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Remain Calm

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The problem with disaster preparedness is that it all too often involves fighting the last war. In New York, of course, that means 9/11. Redlener contends that though some progress has been made, disaster planning on the whole remains hampered by a kind of first-wave mentality. That is to say, too many people are still stuck in the same mind-set they were in immediately after 9/11.

“We started backwards,” he says. “We put the money first and told people to go buy things, and now we’re struggling to define what it is we wanted them to achieve with that money.”

Even more problematic is the alarming lack of creativity. After 9/11, everyone focused on planes and airline security. When Richard Reid, the shoe bomber, was caught, suddenly there was great urgency about having everyone remove their shoes at the airport-security checkpoints. Everything is always reactive.

“Now the focus will undoubtedly be on hurricane planning,” Redlener says. “We’re always playing catch-up. We’ve got to get over this disaster-du jour mentality and develop the ability to take a broader, overall view, or we will continue to get blindsided.”

In fact, there is a new way of looking at things, a view that does reflect the reality that everyone has had four years since the initial shock of 9/11 to think about readiness. Rather than all terrorism all the time, planners have begun to focus on a more sophisticated, more adaptable strategy called the “all hazards” approach.

The idea is simple. When dealing with the impact of a catastrophe, the cause (terrorism or Mother Nature), at least as far as recovery and rescue are concerned, is almost irrelevant. People have to be evacuated, the wounded have to be treated, the displaced have to be sheltered, order has to be maintained, and so on. In other words, much of what composes an effective response is largely the same in every emergency situation.

Even the feckless Department of Homeland Security has recognized the need for this approach, issuing a list of fifteen possible disaster scenarios that it has urged every state to prepare for. New York City’s Office of Emergency Management switched to an all-hazards strategy nearly two years ago.

State Assemblyman Richard Brodsky, who recently completed a highly critical study of New York’s hurricane evacuation plans, argues, however, that the city’s stated change in approach is little more than lip service. “All they’re thinking about is terrorism,” Brodsky says. “And the net result is that the hurricane plan is embarrassing. The city is as unprepared as FEMA.”

And Redlener argues that even the all-hazards approach is not enough. There must be a distinction in planning between calamities that are manageable in scope and what he calls mass events. He believes, for example, a suicide bomber in the subway would be a completely manageable event. Horrific and disruptive, no doubt, but manageable.

“But a nuclear explosion, a flu pandemic, an earthquake, or a major hurricane would be something else entirely,” Redlener says. “These kinds of events, where the number of casualties exceed the ability of our health-care system to respond and where you’re likely to have a breakdown of essential systems, are another matter. This is where our planning and our imagination fail to meet the reality.”

To virologists and infectious-disease experts, the flu scenario presented above is all too real. “When those of us in public health think about the terrible things that could happen,” says Dr. Thomas Frieden, New York City’s health commissioner, “pandemic influenza is right there at the top. And we’re clearly in a situation now that’s different from where we were ten years ago. It’s estimated that 150 million birds have died from avian flu.”

A pandemic would affect virtually every aspect of life in the city. Consequently, Frieden and members of his staff have been meeting with leaders from all sectors across New York to make sure everyone understands that a pandemic would be more than just a health crisis.

As much as 30 percent of the workforce may not show up owing to illness or fear of getting sick. This could result in disruptions in power and phone service. Fewer deliveries could produce food shortages, and maintaining sufficient Police and Fire Department manpower could cause problems in protecting the city.

In a pandemic, the first line of defense is the hospitals. Several weeks ago, the Health Department ran a tabletop exercise with hospital executives, simulating a pandemic to try to identify weaknesses in the system. Frieden says that despite worries about surge capacity, the overall number of beds was not an issue.

“We’re most concerned about respirator capacity and ICU beds. That’s the bottleneck in the models we’ve run,” he says. The department is currently evaluating low-cost portable ventilators. He’s also working with the hospitals to run crash courses for respiratory technicians and nurses.


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