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^ :S 8 F # 0 S A ~ $ A A S A : 15th Annual federal emergency management higher education conference
JUNE 4-7, 2012
decision making and special populations in public health disasters
(2nd Breakout Session of Tuesday, June 5, 2012)
Moderator
Deborah Quick, Ph.D.
Associate Professor of Sociology
Johnson C. Smith University
Charlotte, North Carolina
Presenter
Joseph J. Contiguglia, MD., MPH&TM, MBA
HYPERLINK "mailto:jcontigu@tulane.edu"jcontigu@tulane.edu
Clinical Professor
School of Public Health and Tropical Medicine
Department of Environmental Health Sciences
1440 Canal Street, Suite 2100
New Orleans, Louisiana 70112-2704
decision making and special populations in public health disasters
Prepared by:
Les Welsh
HYPERLINK "mailto:lesleywelsh@mail.adelphi.edu" lesleywelsh@mail.adelphi.edu
Emergency Management Student
Adelphi University
Introduction
Dr. Contiguglia is currently completing his 6th year as a clinical professor of Public Health at Tulane Universitys School of Public Health and Tropical Medicine, and his first year as a clinical professor at the Oklahoma Disaster Institute. In 2007, after 29 years of selfless service, Colonel Contiguglia retired from the United States Air Force as the Director of Operational Medicine and Chairman of the Department of Military Medicine at Keesler Medical Center in Biloxi, Mississippi.
On June 5, 2012, Dr. Contiguglia provided a 2-hour presentation focusing on the ever increasing challenge emergency managers and public health officials have on making timely and effective decisions before, during, and after a disaster that support special population needs. Precipitating this challenge was the equally important concern of actually delineating these special population groups. Who are they? And why are they becoming a greater concern for the emergency management community at large?
Summary
During the seminar, it was highlighted that special population groups could be defined and described several different ways. They could be categorized by age, disability, income, food availability and accessibility, culture and lifestyle, and many others. They make up demographics in both the rich and poor countries of the world. They are adversely impacted by disasters disproportionately more than other demographics. Therefore, it is imperative that prior to a disaster, detail and attention must be given to delineating the various special population groups and their unique needs. Operational focus must be on the needs of the population. Ensure safety, water, food, shelter, etc. are readily available.
For example, over the past 85 years, the world population has increased from 2 billion (1927) to 7 billion (2012) people with almost 50% living in highly concentrated urban population centers vice rural areas. This migration is projected to increase to 75% over the next 40 years. This trend increases peoples vulnerability thus their risk to various types of hazards (e.g., pollutions, crime, poor sanitation, disease, etc.). To make matters worse, people are also living longer. On average, the life expectancy of a US male has increased from 47.9 years in 1900 to 75.6 years today. Additionally, the fastest growing age group is the 65 years and older. As a result, these special population groups staggering statistics are challenging the health and medical community and stressing the public health emergency management planner and responder . The stressors and concerns stem from the need for uninterrupted medicines, acute and chronic health care, psychological health care, disability requirements, and many others.
To address the escalating special population groups and their needs, emergency planners and the public health commune must establish effective and empowering team work. The goals and objectives of these multi-disciplinary teams must be clearly defined. Roles and responsibilities, communication networks, training requirements, coordination and collaboration, and exercise scenario design are critical factors that must be clearly understood by all team members. For example, some lessons learned from the 9/11 first responders included the need for better chain of command clarity, improved communication protocols, more effective mobilization of first responders, and more efficient provisioning and distribution of emergency and donated equipment. Additionally, Dr. Contiguglia emphasized more training for public health responders, such as; review of the all hazards concept model, NIMS, WMDs, surveillance, medical countermeasures, forensic epidemiology, and evaluation.
Another concern was coping with the psychology of conducting emergency response. In most disasters, responders become casualties and victims just like the affected special population. Fatigue, stress, depression sets in and ultimately causes psychological injury to the responder. Dr. Contiguglia advocates realistic and comprehensive training and effective leadership as methods to minimize these adverse impacts. Disaster training, thus operations should be an extension of routine practices. Design the exercise for the worst case scenario. Expect the unexpected, think the unthinkable, and do the undoable. Focus on your jurisdiction and its unique perils. Follow the action phases of readiness, prevention, preparation, execution, and recovery.
Life lost in two hours cannot be saved in 24 hours is a quote Dr. Contiguglia stated when he described time. Time is of the essence and every minute counts. That is why he stressed the importance of effective command and control, specifically on superior leadership, taking accountability, integrity and credibility. He also emphasized the importance of triage, initial care, surgical treatment, and medical response. These health and medical actions save lives but are directly linked to the efficient use of time.
Other disaster response activities that must be improved upon are disaster warnings, sheltering, and evacuation. In most cases, special population groups do not like to evacuate from their homes and shelter in unfamiliar locations with strange people. Breaking up is hard to do.
One of the most important take a ways from Dr. Contiguglias presentation was that plans are nothing, planning is everything. You cant always get what you want. Therefore, developing contingency plans and incorporating flexibility into these plans are crucial. It is important to keep your eye on your end result (or standard), even at the expense of changing your procedures or processes. Optimize your outcome under evolving disaster conditions. Two planning techniques Dr. Contiguglia outlined were recovery-based management and prevention-based management. Recovery-based management primarily focuses on disaster events, whereas prevention-based management focuses on vulnerability analysis and risk assessments.
The last lesson Dr. Contiguglia discussed was on tactical risk communication and how the media facilitates this vital endeavor. He stated that tactical risk communication must be short, authoritative, concise, and focus on its intended special population target audience. One major role of the media is to help deliver these messages. The media are the main source of health information for the public in a non-disaster situation, and the only source of any information in a disaster event! The media and proper communication messaging provides and maintains situational awareness and common operating picture for the public. Statistically, this has contributed significantly to the absence of public panic and widespread crime.
Conclusion
During this 2-hour information briefing, Dr. Contiguglia highlighted the ever increasing disaster preparedness and mitigation challenges special population groups possess in a world that continues to grow and migrate to population centers. As a public health official and subject matter expert, he outlined the need to improve our current disaster management techniques and strategies to meet tomorrows issues and concerns. What worked yesterday most likely will not work for tomorrows problems. Though, during this briefing, he focused on a public health concern special population groups, the solution is comprised of multi-disciplinary factors. These factors range from establishing effective teams and team work, conducting successful coordination and collaboration, integrating and synchronizing efforts and outcomes, understanding the importance of time, empowering decision making, understanding that planning is a continuous process, and relevant risk communication messaging.
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