What I learned in Puerto Rico

There’s an old saying in emergency management, “There are no new lessons learned in emergency management, just new people learning the same old lessons.” Hurricane Maria in Puerto Rico was the 21st hurricane response in which I had participated, the first being Hurricane Opal striking Florida in 1995.

A much younger Michael Whitehead at the State Emergency Operations Center in Tallahassee during the Hurricane Opal response in 1995.

I traveled to Puerto Rico as a part of a Red Cross contingent mixed in on a charter flight with a Disaster Medical Assistance Team from Arizona. We landed at a darkened San Juan Airport at 2 AM on September 23, a few days after the storm struck the island. I was the second Red Cross person to arrive at the federal and state operations center in the San Juan Convention Center.

September 22, 2017: Red Cross volunteers and staff in Atlanta boarding a FEMA chartered flight for San Juan, Puerto Rico.

Many people asked me what I learned as a result of my participation in the initial response. On the spur of the moment I made a quick list of takeaways from my time in Puerto Rico. And I'm not speaking here about the Red Cross response in Puerto Rico, but about the overall response by the federal, state, local, and nongovernmental organizations that were involved.

This response was so unique and different from the others that I learned some new lessons while re-learning some of the old ones:

•        There was no power, no communications, no water and no sewage almost anywhere on the Island when I arrived. In a situation where resources are in such short supply and distribution is a challenge the mass care Priority #1 is to resource the shelters. The shelters then become a Point of Distribution and the local community comes to that location to get food and water.
•          “We were stuck on Day 2 of the response.” By days 3-4 in most responses power starts coming back on and the influx of outside resources catches up with demand. In PR we couldn’t get past Day 2 – the power didn’t come on and the terrible logistics of an island response kept FEMA from getting enough food and water on the island. In fact, in much of PR we are still in Day 2 of the response.
•          The lack of communication was unprecedented in my experience. We had difficulty emailing or even making a cell call in the San Juan Convention Center where the Joint Field Office was established. At times, we couldn’t email or call someone on another floor or even across the room! We took pictures of each other’s pieces of paper, or their computer screen or their iPhone to capture the information that we needed.

A picture that I took of a piece of paper in order to capture the addresses because our email was limited.

•          Large earthquakes like the New Madrid and San Andreas will create islands like PR, filled with millions of people unable to get power, communication, food or water. And with the bridges down, they will be unable to leave. Ironically, the many lessons learned from this response will apply to large earthquake responses.
•          With populations this large (there are over 3.5 million people on the Island), we cannot bring enough shelf stable meals and bottled water on the island fast enough to meet demand, much less get it distributed in an equitable manner. We needed water purification tablets, straws and large Units capable of producing water in bulk, which is what they started bringing on the Island. Then they brought in containers for the populace to carry the water. And propane cooking stoves so that they can distribute food boxes with food that can be cooked.
•          And finally, more of the responders got traumatized than in other disasters. I was.

Traumatized? Me? Yes.

I've traveled and been and seen things like this before. I was in a war zone for a year. I arrived in southern Mississippi 3 days after Hurricane Katrina slammed into Bay St. Louis and Waveland and Biloxi and all the other towns that were devastated. I spent 2 weeks in Manhattan after Hurricane Sandy. I've seen acres of carbonized homes with solitary chimneys left standing in mournful protest after wildfires.

But Puerto Rico was different.

I didn’t travel about the Island. Like during Katrina, I was working long hours so I missed all the terrible television images that many of you saw. For 3 weeks, I sat at a table that was one of many identical tables on the 3rd floor of the Convention Center. In the first weeks that I was there a parade of people with problems and questions for the Red Cross came to see me and my partner. Sometimes they were lining up to see us. Some of these problems and questions we were able to resolve. For most of the problems and questions we had no ready solutions nor answers.

The Joint Field Office on the 3rd floor of the San Juan Convention Center where I worked for 3 weeks responding to Hurricane Maria in Puerto Rico.

What follows is a brief but representative collection of the information that came to me by message, phone or in-person:

• Search and Rescue reported finding dead bodies and live people in the same house.
• A request for assistance from a nursing home, saying that they had no food or water for 2 days.
• The Puerto Rican Red Cross volunteer who burst into tears mid-sentence as she was talking to me and sobbed, “I have been trying to bring food and water to my family, but I can’t.”
• The man from Dominica who saw my Red Cross hat and stopped me as I left the Convention Center. He said that he had been living at the airport for 3 weeks trying to get home. I could see the desperation in his eyes.
• A family of tourists in a hotel who needed food for their children because they had run out of cash and no store could take a credit card.
• A family who needed a generator because their child would not survive without electricity.
• Hospitals that couldn’t get diesel for their generators because the tanker drivers were afraid of being hijacked.
• A message: “I have not heard from my elderly parents for a week. Can you tell me if they are okay?”
• A message: “My father lives alone and needs insulin. Can you help me get him a resupply?”

• An overheard conversation:

“These two elderly women live near my house. How can they get some food and water?”

“They need to go to the point of distribution for the municipality.”

“That’s a 30-minute walk from their house and we live on top of a hill.”

“You need to talk to the Mayor of the municipality.”

“We never know when the distribution site will be open. And by the time we get there everything is gone.”

“You need to talk to the Mayor of the municipality.”

“Isn’t there any other way to help these people?”

“This is the system that the Puerto Rican government has established. Go talk to the Mayor.”

We had lots of electronic communications devices but very little communications.

• There was the young guy in the nice, blue U.S. Public Health Service uniform: 

He was on the Disaster Mortuary Team. “Red Cross workers in the field discovered some dead bodies,” he said. He wanted to make sure that if we discovered any more that we recorded the precise location and passed the information on to him. “We need to pick up the bodies,” he explained, almost apologetic. “It’s our job.”

There were more stories. Many more. I can’t remember them all, but I can’t seem to forget enough. The daily onslaught of messages from desperate people who I knew would die or suffer greatly if we could not help them, and we could not help all of them, took an emotional toll. I didn't need to travel to the cities or the shelters to know what was going on. I had enough disaster experience to know what the conditions were like on the island based on the reports I was seeing.

I think that I was traumatized by the fact that I traveled to the Island to help but I found out when I got there that I was unable to help everyone. In the other disasters I felt like we were behind but we were catching up and eventually we would get to everyone. In Puerto Rico, standing on the 3rd floor of the San Juan Convention Center, I didn't feel that way. I felt like I was in an alternate disaster universe, or in the disaster version of Groundhog Day, where we performed the same tasks with the same unsatisfying results.

I was deeply saddened by this knowledge, and still am to this day. I did the best I could. In fact, I think that I did one of the best jobs that I've ever done in any disaster. And I'm so very sorry that it wasn't enough.

Estimating mass care resources: the example of the Kumamoto earthquake

I've been trying for over 20 years to estimate the amount of mass care resources that would be required in a disaster. In 2004 when Florida was hit by 4 hurricanes in a 6 week period I had multiple opportunities to try and figure this thing out. One thing I learned pretty quick in the 6 weeks was that when someone wanted me to provide a mass care resource they wanted it RIGHT NOW. Or, preferably, yesterday.

I also learned that in the State Emergency Operations Center during a hurricane response we weren't able to do "right now." For certain things that were already in the State Logistics Staging Area (like bottled water) we might even be able to do "tomorrow." More likely it was going to be day after tomorrow. And if they wanted something that we hadn't already ordered it would be, well, days until they would get it. That is if the requester was lucky and everyone, including me, did everything right.

There was a lot of things that I remembered and a lot of things that I forgot after Charlie, Francis, Ivan and Jeanne paid us all a visit. My big takeaway was that we needed to be able to estimate mass care resource requirements before the damage assessments were completed and in some cases, before the event actually happened.

How in the world are you going to do that? you may ask. Think about it. If a Category 5 Hurricane is lined up on Miami and forecast to hit there tomorrow we don't need to say, "Well, as soon as the damage reports are compiled, probably a few days after the storm hits, we'll know what we need to order. We'll just have to wait until then to figure out what we need."

We have to do better than that.

The things we need to order are always the same: cots, field kitchens, shelter managers, bottled water. What we don't know are what numbers we need to put in the quantity blocks of the requisitions. What frequently happens are conversations like this:

MASS CARE GUY: I need cots.
LOGISTICS GUY: How many?
MASS CARE GUY: I have no idea.
LOGISTICS GUY: "I have no idea" doesn't fit in the quantity block of the requisition.
MASS CARE GUY (MAKES UP A NUMBER): What about 10,000?
LOGISTICS GUY (WHO DOESN'T CARE WHAT THE NUMBER IS BECAUSE YOU'RE JUST ONE MORE PROBLEM BETWEEN HIM AND THE END OF THE DAY): OK.

I've had those conversations during a disaster. More than once, I'm afraid to say. But what could I do? There wasn't a manual or instruction book explaining how to do all this stuff I was doing. I decided that there had to be a better way of doing things than making up the numbers.

After 10 years of talking, explaining and arguing with some knowledgeable mass care people we've come up with a process to estimate mass care resources. The process is crude and needs a lot of refining, but guess what? Doing it this way is better than making it up.

The demand for mass care resources after an event is based on three factors: population, intensity and vulnerability. The population numbers we can get from the Census. To estimate intensity levels we developed this chart:

Table to estimate event intensity.

What we do next is estimate the number of people who were affected by each intensity level. For hurricanes we have the Saffir-Simpson Scale.  The U.S. Geological Service puts out PAGER Alerts after significant earthquakes. The basis for measuring earthquake intensity in these Alerts is the Modified Mercali Intensity Level:

The PAGER system provides fatality and economic loss impact estimates following significant earthquakes worldwide. This information is usually available within hours of the quake and provides an immediate estimate of the number of persons affected.  The USGS put out a PAGER ALERT for the Kumamoto, Japan earthquake that happened several weeks ago. The PAGER looked something like this:

The PAGER showed estimates of the number of persons affected by MMI level. Using the Event Intensity Table I came up with the number of persons affected by High (194k), Medium (1,410k) and Low (2,865k) intensities. I entered these population numbers into the Mass Care Planning Tool spreadsheet that we've developed to estimate mass care resource requirements

Remember: the demand for mass care resources is a function of population, intensity and vulnerability. Using the Intensity Table and the PAGER we were able to estimate the population affected by intensity. From these numbers we need to estimate the % of people who need to be fed and sheltered, for each intensity level. The percentages would vary according to the vulnerability of the people.

In some places, for example, the percentages for sheltering would be 10% for High, 5% for Medium and 1% for low. There are different percentages to estimate the feeding numbers. I had no idea what %'s to use to make a shelter estimate for a Japanese earthquake so I used the 10/5/1 that I had. The estimate using those percentages for the Kumamoto earthquake was 118,550 persons needing shelter (see Table below). Then I waited for the off chance that I might actually be able to get an estimate of the number of persons requiring shelter.

A few days later I read in the Wall Street Journal": “A total of 41 people were confirmed dead in Kumamoto prefecture, the epicenter of a magnitude 6.5 quake on Thursday night and a magnitude 7.3 quake 28 hours later early on Saturday. About 110,000 people were taking refuge at temporary shelters there as of Sunday afternoon, a Kumamoto prefecture spokesman said.”

Weather.com also reported that: “Local media reported that nearly 200,000 homes were without power and an estimated 400,000 households were without running water…[and] 180,000 are without shelter.”

Now that I had some actual numbers of people needing shelter I could see that the estimate of 118k needing shelter was low.  The 10/5/1 shelter percentages that I used weren't high enough, and probably should have been higher.  In other words, their vulnerability to the hazard was greater than I estimated.

As we socialize this estimation process in the mass care community and people start using it in disasters our ability to estimate these vulnerability percentages will improve. The conceptual framework for this estimation process has been included in the new FEMA L418 Course: Mass Care/Emergency Assistance Planning & Operations Course. This concept is also included in the new (soon to be released) Red Cross Feeding Standards & Procedures.

 Like I said, the process is crude and needs a lot of refining. But take my word for it: estimating mass care resource requirements this way is one HECK of a lot better than making up the numbers.

Disaster Feeding in New York City during Sandy

Hurricane (or, if you prefer, Post Tropical Cyclone) Sandy had a major, but not catastrophic, affect on New York City. Of the four hazards from a hurricane (surge, wind, inland flooding & tornadoes), surge was the principle source of the damage to the city. There was not the extensive inland roof damage from winds that happened in, for example, Wilma. Six months afterward, when I flew into Ft. Lauderdale, I was greeted by a sea of patched, blue roofs. I tried to explain to some New Yorkers that the wind damage was minimal but they protested and showed me their cell phone photos of destroyed, ocean side homes. I had seen such images before, in pictures and in person. What I was unable to convey to them , or they couldn’t understand, was that when a storm delivers surge, wind, inland flooding & tornadoes to a spot, there are no pictures of wrecked houses. There is only, like I saw in Bay St Louis after Katrina, the empty, concrete slabs where the houses had once been.

The City of New York, under the strict supervision of the Mayor’s Office, applied the considerable resources at their disposal to the task of feeding the survivors of the disaster. After tasking the National Guard to deliver shelf stable meals and bottled water to Points of Distribution, the City contracted for catered hot meals to be delivered to fixed feeding sites in the affected area. They also hired a number of the abundant food trucks to perform mobile feeding. These actions were paid for from the Mayor’s Fund, a stash of donated dollars available for use at the Mayor’s discretion.

The American Red Cross and the Southern Baptist Convention contributed considerable resources to the establishment of a mass care feeding infrastructure in the five Boroughs of the City and on Long Island. Three Baptist Field Kitchens were positioned in the City (Staten Island, Brooklyn & Queens) and one on Long Island. In mid-November there were approximately 120 Emergency Response Vehicles (ERVs) assigned to distribute the production of the 4 Field Kitchens and any additional catered meals.

The Food Banks in NYC, with their associated food pantries and soup kitchens, shoulder the burden of feeding the needy every day during blue skies. With the advent of the disaster their burdens were increased.  The truckloads of donations increased significantly after the disaster, which is a good thing. Receiving, sorting and distributing the additional donations was an additional burden on already exhausted staff, which is a bad thing.

Finally, ad hoc groups of people sprang into existence to take care of unmet feeding needs. The Food Banks and the Red Cross tried to assist these groups with varying success.

When I arrived in NYC in  the middle of November 2012, almost 2 weeks after the impact of the storm, very little of this feeding activity was coordinated. There were, in the words of a friend of mine, “multiple, parallel, non-converging" feeding efforts under way in the City (although parallel is, by definition, 2 straight lines that do not intersect, I add the term “non-converging” for those of you who never read Euclid). After speaking at the recently completed National Hurricane Conference to a number of individuals in the mass care community who served in NYC during Sandy, I arrived at several conclusions that I would like to share with you.

The reasons for the lack of coordination are primarily cultural and institutional. I will deal with the institutional first.

NYC is a hard place to live in on a good day and I imagine is a very difficult place to manage. The successful elected officials and managers in the City succeeded because of the particular way that they solved problems. I am not going to attach adjectives or moral judgments to their problem solving processes. Long ago the 5 Boroughs of the City decided that the best way to manage the City was with a powerful Mayor. Broward County, Florida, with a population of about 2 million persons, has 31 municipalities and a county government without an equivalent, powerful central executive. The problem solving processes in NYC and Broward County are different but satisfactory to a majority of the populations in each jurisdiction. When a Big Disaster Strikes the City the elected officials and managers address this problem the same way that they have been successful addressing Big City problems in the past.

The Whole of Community concept that FEMA Administrator Craig Fugate developed in Florida and brought to the nation emphasizes communication, collaboration and cooperation in the disaster response so that all of the resources in the community are brought together in a Unified Effort. The Unity of Command brought about by a powerful Chief Executive comes at the expense of a Unity of Effort. The fact that the disaster was not catastrophic meant that Unity of Command was sufficient for a successful response. A Unity of Command, that is, augmented by the remarkable and enormous resources at the disposal of the City Government and the admirable hardiness of the New York City survivors.

Another reason for the lack of coordination in the City during the Sandy response was the clash between the Culture of the New Yorkers and the (Southern, Midwestern, take your pick) cultures of the Femites and mass care volunteers who poured into the City during the response. The things that we did and said angered and worried the New Yorkers. How could they have confidence that we would perform when we had that kind of attitude? The things the New Yorkers did and said shocked and offended us. I remember thinking: I volunteered my time and energy to come here and help. Why are they treating me this way?

This was not a good environment for communication, collaboration and coordination.

I don’t believe that NYC is going to change the way that they handle disasters. They have been hit by 2 storms in successive years and they believe that their responses were successful. Why should they change?

They should change because Unity of Command will be overwhelmed in a catastrophic event. Whole of Community was adopted and implemented because Unity of Effort is the best way to respond in a catastrophic event. The City of New York can figure that out now or they can have that conclusion forced on them days or even weeks into a catastrophic event. It’s their choice.