Inspired by one of my favorite movies, Kingdom of Heaven. The movie takes place during the time of the Crusades of the 12th Century. During the one scene Balien (Orlando Bloom) is speaking to a crowd of scared residents of Jerusalem. While his speech focuses on religion and the various claims to pieces of land, the statement “No one has claim. All have claim!” speaks to me. It speaks to me in relation to our current COVID-19 predicament, particularly statements by governments, experts and the media that no-one has ever thought of preparing or responding to a COVID-19 like outbreak. They are wrong. All are responsible. No-one is responsible.
It’s All Our Fault
What does that mean? It means pandemic planning exists in many, many planning documents found at the Local, State and Federal levels. This is where “All have claim!” comes in. The world is hearing statements like, “No-one could have planned for this” or “Who could have thought of this?”. Yes, we could have. Yes, we did think of this. In fact, some leaders sign a document every year that states we are “NIMS Compliant”. What’s more, it’s usually on official letterhead. So what is NIMS?
The National Incident Management System (NIMS) is a national guiding document for Local, State, Federal, Tribal and Private Sector partners. NIMS is a guide to use to prepare for and respond to all-hazards…ALL…hazards, including pandemics. In the 2017 version of NIMS “Public Health” is mentioned 14 times. These mentions include areas like Public Information and Multiagency Coordination Groups (MAC Group). They further include how to incorporate Public Health and other partners in Operations within the Incident Command System (ICS).
Hmm…surely a one off, right? No. Let’s take a quick gander at the National Response Framework (NRF). What is the NRF? From the document, “The National Response Framework (NRF) provides foundational emergency management doctrine for how the Nation responds to all types of incidents.”. In the latest version of the NRF the term “Public Health” is used 35 times. Additionally Public Health is mentioned with Healthcare 9 additional times. So what?
Disrupting the Norm
From about 2011 and throughout my time in Public Health and Emergency Management, I was a bit of an outlier. Why? Because I latched onto the principals of all-hazards incident management. Once exposed I felt the importance of preparing myself, my colleagues and the health department to really be ready. This included partnering with my Public Safety and General Government partners. We discussed, drilled and fully exercised a pandemic-like response every year. These practical skills provided way more value than the lengthy, administratively draining checklists we were required to complete.
These checklists were used as the measures of “readiness” according to the CDC. Really what they did was take up time and gauge how large someone’s plan was. Do I think my partners and I at the Local and State level were special? Yes, I believe we were. Why? We prepared together, we argued, we pushed through preparedness and response initiatives like H1N1, Tuberculosis outbreaks and Ebola. But we did it together, and for real.
I’ve found that similar partnerships across the Public Health, Public Safety, Healthcare and Private sector are not equal or efficient. Below are my thoughts on how we move forward from here.
How to Become Truly Ready
- Public Health and Healthcare get a better seat at the table
- Public Safety and Emergency Management partners must understand the value of Public Health and Healthcare as partners in emergency preparedness. I also saw where this was not the case, but it’s a two-way street.
- Public Health and Healthcare need to step up. They need to prepare their own staffs for real world responses and with a louder voice among their Local, State and Federal partners
- Require ICS training for all employees up to the 300 level
- This is required for some government employees. This should be required by Private sector partners and tied to funding and license approvals. These courses provide more hands-on training than the lower level and sometimes online only ICS courses
- Get rid of the Hospital Incident Command System (HICS)
- HICS is a neat concept, but it doesn’t provide the broader skillset that a solid foundation in the all-hazards ICS principles would (see suggestion above)
- Leaders need to make time
- Leaders see many documents cross their desks. When those documents state a government or business is ready for hurricanes, outbreaks, etc., take a few extra minutes or meetings to dig deeper and get examples of the practical preparations.
- Talk through and plan for uncomfortable topics
- Mass fatality management, medical surge, crisis standards of care and more. At times no one wanted to own these, but now…we have to.
- Work with funeral directors, partner with hospitals, and practice and document how, at the worst of times we’ll have to do “the greatest good for the greatest number” with limited resources
- Practice points of dispensing…for real
- Give annual flu shots as if you’re really responding and providing a cure…you actually are right?
- Set external security, set internal security, create Nursing Strike Teams. manage the logistics of vaccine cooling, etc., but do it full scale and don’t just “check the box”
The Path Forward
So, how can we say “No one has claim”? For pandemics like COVID-19 or others, we can never have enough ventilators, masks, gloves, etc. The numbers are just too hard to keep up with. What we can do is prepare our minds and muscle memory to be ready through practice, discussions and exercise.
I submit we should also not rush to buy a bunch of stuff that will go bad. This happened after 9/11 and Hurricane Katrina and it was wasteful. Now there is radiation response and active shooter gear gathering dust in the closets of Localities across America. Instead, let’s focus on continuing to shore up our actionable plans. Make them shorter and easier to follow. Practice them. Know them before something bad happens.
We must coordinate with our PEOPLE. Follow effective preparedness and response PROCESSes. Then, we can make significant PROGRESS.
Stay safe, wash your hands and Godspeed,
Kevin Pannell, PMP, Creator & Host, ‘People, Process, Progress’ podcast
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