Integrating Emergency Management and Disaster Behavioral Health

One Picture through Two Lenses

Brian Flynn, Ronald Sherman, Brian Flynn, Ronald Sherman

• Publisher: Butterworth-Heinemann
• Year: 2017
• ISBN:
  9780128036396
• Topic: Scienze sociali
• Subtopic: Geografia umana

Integrating Emergency Management and Disaster Behavioral Health identifies the most critical areas of integration between the profession of emergency management and the specialty of disaster behavioral health, providing perspectives from both of these critical areas, and also including very practical advice and examples on how to address key topics.

Each chapter features primary text written by a subject matter expert from a related field that is accompanied by a comment by another profession that is then illustrated with a case study of, or a suggested method for, collaboration.

• Addresses the current state of the collaboration between the emergency management and disaster behavioral health communities as presented from pioneers in their respective fields
• Focuses on practical examples of what works and what doesn't
• Stresses both legal and ethical considerations and the public-private partnerships that are important for leadership in disaster situations
• Covers Emergency Operations Centers (EOCs) and risk communication

Section II

Key Areas of Integration

Outline

Section II. Key Areas of Integration

Chapter 5 Integration in Disasters of Different Types, Severity, and Location

Chapter 6 Not All Disasters Are the Same: Understanding Similarities and Differences

Chapter 7 What Can DBH Actually Do To Make Emergency Managers Jobs Easier?

Chapter 8 Expanding the Tent: How Training and Education Partnerships with Other Professions Can Enhance Both EM and BH

Chapter 9 Linking with Private Sector Business and Industry

Section II. Key Areas of Integration

This section explores several specific factors critical to establishing and sustaining integration. While sharing many characteristics, every disaster is different, every community that experiences a disaster is different, and every disaster response is different. Chapters in this section explore how these variations impact the roles and functions of both emergency managers and behavioral health professionals, and what this means in terms of integrating their efforts.

These chapters also explore the creative ways in which training and educational opportunities might be integrated and expanded. They also review the benefits for disaster survivors that can result from the integrated efforts of the disaster behavioral health and emergency management professions.

Chapter 5

Integration in Disasters of Different Types, Severity, and Location

James M. Shultz¹, Marianne C. Jackson^2,3, Brian W. Flynn⁴ and Ronald Sherman⁵, ¹University of Miami Miller School of Medicine, Miami, FL, United States, ²Federal Emergency Management Agency (Retired), New York, NY, United States, ³NYC Emergency Management, New York City, NY, United States, ⁴Uniformed Services University of the Health Sciences, Bethesda, MD, United States, ⁵Independent Consultant, FEMA Federal Coordinating Officer (Retired), United States

Abstract

The authors use disaster experiences that range from quite localized incidents to catastrophes around the world to illustrate how integration can work on many levels. From the disaster behavioral health (DBH) perspective, the response draws upon a highly variable collection of persons (primarily volunteers) whose makeup varies by state and jurisdiction. At the international level, evidence-based guidelines for Mental Health and Psychosocial Support (MHPSS) in emergency settings have been widely ratified and used effectively in responses to natural disasters, armed conflict, and humanitarian emergencies. This is a phrase equivalent to DBH in the US Future directions highlight the advantages of developing a more systematic, science-based, and professionalized DBH response within the United States, and incorporating the international MHPSS guidelines to enhance DBH within the United States and to streamline integration when the United States participates in an international response.

From an emergency management (EM) perspective, the scale of the disaster is a primary determinant of the levels of response that must be activated to manage the event. The chapter includes four case studies that focus on best practices, lessons learned, and provides a planning matrix to improve integration.

Keywords

Complex systems; Complexity; scalability; mental health psychosocial support; cluster system; disaster behavioral health; Binghamton shooting; Deaf Mexicans; Boston Marathon Bombing; Global mental health

Through a Disaster Behavioral Health Lens

James M. Shultz

Emergency management (EM) and disaster behavioral health (DBH) integration is progressively evolving but varies markedly by level of disaster response (ranging from local to multinational). Prior to discussing multiple levels of response, it is important to explain how the complexity of disaster events underlies the need to achieve coordination among levels of response.

Complex Systems Thinking for EM and DBH Integration in Disasters

The application of “complex systems thinking” provides useful insights that are particularly relevant to the theme of integrating EM and DBH across different levels for disasters and catastrophes (Cavallo, 2014; Cavallo & Ireland, 2014). It is evident that as disasters increase in scope, they require the activation of higher levels of incident management, bringing more response assets into play and involving more expansive jurisdictions. The ability to enlarge the response network to match the demands of the disaster is a mainstay of EM worldwide.

As incidents scale up in magnitude and intensity they frequently acquire new properties and transform in complexity. It is important to discern that disasters (or catastrophes) are not simply large-scale emergencies. Conversely, crises and emergencies are not “mini-disasters.” Whatever the metric that is used to measure the size or force of a disaster hazard, frequently a twofold increase in “dose” produces more than a “double batch” of disaster consequences.

Physicist Dirk Helbing, a renowned complexity scientist, captured this in a disarmingly simple phrase when he wrote, “disasters cause disasters” (Helbing, Ammoser, & Kühnert, 2005). Beyond the small-scale emergency level, the propagation of a hazard is not a linear process. One explanation for why disaster effects can mushroom unpredictably is that we live in a world of “globally networked risks” (Helbing, 2013). Human communities dwell within densely populated “risk landscapes” that influence the occurrence, types, and severities of disaster events (Shultz, Espinola, Rechkemmer, Cohen, & Espinel, 2016; Shultz, Galea, Espinel, & Reissman, 2016). The take-away for EM/DBH integration is that management of larger events is not just a matter of increasing proportions; the level of difficulty also amplifies rapidly (Helbing et al., 2015).

As a pragmatic example, a multidisciplinary author team worked together to elucidate the cascade of events that were set in motion during the deadly railway crash that occurred in Santiago de Compostela, Spain on the evening of July 24, 2013 (Shultz, Garcia-Vera, et al., 2016). Authors described the physics of train derailment, the patterns of physical injury sustained in a tumbling passenger carriage, and the expanding rings of psychosocial impact that subsumed injured crash survivors, bereaved loved ones, rescue personnel, citizen responders, local community residents, and the national population of Spain.

Different Levels of Disaster Response

One of the defining dimensions of EM/DBH integration is the level of response necessary to manage the extreme event. Response levels range from local to international. The scale of the disaster is a primary determinant of the scope of the response that must be activated to manage the event.

The Event Dictates the Level of EM Response

As the disaster enlarges to affect a larger population or geographic area, event management necessarily expands to include EM offices for all disaster-affected communities and the overarching EM command structure for the region. However, there is more to matching the level of the EM response than just the spatial dimensions of the disaster.

As the severity of disaster impact increases, event management moves upward to higher administrative levels. One way to conceptualize the level of EM coordination is to consider the relationship between the demands posed by the disaster and the response capabilities of the disaster-affected community. Quarantelli (2005) has created a rank ordering of terms to describe critical incidents that trigger an urgent response, to which “crisis” has been added (Shultz, Espinola, Rechkemmer, Cohen, & Espinel, 2016; Shultz, Galea, Espinel, & Reissman, 2016):

• Crisis	Capacities exceed demands—with capacity to spare.
• Emergency	Capacities meet (and may somewhat exceed) demands.
• Disaster	Demands exceed capacities. Outside help is needed and may direct the event.
• Catastrophe	Demands overwhelm and obliterate capacities. Outside help takes over direction of the event by default.

A community can deal with a crisis or emergency using local resources. Indeed, most events are crises or emergencies that can be handled by dispatching a small number of trained and experienced responder units. The incident command for many of these events does not flow through the local emergency operations center but is handled, for example, by fire/rescue services at the station level or by law enforcement at the precinct level.

An important boundary is crossed when the event rises to the level of a disaster (or catastrophe). The concept that a disaster crosses a critical threshold is implied in the definition: “a disaster is an encounter between forces of harm and a human population in harm’s way, influenced by the ecological context, that creates demands exceeding the coping capacity of the affected community,” (Shultz, Espinel, Flynn, Hoffman, & Cohen, 2007; Shultz, Espinel, Galea, & Reissman, 2007; Shultz, Espinola, Rechkemmer, Cohen, & Espinel, 2016; Shultz, Galea, Espinel, & Reissman, 2016). In contrast to crises or emergencies, disasters are population phenomena, affecting entire communities or larger geographic areas (Shultz, Espinola, Rechkemmer, Cohen, & Espinel, 2016; Shultz, Galea, Espinel, & Reissman, 2016). A disaster event is too big for a community to respond adequately utilizing only its own resources. Therefore, outside assistance must be requested, or assistance will be offered proactively, pending acceptance by the local authorities. The EM response typically shifts from the community jurisdiction, guided by local leadership, to an overarching incident command structure managed at a higher level.

Major disasters are locally rare but globally common, so disaster professionals should heed the guidance to “think locally, act globally” (Shultz & Cohen, 2015). Disasters often call upon EM professionals to deploy to events occurring outside their home territories. Actually, this is a fundamental precept of incident command management, creating mobile resources that can be directed where they are needed, guided by flexible, interc...