No single entity or agency can fight the war on terrorism--or handle the aftermath of any single battle-alone. Those tasked with response or recovery duties, at least the forward-thinking ones, understand that and embrace certain fundamental truths about U.S. domestic-preparedness policies and programs today, and for the foreseeable future-namely, that boundaries in and between agencies must be dropped; that operations exclusive to individual “kingdoms” or fiefdoms are no longer the most effective way to combat terrorism; and that, no matter what their history, all of the nation's preparedness agencies must be willing to share their own information, talents, and training with all other offices and agencies working in the same field.
This is the nature of the beast that is now driving the preparedness professionals, military as well as civilian-in the nation's entire domestic-preparedness/counterterrorism field-who are making the extra effort to reach across traditional boundaries and work with their counterparts in other agencies in not only traditional but also some nontraditional ways.
It might help, to more fully grasp what has happened over the past several years, to think of domestic preparedness as a giant kettle filled to the brim with varying-sized chunks of several different kinds of meat, as well as a dozen or so types of vegetables. The domestic-preparedness “kettle,” perched above a roaring fire called terrorism, is filled with varying talents, skills, and fields of experience--in police work, firefighting, emergency medicine, matters related to public health, and other specialty areas. All are part of the nation's overall domestic-preparedness/military-response network.
Numbers, Variables, and Fiefdoms
Among the key players in that network are the 188,000 military and civilian employees of the U.S. Department of Homeland Security (DHS). But there are numerous other local, state, and federal agencies, as well as a number of private-sector organizations, also working in the fields of domestic preparedness and counterterrorism. These days, the heat generated just by the threat of terrorism will start the cooking process. Each ingredient would have different ideal cooking times and temperatures, of course, but with the proper care and attention, and sufficient cooking time, the resulting mixture would be as hot and fluid as the fire below. The kettle analogy may seem at first glance to be a bit forced, but it should be remembered that the United States, as a nation, frequently has been described as a vast “melting pot” of people of every race, nationality, religion, and cultural background from all over the world.
As with the nation, the melting pot of “ingredients” in the domestic-preparedness field includes numerous variables, including the prevailing political and financial climate as well as the internal cultures and perspectives of many different professions. If all goes well, though, previous fiefdom boundaries and attitudes will give way to a spirit of mutual trust and cooperation, and the end result will be an interrelated and truly interoperable system. Unfortunately, such a state of utopian preparedness cannot and will not happen overnight, or in the near future. There even is a distinct possibility that it may never happen, but that seems unlikely, given the mood of the American people and the seeming determination--in the fields of counterterrorism and domestic preparedness, if nowhere else--of most of the nation's political and military leaders to work together to make the nation, and the world, safer and more secure.
There are some major obstacles to hurdle. Changes are required in certain federal regulations, the numerous political and cultural differences between and even within various professional disciplines will have to be reconciled, the vendor market has to be brought into the picture more completely, and a number of intangibles will undoubtedly crop up that also will affect the way that business gets done and relationships are forged.
Overall, the financial climate for domestic preparedness is improving, but not evenly and at the same pace for all first responders and/or for the other agencies involved. Most of the nation's hospitals, for example, are behind local police and fire departments in the amount of federal funding they already have received, and/or can expect to receive in the future. This disparity is a matter of considerable concern to hospital administrators.
Frank Califano, safety coordinator and network emergency manager for the North Shore Health System of Long Island, N.Y., commented as follows on the subject of hospital preparedness: “The hospital sector does not have [the same] access to federal funds that other responders do, but I think that is changing. Also, some hospitals work with public-sector responders in terms of personal protective equipment, respiratory protection, and decontamination, but that is not the case industry-wide, especially with smaller hospitals-many of which, it seems, are not sure what type of hazmat [hazardous materials] training is most effective, for example, or how to handle contaminated patients.
“But that, too, may be changing. In December of 2004, OSHA (the Occupational Safety and Health Administration issued a “guidelines” report Best Practices for Hospital-Based First Receivers that I think will help hospitals across the country understand what they need to do to handle contaminated patients.”
First Receivers is a relatively new term in domestic preparedness and should not be confused with first responders. Historically, first responders are firemen and policemen-i.e., those men and women who throughout the nation's history have been called upon to work at the scene of an incident. First receivers, on the other hand, include doctors, nurses, clinicians, emergency services personnel, and other medical people charged with treating contaminated patients in facilities (hospitals, usually) and at distances away from the incident scene.
Attitudinal and Other Problems
Califano and other hospital professionals consistently mention a number of problems that must be overcome before major improvements in hospital preparedness can be achieved. Some hospitals are apathetic about preparedness in general, for example, and do very little training or planning. Others adopt the philosophy that the local fire department will take care of the victim-decontamination problem. Even when there are no “attitude” problems, there still may be a number of harmful misconceptions about the precise levels of HAZMAT training that is needed and the appropriate types and amounts of respiratory protection that should be available in the hospital setting.
“Before the OSHA Best Practices document was issued,” Califano says, “federal regulations provided guidance for HAZMAT training. Those regulations [spelled out in the Code of Federal Regulations Title 29, section 1910.120 subpart (q)] are based on what is best for industry and public safety, not what is best for the hospitals.”
For the most part, however, Califano said, the hospital community is improving overall, in terms of fitting into the big picture. “It is getting better, but even in hospitals with proper training and equipment there is still an issue with staffing. In a lot of places, an emergency department does not have enough staff both to do decon and provide care- they have to choose, and that creates an obvious problem. We learned a lot from the Tokyo subway incident and the World Trade Center.
“In Tokyo,” he continued, “over 5,000 people went to hospitals-90 percent of them bypassed the first responders. The World Trade Center had the same profile. The downtown New York hospitals saw walk-ins well before the 9/11 patients started to arrive. Hospitals just cannot rely on the traditional method of receiving patients anymore.”
It is this fact, Califano and others have suggested, that should drive hospitals and public-sector responders to work together and understand each other's strengths and limitations. A concept applicable to all members of the domestic preparedness community is to understand how their own agencies fit in, locally and regionally, and how they can contribute most effectively. Much of this, of course, is simply human nature: It is the relationships made before disaster strikes that will help the entire process work efficiently.
In that context, Frank Califano offers a basic but important bit of advice, germane to all players in the domestic-preparedness arena: “We should not be competitors-everyone must work together.”