Disaster psychology: Where and how plans go wrong or right
Planning is a major element of effective response to disaster and terrorism, or to any other aspect of emergency response. But plans are too frequently crafted to demand novel and often unworkable responses to be mounted in the face of rare and often overwhelming events. It's hardly surprising that such plans often find limited utility, face uneven implementation, and yield disappointing results. Planning works best when it provides reasonable and practical ways to expand missions and extend skills already ingrained in the organization's routine operations.
Federal policies now mandate that plans include accommodation for a wide range of special needs, but the problem is that these plans too often aren't learned, practiced or used. Special-needs plans, like many other disaster planning elements, may be underemployed for a number of reasons. Some of the leading culprits are:
• Plan may depend on things people won't do.
• Plan may depend on things people can't do.
• Plans may require information we don't know.
• Plans may require information we can't know.
• Plan may require that people or responders take new or novel actions for which they're not prepared. (An emergency is not a great time to be learning brand-new skills or responsibilities!)
• Plan may be unknown to the responders who are expected to execute it.
• Critical elements may prove unworkable for responders in the circumstances posed by a given emergency.
These things often occur where planning is conceived as an element separate from operations, especially daily, routine operations.
Mission extension should be pretty easy
Disaster response is most effective when actions to be taken represent expansion of the response agency's daily mission to include the requirements of a special situation and are based on extension of the basic skills, practices and protocols of its responders to circumstances and demands that may be larger in scope, intensity and/or duration than its typical responses.
In many critical respects, a high-rise fire is lots of kitchen fires stacked atop one another. Effective suppression uses basic skills and strategies that now include planned extension to accommodate the unique circumstances that vertical stacking adds to the equation.
A bus wreck is, in many critical respects, a lot of injured ankles in one location. Here as well, effective treatment involves extension of those basic skills in a broadened and heightened context of triage, distribution and transport that may also include integration with other responders performing rescue and extrication, as well as managing information about who's being treated, where they've been taken and how they can be reached.
Most active response agencies accommodate the extension elements reasonably well, because they encounter situations demanding the fundamental skill sets and organization patterns on a regular basis. The principal determinant for successful extension lies in the consistent use of a coherent structure that has been designed to grow with the needs of the event.
One of the critical contributions of uniform incident management systems is their capacity to expand and contract with the dimensions and dynamics of changing situations. Fortunately, most primary response agencies, especially fire service and EMS, have become practiced and adept in their daily use.
Mission expansion failure
The challenges that cause disaster plans to crash and burn are more likely to be associated with the expansion of mission these events tend to demand. This is where things like special needs can present rapidly escalating complications.
Expansion requires changes in mission boundaries, those usually foggy conceptual lines that separate what we perceive to be our mission from what we perceive as the missions of others.
While good fences usually make for good neighbors, there is also a strong need for talking over the fences to ensure that we remain aware of our neighbors' interests, activities and limitations. This is especially so we can know how a given event might be affecting their capacity (the volume of service they can manage) and their capability (the range of services they can handle). Where successful extension depends on structure, success in managing expansion is driven by relationships.
The best way to ensure that any element of a plan will be effectively employed in a major event is to make its basic elements applicable in daily operations. If a plan requires mission expansion, as special-needs elements are often perceived to do, it's important to look for places where the contemplated expansion is already accommodated in the agency's typical response patterns.
These may also present opportunities for the agency to expand its ongoing service base — and its value — to the community it serves, without drastically changing its skill requirements or demand profiles.
Consider the relationship between special-needs profiles such as poverty, language, mobility, intellectual limitations or psychiatric impairments and your agency's emergency medical services.
Where to start
Almost without exception, these are challenges you're accommodating daily. How are those challenges being addressed? If you can't quickly point toward designed and defined elements that include both the skills your personnel apply daily and the agencies and services with which they interact to manage the cases they see, you've already identified where your planning needs to begin.
If your incident management systems do not contain elements needed to accommodate extension of branches and divisions to address special needs, you'll be hampered in making effective use of the skills your people have developed in dealing with existing special-needs encounters.
If your connections and interactions at the system level as well as in the street do not include regular interaction with key agencies dealing with these clients, you may not have the foundations those relationships provide ready when you have to take on new dimensions in an urgent circumstance.
The essence of disaster impact on response systems is essentially this: You end up doing a whole lot more of what you typically do, and you end up doing it for more people with a longer time of engagement and a greater breadth of responsibility.
If you pay attention now to systematically managing those encounters that lie at the margins of your missions and developing the relationships needed to deal with them daily, you'll be well ahead in managing the bigger, badder and unexpected feature a disaster drops on your doorstep.
We'll discuss more about doing that systematic development in our next installment.