In the U.S. it is often said that “all response is local” – at least initially.
The first time I truly understood this was an internal conference of a large federal agency convened to consider lessons from the response to 2005’s Hurricane Katrina. One speaker, a confident, seasoned, burly ex-fire fighter, recounted being among the first federal responders to arrive at a mass shelter site at the New Orleans stadium and conference center. Conditions in these sites had been grim, with sweltering heat, and shortages of reliable power, working sanitation, food, and water. The speaker choked back tears as he recounted the anger and desperation of local responders who wondered “Where were you?!” as they had been left on their own to care for thousands evacuees, many of them medically fragile. The event underscored that resilience needs to be multi-level, blending efforts of individuals, households, community organizations, and local, regional, national and cross-national-level governments.
I’ve spent much of the two decades since working to foster community anchor institutions’ ability to help foster community to natural disasters, terrorist attacks, large-scale accidents, disease outbreaks, and other threats. Anchor institutions are large, locally-rooted organizations such as hospitals, universities, schools, businesses, and libraries that possess staff, space, equipment, and relationships that make them natural hubs for building and sharing capability across a community.
Over the years that work revealed four major challenges in disaster preparedness relevant to those preparing their communities to be resilient in the face of a wide range of risks.
The first is the important distinction between capacity (possessing the staff, space, stuff, plans, and materiel for response) and capability (the ability to use those capacities in realistic, stressful, dynamic situations. I own five musical instruments (capacity), but that is no guarantee that I can play them well, play them in an ensemble, and improvise when needed (capability).
Even in small countries, however, there is often considerable variation in community culture, language, infrastructure, geography, and other factors. Thus, increasing the number of individuals, households and communities engaged in resilience activities often requires adapting practices to fit with local context.
Resilience often involves adapting to rapidly changing conditions. Most people are familiar with the Ukrainian military and defense industrial complex’s high-tempo efforts to adapt first-person drones and other technologies to stay one step ahead of an adaptive adversary. The same holds for local communities and institutions, who must also build a similar type of agility.
Communities typically have limited resources to put together resilience-building activities. Even in the U.S. – overall an incredibly wealthy country—some 37 percent of households report not being able to cover a $400 unplanned expense, and state and local preparedness activities remain heavily-dependent on federal subsidies. Resilience-strengthening tools need to be lean and low-cost.
Over the years, my teams and I developed and implemented range of simple, user-friendly tools for testing and improving front-line operational capabilities that remains sensitive to local variation and cost constraints and helps strengthen connectivity across anchor institutions. I illustrate with reference to a tool for ongoing testing and improvement of hospital surge capacity: the ability to maintain adequate medical evaluation and care during events that exceed the limits of the normal medical infrastructure.
The first step is to identify a full range of response activities required by various attack vectors. But instead of focusing obsessively on the details of each scenario, we identify common-mode, modular elements (think Lego blocks) that are common to many of them. For hospitals, one is the ability to clear emergency departments to make room for disaster patients.
Second, we select a small number of these Lego building blocks and developed small, user-friendly, low-cost exercise modules around them that allow staff and stakeholders to run semi-realistic tests of them.
In the hospital surge exercise assessors present to the emergency department (ideally without prior warning), inform them that this is a drill, and then proceed to provide ED leaders with a series of short disaster patient scenarios (e.g., Female, 40 years old, unresponsive; Male, 56 years old, amputation, etc.), with the flow rate designed to match typical patterns in real mass casualty incidents.
Keeping the burdens low encourages hospitals to use the tool for ongoing quality-improvement cycles, where initial runs are used to identify gaps, followed by efforts to plug the gaps and retest to see whether these and other gaps remain.
Hospitals are encouraged to use peer assessors from neighboring hospitals, which reduces cost and some of the “evaluation anxiety” associated with evaluations by official government inspections, and helps facilitating the spread of ideas and resources during a disaster.
This general approach might have promise for improving resilience in other anchor institutions such as schools, local businesses, churches, and other civic organizations. It is not a replacement for household level resilience-building but can be part of an integrated multi-level approach.
The 2012 film Red Tails recounts the story of the Tuskegee Airmen, a squadron of African American fighter pilots who protected Allied bombers and fought the Nazi Luftwaffe over Europe during World War II. In a closing scene, one character observes: “Experience is a hard teacher because she gives the test first, the lesson afterward." Low-cost, modular exercises for the front lines provide a way to simulate some of those tests early on so communities can get the lessons in time to prepare us for the big real-world tests to come.
