the Midwest - are your employees vaccinated?

19. Lessons from Katrina The Blind Men and the Elephant

20. Why the Evacuation Failed

21. Transportation IssuesSurface Causes • Evacuation not triggered until too late • No provision for moving folks without transportation • When transport was available - school busses - there was no provision for drivers • No provisions for jails and hospitals • No provision for secondary evacuation form the Superdome and other facilities

22. Transportation Issues:Surface Solutions • Better plans • More modes of transportation • Earlier evacuations • "Manditory" evacuations • All sound, but all miss the point

23. Transportation Issues:Root Causes • New Orleans has flooded frequently • Most of the land that flooded is reclaimed bay and swamp that is up to 20 feet below sea level, not historic New Orleans • People lived next to levees with water 5 feet over street level every day • Flood insurance was not required because it was assumed that the levees could not break

24. The Implications of a Real Evacuation • The only reason to really evacuate is if the levees fail, which was ruled out • The Superdome and shelters of last resort • Delaying the call for evacuation • Why? • 40 years of false alarms • Admitting the levees could fail would destroy the real estate values in New Orleans • Routine serious evacuations destroy business

25. The Real Lessons from Katrina • Plans based on politically unacceptable actions will not be carried out • Long term prevention loses out to short term economic and political considerations • Do not build in dangerous areas • Require realistic risk analysis for insurance • Do not downplay risks that cannot be managed

26. How Would All Hazards Planning Have Changed the Outcome? • Focus would have been on the risks of living below sea level, not just on the evacuation • Planning would have explicitly included levee failure • Flood insurance • Business interruption insurance • Meeting appropriate life-safety codes for hospitals • Personal evacuation planning • Addressing these would have changed the political dynamic, allowing a proper evacuation