Emergency Response

I’m neither a doctor nor a politician. But I am a former Incident Commander, trained in the Incident Command System pioneered by fire fighters in Southern California in the 1960’s. The reason they created this system was a realization that weaknesses in emergency management were often due to:

• Lack of accountability, including unclear chain of command and supervision.
• Poor communication due to both inefficient uses of available communications systems and conflicting terminology.
• Lack of an orderly, systematic planning process.
• No predefined methods to integrate inter-agency requirements into the management structure and planning process effectively.
• Freelancing by individuals within the first responding team without the direction from team leader (Incident Commander) 
• Lack of knowledge with common terminology during an incident.

Today, all major governmental, police, fire, military and emergency response organizations use this structure to respond to emergencies. The system has been proven countless times in all sorts of emergencies. 

Information flow is critical during major event response, including the form of the information, the speed of the information flow, and the requirement that those who need the information actually get the information.

I’ve been frustrated watching the White House Press briefings over the last several weeks. Although we are being presented with some important information, a large amount of time is spent on presenting activities rather than results. I’ve heard the President, the Vice President, Cabinet members, and Admirals speaking of details while not providing higher level information to the American public. For example, the number of ventilators in the national stockpile is an important number but it means less than a projection of needed ventilators over time and whether the total supply will meet demand over the course of this pandemic. The is also true for gloves, masks, ICU beds, healthcare workers, or any other essential need. 

Using an example from my background, during the widespread power outages that we experienced in New York during Hurricane Sandy, we had several key metrics such as the total number of customers affected and the estimated restoration date for when all customers would be restored. In addition, it is expected that after damage assessment and crew availability is determined, estimated restoration will be provided for each customer affected. During events like Sandy, we tracked the number of restoration crews available to support us from around the country (think healthcare workers), the amount of vehicles, cable and wire, and poles, and switches we needed (think respirators, beds, etc), and the necessary restoration crew electrical protective equipment (think medical protective equipment) in order to achieve the overall restoration objectives. What I’m seeing in many of the press briefings during the pandemic is a lot of information, but it is not presented in a way that informs us about our progress in relation to our major objectives. 

The major objective for an electric system outage is restoration as quickly and safely as possible. The Administration has correctly made minimizing loss of life as the major objective for this pandemic. We experienced an unprecedented level of flood and wind damage during Sandy which required a tremendous amount of public safety work before we could deal in earnest with damage assessment and service restoration. I realize the pandemic we are currently facing is also unprecedented. It requires flexibility and resourcefulness and clear communication, especially when much is unknown and resources are constrained early on while ramping up to meet the many challenges of a large scale emergency. 

I don’t know what all the correct measures are for this type of emergency. I’ll leave that for the experts. But a set of curves charting current and projected needs of critical items compared to the current and projected availability of those items would be helpful, it seems to me. This could be done for respirators, ICU beds, gloves, masks, test kits, and anything else that is required to achieve the major objectives. This could be done on a high level (federal), at an interim level (state), and at the micro level (hospital). These graphs would actually be built up from the micro to the macro level. From these graphs, we could clearly identify and then address deficiencies in actual and projected needs by either moving resources from an area of surplus to an area of deficit or by increasing production. There is nothing that can be addressed when information is presented in a random and scattered manner. The information needs to be turned into a useful form that makes it actionable. Based on the major objective, targets can then be set to let the response team and the public understand the progress. Assumptions may be needed to build these models. As we learn more, the curves should be revised to reflect the new knowledge. The assumptions should be clearly stated.

It seems to me that there are parallel objectives. In addition to minimizing death for those afflicted with the virus, there are also objectives around prevention. This includes the stay at home orders, the development of a vaccine, development of an antibody test, and the plan for reopening of the economy. All of these could be tracked and a critical path developed. The Incident Commander cannot get bogged down with minutia or become distracted from the overall objectives and the plan to achieve those objectives during a massive event response.   

Those in charge of a crisis require many skills including drive, persistence, determination, compassion, leadership, resourcefulness, and strong communication skills. But a leader also needs to see the big picture and the ability to remain focused on the mission objectives. But the only way to understand how the team is performing is by measurement.

Peter Drucker was correct when he said you can’t improve what you can’t measure. We need to run this emergency using the well-established ICS emergency response structure and to create the metrics that allow us to readily see where we stand and where we are going. Without these measures, we are flying blind.