The Edge Of Disaster - Managing Expectations
Steven Flynn’s recent book
Point by point the Department of Homeland Security and the Federal Emergency Management Agency (FEMA) again remind the American public that a federal response is always more than 24 hours away, in fact, usually 48 to 72 hours. The familiar theme of self-responsibility and self-preparedness are trotted out again for review of a distracted American public.
Unfortunately, both the Department of Homeland Security and Mr. Flynn are right. In America, as soon as the catastrophe or a disaster has past we busy ourselves with the activities of every day life and forget the lessons that we learned when the most recent adversity struck us. In short, we never develop resilience.
It is gratifying to me, having declared 2007 unofficially the year of resilience, that speakers and pundits around the country are now re framing their message not in terms of disaster preparedness or response, but in terms of resilience, the ability of a community or an individual to thrive in the face of adversity. Dory Riceman characterized resilience as mastery against adversity and nothing could be more true.
The Federal Government, as is its habit, has turned disaster preparation into yet another unfunded mandate. The cost for training and preparation often exceed $100,000.00 per facility falls completely on these private agencies and the individual practitioners within them. Full scale disaster drills that are coordinated within the community can cost hundreds of thousands of dollars and are now a yearly requirement on all hospitals and healthcare facilities.
The Institutes of Medicine have soundly criticized hospitals for not including communities, EMS, law enforcement and other responders in both their disaster plans and exercises. The Federal Government has even gone to the point of setting the stage for several and even criminal prosecution of hospitals and healthcare facilities that continue to bill Medicare, Medicaid, Tri-Care, but are not in compliance with National Incident Management Systems and the National Response Plan. These penalties were promulgated within the Federal Government, but by so doing became incumbent upon those who build a Federal Government under the Medicare, Medicaid and Tri-Care systems due to a little known clause which requires an attestation of compliance with “all regulations” promulgated by or upon CMS.
The problems do not exist just within healthcare, however. Disaster preparedness and response are closely linked in the public mind, but separated in time by the event. As the Department of Homeland Security regularly points out there is not sufficient resources within a one hour response time of every community in the United States. Communities cannot rely on federal assets or even state assets in the event of adversity.
If resilience is mastery over adversity then that mastery is achieved through ensuring that resources never exceed needs. Disaster is when you need to exceed your resources. If you can prevent that single failure you can prevent disaster.
There is an unfortunate tendency to believe that disaster is unpredictable in its timing, scope and nature. The Department of Homeland Security itself echoes this myth as does Steven Flynn and many other authors and “experts.” The predictability of disaster is in fact absolute. If your needs exceed your resources regardless of the nature of the adversity that you face, you have a disaster. Similarly, if your needs exceed all ability to respond, you will face a catastrophe.
On the other hand, the same pundit’s government officials and experts state that resilience is severely lacking in America. The 9/11 attacks proved quite the opposite. Resilience comes to us in four areas of life:
* Our physical resilience; that is the resources internal and external that we hold in reserve for moments of adversity.
* Our emotional resilience; that internal ability to draw on our experiences and our emotional strength garnered from our relationships that allow us to cope with the stress and impact of adversity.
* Our relationship resilience; those community, professional and family connections that we have nurtured such that we may tap into them to garner additional resources whether physical or emotional to assist in mitigating disaster.
* Our spiritual resilience; that strength that is gained from believing. It is in fact not important what we believe, but that we believe because it is in the mere act of believing that we gain strength and resilience.
Government by its nature is reactive, not proactive. It responds to the needs of voters, it responds to the needs of constituents, it responds to the needs of society and it responds to the needs of the law. It is only natural that in their world, the narrow world of reactivity, disaster is unpredictable.
Fortunately, the rest of us live in a world where we are proactive. In a proactive world we use our personal and societal experiences to predict the likelihood of future events, even adversity. By knowing the types of adversities we have faith in the past, we can prepare for those adversities in the future. If our preparation is strong, if our preparation is strong, if it is comprehensive, if it is now, we will prevent adversity from becoming disaster in the future… We will achieve mastery against adversity.
Dr. Maurice A. Ramirez is the founder and president of the consulting firm High Alert, LLC. He serves on expert panels for pandemic preparedness and healthcare surge planning with Congressional and Cabinet Members. Board certified in multiple specialties, Dr. Ramirez is Founding Chairperson of the American Board of Disaster Medicine and serves the nation as a Senior Physician-Federal Medical Officer in the National Disaster Medical System. Dr. Ramirez has a new book: You Can Survive Anything, Anywhere, Every Time. His website is http://www.High-Alert.com
Tags: FEMA, Flynn, Maurice, Ramirez, Steven
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