Are You Ready to Respond?
Since the attacks of September 11, 2001, emergency preparedness has been a hot topic in the United States. However, long before 9/11, it had become apparent that our nation's ability to handle large-scale disasters was in need of major revision.
In-depth Supplement
Community Preparedness Scorecard
A Community Evaluation Model
This article focuses on various facets of community preparedness for events involving terrorism and weapons of mass destruction. It presents a way to measure a community's preparedness by means of a Community Preparedness Scorecard that can be used to assess readiness for several types of potential terrorist activities, including chemical, biological, radiological, nuclear and explosive (CBRNE) incidents. The scorecard establishes an inventory of a community's resources through a series of questions in six dimensions within two domains. The Preparation Domain has four dimensions: risk assessment; screening and identification; prevention, deterrence and planning; and training, awareness and application. The Implementation Domain has two: activation and response; and leadership, authority and communication.
An accompanying Capacity Worksheet takes information entered into the Community Scorecard and places it in appropriate categories, automatically calculating such things as the number of people who should be able to be decontaminated in a specific time frame, how many healthcare personnel are required to accomplish this and the required numbers of medical supply distribution teams and amounts of equipment. Each scenario defines the population at risk in a specific community, as well as resources available locally and nationally, based on previous information submitted in the Community Worksheet for the early phases of an emergent event.
Representing a systematic and methodical approach to assessing community risk factors, the scorecard can assist a community in developing a plan to reduce and eradicate its weaknesses. It provides a scalable template for communities to use as a guide while planning preparedness efforts before, and actions taken during and after, an emergency.
Three research questions were asked in developing this tool: 1) Can the use of a community assessment tool designed to evaluate the level of preparedness for different terrorism scenarios assist communities in determining their level of emergency preparedness? 2) Can the use of a scorecard type of tool designed to evaluate multiple dimensions of a community's preparedness demonstrate areas of strengths and weaknesses within each of these dimensions? 3) Can a scorecard type of assessment tool be used across communities that differ by geographic area and community type (urban, suburban, rural)?
Discussion
The differing levels of preparedness needed to respond to any given emergency depend on a number of demographic characteristics. A disaster management plan must be based on the community's health status, available resources and the cohesiveness of the community members.
The many factors involved in developing adequate disaster response include identifying triggering agents and vulnerabilities, and breaking down barriers that separate disaster-related actors and institutions from one another. Improvements in political support, legislation and the provision of human and material resources for disaster management purposes will be necessary.1
The ultimate goal of the disaster management plan is to effectively allocate resources in a timely manner.2 Risk is defined as “the estimated impact that a hazard [may] have on people, services, facilities and structures in a community; the likelihood of a hazard event resulting in an adverse condition that causes injury or damage.”3
Surge capacity is a healthcare system's ability to expand quickly beyond normal services to meet an increased demand for medical care in the event of a large-scale public-health emergency.4 Stakeholders such as healthcare providers, emergency planners and federal, state and local decision makers play a vital role in ensuring sufficient surge capacity within their communities and regions. To achieve a rapid response in the event of a public-health emergency, there must be sufficient staff that understand their roles and are able to perform them effectively.4 As the ongoing effort to lessen the impact disasters have on people's lives and property through damage prevention, mitigation is the cornerstone of emergency management.5
Methods & Results
To complete the scorecard, community officials provided primary data by responding to a questionnaire. The scores of each community were placed in a database and coded by region and community type. Inferential statistical measurements were used to measure and analyze the data received to test the research questions. Establishing validity and reliability for the model was achieved by sending it to a panel of experts.
The results were based on the responses of 31 out of 53 townships and boroughs from two counties in northeastern Pennsylvania. The best possible overall score was 100. The scores for these communities ranged from 12-59 and averaged 24.
In the Preparation Domain, the average risk assessment score was 10 (out of 10), and the average for screening and assessment was 5.7 (out of 30). For prevention, deterrence and planning, the average score was 15.8 (out of 30), and for training, awareness and application, it was 5 (out of 30). Within the Implementation Domain, the average score for activation and response was 18.87 (of 35). Leadership, authority and communication received an average score of 15.7 (also of 35).
Recommendations
The study highlighted several recommendations that could improve preparedness:
- Improve communication and education between townships and county offices of emergency management.
- Expand the scope of the model in order to document previous experience with particular types of emergent events and natural disasters.
- Require community leaders to complete FEMA's Orientation to Hazardous Materials for Medical Personnel: A Self-Study Guide, IS 346, and Incident Command System: Independent Study Course-Basic. All public officials would additionally benefit from being familiar with FEMA's Guide for All-Hazard Emergency Operations Planning, State and Local Guide (SLG) 101.
- Establish a baseline of communication that can serve as a standard.
Limitations
The size of the study was limited to two northeastern Pennsylvania counties that were predominantly rural, with a small number of urban and suburban communities. A second limitation was the inability of the model to address the different levels of experience among the surveyed communities.
Limitations also included the various levels of communication in use (some of the townships and boroughs did not possess computers, which present a challenge for adequate emergency preparedness) and identification of hazards and risks that could impact a county, but were located outside that county's boundaries. A county would still need to prepare for these hazards, whether they're within its boundaries or not, but many of these communities considered themselves to not be at imminent risk of a terror attack.
Conclusion
A community evaluation model could be invaluable to the development of an effective, efficient emergency preparedness plan. In addition to providing critical information to the community about its strengths and weaknesses, a model of this type would also provide a basis for developing a plan to ameliorate and eliminate those weaknesses. Excellent leadership is necessary to plan for and provide resources to the community, especially when the terrorism threat, to many, does not feel imminent.6
References
- McEntire DA, Triggering agents, vulnerabilities and disaster reduction: Towards a holistic paradigm. Dis Prev and Management 10(3):189-196, 2001.
- Bechtel GA, Hansberry AH, Gray-Brown D. Disaster planning and resource allocation in health services. Hospital Materiel Management Quarterly 22(2):9-17, 2000.
- Mid-American Regional Council. Part III risk assessment. www.marc.org/emergency/hazardplan.htm, 2004.
- Agency for Healthcare Research and Quality. Surge capacity: Education and training for a qualified workforce. AHRQ Publication No. 04-P028, www.ahrq.gov/research/biomodel.htm, 2004.
- Federal Emergency Management Agency. CHER-CAP fact sheet. https://fema.gov/library/cher_capf.shtm, 2004.
- Ledlow G. Community preparedness and response to terrorism. Westport, CT: Praeger Publishers. pp. 95-159, 2005.
Bibliography/Additional Resources
James A. Johnson, Jr., PhD, is a medical social scientist and author of 10 books on a wide range of health issues. He served as series editor of Praeger's Community Preparedness and Response to Terrorism series. He is also a professor of health sciences and health administration at Central Michigan University and last year participated in relief efforts for Hurricane Katrina on the Gulf Coast.
Gerald R. "Jerry" Ledlow, PhD, MHA, CHE, is a board-certified healthcare executive with nearly 20 years of healthcare leadership and management experience. He is currently system vice president for the Sisters of Mercy Health System, Genesis Project. He is a tenured associate professor at Central Michigan University.
Donna Barbisch, DHA, MPH, retired as a Major General in the U.S. Army Reserve, with over 25 years of leadership experience in the military, government and private sector. She is now among the nation's most distinguished experts in creating collaborative solutions to terrorism and disaster challenges.
Everitt Binns, PhD, is executive director of the Eastern Pennsylvania Emergency Medical Services Council. He is a management expert, educational consultant and organizational leadership specialist to corporations, hospitals, higher education and emergency service organizations. Additionally, he has over 35 years experience in emergency medical services.
