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.

Increasing national mass care capacity

I have been on the road the last two weeks advancing the cause of national mass care capacity, courtesy of FEMA funding and the knowledge that Florida will need to draw on this national capacity should a catastrophic event strike the state. In my humble opinion our national mass care capacity has been hindered by two significant shortfalls: a lack of mass care coordination capability at the state level and a lack of integration of mass care voluntary agencies into emergency management at all levels of government.

Providing shelter and food to survivors is the primary role of mass care in a disaster. The capacity to deliver this mass care role has traditionally been provided by the large voluntary organizations like the American Red Cross, the Salvation Army and the Southern Baptist Convention. These agencies have national organizations, mobile equipment, legions of trained volunteers, and full-time staff with the expertise to marshall these resources at a disaster location in order to feed and shelter the survivors.

These organizations respond to hundreds of incidents requiring mass care support every day. My very own Capital Area Chapter of the American Red Cross in Tallahassee responded yesterday to a multi-unit apartment fire, and was on hand with an Emergency Response Vehicle to assist both the firefighters and affected occupants of the buildings. I donate monthly to my local Red Cross Chapter, as do many others, so that this capability will be there when needed. 

When the disaster is greater than the local capacities of the voluntary organizations, then they call on their national organizations, bringing in personnel, equipment and organizational expertise gained from multiple responses across the country. But what happens when the disaster is catastrophic, when the mass care capacity required for the event exceeds the available national resources of the voluntary agencies?

This is where the overall lack of state mass care capacity comes in.  If the event exceeds the capabilities of the voluntary agencies  then the affected state must either provide resources to address the shortages, or request additional resources from the federal government through FEMA, or both. Unfortunately, because catastrophic events are so rare, most states not only have no one trained to perform this critical function, they have no one identified to perform this critical coordination role in a disaster.

Due to fate and circumstances, I received considerable experience in the role of state mass care coordination when I was involved in the response to eight hurricanes during 2004 and 2005. FEMA provided me the opportunity to assist in the development of a state mass care planning course, and then serve as one of the instructors for the pilot course June 8-9 in Lake Mary, Florida. State mass care planners from 11 states in 4 FEMA Regions were on hand for the pilot, and I think FEMA did more to enhance state mass care capacity in those two days than they have done in the last year.

Now that we have completed and tested a two day planning course, we will develop a two day state mass care operations course. If we don't get too tied up with hurricanes between now and the end of the year, we should have the operations course ready to pilot by the beginning of next year.

As for the lack of integration of mass care voluntary agencies into emergency management at all levels of government, we am working on that, too. I will explain what we are doing in a later post.