2006 StrongAngel III - integrated disaster response demonstration in San Diego. Directed by mentor Dr. Eric Rasmussen,MD,MDM,FACP http://about.me/EricRasmussenMD

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EMERGENCY PREPAREDNESS
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by Doug Hanchard and Eric Rasmussen
Principles of Resilience
An Evolution in
Preparedness
Many FrontLine readers are directly
responsible for emergency preparedness
within their community, region, or
nation. We recognize that our preparations for catastrophe are based on our
education and research, our best thinking
about specific areas, and how best to use
our (always limited) resources. We also
know that, when chaos finally strikes, the
drills and inventories and manuals that
gave us a reasonable degree of confidence
will prove inadequate in some fashion.
We are aware that our populations may
someday suffer in ways that, in retrospect, might have been partially avoidable. This understanding of the challenges
we face stimulates us in our tasks and
makes us more diligent – but there is an
evolution in disaster preparedness that
may alter our methods for preparation,
perhaps enhancing our eventual effectiveness in a real-world disaster.
Exercises, usually the capstone event
in disaster preparedness, are frequently
rigid, with pre-defined metrics and milestones to ensure that the team is covering
responsibilities in the “real-world.” The
implication is that if the team can do X in
an exercise, they’ll be reasonably sure of
doing it during an actual event, a reflection of the military dictum “train as you’ll
fight, then fight as you trained.”
There are minor flaws in that supposition. It presumes that the entire team will
be present and functioning at peak; that
resources will flow as designed; that the
real-world problem will look like the
exercise scenario you’ve chosen; and that
the non-actors in your exercise (the
media, your neighbors, your national government, local private industry, roads,
waterways, civilian communications,
civilian food and water logistics, and the
weather, for example…) will also be nonactors in a real event. There are now
models for how several of these can be
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International cooperation,
mandated “to learn” will
allow us to be truly prepared.
Strong Angel III demonstrated that using multi-media technology to collect and push
information to the outside world improves the team’s capability to solve problems.
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PHOTO: JOHN CROWLEY

2. incorporated into a disaster response
demonstration (quite different from an
exercise) in a manner that forces flexibility, adaptability, and the co-development
of resilience within both the responders
and the communities at risk.
sustaining responses, and that a careful
hybrid of policy-and-procedure, coupled
with well-trained independence, is often
closer to ideal.
Policy and Procedures
There are a few core issues during the
first phases of a disaster where most
responders would expect shortfalls. For
many of us, those would start with communications, transportation logistics, and
electrical power. Without those three,
comms, lift, and power, very little can be
effectively designed or implemented as a
disaster unfolds. “Layering” is a term
sometimes used to define a process for
preparing as many methods for the delivery of each of these critical resources as
can be devised.
Policies and procedures are a critical
component of our disaster preparation,
ensuring we’ve thought carefully about a
range of possible eventualities and done
what we could, physically and procedurally, to prepare for them. Those guidelines, however, rarely offer the flexibility
to simply adapt to what’s working in the
real world when the event occurs.
Acquisition methods are often slow,
and sometimes driven by a single individual’s familiarity with current research in
the field – this can lead to missed opportunities for making important connections
with new capabilities outside of our exercise space. We all have regulatory and
management structures, but we also need
to communicate frequently and effectively with each other and with an
affected population. Today’s methods are
rapidly evolving, and bear serious review.
In our view, policies and procedures
often restrict creativity-toward-success in
favor of a more centralized and hierarchical
security. First responders acknowledge
that such restrictions can impede life-
Comms, Lift, and Power
cation, and core public health resource
management in a post-event reconstruction. The third, in 2006, looked at community resilience in the face of a natural
disaster (including an epidemic), where
all outside resources were lost for an
extended period. Strong Angel III involved
roughly 800 participants from nine
nations, including more than 70 national
and international corporations, and several academic institutions.
From that very large, week-long
effort, in an isolated and challenging environment (a cold, dark, hazardous building
abandoned for fifteen years), came a set
of lessons and pragmatic tools that have
altered disaster preparedness discussions
at the highest levels of several governments, and are worth reviewing.
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• Collaborative Layering
Strong Angel
On the list of early considerations is the
concept of layering (used in the same
sense as when the weather cannot quite
be predicted). It implies designing for
resilience and a graceful degradation
mode, even when the most unexpected
events occur.
For most of us, some sections of our
plans have assumptions that seem so
fundamental that we simply accept them,
but is that wise? At Strong Angel we
worked carefully to remove some of
those assumptions. We eliminated, at odd
PHOTO: JOHN CROWLEY
Over the past seven years there have
been three international disaster response
demonstrations called Strong Angel – and
each Strong Angel has demonstrated the
consequences of shortfalls in comms, lift,
and power.
The first, in 2000, was a displacedpopulation problem addressing civilmilitary co-management in the field. The
second, in 2004, was driven by problems
identified in Afghanistan and Iraq, and
looked at communications, cultural edu-
Daily briefings are key to the
success of any exercise. We
briefed three times a day
during Strong Angel.
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3. PHOTO: JOHN CROWLEY
intervals, power, light, radio waves, transportation, wireless clouds, staff, hierarchical structures, and expectations.
This intermittent and unpredictable
loss of fundamental resources led to a
responsive and highly collaborative effort
that, in turn, led to some very creative
synthesis and a degree of success that surprised virtually every participant. It was
also a superb team-building demonstration – it led to very high morale and a
genuine sense of earned self-confidence.
We had, for example, Bell Canada and
Sprint Nextel sitting at the same table
writing configurations together to make
their systems work seamlessly because
neither could meet a new and urgent task
independently and (in the scenario) lives
were at stake.
In any Strong Angel demonstration,
failure is an occasional and accepted outcome – though not encouraged. However,
failures become fewer and the creative
initiatives more admirable over time. It is
important to note that the more often a
broad-based team faces unexpected challenges that push toward collaboration-acrossboundaries, the more readily they reach for
interesting solutions. Each begins to look
at other agencies, organizations, and
interests as a common pool from which
to draw life-sustaining support when
resource silos and stovepipes collapse.
Medical teams learned how to interoperate with other groups and technologies.
cols. In the scenario, the Commander
knew nothing of the Incident Command
System and asked no organizational
development questions of the assembled
team. He simply determined what he, a
genuine expert in the circumstances but
who knew nothing of the community,
needed from the crowd. He then
demanded those things to be accurately
determined on a scheduled basis – no
matter how the information was derived
as long as it was trustworthy and accurate
to a sensible degree. The information was
then built into further requirements for
assessment and action and the development of a plan. That plan, in turn, was
implemented throughout a large geographic area with only ad hoc communications that yet needed close coordination. Tough problems.
It became readily apparent to participants that a system of flows was needed
– information, decision, and action. Some
rough starts over 24 hours led to the
development of a fairly complete Incident
Command System, on the current model.
The reasons for such a system were clear
to the large number of non-Emergency
Response participants and it seemed welldesigned for a domestic response.
• Redundant, Diverse, Resilient,
and Open-source
Questions asked by the Scene Commander were both basic and complex.
The answers required rapid assessment of
critical information from many sources,
and collection, analysis, and reporting tool
development soon took on a life of its
own. The Scene Commander was very
clear about the accuracy and reporting
requirements – the teams on the ground
had specific guidance on what and when,
but not how! They were left to their own
devices for solving problems, using any
tools at hand.
The teams soon realized that a working directory of who was doing what,
where and with what resources was a
critical component of effective and timely
work. A “Dynamic Directory” was born,
and several individuals were given
responsibility for maintaining it – dedicating valuable staff resources in the middle
of an emergency because they determined
that capability was absolutely necessary.
The participants also found that
proprietary tools were… unhelpful. Tools
built on open-standards that interoperate
gracefully saved time and irritation dur-
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• Leadership
In Strong Angel, the initial conditions were
set with no hierarchy and no one in
charge. Mid-way through the first day,
several hours into the response, a CDC
physician, coincidentally in the newly-isolated city for a conference, was appointed
Scene Commander by the US President,
completely bypassing all standard proto-
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4. PHOTO: JOHN CROWLEY
It is not always possible for your staff
to avoid the media, despite perhaps careful instructions to do so, therefore, preparing them for that interaction is a fair and
sensible part of their training. We use a
three-day course at Strong Angel, called the
Media Crucible, and the role-playing
there, under multiple scenarios and
increasing pressures, has reportedly been
most useful later for its participants in a
number of real-world events.
Resources Improve
Equipment has to operate and be
useable 7/24. Teams learn how to
operate in extreme environments.
Temperatures here were regularly
over 30°Celsius.
ing a period of crisis, and our initial
choices of software and radios provided
reassuring evidence of a pre-conceived
willingness to cooperate with partners.
We also noted repeatedly that personal, face-to-face communications saved
time and improved efficiency. Personal
relationships also help reduce the risk of
small errors becoming inflated, distracting
issues. In our view, using every conceivable opportunity to meet, chat, share
a cup of coffee, work through practical
and strategic issues over dinners, and
arranging tabletop exercises that gave
good reason for everyone to participate
collaboratively, all helped to cement a
coherently smooth emergency response.
We were careful to include all of the
actors who might potentially affect those
in the field, not just EMS – power, water,
light, schools, airport authorities, city
councils, vets, mosques, churches, synagogues and more were all on our invitation list.
One tool proved exceptionally effective. The use of internet-based chat and
Voice-over-IP (VoIP) through tools like
Skype cost very little, are commonly used
by a very large number of people, are
dependent only upon internet connectivity of any kind, and can call any phone on
the planet. We also found that off-theshelf resources like Skype continually
improve through market pressures and all
we needed to do was download the most
recent version (at no charge) periodically.
Social Interoperability Networking
(SIN) events, one term for such designed
and metrics-based mashups of people and
technologies, like Strong Angel, are useful
for many tasks, not just disaster
responses. Capabilities like Skype (or
Groove, or Jot, or MySpace, or wikis, or
blogs, or…) are most beneficial when used
frequently. It’s sensible for any Emergency
Manager to ensure his staff has the tools
(and reasons) for frequently reaching out
to other responder agencies, offering
relevant assistance and keeping the multilateral flow of information smooth.
Frequent communication over nonstandard and ad hoc methods keeps
everyone aware that, when bad things
happen, policies and procedures should
be known and used where they fit, but
there should be little hesitation in
empowering far-forward personnel to
make independent judgments that get the
job done intelligently.
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Media Complications
One frequently overlooked training
requirement in disaster response is media
management. There will be more media
and more politics than preferred – and the
consequences of a poor interaction in
either can be disastrous, even if the actual
response is performed reasonably and well.
Strong Angel III started with roughly 50
disaster-response tasks to perform, and
most were completed successfully. Some
were simple, some complex, some trivial,
and some impossible. Each was designed
to meet a real-world problem experienced
by one of the eleven Executive Committee members. Each proposed scenario
was evaluated on the likelihood that such
a problem would re-appear again in the
future. If we agreed it would, we included
it as a task for which we’d pursue solutions. In doing so, we found that the ad
hoc resources available to an emergency
responder in 2007 are more useful than
most realize, and the tools in the community, both technical and social, are becoming paradoxically more sophisticated and
simple all the time. S
Strong Angel IV is in planning stages for
2008. Further information, and the results
of the 50 or so demonstration tasks pursued
in Strong Angel III, can all be found at
www.strongangel3.org
U.S. Navy Commander Dr. Eric Rasmussen
is Chairman of the Department of Medicine
at the U.S. Navy Medical Center outside
Seattle, Washington. He is also Director
of the Strong Angel series of humanitarian
support demonstrations, and is currently
deployed to Afghanistan working on medical
reconstruction.
Doug Hanchard is Director and Architect,
Solution Management Practice at Bell
Canada. He was an Executive Committee
member, Technical Communications Advisor
and civilian leader for United States Marine
Corp MCI-West RSS unit at Strong Angel
III. In addition he serves as Technical
Communications Advisor for World Wide
Consortium for the Grid (www.w2cog.org)
– U.S. Northcom.
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