State Mass Care Coordination

The national mass care community needs to agree on a standard state mass care coordination process and then sell the concept to the emergency management community. I am sure that this is not a burning item on your priority list but here me out. Right now, responsibility for mass care coordination for most of the fifty states can be divided into one of three categories: 1) Let the Red Cross do it, 2) Let the Red Cross and FEMA do it, and 3) let a social service service state agency do it.

Emergency managers don't want to mess with mass care. This situation reminds me of the role of civil affairs in the Army. Civil Affairs consists of officers and soldiers who deal with civilians on the battlefield. The Infantry and Armor Officers who are In Charge don't want to mess with the civilians because they wouldn't take orders and were a drain on resources needed for combat operations. All of our tabletop and field exercises were full of combat units but civilians and their problems were nowhere to be seen. The civilians were assumed to be out of the exercise, taken care of by the civil affairs units.

Emergency managers are rightly concerned with life safety actions immediately after the disaster hits. But, as they say, after 72 hours you're not doing search and rescue, you're doing body recovery. Most big exercises end by 72 hours after the event, if they even last that long. Yet, at 72 hours, in disasters involving millions of people (which are the ones that most concern me) the mass care problems are only beginning.

The intent of a standardized state mass care coordination process is not to dictate to states how they should do business. When the Big One hits and the State starts screaming for help and people from other states or voluntary agencies or FEMA start streaming into the State EOC it would be very helpful if everyone used and understood a common process for mass care coordination. These new people are already dealing with an unfamiliar geography, a strange system and co-workers that they have never seen before. By giving them a nationally known and familiar process we can immediately increase their effectiveness. Preferably this process would have been taught in FEMA mass care courses and practiced in exercises like the National Mass Care Exercise. I've written about this in a previous blog post.

After the recent National Mass Care Exercise, held in Tallahassee in May, we came up with the diagram below to explain the coordination process that we utilized in the exercise. This diagram didn't spring forth from anyone's head fully formed. At least 30 or 40 members of the national mass care community nationwide made comments on various drafts. At first they said to add this and don't forget to include that.  Then they said the damn thing was too complicated and hard to understand. So we simplified the diagram and found someone in FEMA Headquarters who could draw pretty Power Point pictures. This is the result.

At the FEMA Region IV Individual Assistance Conference in Atlanta last week I briefed this diagram to the FEMA, state and voluntary agency attendees. They then broke up into groups and discussed the diagram. Some groups briefed that we needed to add this or include that. Others said that it was too complicated.

But we're making progress. We need to get the diagram out in front of people so that they can talk about it and maybe even think about how they can adopt it in their states.

To me there are a number of important features of the diagram that must be pointed out. First, and most importantly, the diagram establishes the critical role of the State Mass Care Coordinator (SMCC). FEMA has published a Job Title that establishes education and experience requirements for a Type 1 and Type 2 State Mass Care Coordinator. The National Mass Care Strategy recommends that states identify a State Mass Care Coordinator. FEMA needs to encourage this by sending identified State Mass Care Coordinators to training and exercises, like the National Mass Care Exercise.

A second important feature is the concept that the SMCC acquires, prioritizes and allocates resources and information to the supported agencies. In large events the SMCC is assisted in this coordination process through the establishment of Mass Care Task Forces, that operate in accordance with State Mass Care/Emergency Assistance Plans.

Finally, the diagram defines the supported agencies as the affected counties, the Mass Care Voluntary Agencies Field Headquarters (like the American Red Cross Disaster Relief Organization) and those state agencies that perform mass care (like a state Social Services agency that operates shelters). These Supported Agencies request and receive resources from the State EOC.

I am going to do my best to engage the national mass care community with the concepts incorporated into this diagram. The first step in the engagement is to get everyone to understand the existence and importance of the state coordination process. The second step in the engagement is to get everyone to understand the concepts represented in the diagram of the process and how they would apply to a disaster in their state. Finally, I want to get informed analysis and criticism of the diagram so that we can make it better.

What I learned in the 2013 National Mass Care Exercise

The 2013 National Mass Care Exercise, held in Tallahassee, FL from May 20-24, 2013, brought together 60 federal, state, local, nongovernmental (NGO) and private sector mass care practitioners. We struggled to respond to two hurricanes and three impacts on the state. We tried out several well thought through plans and operational procedures. Like last year's exercise, some things worked and some things didn't. 

But because of last year's exercise, we executed our plans and procedures better this year. And next year we will do even better.

A draft of the Exercise After Action Report has been prepared and circulated to the participants for their comments. Our goal is to have the Report finalized and posted to the National Mass Care Strategy web site by July 1.

In the meantime, however, I can let you know what I learned. First, I learned that to write state mass care doctrine, train people to that doctrine, and then exercise that doctrine simultaneously is difficult for the exercise organizers and confusing for the participants. 

In a previous post I talked about creating a state Mass Care Services Doctrine. We've come a long way on the last 10 years toward standardizing the way we coordinate mass care at the state level. FEMA has put some of this process into a course, which I talked about in a previous post, but we need to get this course adopted by EMI and get federal, state, NGO and private sector mass care practitioners trained in the process. The exercise would be more effective if all the participants had the benefit of this course as a common baseline of understanding of the state mass care coordination process. I am going to push to make that happen.

The second big thing I learned in this exercise was how to forecast long term feeding and sheltering requirements for a hurricane. The exciting part about this was that we developed simple and effective formulas to make these estimates, and this process can easily taught and widely adopted in the mass care community. 

Forecasting future mass care requirements is an important part of the state mass care coordination process. The state does not have an on hand inventory of mass care resources that can be doled out to counties and the voluntary agencies when the requests roll in after the disaster. These resources must be either purchased by the state or requested from FEMA, a process that can take days or longer. This delay in fulfilling the request means that survivors on the ground in the impact area are doing without. This means that I can be requesting resources before the storm has even hit.

What? Requesting resources before the storm has even hit? You could order too much or too little. That's wasteful and in efficient. As Craig Fugate taught us many years ago, there are 3 ways to respond to a disaster: Cheap, Efficient or Fast. You have to choose one. Our political leaders and the public want Fast, which is inefficient and expensive. You want Fast? Then you project the type, kind and quantity of mass care resources that will be in short supply after the disaster and order them before the disaster so that they will be on hand when the public needs them.

Doing that has got to be hard. You're right, it is hard. But as a result of the 2013 National Mass Care Exercise we made a lot of progress toward figuring out how to make those forecasts for feeding and sheltering.

Coordination Complexity & the National Mass Care Exercise

On Friday, August 13, 2004 I was in the State Emergency Operations Center (EOC) in Tallahassee when Hurricane Charley struck Charlotte County on the southwest coast of Florida as a Category 4 Hurricane. The storm plowed through central Florida and exited into the Atlantic Ocean as a Category 1 near Daytona Beach. Twenty five of the state's 67 counties had been struck by hurricane force winds and they all began screaming for help at the same time.

At that time I had been the State Mass Care Coordinator for almost 5 years. This was my first big disaster and I had plenty of time to study the requirements of the job. I thought my intelligence and diligence would leave me prepared for the tasks at hand. I was wrong. I spent the first week of the disaster overwhelmed and confused. With the hindsight of my current experience I realize that I focused on the trivial and overlooked the important areas, not out of disregard, but out of ignorance of their existence.

I did a few things right. I realized that I was overwhelmed and called for help. The Emergency Management Assistance Compact (EMAC)  is a process for states to ask for and receive emergency personnel from other states. I remember filling out an EMAC form asking for "state mass care workers" and then returning to the EMAC desk each day with a hopeful expression. I was so ignorant that I didn't realize the number of state mass care workers in the nation was infinitesimal and I might have had better success asking for kangaroo trainers. 

In my defense there wasn't a single document in the nation in 2004 that even identified the position of State Mass Care Coordinator much less explained how to do the job. Now FEMA's National Integration Center has approved Interim Guidance for the State Mass Care Coordinator Job Title. And the nation will be testing a wealth of documents on how to manage mass care at the state level during the 2013 National Mass Care Exercise to be held in Tallahassee, FL from May 20-23, 2013.

The screen shot below of the old Tracker message system we used in the State EOC in 2004 for the Charley response shows a sample of the resource requests and information messages we received on August 16th. At that time, on Day 3 after the storm, we had already received over 3,300 messages. The works out to about 800 a day, or 35 an hour if you assume that they arrived evenly over the 24 hours in the day. But they didn't arrive evenly. The messages came in gushers and waves during the daylight hours and this inundation overwhelmed our ability to process and understand what was happening in the affected area.

I remember many times during those early days sitting at my desk in the big room of the EOC with a land line in one ear, a cell phone in the other ear, and 3 people standing behind me waiting to ask a question. How much planning and analysis of this wealth of information was being performed by me or anyone else? 

We weren't planning for anything. We were just reacting.

During large disasters the very real situation that I just described is not uncommon. Those of you who have experienced these situations are nodding in agreement. The symptom of overwhelmed EOC workers is caused by under-staffing. Duh. So why aren't we doing something about it?

The reason emergency managers across the country are in the situation I described in August 2004? We don't know what we don't know. I didn't know that the systems that I put in place would be inadequate for the required level of the disaster response. I could not have been expected to divine this, and there was nothing written down that could aid me in arriving at this conclusion.

A Homeland Security Institute document published in February 2009 finally gave me a name to the problem that we were facing: Coordination Complexity. An Appendix to this document, entitled Coordination Complexity, talked about the concept but lamented that FEMA had yet to define the term. With the National Integration Center now in the throes of updating the National Incident Management System manual I want to throw the concept of Coordination Complexity on the table as something that needs to be presented and defined in the new manual. Since for my own purposes I needed a definition now, I throw this out for everyone to criticize:

Coordination complexity is the degree to which the size and nature of an event increases the volume of required agency interactions and degrades the ability of an Emergency Operations Center to function without additional procedures and staff.

The Homeland Security Institute article did list some parameters for coordination complexity which I assembled into the table below.

"Media Attention" is the parameter at the top since it tends to influence actions of the elected leaders who are our bosses. This introduces in some jurisdictions the phenomenon that I call "briefing up," wherein the poor emergency manager is pulled from his/her critical tasks in the EOC to give detailed and lengthy explanations to the elected officials, discussions that would have been more fruitful and less disruptive to the response if they had been conducted before the disaster started. 

An EOC is a facility where response agencies assemble to coordinate their actions. The "Stakeholder Composition" of those agencies is a major determinant of the level of coordination complexity involved in the response. The large number of agencies within the EOC are coordinating with local, state and federal agencies external to the EOC. And the agencies involved in this coordination have varying levels of expertise, experience and skill.

Finally, type and quantity of the tasks performed within the EOC and the number and competency of the staff assigned to execute those tasks affects the level of coordination complexity of the event. My favorite parameter is the "# of follow-up actions required" to complete a task. 

Using these different parameters one can construct a table to determine the Coordination Complexity Level of an event. The table below is just such an example and can be used to assign the Coordination Complexity Level for a mass care response in Florida.

In this table a Level 1 is more complex than a Level 3. Thus a State Mass Care Coordinator can use this table (or a similar one adapted to the jurisdiction) to estimate the Complexity Level before the storm hits and then request the additional personnel required to meet that level of complexity.

What level of capability is required for a given Complexity Level? We are working to answer that question during the National Mass Care Exercise this month. Stay tuned.

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.

On the 10th Anniversary of the start of the Iraq War

The New York Times reported this weekend that the 10th anniversary of the start of the Iraq war would arrive this Wednesday, March 20. I had vivid memories that the war started on March 19. After a check I discovered that through the miracle of time zone travel we were both right: when the bombs started falling in Iraq on March 20 the date in my temporary home of Ft. Bragg, NC was still the 19th.

On that cold, rainy North Carolina evening the room that I shared with Colonel Dale Foster in a dilapidated World War II barracks filled with officers and soldiers of the 358th Civil Affairs Brigade. The object of our attention was my transistor radio, tuned to the local National Public Radio station, from which we expected to hear a speech by the President of the United States. We were all wearing crisp, newly issued Desert Camouflage uniforms. I still carry the memory of the raindrops forming on the window panes behind the radio.

March 19, 2003 Packed and ready to go.

I didn't know if this speech would be the start of the war or not. I had been working full time for almost five months preparing my unit to go to war and in that time there had been a series of important speeches and announcements, any one of which could have been the one that signaled the start of hostilities. On March 10th I celebrated my 25th wedding anniversary at Ft. Bragg without my spouse. I had kissed my wife goodbye, not knowing when I would return or if I would be going to a war, not once, not twice, but three times. The fourth time, on February 8, 2003, I squeezed her hand, gave her a smile, and jumped out of the car. That was the best we could do. I wouldn't see her or my family or my home until December 21, 2003.

The crowd in my barracks room showed no outward display of emotion after the President's speech, even though this was a very significant event in our lives. We were going to war, some on us for the first time. For others, like my good friend Leo Rivera, who had served in the Gulf war, this would be his second trip to Iraq in a U.S. military uniform.

The next day, March 20, we finally got the word that we had been expecting and waiting for since we had arrived in Ft. Bragg six weeks before: Donald Rumsfeld had decided that it was time for the civil affairs units to "start flowing into theater" (in the quaint Pentagonese term for it all). On March 21 we loaded out luggage (2 duffel bags and a ruck sack ) on a truck and climbed into buses with our carry-on items. Our immediate destination was Green Ramp at Pope Air Force Base.

March 21, 2003 - Waiting for a plane at Green Ramp.

One of the innumerable lessons of military life, especially relative to military contracted or U.S. Air Force flown intercontinental air travel, is to live in the moment and keep expectations at a very minimal, even subterranean level. This is no knock on my Air Force brethren, as I have always considered the Air Force to be a suitable substitute for military service. Let us just say that a United Airlines B-747 showed up at the right place at the right time, and didn't break down, and we left for Kuwait on the day that we were assigned. The platoons of staff officers in the Pentagon could check off one more box completed in the war effort.

March 21, 2003 - Boarding the plane

In a burst of egalitarianism, no doubt inspired by the Air Force, we boarded the plane in alphabetical order as opposed to rank. Thus, the World continued to inflict crass discrimination upon me because of my last name and condemn me to the end of the line.

March 22 - Camp Wolf, Kuwait

After a stop in Germany we arrived in Kuwait the next day and greeted our luxurious accommodations.  The Air Force Technical Sergeant who greeted our plane at Kuwait International Airport recommended that since the Airport was a target for the Scud missiles that even then were descending on Kuwait we should unload the plan and get off the runway as quickly as possible.

We all agreed with the Air Force Sergeant and did our best to comply.

Mass Care Common Operating Picture

We have been talking and having conference calls about a Mass Care COP lately. COP is short for Common Operating Picture, the quaint and curious concept that the many decision makers within the many agencies involved in a decision should be making their many decisions based on the same set of information.

There were multiple mass care operating pictures in New York City during Sandy but they had little in common. The reason for this was not a conspiracy of incompetence but a reflexion of the difficulties facing the mass care practitioners trying to direct resources in a large, urban environment.

The American Red Cross had 120 Emergency Response Vehicles (ERV) performing fixed and mobile feeding in NYC and on Long Island. The ERV crews were volunteers from places like Kansas and Indiana and Georgia. They knew as much about NYC geography as I did, and I was discovering (to my eternal amazement) that Coney Island wasn't an island, but a peninsula. I could be standing in Queens and someone could give me an address and I wouldn't know whether it was 3 blocks or 3 miles away (assuming that I even knew where I was).

That's what a GPS is for, you say. But a GPS doesn't solve this problem. A GPS tells the user how to get from Point A to Point B, not the relative positions of Points A through Z. The people directing the ERVs in Sandy weren't receiving one or two reports of people needing feeding, they were receiving dozens. Not being from the area, they couldn't look at the addresses and know if some of the requests were clustered together. As far as they knew they were all separate entities, each clamoring for a limited number of a precious resource.

Normally, this isn't such a problem, but Sandy was different; the impacted area was large, urban, and densely populated. There was a disconnect between those who could identify the location of the need, and those who could direct the resources to meet that need. Just call them on the cell phone, you say. Well, the cell phones don't always work in a disaster, and this is not a point to point communication problem. This is an information processing problem. 

The solution, of course, is to collect all of the information and display it electronically on a map. The technology to do this is well developed and inexpensive. In our computer literate society information is collected, put in the right format, and transmitted to the correct depository millions of times of day. How hard could this be? What problem could keep us from making this happen?

The biggest problem of all: We've never done it this way before.

But we're going to fix it. We've got it fix it. In the upcoming years the American Red Cross will be fielding a new fleet of Emergency Response Vehicles with tracking devices that will convert them into blinking dots on an electronic map. The Salvation Army has already placed similar devices on a portion of their fleet of canteens. Each agency will convert their information into data feeds that can be assembled and displayed on a map along with shelter locations, field kitchen sites, power outage data, damage assessment reports and all the other bits of information that are pouring into emergency operations centers.

But all of that won't happen by this summer. And I am all about what can you do for me now. What will be ready when the Big Storms start swelling on the satellite pictures? For the last 12 years my New Year's resolution every January 1 is to get ready for a Category 5 hurricane to hit Miami. What have I got against Miami? Nothing. That's my worst case scenario. And that's the standard against which I have to compare my level of preparations.

Knowing my job, people ask me all the time about my opinion on the latest forecast for the hurricane season. Because of my job I am well aware of the hurricane season forecasts but they have no impact on my preparations. Regardless of the seasonal forecast, I have to get ready for the Cat 5 hitting Miami. As June 1 approaches my preparations grow more frantic. 

I asked a friend why this was so and he said, "You've seen the elephant."

Because I've seen the elephant we're going to jury rig some kind of mass care COP for this summer. We've already figured something out. We will test the contraption at this year's National Hurricane Exercise in Tallahassee in June.

And then, if the Big One to Florida comes this summer, we will use it.