Why Community Planners Need an Effective Fatality Management Plan and How to Get Started
Author: Elizabeth Jarrett, Office of the Assistant Secretary for Preparedness and Response
When a major disaster strikes, good community planning can help the survivors cope with all of the losses that they have sustained in the emergency. In mass fatality incidents, it can help ensure that remains are treated with respect and that their loved ones are notified in a timely fashion. A good fatality management plan is critical to reducing the pain of an already terrible situation and helping individuals, families and communities find closure.
Take the time to learn about the federal assets that your community can call on in times of crisis, including Disaster Mortuary Operational Response Teams (DMORTs). DMORTs work under the guidance of local authorities by providing technical assistance and personnel to recover, identify, and process deceased victims. Teams may include funeral directors, medical examiners, coroners, pathologists, forensic anthropologists, medical records technicians and transcribers, fingerprint specialists, forensic odontologists, dental assistants, x-ray technicians, and other personnel. These teams have deployed 30 times in the past 20 years to augment local medical examiners’ and coroner’s offices. HHS also maintains several Disaster Portable Morgue Units (DPMU) that can be used by DMORTs to establish a stand-alone morgue operation.
authorities normally handle deaths in a community, but whether it’s a
plane crash, an industrial accident, a mass shooting, or a natural
disaster, the sheer number of fatalities can overwhelm local resources
so adequate planning can make all the difference when or if it happens,”
said Dr. Edward Kilbane, Fatality Management Program Manager for the
National Disaster Medical System within the U.S. Department of Health
and Human Services’ Office of the Assistant Secretary for Preparedness
and Response (ASPR).|
Become familiar with the process to activate the federal response system. The governor’s office or state health commissioner must request federal assistance before federal agencies can activate resources, including DMORT. Requests are directed through the local disaster management structure to the state level. Be prepared to describe the magnitude of the incident, what you’re doing locally and how you’re leveraging surrounding jurisdictions as well as state resources. When there are resources gaps, look to federal agencies for unique ability or to supplement your efforts. To learn more about activating federal, state and local resources, see the online FEMA Sequence of Events training.
A mass fatality plan is one part – one important part – of your community’s overall disaster response plan. Make sure that your fatality management plan is well integrated into the rest of your community’s planning efforts.
By planning now, you can be better prepared to handle a mass fatality incident if it occurs in your community. In a crisis, that may mean that you are better able care for the dead by ensuring that their remains are handled with respect and that you can help the survivors by providing an important step on the path to closure.
How My Friend’s Preparedness Made Him an Awesome Dad
Author: Elizabeth Jarrett, Office of the Assistant Secretary for Preparedness and Response
My friend is an awesome dad – and not because he takes his daughter to guppy swim classes or makes the best grilled cheese sandwiches ever or goes camping with his little girl. Not just for those reasons. Fred is a great dad because he is ready for anything and has taken steps to make sure that his family will stay safe during a disaster.
When Hurricane Sandy struck, it destroyed Fred’s house. And when it did, he was ready for it. Even though evacuation orders weren’t issued in the area he lived, Fred and his family couldn’t stay in their house. He stayed calm. He put the go bags and some water in the car, and sent his wife and daughter to a hotel. When his wife and daughter got to the hotel, they went to the room and pulled out the go bag. His wife reportedly said, “thank God for Fred!” Everything they needed was in there – clothes, toys, fun stuff, pet stuff, flashlights, all the important things for people evacuating with small children and large dogs. The hotel was a safe place to stay, but it didn’t have water. No problem; Fred had packed a couple of cases.
Fred ended up deploying to New York as part of the response to Hurricane Sandy, so he couldn’t stay with his family for over a week following the storm. But his family had an emergency plan, so everybody knew what to do. They had supplies, so everybody was equipped to carry out the plan. And they knew that they could rely on each other for encouragement, hugs and support to get them through the storm. Even though he couldn’t be with his family, he had left them with the things that they needed to stay safe and healthy. And that fact gave him some peace of mind as he helped people in another part of the country.
Interested in following Fred’s totally awesome dad example? Here are some things you can do before an emergency that can help make you a great parent during and after an emergency:
- Get a Plan for Everyone in your Family: Make a family plan and make sure that everybody in the family is included in the plan and knows what to do. Not sure where to get started? CDC and the Red Cross have some suggestions on what to include in your family plan. If you have pets, be sure that you have a pet preparedness plan and supplies as well.
- Stock up on Supplies: Lots of things could happen in an emergency. You may need to stay in your home without power or water, or you might be asked to evacuate quickly. Check out the list of recommended supplies from CDC and Red Cross to help you create an emergency kit and a go bag.
- Stay Calm: When a disaster strikes, it can be easy to get overwhelmed, anxious and worried. Staying calm will help you and your loved ones make better decisions and get through the storm safely.
- Recognizes Signs of Stress in Your Children: Kids show stress in different ways as they age. Learn what to look for and how to help them cope now so that you’ll have the skills you need when you need them most.
Minimizing the impacts of power outages on people with chronic conditions
Author: Stacey Elmer, Office of the Assistant Secretary for Preparedness and Response
Every year for the last fifteen years, there has been a hurricane that caused a major disaster somewhere in the United States. The question isn’t so much whether or not we’ll have a hurricane as when it will happen, where it will happen, how severe it will be, and how it will affect you. Last fall many of us along the East Coast felt the impact of Hurricane Sandy, one of the largest hurricanes in history. In recent years, we’ve also felt the impacts of hurricanes Isaac, Irene, Gustav, Rita and, of course, Katrina. Each of these storms impacted people’s health, but those who rely on electricity for the continued functioning of their electrical equipment are at greater risk.
When a hurricane strikes, emergency rooms fill up quickly – but they aren’t just full of people who have been injured by the storm directly. If the power goes out, residents with chronic medical conditions who rely on durable medical equipment, such as oxygen concentrators, ventilators and intravenous infusion pumps, may not have a way to get the care that they need. After days without power at home, the batteries will run out and need to be plugged in somewhere to recharge. People who need dialysis may also find that their regular centers are closed following a hurricane. Even though these people aren’t normally patients, many of them come to emergency rooms because their regular means of taking care of themselves aren’t working and they need help.
These issues not only adversely impact the health individual outcomes but also may stress the local healthcare system further, reducing a community’s resilience and capability to rapidly recover from an emergency.
ASPR and FEMA are working together to enhance community and individual resiliency before, during and after a disaster. We recently solicited ideas that may enable us to develop a suite of solutions, including battery-life sensor-signaling devices, longer-life universal batteries, safe power generation and communication-enabling technologies that can accurately locate and assist power-dependent DME populations prior to, during, and in the aftermath of a public health emergency or disaster.
But even with solutions in place, personal planning matters. It matters most for the millions of Americans who manage chronic medical conditions on their own every day. For these people, an extended power outage can be more than an inconvenience; it can be life threatening. If you, a family member, a friend or a neighbor has a chronic health condition, especially one that power-dependent equipment, take time now to plan for the next storm.
If you take medication regularly, have extra medication or a copy of the prescription in a water-proof bag, ready to evacuate with you. Keep a little bit of cash with it (if you can) for the co-pay to refill the prescription if the drugs are damaged in a flood or lost. Remember, credit card machines at the store and money machines require electricity.
If you use dialysis, know where the alternative locations are and ask staff your center about the facility’s emergency plans.
If you use power-dependent equipment, charge the battery as soon as you hear about a potential storm heading your way and identify places you can evacuate outside the affected area where electricity is not likely to be lost.
Consider the positive impact of taking these steps: better health outcomes for you and the people you love, less stress on the local healthcare system, greater community resilience and a more rapid recovery from an emergency.
Author: Yong-Bee Lim, Graduate Student Intern,Division for At-Risk Individuals, Behavioral Health, and Community Resilience
What do the names Chris, Debby, Kirk, and Nadine have in common?
If you answered that they are all relatives you will see at your next family barbecue…sorry, but that wasn’t the answer I was looking for. The answer is that they are all names of hurricanes or tropical storms that occurred in 2012.
The month of May precedes hurricane season, which runs from June 1st to November 30th in the Atlantic Ocean and May 15th to November 30th in the Eastern Pacific Ocean. While hurricanes can pose a great threat to life and property, they also can impact mental health negatively; this can be especially true for people who live in communities that have been through prior storms such as Katrina or Sandy. From the time that a tropical disturbance forms in the ocean and is announced via television or radio, to the aftermath of and recovery from a hurricane, these events can create stress resulting in physical and emotional impacts. These effects can include feelings of fear, anxiety, and psychological distress, or present as elevated blood pressure, increased heart rate, or difficulty sleeping.
Taking steps to prepare before a storm can help reduce the stress or worry you may face related to meeting basic necessities, securing your important possessions, and ensuring individual safety. Fundamental planning and preparedness strategies include:
- Start a Conversation. It's important that you know who you are counting on in an emergency and who is counting on you. For some people, that's pretty obvious - parents know that young children depend on them and spouses probably already know that they are in this together. But sometimes who you can count on isn't so obvious - particularly for groups of friends or people without family in the area. So take some time to think about who you are counting on - and who is counting on you - for support during a hurricane. Then take some time to talk with them and make sure you are on the same page.
- Gather Information and Stay Connected: Knowing the unique hazards of where you live will help inform your planning and preparedness priorities; you can also sign up for state-based alerts to stay connected.
- Make a Disaster Plan: Have an emergency plan that covers communication, sheltering in place, and evacuation. Know what to do before, during and after the storm.
- Complete a Preparedness Checklist: This should include things such as having emergency phone numbers and copies of important documents, knowing how to register for programs such as the American Red Cross Safe and Well website, and having a disaster supplies kit.
- Get Your Kids Involved: Involving your kids in a disaster planning now can help them cope with a disaster when it happens. If you have little ones, check out Sesame Street’s Let’s Get Ready! Planning for Emergencies. If your kids are a little older, try FEMA’s preparedness-themed activities. Have your older kids help you plan for a Zombie Apocalypse and they’ll be better able to deal with a real emergency.
- Protect Your Furry Friends: Plans and kits aren’t just for people. Learn what you need to put in your go-bag with the ASPCA’s Emergency Supplies and Traveling Kits Checklist. Also, remember that not all shelters accept pets, so make sure that you have made plans in advance – check out tips from FEMA to help you plan.
- Plan for Older Adults: Older adults often have special needs in disaster, including mobility issues, dependence on medications or other special needs. Not sure what to plan for? Check out Emergency Readiness for Older Adults and Caregivers.
- Practice Your Plan: Having a plan is good, practicing your plan is even better!
While graduations, barbecues, reunions, pool parties, and other outdoor summer gatherings have their own unique hazards (make sure to bring the sunscreen and insect repellent), don’t let these events get in the way of preparing yourself and your family for hurricane season. Getting informed, staying connected, and having a plan will reduce your stress and other headaches in the future.
A statement from HHS Assistant Secretary for Preparedness and Response Nicole Lurie, M.D.
This week, our nation honors emergency medical service (EMS) professionals for their dedication to public service. As the HHS assistant secretary for preparedness and response, I know how important their role is in disasters. As a primary care physician, I know how important their work is every day. People rely on EMS in disasters and other public health emergencies, as well as for personal emergency care.
We know that our health care system must be ready at a moment’s notice to respond to threats to the public’s health. Time and time again, disaster after disaster, EMS responders across the country have risen to that challenge, whether the community is impacted by a hurricane, wildfire, flood, bombing, chemical plant explosion, and pandemic flu. In recent disasters, we have witnessed EMS responders providing triage on the scene in Boston after the bombing, helping evacuate nursing homes in New York state after Hurricane Sandy, and caring for injured or ill patients as they were transported to hospitals in Texas after a plant explosion. Dozens of EMS responders give their lives every year in the service to our communities and our nation. Those who remain continue to take pride in being the people we can depend on even in difficult and dangerous situations.
To become better prepared, the nation is moving increasingly toward building coalitions bringing together EMS providers, public health agencies, hospitals, nursing homes, dialysis centers, health care providers, home health agencies, emergency management agencies, and local businesses. EMS is a critical partner in our health care system, so I encourage EMS professionals to take an active role in helping communities forge and strengthen these partnerships. Given the regular interaction EMS responders have with these organizations in the community, EMS is uniquely positioned to bring potential partners together to plan for and minimize the impact that disasters have on health. Use your networks to strengthen a coalition between these partners in your community and in your region. Talk about it with the preparedness director at your local hospital.
Disaster response and recovery requires a whole community working together. It’s one mission, one team. EMS is a crucial part of that team, there when every minute counts.
How ordinary people became first responders and what we can learn from them
Authors: Gregg Lord and Arnold Bogis, ASPR’s Emergency Care Coordination Center
The bombing of the Boston Marathon was a tragedy by any measure. But even as bombs continued to go off, there were brave individuals who ran towards the danger, not away from it, to help those in need. These people showed the vital role the community plays during any disaster and their bravery should inspire everyone to recognize the critical role that the community plays in planning for, responding to, and recovering from a tragedy.
Take a moment to consider how many professional doctors, nurses, paramedics and EMTs were actually on the scene before the tragedy struck. Massachusetts officials consider Patriot’s Day a “planned disaster” and they prepare for terrorist attacks and other types of disasters while managing the race itself. The planning goes on all year and requires the deployment of an impressive number of medical personnel. Considering the types of injuries caused by the blasts, these people undoubtedly saved lives.
Yet even with all of these pre-positioned medical resources, the public still played a critical role in the response. The amazing stories about these heroes are just starting to be told. A man who lost one son in Iraq and another to suicide helped stop the bleeding of a man whose leg was blown off. Runners who only moments earlier finished the race rushed to apply makeshift tourniquets to the injured or donate blood. Volunteers and spectators also provided aid and comfort when the people around them needed it most.
How can people get ready for a disaster like this? Learning first aid and CPR and understanding risk awareness can definitely help prepare you to help others – friends, family members, and even strangers. But you don’t need to have formal training to save someone’s life or provide them with the care that they desperately need at that moment.
Sometimes, you just need to be willing to help carry someone who is hurt to safety, provide comfort to someone who is frightened, or help someone find the medical care they need. Prepared individuals are aware of potential risks, understand where they can turn for help, know what their personal responsibilities are, and are willing to help their neighbors and community members.
At the core of a resilient nation are communities and individuals who know what they can do to protect themselves and are willing and able to do it. This effort requires shifting the culture surrounding the essential role of community first aid during an emergency. Health, safety, and security cannot only be “left to the professionals,” but instead should be recognized as everybody’s responsibility.
Success in preparing for and responding to any large event will rest in the ability to harness the immense potential of the community, as was exhibited by those Boston heroes, formal first responders and those who simply took action when faced with unimaginable tragedy and helped their fellow citizens in the moment of greatest need.
Simply put: bystanders didn’t stand by. They saved lives. We should learn from their bravery and plan on ways that we, as part of our community and our nation, can be better prepared to help out in the next disaster.
Author: Kevin Horahan, J.D., M.P.H., NRP, Senior Policy Analyst, Office of Policy and Planning, HHS Office of the Assistant Secretary for Preparedness and Response
In every disaster we see neighbors helping neighbors, community organizations reaching out to support people in need, and local businesses raising funds or donating products to help the community recover. Responding to disasters and recovering from them means engaging the whole community. So wouldn’t it make sense for each organization, business, or agency to know how the whole community will work together and plan for that collaboration? Maybe even figure out how to work together and plan for a disaster so the community can bounce back even faster?
That’s what the National Planning Frameworks do. They identify five key phases of a disaster and describe how the whole community work together, including all levels of government, private and nonprofit sectors, faith-based organizations, communities, and individuals. The frameworks spell out how the entire community builds, sustains, and delivers the core capabilities needed to achieve a goal of national preparedness as part of a unified and coordinated effort.
There’s a framework for each of the five areas: prevention, protection, mitigation, response and recovery. They reflect the value of relationships and partnerships across the whole community not just during an emergency but before and after as well. This approach keeps the whole community informed and fosters a shared understanding of risks, needs, and capabilities with a goal of a more secure and resilient nation.
Three of the five frameworks—Prevention, Mitigation and the updated Response Framework—were released last week. Every disaster can impact health, so health is reflected in each framework, covering the entire continuum of preparedness.
Find out where you fit into the National Planning Frameworks. FEMA even put together a tutorial. As the work to implement the National Preparedness System continues, check the online collaboration forum and visit the Frameworks website to voice your opinion and share your experience.
Author: Edward J. Gabriel, Principal Deputy Assistant Secretary for Preparedness and Response
This week, we celebrate National Nurses Week. Nurses are the largest profession in health care today. There are over 3.1 million passionate Registered Nurses who provide highly skilled, safe, and quality care in a variety of settings in communities across our nation.
Nurses work in hospitals, emergency rooms, school based clinics, long-term care facilities, and provide advice and guidance through triage call centers. Nurses provide clinical services, behavioral health support, health education and promotion. The nursing profession continues to expand in scope and practice as communities put increased trust in their skills. It is both an art and a science that is vital to meeting the healthcare needs of the American people and maintaining the healthcare enterprise.
In emergency response, we clearly see this year’s National Nurses Week theme is “Delivering Quality and Innovation in Patient Care” play out. Nursing professionals play an essential role in improving patient outcomes, increasing access, coordinating care, and reducing health care costs. These day-to-day improvements can make a tremendous difference in people’s health and safety during emergency. That’s why we at ASPR also strive to improve our health systems and develop innovations for improved patient outcomes – because we know communities respond with the systems they have in place at the time. Those systems have to be ready and able to respond.
Nurses serve people in the toughest of times. During disasters as diverse as Hurricane Sandy, the Sandy Hook Elementary School shooting, the Boston Marathon Bombing, and the flooding in the Midwest, nurses worked around the clock to make sure people get the care they need when every minute counts.
On behalf of ASPR, I would like to thank all nurses for their continued service and dedication to the health and well being of all Americans, particularly in during disasters and emergencies.
Authors: Jessica Tucker and Elizabeth Jarrett, Office of the Assistant Secretary for Preparedness and Response, U.S. Department of Health and Human Services
Disasters don’t repeat themselves, but they do have a rhythm. Every hurricane, flood, nuclear accident, or terrorist attack unfolds differently. But there are common challenges to many disasters and there is a brief moment when we can most effectively learn about them and evaluate what worked – and what didn’t – during response and recovery. In the wake of Hurricane Sandy, that moment is now and ASPR is working with its partners to find the best ways to learn from Hurricane Sandy, inform recovery efforts for communities affected by Hurricane Sandy moving forward, and ultimately improve disaster response and recovery.
In November 2012, the HHS Assistant Secretary for Preparedness and Response asked the Institute of Medicine and the New York Academy of Medicine to convene subject matter experts to identify priorities for immediate research. Using the outcomes from this meeting, ASPR conducted additional assessments and is now requesting proposals for research to inform long-term recovery from Sandy under the ASPR Grants to Support Scientific Research Related to Recovery from Hurricane Sandy.
These research grants will focus on priority areas related to community resilience and recovery; risk communication and the use of social media; health system response and health care access; evacuation and policy decision making; and mental health.
By issuing grants to external investigators during recovery from Sandy and taking this opportunity to study multiple aspects of the health impacts of the disaster, we will be better equipped to make effective decisions based on scientific evidence that will impact long-term recovery for the affected communities moving forward.
The research projects under this grant may take many different forms. For example, an evaluation of mental health outcomes of affected residents and communities could help decision-makers to identify more effective mental health interventions throughout long-term recovery. Or we could use the information gathered under these grant programs to better understand how social connectedness in communities predicts resilience and positive recovery outcomes. Once equipped with that knowledge, we can better identify the right interventions or programs that can serve to enhance those social linkages.
To date, this effort has provided a useful model for conducting scientific research that can inform response and recovery to public health emergencies: engage local research communities to define priorities for immediate research, provide funding opportunities accordingly, and fund work that benefits affected communities. We plan to build on this model and use the information that we gather to inform policies and programs for Sandy-affected communities during the recovery period.
By taking steps now to improve our understanding of the common elements of disasters and the ways that people behave in a response, we will be able to better protect public health and help save lives when the next disaster strikes.
Author: Nicole Lurie, M.D., M.S.P.H., Assistant Secretary for Preparedness and Response, U.S. Department of Health and Human Services
Every disaster affects people’s health – often in very
different ways. In my tenure as Assistant Secretary for Preparedness and
Response we’ve seen the H1N1 influenza pandemic, an earthquake in Haiti, the
Deepwater Horizon oil spill, the nuclear emergency in Japan, the 2011 tornadoes
across the US, numerous hurricanes, Superstorm Sandy, and a host of other instances like foodborne illness and weather
To protect people’s health as we respond to these events, we
need to have knowledge and strategies based in sound science. So far in every
event we’ve seen both great science successes, and – critically - significant
gaps in knowledge. The response to the H1N1 pandemic offers good examples of
both. There was evidence of real progress and success. Soon after the first
cases appeared in the US, scientists quickly identified and characterized the
new virus strain. As a new vaccine was developed at an unprecedented
scale, we were able to determine priority groups for vaccination and the
effective doses for adults and children. But there were critical gaps in
knowledge too, and barriers to performing research in time to have helped treat
ill patients. For example, we could have done much better studying the
effectiveness of antiviral drugs and respiratory protective devices. The
current research infrastructure – which includes funding, reviews, protocols -
simply wasn’t built to be nimble and quick, as public health emergencies
Other disasters have demonstrated gaps too. In the Gulf
after the oil spill, people were understandably concerned about how exposure to
oil and dispersants might affect their health. Unfortunately, studies conducted
on previous oil spills didn’t offer enough information to allow us to answer
that question. And we missed an opportunity to collect baseline data that would
have helped us in the future.
Removing barriers and developing the infrastructure that
will allow us to do disaster-related science is a critical issue and one of my
top priorities, and my office is making quick progress in our work to promote
what we’re calling “science preparedness and response.” Being able to conduct
effective research before, during, and after disaster means we need to do
things like identify scientists with needed expertise who can be ready to respond;
identify and prioritize research needs; ensure rapid and appropriate human
subjects review; be able to rapidly fund studies; and work to meet the needs
and understand the concerns of affected communities. There is work underway
globally, and much more needs to be done to set up agreements and the
infrastructure to build this capability.
Here’s one promising recent step - in November in the midst
of the response to Superstorm Sandy, I asked the Institute of Medicine and the
New York Academy of Medicine if they would convene subject matter experts to
identify priorities for immediate research (it was important to hold this kind
of discussion as the response was still happening). Using the outcomes from
this meeting, my office conducted additional assessments and we’re now
requesting proposals for research to inform
long-term recovery from Sandy. The research will be in key priority
areas around community resilience and recovery, risk communication and the use
of social media, health system response and health care access, evacuation
decision making, and mental health. Check out the funding opportunity announcement Assistant Secretary for Preparedness and Response Grants to Support Scientific Research Related to Recovery from Hurricane Sandy.
I’ve been encouraged lately to see the international
community of policy makers, academics, and scientists making science response a
larger part of the conversation. It’s going to be critically important for
making our nation and the world more resilient to disasters.
For a more detailed treatment of this subject, see an
article that colleagues in HHS and I recently wrote in the New England Journal of Medicine.