Preparing for Terrorism Tools for Evaluating the Metropolitan Medical Response System Program (2002) / Chapter Skim
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Executive Summary
Executive Summary
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to assist in assessing the effectiveness of the MMRS program by identifying or developing performance measures and systems and then using those measures to establish appropriate evaluation methods, tools, and processes for use by OEP to assess both its own management of the program and local preparedness in the cities that have participated in the program. Both the MMRS program and the local preparedness to cope with terrorism that it seeks to enhance can and should be improved by a comprehensive evaluation program.
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The tools provided are a questionnaire survey elicitingfeedback about the management of the MMRS program, a table of preparedness indicators for 23 essential response capabilities, and a set of three scenarios and related questions for group discussion. The assessment method described integrates document inspection, a site visit by a team of expert peer reviewers, and observations at community exercises and drills.
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In Phase II, the committee used the preparedness indicators established in Phase I to develop usable evaluation methods, tools, and processes for assessing both program management by OEP and the capabilities of the local communities necessary for effective response to CBR terrorism. Those methods, tools, and processes are the subject of this report.
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takes time, however, so the effects of viruses, bacteria, and fungi may not become apparent until days or weeks after the initial exposure. There may be no obvious temporal or geographical concentration of victims to help medical personnel arrive at a diagnosis and make law enforcement personnel suspect a crime.
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teams; and their plans, training, and equipment focused on the demands of coping with potential events involving chemical agent. Some of the other early MMRS program cities changed the strike team concept by integrating strike team capabilities into existing fire department, emergency medical services, and police training and organizational infrastructures.
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It argued that strengthening existing mechanisms for dealing with unintentional releases of hazardous chemicals, for monitoring food safety, for detecting and responding to infectious disease outbreaks, and for coping with natural disasters with large numbers of casualties is preferable to building a new system focused solely on potentially devastating but low-probability terrorist events. The all-hazards approach currently advocated by emergency managers requires the availability of systems capable of responding not only to high-probability hazards but also to unexpected events.
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It provides funds for the purchase of special CBR agent-specific equipment, supplies, and pharmaceuticals for local law enforcement, fire department, and emergency medical personnel, while it demands substantial integrated planning by the local partners. An important element of that planning and an important consideration in any attempt to measure the impact of the MMRS program is the fact that at least four other federal entities provide additional equipment and CBR agent-specific training: the U.S.
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Those recommendations call for a three-part process composed of periodic review of documents and records, on-site assessment by a team of peers, and observation of community-initiated exercises and drills. Together the three components provide the means for assessing 23 essential capabilities necessary for any community to respond effectively to the wide variety of CBR terrorism incidents that it may suffer.
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Follow-up study of responder, caregiver, and victim health 23. Process for continuous evaluation of needs and resources Because not all of these capabilities are addressed in the MMRS program contracts, and the Committee was seeking to measure not contract compliance but actual preparedness, the Committee chose to build its evaluation program on these 23 essential capabilities rather than the 12 "deliverables" demanded by the MMRS program contracts.
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Preparedness Indicators The products demanded of the communities with MMRS program contracts are for the most part written plans, and although written plans are certainly necessary elements of preparedness, they are in most cases only the beginning of a continuous process. Some elements of these plans can be implemented only during or after an actual incident or a very realistic exercise; but many require advance preparations, such as the purchase of equipment, hiring and training of personnel, or even changes in the way in which routine operations are conducted (for example, citywide electronic surveillance of emergency department visits or 911 calls)
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Exercises and Drills The committee members began their task with the common view that, in the absence of regularly occurring CBR terrorism incidents, the plans produced by MMRS program cities might be best evaluated by large-scale field exercises that would simulate such an incident and more specialized drills that would test the performances of specialized portions of the overall response plan. This approach was ultimately rejected as too expensive in terms of the financial costs for OEP and in terms of time for local emergency response and medical personnel, difficult to tailor to 100 different locales, and in the case of a covert release of a biological agent, impossible to simulate realistically and ethically.
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Site Visits and Peer Evaluators Although the details of any site visit to some extent will be specific to the site being visited, the committee envisions a typical site visit consist
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Table 8-1 1 ' I I 1 ' 1 Preparedness Criteria (1-7 each) Pane 1 34ff ~ · ~ Exercise On-site Obse rvati o ns I nte rvi ews 13 Document Inspection FIGURE ES-1 Relationships among essential capabilities, preparedness indicators, preparedness criteria, and data collection methods.
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To this end the committee recommends a fire department representative familiar with hazmat operations; a city- or county-level emergency manager; a local public health officer familiar with surveillance systems; an individual with extensive managerial, operational, and clinical experience in the field of prehospital emergency medical services; and an acute-care medical practitioner, who could be a nurse or a physician, with clinical experience in infectious diseases or emergency medicine and mass-casualty operations. At least three of the five members should have some current or previous involvement with the MMRS in their own communities.
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As the project concludes, the committee believes that OEP must be empowered to take a stance that fosters voluntary collaboration but must be willing and able to enforce integration of local, state, and federal services as a pressing societal need for coping with inevitable future acts of terrorism. The importance of the MMRS program effort is no longer equivocal, questionable, or debatable.
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