In emergency planning efforts, there is much debate about whether to plan for the worst and scale down, or plan for current threats and scale up. Of course, in complex systems, small changes in initial conditions can have profound effects. By considering larger, low-frequency events, communities can overcome this challenge and be better prepared for disasters of all sizes.
In certain areas of life, it is normal to start big and end small. Tailoring begins with large sheets of fabric that are cut, sewn, and fitted to make the perfect suit. Stones are chiseled down to form a sculpture. Yet, in some corners of the emergency management community, there is continued debate about the direction of scalability: prepare for large-scale, catastrophic events and scale down to deal with smaller incidents; or plan around more probable events and rely on the inherent flexibility of the response system to scale up.
Budgets, time constraints, and a variety of other contributing factors have caused many in emergency management to focus on the threats and hazards that are most likely to occur. As a result, some in the field forego consideration of catastrophic events that would lead to mass casualty incidents. Preparing for these large-scale events, however, provides the best forum for a truthful consideration of a community’s capabilities and needs.
The Doctrine Case
Modern doctrine points to the need for scalability in community planning and operations. One of the defining characteristics of the National Incident Management System is that operations should be scalable, providing the ability to deal with not only day-to-day incidents but also large-scale events. Comprehensive Preparedness Guide 101 recommends flexible planning that can address traditional and catastrophic incidents. The National Preparedness Goal has as one of its key drivers the need to consider cascading events in order to fully understand the potential hazards facing a community. Each piece of doctrine was developed after engaging stakeholders from across the nation – experts in emergency management and homeland security. Despite the recommendations of colleagues to consider these mass casualty events, there is still debate within the field.
Applying the Chaos Argument to Operations
Considering chaos theory in mass casualty planning helps paint a clearer picture as to why it is better to think big and scale down instead of thinking routine and scaling up. Edward Lorenz, a meteorologist and mathematician, described in his 1995 book, “The Essence of Chaos,” that chaos theory was a way “to refer collectively to processes … that appear to proceed according to chance even though their behavior is in fact determined by precise laws.” More specifically, chaotic systems are subject to sensitivity dependence – more commonly known as the “butterfly effect.” Sensitivity dependence means that even slight changes in initial conditions can have a profound effect on outcomes. Mass casualty incidents occur in a complex and chaotic system. So, when faced with sensitivity dependence, rather than relying on plans and procedures that need to scale up to deal with a mass casualty incident, it may be more effective to respond big and scale back if needed.
Thinking and considering complex events is a necessity; repeatedly, reality has proven stranger than fiction. For example, it is unlikely that emergency planners would have constructed a tabletop exercise with a scenario that includes a 9.0 magnitude earthquake that generates a tsunami, causing a meltdown and containment failure at a nuclear power plant. Equally unlikely would be an exercise about a post-tropical cyclone with hurricane-strength storm surge, wherein a few days later there was a snowstorm – all while preparations were underway for a highly contested presidential election. Although both of these high-consequence, low-probability events actually did occur, they fell outside normal planning scenarios.
Considering cascading events can be daunting for emergency planners. There are unfortunately many examples of large-scale non-cascading events that will generate mass casualties. Complex coordinated terrorist attacks, the use of anthrax in the postal system, active shooter events, and a host of other incidents emphasize the need to plan beyond comfort zones. This kind of thinking encouraged several jurisdictions around the United States to acquire medical ambulance buses. By considering large-scale terrorist threats and planning accordingly, these communities were able to make strategic acquisitions and ensure that correct protocols were in place to use these assets in a crisis.
On 15 May 2017, one of these buses was used in support of a mass casualty incident with over 20 injured, resulting from a motor vehicle accident on Interstate-95 in Maryland. Planning for larger events enabled the local jurisdictions to scale down and effectively respond to an overturned charter bus. Had their thinking been reversed – only planning for an incident with two or three or even five casualties – there is no guarantee the capacity would be available to deal with this larger event. Even if the capacity existed, the lack of multijurisdictional integrated planning that results from considering large-scale mass casualty incidents would have hampered response operations.
Challenging the Thought Process
Reasonable people argue that planning for larger mass casualty incidents is time-consuming, that the events are so infrequent that the focus should be on more likely events, and – even if these factors are ignored – that there will never be enough resources in their jurisdictions to deal with such an event. Planning for incidents that stress and break existing response systems is certainly time-consuming. And, yes, a community may never have all the resources it needs to single-handedly manage a large mass casualty incident. However, that is the purpose of mutual aid.
In light of recent mass casualty incidents that have occurred in diverse communities across the nation, frequency is no longer a valid argument. A mass casualty event will happen again. It may happen today. The key lesson to be learned from recent incidents is that the first time determining how to manage such an event should not be as the event is unfolding.