Where We’ve Been and Where We’re Going: Disaster Response
After two years of intense hurricane seasons, active wildfires, and the worst flu season in decades, it’s safe to say that the resources of the emergency preparedness and response field have been stretched by recent events. As a brief reminder, the Department of Health and Human Services made/renewed 33 public health emergency declarations since the beginning of 2017, FEMA declared emergencies in individual states or territories over 250 times in the past two years, and the CDC reported over four thousand disease outbreaks last year. What do these numbers mean? While they reflect distinct events, the culmination of these emergency activations has led to a heightened awareness that disasters and disease outbreaks are occurring with greater frequency and intensity. Now the question is, “what can we do?”
Another harsh reality of the current pace of emergency activations is that we have long passed the era where we could conduct an in-depth, sustained after-action process following each major event. Instead, we have been forced to move on quickly to the next emergency response . This flood of activity has led the field into an ongoing loop of after-action reporting, which means we’re trying to incorporate core lessons learned and established partnerships into our work almost immediately, all while responding to the next disaster. This has made it difficult to adapt and continuously improve our approach in time to prepare for the next event.
Our current environment of continuous after-action reporting is also an opportunity to build on recent responses and continue to find solutions for the challenges ahead. However, this is a double-edged sword, as it also requires that we mobilize almost immediately after an event (or sometimes during the event) to aggregate our lessons and build plans to improve right away. While this sounds straightforward, it adds an additional burden to emergency management, preventing responders from ever really shifting back down to “steady-state.” Basically, this new reality can be exhausting and in the current infrastructure, become a hindrance to improvements.
This momentum has continued to grow since 2016 with Hurricane Matthew, and the last two years have seen the cascading and long-lasting effects of disasters, such as the Camp Fire wildfire and Hurricanes Harvey, Irma and Maria. Many people do not account for the long-term impacts once the storm has passed, just as we saw with Hurricane Maria, which impacted critical infrastructure and disrupted the healthcare supply chain for years to come.
However, there is a glimmer of hope. The increased visibility of the importance of emergency preparedness and response has allowed the entire field to demonstrate the value of sustained investments in infrastructure, training, and partnerships to bolster our capabilities.
A prime example of this elevated focus is the incorporation of healthcare partners at the community level to support local emergency response plans in new and exciting ways, as seen last year in Texas through the work of the South East Texas Regional Advisory Council (SETRAC). During the Hurricane Harvey response, SETRAC, a coalition of hospitals, healthcare groups, and local organizations that support disaster responses, transported more than 1,500 patients and performed evacuations of 44 hospitals and nursing homes. These powerful numbers reinforce the need for community-based response efforts. Another new effort gaining traction in the emergency management field is the expansion of the FEMA National Business Emergency Operations Center, designed to foster public-private partnerships in emergency management.
Additionally, we’ve seen the movement or passage of legislation that defines the importance of emergency preparedness and response, creating an opportunity for the field to grow and posture itself differently in the future. Specifically, the passage of the Disaster Recovery Reform Act of 2018 (DRRA) shifts emergency management in notable ways, including the reallocation of resources towards state and local jurisdictions faster. This crucial development signals the recognition that local governments play a key role and must be sufficiently resourced to respond to major events.
While we’ve seen public health take such steps through preparedness and capacity-building programs like the HHS Hospital Preparedness Program and the Public Health Emergency Preparedness Cooperative Agreement, it’s great to see local emergency management move in a similar direction to provide sufficient resources for mitigation, preparedness and response. Additionally, the support available through the DRRA for survivors with disabilities will help many of the vulnerable populations we serve to be able to recover with greater ease.
In addition to the DRRA, recent movement of the Pandemic All-Hazards Preparedness and Advancing Innovation Act (PAHPAI) is a signal that the importance of healthcare and public health preparedness and response could also shift in critical ways, if signed. PAHPAI passed in the House and is awaiting a vote in the Senate. If not passed, it is a missed opportunity for Congress to recognize that improved partnerships (especially with the private sector and NGOs) are critical to supporting public health functions during disasters. Time and time again we’ve seen that sustained investments in preparedness help build the infrastructure needed to respond and recover from future events. The immediate passage of PAHPAI would support this notion and position health security even more clearly as a critical component of national security. The legislation would also enable us to build the capacity required to bolster the U.S. health security posture to respond to a wide-range of events. Whether it be infectious disease outbreaks and nuclear threats, or environmental hazards and natural disasters, this legislation is a vital opportunity we must size now.
All in all, 2018 was a year of progress. While we have many areas still in need of improvement, I am confident that 2019 will also be a year of advancing the emergency response field to keep pace with the increasing frequency of disasters. Because we know it’s not if, but when, the next disaster will strike.
Nicolette A. Louissaint, Ph.D., is executive director of Healthcare Ready.