This week, we're going to take a look at the fifteen Emergency Support Functions, (ESF 1-15), with an eye on one of them, ESF 8, that would be used for a medical or public health emergency. From the ESF overview (.pdf):
The ESFs provide the structure for coordinating Federal interagency support for a Federal response to an incident. They are mechanisms for grouping functions most frequently used to provide Federal support to States and Federal-to-Federal support, both for declared disasters and emergencies under the Stafford Act and for non-Stafford Act incidents.
Just inspecting the ESF's (ESF 1-8 and ESF 9-15) will give you an idea of the types of disasters covered, and the responsible agencies. For example, a dam breaking might fit under ESF #3 – Public Works and Engineering and fall under the Department of Defense (through the US Army Corps of Engineers) as lead agency, while a major area wildfire on federal land might be under ESF #4 – Firefighting (Department of Agriculture's US Forest Service). A flu pandemic, as a public health issue, would fall under ESF #8 – Public Health and Medical Services which includes:
- Public health
- Mental health services
- Mortuary services
created a lead federal official for public health and medical emergency preparedness and response within the HHS named the " The Assistant Secretary for Preparedness and Response (ASPR), currently RADM Craig Vanderwagen, a family physician with significant prior experience with the Indian Health Service, service in Iraq, and the HHS senior officer in the HHS responses during the 2005 Hurricane season and the Tsunami, serves as the lead official for Emergency Support Function #8, the Public Health and Medical Annex under the National Response Plan [to be replaced by the proposed National Response Framework with changes in the annexes].
The problem with public health emergencies, and especially pandemics, is that they fall under the category of wicked problems.
The concept of "wicked problems" was originally proposed by Horst Rittel (a pioneering theorist of design and planning, and late professor at the University of California, Berkeley) and M. Webber  in a seminal treatise for social planning. Rittel expounded on the nature of ill-defined design and planning problems which he termed "wicked" (ie. messy, circular, aggressive) to contrast against the relatively "tame" problems of mathematics, chess, or puzzle solving.
Wicked problems have incomplete, contradictory, and changing requirements; and solutions to them are often difficult to recognize as such because of complex interdependencies. Rittel and Webber stated that while attempting to solve a wicked problem, the solution of one of its aspects may reveal or create another, even more complex problem.
As an example, here's an illustration of the area of the country covered by 100 mile radius 'buffer zones' from major hub airports (illnesses that travel by air can get around fast). And lest you think this is entirely theoretical, google the case of one Andrew Speaker, who flew to Europe and returned home by air while infected with tuberculosis. Now, TB might infect others on the plane; other illnesses might spread to the surrounding area. Pandemic flu (any novel human flu that people have no resistance to, not just the current H5N1 in the news) might spread to the rest of the country. And keep in mind that we are talking about a federal coordination issue here – the NRF is about how Federal agencies like CDC work with other fed agencies and Departments like (in this case) the Federal Aviation Agency, customs, DOJ, and the states (with their equivalent Departments)... in short, how you coordinate the solution to a wicked problem. This means that in the case of an ESF #8 incident, DHS not only has to coordinate with HHS and other agencies, but work closely with the Assistant Secretary for Preparedness and Response within HHS, the lead agency for ESF #8 events. And everyone's role has to be crystal clear. Got all that?
Now, one more thing. Not every problem is a bioterror -> evildoer problem. In many cases, voluntary actions on the part of ordinary citizens can be part of the scenario. To illustrate that further, let's return to a theoretical pandemic.
Should a pandemic happen, 25% of the workforce could easily be either sick, caring for someone, or afraid to go to work (e.g. a hospital nurse with a diabetic child and an elderly mom, who doesn't want to bring illness home). The impact on business might be considerable, and so might the effect all the way down the supply chain. If schools close (up to 12 weeks, as recommended by CDC in a severe pandemic), the impact of parents who now have to care for their children will be felt in the workplace as well. Telecommuting puts pressure on the internet backbone (so will kids at home who want to IM their friends), with both cable companies and electrical grid infrastructure experiencing the same shortfalls in personnel (see The Prioritization Of Critical Infrastructure For A Pandemic Outbreak .pdf, 129 pages)... well, you get the idea. A wicked problem, indeed.
And, since infrastructure might be affected, we begin to stray into other "lead agencies" and ESFs such as ESF #2 – Communications (DHS takes the lead in ensuring infrastructure) or even ESF #13 – Public Safety and Security (DOJ) if there's looting or quarantine to enforce (HHS is clear that quarantine issues are voluntary, but DHS is just as clear that everything needs to be considered as possibilities (see Pandemic Influenza: Best Practices and Model Protocols (.pdf, 37 pages) wherein it states on p.7: "The population may be directed to remain in their homes under self-quarantine 90 days per wave of the outbreak to support social distancing practices" and "Telecommunications may likely be overwhelmed due to increased utilization caused by telework employees, homebound citizens, and public services search for resources"). However, it's not clear where every problem fits... there's no ESF for food supply (cities like NYC don't have more than 24 hours on hand should it get cut off from the rest of the world and it's not clear ESF #11 (Agriculture, food safety) is really set up to support the supply chain to grocery stores, etc. The 'food and agriculture' incident annex .pdf is more geared to a terrorist attack on the food supply than the delivery folks all calling out sick).
The point of going through some of those worst case scenarios is to focus on the need to practice the intra-agency coordination issues that would invariably occur should HHS, DHS and DOJ all be called upon to support ESF functions that overlap. The larger the disaster, the more likely it's a 'new and never before seen and done' scenario requiring flexibility and competence. It's why the NRF requires PFOs and FCOs (see part I). And this tongue-in-cheek slide (presented at this conference) might summarize the envisioned response (contrast and compare):
Given the above, a case could be made for following the advice of the National Response Framework: incidents should be handled at the lowest jurisdictional level capable of handling the work (including at the state level). And, in fact, sometimes the lowest jurisdictional level capable of handling the work is the family unit. That's why, in addition to familiarizing yourself with the NRF and the federal role, you should find out more about what's happening in your own communities. For ESF #8, that's best done through your local health department, which likely has a web page that can get you started. And to further assist you, we will be pointing to other web pages that can help, such as Minnesota's codeReady page (put your family number in, and number of pets, and how many week's supplies, and the page will calculate what you need to prepare for any disaster), and Influenza Pandemic Preparation and Response - A Citizen’s Guide version 1.3., a .pdf to cover all the panflu basics.
Actually, blogs would be a major asset during a pandemic or public health emergency, at least if the grid stays up (attention those who want to control message: you can't. So, use blogs and wikis as an asset, not an enemy. We can educate faster, and sometimes better, than you can, and we know our community). In a true public health emergency, ESF #8 would apply and advice and directions would come via HHS through your local authorities and maybe (if they're smart) through blogs and alternative sources. Help them by helping yourself - prepare in advance and be better able to deal with whatever comes. And that's partly because there's little enough in any of these charts and plans about you and your family, and we don't want you to be left out.
More details can be found posted by the regulars here. Next week, more of what you can do, and where to find more information
Bonus material: example of pandemic specific guidance for businesses.
...the Marsh – Albright Group study lays out 10 best practices that leaders can use to improve their state of preparedness for a pandemic. These steps include:
* Treating a pandemic as a truly catastrophic event versus a "manageable disruption;"
* Establishing pandemic planning committees, supported by an actual budget;
* Identifying and pre-qualifying alternate sourcing capacity
* Incorporating their entire global supply chain—including critical suppliers, customers, and other key stakeholders—into the organization’s threat and vulnerability profile;
* Prioritizing critical products and services and preparing to protect those, even at the expense of other important elements of a business model;
* Developing a plan that considers the spectrum of response, recovery, restoration, and resumption activities;
* Identifying critical pharmaceutical and non-pharmaceutical interventions and procuring them now;
* Focusing deeply on Human Resources issues, reviewing existing policies and procedures and, in most cases, updating them in an attempt to provide reasonable accommodations for this special circumstance;
* Including a communications strategy as a critical element in the pandemic preparedness plan; and
* Estimating and planning for post-pandemic changes, including shifts in demand patterns, in the availability and morale of staff, and in infrastructure, both locally and to vendors.
"The time to plan is now," said George Abercrombie, president and CEO of Hoffmann-La Roche Inc. "Once the WHO declares that we are in a pandemic, it will be too late for companies to begin planning. Even though, the threat of pandemic avian flu doesn’t make the headlines these days, I hope that business continuity managers will read this report and begin to take the threat seriously."