Newswise — Following the emergency preparedness disaster of Hurricane Katrina, The Department of Homeland Security has updated its National Response Plan, which is now under review. Reaction in state and local governments hasn't been all positive. The University of Maryland's Chiehwen "Ed" Hsu, an expert in public health emergency preparedness, has read the plan and says while there are some improvements, there are some weak spots. One of them is the plan's failure to advocate resources to support the needs of vulnerable populations, such as those with physical disabilities and language restrictions. Here Hsu offers his assessment of the NRP and some specific actions that should be taken to help vulnerable populations. Hsu is assistant professor of public health informatics in the department of public & community health at the University of Maryland. He has published several recent papers on public health needs of vulnerable populations. Read more about Hsu's credentials - http://www.newsdesk.umd.edu/experts/experts.cfm?type=expert_id_all=108224933 Media may use all or part of this interview, with attribution to Hsu.
Q: What are some of the strengths of the National Response Plan?
HSU: It attempts to streamline the disaster management process, to clarify the chain of command, establish policies, procedures, protocols, and include best practice for disaster management. It also defines the federal roles and responsibilities in disaster management, and the level of assistance it could provide to state and local governments. It specifies the stages of federal government response to disaster events, with both proposal timeline and new federal supporting functional units that could serve as the basis for action and policy decisions.
In its most recent revision, it also outlines the needs of vulnerable populations, such as disabled persons, children, seniors, women, residents with chronic diseases who are on long-term medication, and individuals with limited English proficiency, and lessons learned from disastrous events such as Hurricane Katrina and Rita, to include stakeholders with special needs.
Q: Does it succeed in doing those things?
HSU: Clarification of the chain of command (such as emergency operational centers across various functional disciplines and jurisdictions) and the assignment of roles and responsibilities are very important in emergency preparedness and response. Based on the lessons learned from previous and current natural/human-made threats of our times, to avoid the confusion arising from emergency events it will be very important to clarify the roles and responsibilities of the agencies involved. The current year Plan includes provisions and proposes specific strategies for both risk communication and for vulnerable populations, such as disabled persons, children and women, and person with limited English proficiency, which are major improvements, based on lessons learned from Katrina and Rita of 2005. But while the proposals for vulnerable populations are there, recommendations for funding is not. (More detail in question below.)
Q: Will the revised plan work better than the Katrina era operation?
HSU: It's too soon to tell. The Plan could be put to test in the (predicted very busy) hurricane seasons this year. A sound plan should endure time testing and it will usually take a few years for a new policy to exert its effects. On the other hand, the Plan does set up sound logistic procedures to follow when needs arise, and as such there is a reason to be cautiously optimistic that the Plan has great potential for getting this country prepared for future, sometime recurring, natural disasters (such forest fires, hurricanes, tornados, earthquakes) and emergency events to come.
Q: There's already controversy about the Plan. States are saying it's too centralized in the federal government, setting up another Katrina disaster. What do you think?
HSU: I agree. Most emphasis and discussion were placed on federal level agencies. In addition, the funding for the Plan for local governments/organization, are not commensurate with the requirements put forth in either this document or the earlier plan of December 2004. Some of the programs seem to be unfunded mandates that may or may not be implemented given competing heated agendas that might drive resource re-allocation.
Q: What are some things that should be better addressed in the Plan?
HSU: While the plan attends to the needs of vulnerable populations, it lacks funding to identify and render sufficient support for those populations. In preparation for emergencies, it is important to empower every member of the society, including those from vulnerable populations, to be able to be self-reliant. Ensure that the needs of special populations are being addressed through the provision of appropriate information and assistance. It is crucial to define, locate, reach out, and link vulnerable populations to the resources that serve them.
More than 54 million, or one in five, Americans have some sort of physical disabilities. Fifty eight percent of people with disabilities do not know whom to contact about emergency plans for their community in the event of a disaster.
In addition, pregnant women and infants have unique health concerns in the aftermath of a natural disaster such as Hurricane Katrina. Although exact numbers are lacking, a study estimated that approximately 56,000 pregnant women and 75,000 infants were directly affected by the hurricane. Many Katrina evacuees suffered from physical and emotional stress, and many of them have pre-existing chronic diseases who are either on medications or dialysis. And many have limited English proficiency or are culturally isolated. Q: What do you recommend for planning for the vulnerable populations?
HSU: Because all preparedness efforts are local, it is important to involve grassroots associations and community advocacy groups that serve these populations in emergency planning. These include Community or Faith-based organization (CBOs/FBOs). especially in rural and minority communities. These groups could be community assets that could provide identifications of their stakeholders of vulnerable population and available resources when the needs arise. Regular drills and exercises are warranted.
Some specific things I recommend are: * Develop a comprehensive and up-to-date list of assets, hazards, volunteer pool, and health information kits, health care providers who can provide culturally and linguistically appropriate care, and risk communication channels that vulnerable community can use. Based on our previous studies many state medical examiner's offices maintain physician databases that are either outdated or incomplete - some had a third of the information incorrect. This should be improved. * Develop a special need registry to serve as an emergency information system. Vulnerable populations could self-register. This system should be able to receive calls/emails, distribute information, and respond to situations in a declared emergency.* Risk communication: Maps are an important tool for disseminating information, such as community assets, health providers, community resources, evacuation plans. and can be a powerful tool for risk communication for residents with limited English ability. * Volume medications for chronic diseases: there should be discussion of policy changes to allow patients with chronic conditions to obtain volume life-sustaining medications in declared emergencies with or without prior authorization from physicians.
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