Who pays for mass care?

A good friend has a saying: "Whenever anyone says that it's not about the money, you better believe that it's all about the money."

At the Hot Wash discussion at the end of last week's 2015 National Mass Care Exercise in Austin, TX we started a discussion about how mass care responses in large or catastrophic events are paid for. Actually, I made some statements about the topic and this generated a discussion.

Chad Ostlund from Minnesota Emergency Management briefs Texas senior leadership during the National Mass Care Exercise in Austin, TC, June 2015.

I'm going to lay out what I said but first the general reader (i.e. one who isn't a mass care or emergency management professional) will need some explanation to provide context for the discussion. By mass care we mean the provision during disaster of food, shelter, emergency supplies and family reunification. By disaster we mean the range of natural and man made incidents from a house fire to a Category 5 hurricane.

Most of the time mass care resources are provided by the Voluntary Agencies Active in Disaster (VOAD) using funds that have been donated to them for that purpose. During blue skies the VOADs receive donations that they use to pay for salaries, training and exercises so that during gray skies they will have the capability to respond. When disasters happen the appeals go out to the public for donations to pay for the additional costs of the response. Big responses, with lots of exciting video footage of destroyed buildings and dazed survivors, generate a much broader and deeper response from the public than a smaller incident that may only make the  newspaper in their community. The result is that the VOADs often pay the mass care response costs for the smaller or less publicized disasters with blue sky money.

The old emergency management joke defines a disaster as when a tree falls on your neighbor's house and a catastrophe is when a tree falls on your house. Regardless of whether the disaster is federally declared or not, or whether the storm made good video for the Weather Channel, when the tree falls on your home and you're poor and uninsured you've got troubles. And if your county ended up on the list as declared for federal Individual Assistance, the maximum amount that FEMA can give you is $31,000. The average handed out by FEMA is only about $5,000. The VOADs are left with the task of matching the donated dollars they've received with the unmet needs of the survivors.

The gray sky money donated by the public, whether through the "Text $10" appeals or by other means, must pay for response costs as well as the unmet needs of individual families that are uncovered  through case management during recovery. One VOAD indicated that two thirds of the gray sky money that they receive arrives within 5 days of the event. The pot of money that each VOAD can devote to a disaster is therefore fixed and finite, and most of the donated dollars arrive early in the disaster.

Some state and local government aren't inclined to help out during the mass care response. In one of the many storms of my past a member of the Governor's staff, who shall remain nameless, asked me, "Why are we giving truckloads of bottled water to the Red Cross?"

"Because they're handing out the water to our citizens," I replied.

"They should buy their own water with the money the federal government gives them," said the staffer.

"The federal government isn't giving the Red Cross money."

"Oh, yes, they are."

"But really, they're not."

"Oh really, they are," said the staffer in a tone that was meant to conclude the conversation.

Fortunately, someone other than me was able to educate the staffer and the Red Cross got their truck of water.

In another state and another disaster I had an emergency manager question my request to send a truckload of water to the Salvation Army. "Why should we send them a truck of water?" he asked.

"Because they're handing out the water to your citizens," I replied.

The EM frowned. "That community already has ways to get their own water."

I nodded my head and walked away. Fortunately, someone other than me was able to educate the EM and the Salvation Army got their truck of water.

This sets the context for the statements that I made at the conclusion of the National Mass Care Exercise. My contention (and I am not alone in this belief) is that during a federally declared disaster the state government, to the extent responsible, should support the activities of the mass care VOAD agencies through the purchase of logistics and supplies. Examples of logistics that can be provided are forklifts, pallet jacks, portalets, dumpsters, bulk water, propane and diesel. Examples of supplies are bottled water, ice, shelf stable meals. baby supplies, shelter supplies and food for preparation at the field kitchens.

In a large disaster the costs for these items would be millions if not tens of millions of dollars. Whether the state purchases the resources or asks FEMA to do so 75% of the costs are a federal responsibility. And for every dollar of response costs absorbed by government there is another dollar available to the VOADs weeks later to help meet the unmet needs of the survivors.

"So why should the states help out the VOADs during the response?" you ask.

So that they can use the money they save to help the survivors when the government is not in a position to do anything more. And that's a good strategy for any government to follow.

Creating a state Mass Care Services Doctrine

I have stumbled through the wreckage and tumult of emergency operations centers as the occupants try, and sometimes fail, to manage a big disaster. A recurring theme in these situations is how the inhabitants sort themselves into categories. There are those who know that they don’t know what they’re doing, who know that they are steering the boat over the falls, but see no other choice but to grip the tiller and await the outcome. The really interesting ones are those who don’t know what they’re doing, and don’t know it. They may even be riding a delusional wave of euphoria, caught up in the excitement of the disaster and think that they are doing well. The ones who know what they are doing, and know that they know what they are doing, are mixed in among the others, camouflaged by their silence, waiting in vain for someone to ask them what needs to be done. They don’t speak up because they know that unsolicited advice will be wasted. The former category can’t absorb the advice because they are already resigned to their fate, while the latter category disregard their words because they think they already have it all figured out.

In August 2004, after almost 5 years in the job, I discovered how little I really knew about coordinating mass care at the state level. Hurricane Charlie plowed into Charlotte County as a Category 4 hurricane, crossed the state and exited into the Atlantic Ocean as a Category 1 near Daytona Beach. At the State EOC we were inundated with requests from over 25 hurricane-impacted counties comprising millions of people. I know that my frantic and frustrating actions included very little productive mass care coordination. And I knew it at the time.


What is sad about this story is how hard I had worked the previous 4 years to get ready for that moment. My problem stemmed from the fact that most of my efforts were focused on procedures to make things run right in the EOC. I know now that I had a role to play in that world outside the building. After 8 storms in 16 months I started to figure out what that role was. What is also sad about this story is that there wasn't a book, manual, document or scrap of paper that explained how to do my job. The role of State Mass Care Coordinator wasn’t defined. There was no state mass care doctrine for me to learn.

One dictionary defines doctrine as “a body or system of teachings relating to a particular subject.” Doctrine could also be defined as “something that is taught.” The new National Preparedness Goal defines Mass Care Services as: “Provide life-sustaining services to the affected population with a focus on hydration, feeding, and sheltering to those who have the most need, as well as support for reunifying families.” At the national level, FEMA and the American Red Cross are responsible for coordinating the implementation of Mass Care Services in a disaster.

The American Red Cross has assembled a doctrine on providing mass care at the local level from the vast history and experience of the organization. The doctrine is written in manuals and disseminated in classroom instruction by local Chapters year round. To borrow a term from the military, this is tactical doctrine. Mass care tactical doctrine explains how trained individuals and resources arrive at the disaster area and feed, shelter and distribute relief supplies to the affected population. This doctrine works fine for the hundreds of smaller emergencies, events and disasters that occur in the nation every year.

The principle voluntary agencies that perform Mass Care Services across the nation (the American Red Cross, the Salvation Army and the Southern Baptists) struggle to deliver the level of service that the public expects during big disasters. These struggles are not necessarily the fault of the voluntary agencies. Their ability to marshal volunteers (which they have trained at their expense), equipment (which they have paid for) and salaried employees from around the nation and employ them in support of local jurisdictions during a disaster is a feat that does not always receive the appropriate recognition. But their resources are not infinite. Their capabilities and the amount of resources that they can deliver in a crisis are dependent on public support and the donated dollar. For this reason, public criticism of their actions or non-actions by elected officials caught up in the emotions of the response is never helpful.

Fortunately, our country doesn’t have to deal with catastrophic disasters very often. For most emergency managers, when the Big One comes it is their first big disaster. For those that have done it before, their previous experience may not provide a good example. And too often the local politicians decide that this event is “important” and requires their uninformed, uneducated and ill-considered usurpation of the roles for which their emergency managers have been training and preparing for a life time. Is it any wonder that we don’t do well?

We have a tactical mass care doctrine that serves us well in all disasters. What we don’t have, and what we need, is an operational mass care doctrine. Borrowing again from the military (and simplifying the concept considerably) operational doctrine is about moving the resources into place so that the tactical doctrine can be executed. We practice operational tasks infrequently. The mass care community has a lot of skilled, dedicated professionals who have worked numerous big disasters. In some cases they are the ones in the emergency operations centers who know what to do, and know that they know what to do. They understand, through harsh experience, the need for operational doctrine, although they may not phrase it in those terms.

The best and most effective way to manage a disaster, especially a Big One, is in a collaborative manner, utilizing the resources of all the agencies available in the community. This is the philosophical basis for the Whole of Community concept now being promoted by FEMA and other agencies. There are some elected officials who, when the disaster strikes, take control of all emergency management actions, arrive at decisions without consultation with their state, federal, nonprofit and private sector partners, issue directives to their partners as if they were subordinates and then micro-manage the execution of these directives. This approach can, and has, caused unnecessary suffering to the survivors who have the misfortune to live in that jurisdiction. We can only shake our heads at such actions and leave any resolution to the electoral process.

For the great, sane, majority in the rest of the nation we need a collaborative, operational Mass Care Services doctrine. The central actor in any such doctrine must be the state government. Why? Because only the Governor of the State can request federal mass care resources on behalf of the local jurisdictions. By definition, operational actions are only necessary when the local jurisdictions are overwhelmed and need additional resources. The voluntary agencies can bring in their own national assets on their own authority and frequently do so. But what if the voluntary agencies are overwhelmed? Then state and federal assets must be committed by a designated State Mass Care Coordinator trained to do the job.

I have written here before about our efforts to create a State Mass Care Coordinator’s Course (see the new State Mass Care Coordinator's Course). And the national mass care community has been able to develop some documents that explain how the collaborative process should work to coordinate mass care at the state level. These documents can be found on the National Voluntary Agencies Active in Disaster website as well as the National Mass Care Strategy website. These documents, which are the first steps towards an operational Mass Care Services doctrine, are: The Multi-Agency Feeding Plan Template, the Feeding Task Force Guidance Document, the Sheltering Guidance Aid, Household Disaster Feeding, and Federal Mass Care Resources Coordination. To further assist this training process FEMA is publishing Mass Care Resource Typing documents (read about this development here).

Finally, in furtherance of the National Mass Care Strategy, we are holding a National Mass Care Exercise annually in order to train present and future State Mass Care Coordinators from around the nation, as well as mass care workers from the federal, state, local, & voluntary agencies and private sector. The first such National Mass Care Exercise was held in Tallahassee, FL in May 2012 (read the after action report). Another National Mass Care Exercise is planned for Tallahassee in May 2013. The intent of these exercises is to give the national mass care community a chance to practice these operational procedures and train in the difficult but essential collaborative coordination processes that are essential to a successful mass care response.

Hopefully, through these actions, we can help some future State Mass Care Coordinator prepare and do a better job than I did during Hurricane Charlie in August 2004.

The National Mass Care Strategy

Knowledgeable sources have told me that the New National Mass Care Strategy will be unveiled to the public by the end of this month. Look for it on the National Mass Care Strategy website. I have had the opportunity to review and comment on earlier drafts and participated in July at a National Mass Care Strategy Conference with a sizable number of representatives of the national mass care community.

This is a good document and I want to commend FEMA, the American Red Cross and the National Voluntary Organizations Active in Disaster (NVOAD) for leading the effort to develop this strategy. Implementation of the strategy will begin upon publication of the document, and will take years to accomplish. I won't summarize the document here but encourage everyone involved in the mass care community to read it and think about how they can contribute to the implementation of the strategy.

I have already been thinking about where I can contribute. The Strategy has five goals:

• Build Scalability into Service Delivery
• Create the Opportunity for Improved Coordination and Participation
• Engage the Whole Community
• Standardize Mass Care Practices
• Strengthen and Unify Mass Care Legal and Policy Foundations

For each Goal a number of Sub-Goals were developed. These Sub-Goals are assigned in the Strategy to one of three Implementation Teams: Planning, Operations and Legislative Action. Some of the Sub-Goals are in areas of interest to me and for which I have expertise. I will be looking to the National Mass Care Strategy website for information on when and how these Implementation Teams will be formed and for opportunities to comment on the various implementation documents as they are drafted.

In the meantime the best contribution that I can make to the Strategy is to spread the word.