2. All Hazards Planning Edward P. Richards Director, Program in Law, Science, and Public Health Harvey A. Peltier Professor of Law LSU Law Center richards@lsu.edu http://biotech.law.lsu.edu/cphl/Talks.htm

3. Topics What is an All Hazards plan? What is an All Hazards plan? What are the elements of an All Hazards plan? What are the elements of an All Hazards plan? Why is All Hazards planning necessary? Why is All Hazards planning necessary? Examples Examples Preparing for bird flu Preparing for bird flu Evacuation of New Orleans for Katrina Evacuation of New Orleans for Katrina

4. Episode-based Plans Plans to Plan Episode-based plans Episode-based plans Bird flu plans Bird flu plans Anthrax plans Anthrax plans Bomb plans Bomb plans Plans to plan Plans to plan What you need to think about, not what you need to do What you need to think about, not what you need to do No operational detail No operational detail

5. What is an All Hazards Plan? A unified plan that, as much as possible, uses common strategies for emergency response A unified plan that, as much as possible, uses common strategies for emergency response Emergency response is built on day-to-day procedures and resources Emergency response is built on day-to-day procedures and resources All Hazards plans are operational plans All Hazards plans are operational plans They tell you what to do, not just what to plan They tell you what to do, not just what to plan The public is fully informed and an integral part of the emergency response The public is fully informed and an integral part of the emergency response

6. Elements of an All Hazards Plan Analysis of common factors in the different types of emergencies Analysis of common factors in the different types of emergencies Relation of these common factors to routine procedures Relation of these common factors to routine procedures Modification of existing procedures to incorporate elements that will be needed in emergencies Modification of existing procedures to incorporate elements that will be needed in emergencies Public information and education Public information and education

7. Example Transforming a Bird Flu Plan into an All Hazards Plan

8. Episode Planning: Bird Flu Plans for emergency quarantine Plans for emergency quarantine Plans for ethical guidelines on vaccine allocation Plans for ethical guidelines on vaccine allocation Plans for stockpiles of PPE Plans for stockpiles of PPE Plans to work with public health, including an MOU that says we will play nicely Plans to work with public health, including an MOU that says we will play nicely Plans for how to plan to handle the SNS Plans for how to plan to handle the SNS Maybe some training on how to put on a mask Maybe some training on how to put on a mask

9. All Hazard Planning: Bird Flu What are core problems? What are core problems? Protecting staff from infection Protecting staff from infection Assuring adequate staff for operations Assuring adequate staff for operations What are related issues? What are related issues? Yearly flu pandemic Yearly flu pandemic Exposure to tuberculosis and other communicable diseases in the workplace Exposure to tuberculosis and other communicable diseases in the workplace

10. All Hazards Recommendations: Vaccinations Assure vaccination status of employees Assure vaccination status of employees Mumps, measles, etc, which can disable a force Mumps, measles, etc, which can disable a force Yearly flu Yearly flu Benefits Benefits Reduction in lost time from work Reduction in lost time from work Readiness if there is an outbreak Readiness if there is an outbreak Resolves individual and union opposition to vaccination before there is an emergency Resolves individual and union opposition to vaccination before there is an emergency

11. All Hazards Recommendations: Working Sick US culture and especially law enforcement encourages people to work sick US culture and especially law enforcement encourages people to work sick Limits on sick days Limits on sick days Rules that you cannot be on special teams Rules that you cannot be on special teams Increases the spread of diseases such as the flu in the workplace Increases the spread of diseases such as the flu in the workplace Set up criteria for exclusion of contagious workers Set up criteria for exclusion of contagious workers Change work rules to eliminate punishment for being excluded so employees will not hide illness Change work rules to eliminate punishment for being excluded so employees will not hide illness

12. All Hazards Recommendations: Personal Protection Key personal protection Key personal protection hand washing hand washing behavior limitations - handshaking, etc. behavior limitations - handshaking, etc. goggles, masks goggles, masks Recommendations Recommendations Train and equip all officers Train and equip all officers Use these for regular flu and other possible disease exposures Use these for regular flu and other possible disease exposures Make behavioral modifications so these become routine Make behavioral modifications so these become routine

13. All Hazards Recommendations: Public Information There maybe a need to limit travel or impose home quarantine There maybe a need to limit travel or impose home quarantine The public should be educated about all aspects of these possible limitations The public should be educated about all aspects of these possible limitations What is their role? What is their role? Why is it important? Why is it important? How will essential services be provided? How will essential services be provided? How will you assure families will not be separated? How will you assure families will not be separated? This will identify problematic areas and reduce confusion in an emergency This will identify problematic areas and reduce confusion in an emergency

14. All Hazards Planning: Generalization Staffing in emergencies Staffing in emergencies Any emergency that threatens the general public will threaten the employees families Any emergency that threatens the general public will threaten the employees families You have to provide for the families if you want staff to show up You have to provide for the families if you want staff to show up Develop a general plan for family issues Develop a general plan for family issues

15. Evaluation: Episode Based Planning Episode based plans are invisible until there is an emergency Episode based plans are invisible until there is an emergency These are very low probability events These are very low probability events The only testing is by artificial exercises The only testing is by artificial exercises Quality control theory (Demings, etc.) Quality control theory (Demings, etc.) You can only achieve quality through iterative improvement based on data analysis and feedback You can only achieve quality through iterative improvement based on data analysis and feedback This is impossible with an episode based plan This is impossible with an episode based plan

16. Evaluation: All Hazards Planning All Hazards planning does fit the criteria for proper quality control All Hazards planning does fit the criteria for proper quality control Elements of the plan are in operation at all times Elements of the plan are in operation at all times This provides intermediate data, i.e., things to measure short of a disaster happening This provides intermediate data, i.e., things to measure short of a disaster happening Improves routine operations Improves routine operations There is almost no data on communicable diseases in the law enforcement workplace There is almost no data on communicable diseases in the law enforcement workplace

17. Assumptions Behind All Hazards Planning Equipment and materiel that is not routinely exercised will not be maintained and will not function when needed Equipment and materiel that is not routinely exercised will not be maintained and will not function when needed Emergencies are the worst time to change procedures Emergencies are the worst time to change procedures Public cooperation depends on pre-event education and buy-in Public cooperation depends on pre-event education and buy-in

18. Political Reality The public (legislatures) have a short attention span and will not support emergency response once they move on to the next crisis de jure The public (legislatures) have a short attention span and will not support emergency response once they move on to the next crisis de jure Reality Check: Reality Check: 23 states, including most of the most populous, have done away with mandatory childhood vaccinations 23 states, including most of the most populous, have done away with mandatory childhood vaccinations We are in the middle of a mumps epidemic in the Midwest - are your employees vaccinated? We are in the middle of a mumps epidemic in the Midwest - are your employees vaccinated?

19. Lessons from Katrina The Blind Men and the Elephant

20. Why the Evacuation Failed

21. Transportation Issues Surface Causes Evacuation not triggered until too late Evacuation not triggered until too late No provision for moving folks without transportation No provision for moving folks without transportation When transport was available - school busses - there was no provision for drivers When transport was available - school busses - there was no provision for drivers No provisions for jails and hospitals No provisions for jails and hospitals No provision for secondary evacuation form the Superdome and other facilities No provision for secondary evacuation form the Superdome and other facilities

22. Transportation Issues: Surface Solutions Better plans Better plans More modes of transportation More modes of transportation Earlier evacuations Earlier evacuations "Manditory" evacuations "Manditory" evacuations All sound, but all miss the point All sound, but all miss the point

23. Transportation Issues: Root Causes New Orleans has flooded frequently New Orleans has flooded frequently Most of the land that flooded is reclaimed bay and swamp that is up to 20 feet below sea level, not historic New Orleans Most of the land that flooded is reclaimed bay and swamp that is up to 20 feet below sea level, not historic New Orleans People lived next to levees with water 5 feet over street level every day People lived next to levees with water 5 feet over street level every day Flood insurance was not required because it was assumed that the levees could not break Flood insurance was not required because it was assumed that the levees could not break

24. The Implications of a Real Evacuation The only reason to really evacuate is if the levees fail, which was ruled out The only reason to really evacuate is if the levees fail, which was ruled out The Superdome and shelters of last resort The Superdome and shelters of last resort Delaying the call for evacuation Delaying the call for evacuation Why? Why? 40 years of false alarms 40 years of false alarms Admitting the levees could fail would destroy the real estate values in New Orleans Admitting the levees could fail would destroy the real estate values in New Orleans Routine serious evacuations destroy business Routine serious evacuations destroy business

25. The Real Lessons from Katrina Plans based on politically unacceptable actions will not be carried out Plans based on politically unacceptable actions will not be carried out Long term prevention loses out to short term economic and political considerations Long term prevention loses out to short term economic and political considerations Do not build in dangerous areas Do not build in dangerous areas Require realistic risk analysis for insurance Require realistic risk analysis for insurance Do not downplay risks that cannot be managed Do not downplay risks that cannot be managed

26. How Would All Hazards Planning Have Changed the Outcome? Focus would have been on the risks of living below sea level, not just on the evacuation Focus would have been on the risks of living below sea level, not just on the evacuation Planning would have explicitly included levee failure Planning would have explicitly included levee failure Flood insurance Flood insurance Business interruption insurance Business interruption insurance Meeting appropriate life-safety codes for hospitals Meeting appropriate life-safety codes for hospitals Personal evacuation planning Personal evacuation planning Addressing these would have changed the political dynamic, allowing a proper evacuation Addressing these would have changed the political dynamic, allowing a proper evacuation