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Source: http://www.forbes.com/opinions/2008/...0605lynch.html
Commentary
Care After Catastrophe
Gary S. Lynch 06.05.08, 11:10 AM ET
One hundred and twenty seconds of massive shaking. That's the time it takes to challenge, and potentially unravel, a region's critical public health care infrastructure.
In the wake of recent catastrophic events--the earthquake in China, Hurricane Katrina in the U.S., the deadly heat wave in Europe and the respiratory disease SARS in Hong Kong --it has become clear that the health care system is critical for post-disaster recovery but typically faces severe risks and setbacks.
On May 12, a magnitude 7.9 earthquake threatened the health, security and safety of 33.5 million people in southwestern China's Sichuan province. Buildings, infrastructure and people were exposed to "strong to extreme" shaking, according to U.S. Geological Survey data. Not far from the epicenter, another 281 million people and property were at risk from light to moderate shaking. And some 50 aftershocks measuring 4.4 or greater occurred within 72 hours of the massive tremor.
With more than 68,000 dead, approximately 19,000 people missing, another 364,000 injured, somewhere between 5 and 11 million homeless and countless logistical hurdles, it's difficult to imagine how any government could plan for a catastrophic event of this magnitude and its public health consequences.
While local, regional and national governments often plan for the worst case, how often do those procedures match what actually transpires during the first 72 hours?
Using publicly available data from the Sichuan province earthquake, we examined several realities of the post-earthquake response and compared them with typical pre-planning assumptions. The goal is to outline potential opportunities for ongoing improvement in the public health response during the first 72 hours following a catastrophe.
This is a preliminary assessment; it will take months, if not years, to gather the data needed to evaluate the overall effectiveness of the government response. Accounts thus far show that the public health response has been outstanding, especially given blocked roads, threat of floods, rainstorms, aftershocks, landslides and difficult terrain.
Waiting For Help To Arrive Vs. Self-Sustainability
Expectation: Recovery planning is typically limited by capacity--that is, available funding, resources and experience at the local level and, in many instances, at the regional or state/provincial level. It is also typically based on narrow assumptions, such as that only a certain portion of the public health care infrastructure will be damaged or destroyed. This leads to expectations that a higher authority (e.g., national or foreign government) will quickly send in the resources needed for rebuilding the public infrastructure.
Reality: However, in catastrophe after catastrophe, this is often not the case, and in those early stages local authorities must rely on their own resources and take action. That's one reason why, in earthquake-prone regions such as California, hospitals are required by law to be self-sustainable for 72 hours. They must have on-hand all the resources to operate such as: clean water, tents (for a field hospital), latrines/sanitation, food, generators and diesel, security, secure storage, blood, insulin, respirators, anti-hypertensive drugs, gowns, masks, cold storage, surgical equipment, oxygen and mortuary capacity.
In the Sichuan province, the Chinese government made great strides to respond swiftly in both urban and rural areas. While meeting success in urban areas, rural areas--as with Hurricane Katrina and the 2005 earthquake in Pakistan--were extremely difficult to access, and, as a result, the public infrastructure suffered.
Whatever the actual impact of a catastrophe, in the first 72 hours people tend to make decisions at an emotional level rather than a rational level. Many focus on personal and familial survival before returning to their official duties, such as providing health, safety or security or dealing with community issues.
Furthermore, first responders, and those acting as first responders, may take risks beyond their abilities, raising other potential public health issues. Typically, volunteers, local military, police and fire departments band together to establish the first posts of emergency care and public infrastructure. These responders may unknowingly expose themselves to hazardous situations or materials. Over 400 first responders were killed on Sept. 11, 2001, and many more were later harmed by exposure to toxins. Similarly, 20% of all SARS cases were health care workers.
Another obstacle with regard to re-establishing public health infrastructure is that many survivors become incoherent, irrational, difficult to motivate, isolated and defensive, as was the case in the Cayman Islands during Hurricane Ivan and in New Orleans during Katrina. Public infrastructure to support the manifestations of post-traumatic stress is typically unavailable in the first 72 hours.
A Detailed Plan Vs. A Flexible Plan
Expectation: Many recovery plans are based on an expectation that key decision makers will be available, recovery will be orderly and that only a pre-designated area will be affected. However, because there are so many potential outcomes, these planning assumptions are somewhat limited.
As a result, the impact on public health care resulting from common outcomes is seldom accounted for in the planning assumptions. Examples include severed sewer, gas, water and electrical lines and secondary physical events such as flooding, mudslides and hazardous materials release. The amount and scope of regional planning is limited because of the time needed to coordinate a large number of participants and the difficulty of identifying common incentives.
Reality: Major regional disasters present significant logistical challenges during the first 72 hours. Three gaps in logistics planning typically arise immediately after the event:
1. The plan has too small a scope and the impact of the catastrophe is greater than expected. As a result, backup personnel, facilities, technology and/or equipment that were assumed to be readily available are not, because they also were severely affected by the event--for example, primary medical records as well as backup records stored offsite have all been destroyed.
2. The ability to plan for the number of "what if" scenarios is overwhelming and as a result convenient assumptions are made about what roads will be impacted, the time of day the event will occur and/or what weather conditions will prevail. Many times the current state of health care prior to the disaster is not taken into account, such as a lack of respirators, a hospital's financial constraints, the current state of patients in the hospitals, the physically and mentally disabled, children in schools or the prison populations.
3. The potential for quick and sometimes uninformed decision making can further complicate logistics and public health. For example, the decision to close local or regional borders may inhibit the movement of key supplies, especially when a greater authority is required to reopen a key transportation hub such as a port or an international access point.
At the individual level, the desire to fulfill one's immediate needs will prevail--such as the need for water--and additional health risks arise, such as cholera or typhoid. Raw sewage contaminated the drinking water in New Orleans, thus increasing the threat of disease outbreak. Sanitation becomes an issue after the first 12 to 24 hours, as food begins to spoil and the threat of infectious disease outbreaks increases. The location of the disposal facility, in relation to the proximity of the people, is an often-overlooked consideration.
And these are just a few of the many gaps that continue to exist between a community's disaster recovery plan and the actual situation.
Every "unprecedented" catastrophic event over the past century provides the opportunity to overcome previous challenges and leap ahead. What can be--not what was--should be the vision going forward. The goal is to close recurring gaps, strengthen public health infrastructure and improve procedures for disaster recovery.
Gary S. Lynch, the author of At Your Own Risk (Wiley, 2008), is managing director and global leader of Marsh's supply chain risk management practice.
Commentary
Care After Catastrophe
Gary S. Lynch 06.05.08, 11:10 AM ET
One hundred and twenty seconds of massive shaking. That's the time it takes to challenge, and potentially unravel, a region's critical public health care infrastructure.
In the wake of recent catastrophic events--the earthquake in China, Hurricane Katrina in the U.S., the deadly heat wave in Europe and the respiratory disease SARS in Hong Kong --it has become clear that the health care system is critical for post-disaster recovery but typically faces severe risks and setbacks.
On May 12, a magnitude 7.9 earthquake threatened the health, security and safety of 33.5 million people in southwestern China's Sichuan province. Buildings, infrastructure and people were exposed to "strong to extreme" shaking, according to U.S. Geological Survey data. Not far from the epicenter, another 281 million people and property were at risk from light to moderate shaking. And some 50 aftershocks measuring 4.4 or greater occurred within 72 hours of the massive tremor.
With more than 68,000 dead, approximately 19,000 people missing, another 364,000 injured, somewhere between 5 and 11 million homeless and countless logistical hurdles, it's difficult to imagine how any government could plan for a catastrophic event of this magnitude and its public health consequences.
While local, regional and national governments often plan for the worst case, how often do those procedures match what actually transpires during the first 72 hours?
Using publicly available data from the Sichuan province earthquake, we examined several realities of the post-earthquake response and compared them with typical pre-planning assumptions. The goal is to outline potential opportunities for ongoing improvement in the public health response during the first 72 hours following a catastrophe.
This is a preliminary assessment; it will take months, if not years, to gather the data needed to evaluate the overall effectiveness of the government response. Accounts thus far show that the public health response has been outstanding, especially given blocked roads, threat of floods, rainstorms, aftershocks, landslides and difficult terrain.
Waiting For Help To Arrive Vs. Self-Sustainability
Expectation: Recovery planning is typically limited by capacity--that is, available funding, resources and experience at the local level and, in many instances, at the regional or state/provincial level. It is also typically based on narrow assumptions, such as that only a certain portion of the public health care infrastructure will be damaged or destroyed. This leads to expectations that a higher authority (e.g., national or foreign government) will quickly send in the resources needed for rebuilding the public infrastructure.
Reality: However, in catastrophe after catastrophe, this is often not the case, and in those early stages local authorities must rely on their own resources and take action. That's one reason why, in earthquake-prone regions such as California, hospitals are required by law to be self-sustainable for 72 hours. They must have on-hand all the resources to operate such as: clean water, tents (for a field hospital), latrines/sanitation, food, generators and diesel, security, secure storage, blood, insulin, respirators, anti-hypertensive drugs, gowns, masks, cold storage, surgical equipment, oxygen and mortuary capacity.
In the Sichuan province, the Chinese government made great strides to respond swiftly in both urban and rural areas. While meeting success in urban areas, rural areas--as with Hurricane Katrina and the 2005 earthquake in Pakistan--were extremely difficult to access, and, as a result, the public infrastructure suffered.
Whatever the actual impact of a catastrophe, in the first 72 hours people tend to make decisions at an emotional level rather than a rational level. Many focus on personal and familial survival before returning to their official duties, such as providing health, safety or security or dealing with community issues.
Furthermore, first responders, and those acting as first responders, may take risks beyond their abilities, raising other potential public health issues. Typically, volunteers, local military, police and fire departments band together to establish the first posts of emergency care and public infrastructure. These responders may unknowingly expose themselves to hazardous situations or materials. Over 400 first responders were killed on Sept. 11, 2001, and many more were later harmed by exposure to toxins. Similarly, 20% of all SARS cases were health care workers.
Another obstacle with regard to re-establishing public health infrastructure is that many survivors become incoherent, irrational, difficult to motivate, isolated and defensive, as was the case in the Cayman Islands during Hurricane Ivan and in New Orleans during Katrina. Public infrastructure to support the manifestations of post-traumatic stress is typically unavailable in the first 72 hours.
A Detailed Plan Vs. A Flexible Plan
Expectation: Many recovery plans are based on an expectation that key decision makers will be available, recovery will be orderly and that only a pre-designated area will be affected. However, because there are so many potential outcomes, these planning assumptions are somewhat limited.
As a result, the impact on public health care resulting from common outcomes is seldom accounted for in the planning assumptions. Examples include severed sewer, gas, water and electrical lines and secondary physical events such as flooding, mudslides and hazardous materials release. The amount and scope of regional planning is limited because of the time needed to coordinate a large number of participants and the difficulty of identifying common incentives.
Reality: Major regional disasters present significant logistical challenges during the first 72 hours. Three gaps in logistics planning typically arise immediately after the event:
1. The plan has too small a scope and the impact of the catastrophe is greater than expected. As a result, backup personnel, facilities, technology and/or equipment that were assumed to be readily available are not, because they also were severely affected by the event--for example, primary medical records as well as backup records stored offsite have all been destroyed.
2. The ability to plan for the number of "what if" scenarios is overwhelming and as a result convenient assumptions are made about what roads will be impacted, the time of day the event will occur and/or what weather conditions will prevail. Many times the current state of health care prior to the disaster is not taken into account, such as a lack of respirators, a hospital's financial constraints, the current state of patients in the hospitals, the physically and mentally disabled, children in schools or the prison populations.
3. The potential for quick and sometimes uninformed decision making can further complicate logistics and public health. For example, the decision to close local or regional borders may inhibit the movement of key supplies, especially when a greater authority is required to reopen a key transportation hub such as a port or an international access point.
At the individual level, the desire to fulfill one's immediate needs will prevail--such as the need for water--and additional health risks arise, such as cholera or typhoid. Raw sewage contaminated the drinking water in New Orleans, thus increasing the threat of disease outbreak. Sanitation becomes an issue after the first 12 to 24 hours, as food begins to spoil and the threat of infectious disease outbreaks increases. The location of the disposal facility, in relation to the proximity of the people, is an often-overlooked consideration.
And these are just a few of the many gaps that continue to exist between a community's disaster recovery plan and the actual situation.
Every "unprecedented" catastrophic event over the past century provides the opportunity to overcome previous challenges and leap ahead. What can be--not what was--should be the vision going forward. The goal is to close recurring gaps, strengthen public health infrastructure and improve procedures for disaster recovery.
Gary S. Lynch, the author of At Your Own Risk (Wiley, 2008), is managing director and global leader of Marsh's supply chain risk management practice.