At the time, Wallerstein was an emergency room nurse at Holy Cross Medical Center and point person for the hospital's disaster preparations team. He rushed to work--biking around destroyed freeway ramps and blocked streets to get there. When he arrived, he found a scene of almost unimaginable destruction. The hospital was completely trashed. Broken windows and glass were everywhere. The pharmacy was knee deep in drugs and muck. "It looked like a bomb had gone off in every room," Wallerstein says.
Wallerstein was greeted at the emergency room door by the night shift supervisor. "She had her hard hat on," Wallerstein says. "She started to fill pre-designated positions in the operations, planning, administration and logistics sections. At that moment, I said, `Goddamm, it's working.'"
What was working was California's Incident Command System, an innovative management template that lets public safety personnel who respond to a disaster--be it an earthquake, fire, hurricane or hazardous-material spill--organize quickly to get complex tasks done. The structural grid lets everyone know what their role is, who is in charge and how to communicate with other agencies. Each team knows what its job is--be it to commandeer food, put out fires or treat the wounded.
It shouldn't be surprising that the means of managing the response to a disaster should come out of California. Few states experience calamitous natural events on a more regular basis. In the past decade alone, California has weathered a devastating earthquake that leveled large portions of Los Angeles, massive flooding that forced state authorities to evacuate more than 150,000 people in Northern California and innumerable wildfires and mudslides, among other events.
At the core of its approach to managing its disaster response is the Incident Command System, complete with an organizational chart that can be used to coordinate response personnel from more than one agency or teams from more than one jurisdiction.
ICS is not the same as a mutual aid agreement, which many officials rushed to shore up after the September 11 terrorist attacks. Agreements to cooperate don't automatically translate into cooperation in the field. In May 2000, the federal government sponsored a drill that simulated a terrorist attack in Denver with an infectious biological agent. By day three, hospitals were overwhelmed, and state agencies still hadn't come up with an organized way to respond to the crisis. The FBI was looking to the state attorney general for guidance. The state department of public health thought it was in charge. Actual decisions were made via cumbersome conference calls involving up to a hundred people who lacked agendas or clear guidance.
It's precisely that kind of confusion that California's emergency management system is designed to avoid. "Anytime you have various levels of government trying to respond to an emergency, you need to have a standardized approach," says Dallas Jones, director of California's Office of Emergency Services. "ICS brings structure and order to chaos. The night of the disaster is no time to be putting together an emergency response plan."
Federal officials and experts agree that ICS is a sound approach, and ICS training has been a staple of training at the Federal Emergency Management Agency. Yet in many parts of the country, ICS is known only within firefighting circles. Few law enforcement agencies outside of California and a handful of other Western states are familiar with the approach. Among public health officials, the number of personnel who know about ICS is smaller still.
Given the current concern over biological terrorism, that situation would seem ripe for change.
ICS didn't start out to be the standardized answer to managing disasters. In 1970, large swaths of Southern California were consumed by a series of far-ranging wildfires that were too large and moved too fast for any single county fire department to handle on its own. As the fires leapt from one county to the next, fire departments in the region found that they were unable to coordinate their responses.
They did not have common systems. They did not use the same radios. They could not get on the same frequencies. "Nobody was able to take command and organize a response," says Steve Vittum, a division chief with the Santa Barbara County Fire Department. "You just had a whole lot of departments out there freelancing on their piece of the pie."
In the aftermath of the blazes, fire departments in Southern California decided to develop a common way of organizing their responses. Representatives from the California Department of Forestry and Fire Protection, the U.S. Forestry Service, several city and county fire departments and the state Office of Emergency Services fire and rescue division joined together to create a common emergency response methodology. The result was the Incident Command System.
What makes ICS unusual is that it offers emergency responders a structure for coordinating their efforts in dealing with any kind of disaster. "We've seen people use the concepts of ICS to organize barbeques and weddings," says Frances Cowan, an instructor with the California Specialized Training Institute. "It's such a flexible, wonderful system that it can be used for almost anything, if you know it well enough."
The chart starts with a box for the incident commander and is then broken down into four primary functions for emergency responses. In its basic format, it can be used to organize a response to, say, local flooding; in its fully enlarged state, it can be used to respond to a raging, multi-state fire. Moreover, once emergency responders become familiar with ICS, it provides a structure to coordinate the activities of ad hoc, interagency emergency response teams with little or no history of working together in the past.
A key strength of ICS is the unified command component. "Historically so many of us rolled to emergency scenes and set up our little command post with no regard to where fire was or where highway patrol was. Then we wondered why we had coordination and communication problems," says Deputy Chief Michael Cardwell, of the San Bernardino County Sheriff's Office. As a result of ICS, Cardwell notes, "we're all going to the same place and setting up a command post together. Just the act of those agencies pulling into the same corner of the parking lot and talking to each other solves so many problems."
As the system developed in California, it proved to be so effective that agencies, municipalities and other organizations across the state began adopting ICS, among them Holy Cross Medical Center, which found it so helpful in the San Fernando Valley earthquake. ICS also came to the attention of Olympic organizers. In the run-up to the 1984 summer Olympics, several Los Angeles area police departments began to use ICS as a protocol for coordinating emergency responses with other agencies. In the aftermath of the Olympics, the California Peace Officers' Standards and Training program, the organization with certified law enforcement officers in California, began to formally train officers and their supervisors in the use of ICS.
As ICS spread, it began to be inculcated into a locality's structure and become an all-purpose emergency response system. After a killer earthquake struck Santa Cruz and the Bay area in 1989, San Jose, which was in the heart of the affected region, decided to formally adopt ICS for citywide emergency operations. It hired a professional emergency director, Frances Edwards-Winslow, and moved the office of emergency operations from the city fire department to the office of the city manager.
"When you bring the system inside," says Edwards-Winslow, "the only thing that changes is that the top box becomes a management function led by the CEO of the city, normally the city manager." Edwards- Winslow functions as a kind of facilitator. It's her job to make sure that intergovernmental coordination is established and that any issues that come up are assigned to the proper section of the structure.
Despite ICS's growing popularity throughout the 1980s, many agencies continued to view ICS as a rural fire-fighting technique. "A lot of veteran law enforcement officers didn't view what they were doing as broken," says San Bernardino's Cardwell. "A lot of agencies just didn't see the need for standardization."
That changed in 1991. Wildfires raged through the Oakland hills, destroying 3,000 homes and leaving 25 people dead, including a fire fighter and a police officer. California politicians and officials recognized that much more needed to be done to coordinate emergency responses. "Even though fire services had been using ICS, it needed to be more focused," says Jeffrey Rubin, chief of the California Emergency Medical Services Authority's disaster medical services division. What needed to be done, Rubin points out, was to have all the different entities that support the front-line disaster team-- medical teams of doctors and nurses, for instance--knitted together into one common organizational structure.
In 1994, the California legislature created the Standardized Emergency Management System, making the Incident Command System the core of emergency responses. All state agencies were required to use ICS in response to an emergency; local governments that wanted to be reimbursed by the state for the cost of emergency response operations were also required to use an approved version of ICS.
The creation of SEMS took ICS out of a field environment and put it into command centers for any city in California that wanted to receive state funding. It also encouraged government officials to expand ICS to agencies that hitherto had not functioned as emergency responders, such as county public health departments and hospitals such as Holy Cross Medical Center in the San Fernando Valley.
The inclusion of health or medical services was a key to ICS's growth. "Fire and law enforcement are recognized as two of the three legs of the public safety stool," Rubin explains. "There's an expectation on the part of the public that medical would be there just like fire and law enforcement. We needed to make sure that hospitals were prepared, not only internally but externally, to fit into and provide resources to other entities."
California officials acknowledge that some agencies are coming late to ICS. For years, emergency medical services were considered to be ambulances, paramedics and field operations. "It's becoming more accepted that hospitals and laboratories are also part of the first response," says Dallas Jones. "So we're trying to work with them very aggressively to include them into a holistic response." In 1997, the last time California's 500-odd hospitals were surveyed, half of the hospitals reported being "familiar with" the hospital emergency management system. Half of those hospitals actually used the system. Officials say the number of hospitals using ICS has almost certainly grown since then.
"The comforting factor that we're really starting to find in California and other places is, we're all operating under the same system," says Paul Russell, the originator of the hospital emergency incident command system and the medical disaster management coordinator in the Orange County Health Care Agency. "If I call your hospital and need a resource, I know who to ask for."
State officials in California believe the state emergency management system and ICS would work for terrorism attacks. After all, responding to a terrorist incident, like responding to an earthquake, is primarily about managing the consequences.
"In terms of explosions or chemical attacks where there is an epicenter of an incident, ICS is likely to work pretty well," says Arnold Howitt, executive director of the Executive Session on Domestic Preparedness at Harvard University's John F. Kennedy School of Government. "Roles are understood. The emergency would be fairly analogous to other kinds of disaster."
But there is less certainty about how well ICS would function in response to a terrorist attack with biological agents such as anthrax. "Bioterrorism poses some challenges to ICS," says Howitt. "It may not have a clear epicenter. The incident itself--Where did it start? Where is it now?--may be in doubt, whereas with an explosion there isn't any doubt." Moreover, a biological terrorist attack might force public health officials who have comparatively little experience with ICS into command positions. ICS is expandable in principle to deal with these things and is capable of handling multi-locational incidents. But, Howitt notes, "the question is, `Are the people responding familiar with the system?'"
Whatever the current challenges, officials in California say they're confident that ICS would respond as effectively to terrorist attacks as it has to natural disasters. A terrorist attack with a biological weapon, says Edwards-Winslow, "would be just like the flu epidemic, and believe me, that's an incident."
TAKING CHARGE
The Incident Command System was designed in California but has been adapted by several other states. At the top of the ICS organizational chart is the unified command. For small incidents, such as a hazmat spill, the position is filled by a single representative from the lead agency. For a large-scale disaster, the slot is filled by leaders from all of the agencies involved in the response. Four subsections carry out the unified management's directives:- an operations section that develops tactics and directs operations;
- a planning section that develops long- and short-term plans;
- a logistics section that attends to concerns such as equipment, supplies, communications, food, facilities and the like;
- a finance/administration section that maintains personnel and payroll records.
The ICS allows people from other agencies to step into position and start carrying out its functions quickly by providing "position checklists." California has developed such checklists for mass- casualty, urban search and rescue, high-rise fires and hazardous- material crises.
California's ICS, developed by agencies with fire-fighting responsibilities, provides free ICS forms and manuals at http://firescope.oes.ca.gov. The California Office of Emergency Services offers an overview of its standardized emergency management system, which is built around ICS, on its Web site at www.oes.ca.gov. FEMA also offers a wide range of ICS training materials at www.fema.gov/emi/slgcourses.htm.
