InfoGram

March 14, 2002

NOTE: This InfoGram will be distributed weekly to provide members of the emergency services sector with news and information concerning the protection of their critical infrastructures. For further information please contact the U.S. Fire Administration's Critical Infrastructure Protection Information Center at (301) 447-1325 or email at usfacipc@dhs.gov.

The Medical Infrastructure: Not Prepared?

Throughout the United States, plans exist at many municipalities to significantly improve the capabilities of emergency first responders for catastrophic events. However, conspicuously missing from several plans are the methods to fund healthcare system preparations to manage future disasters, especially those involving weapons of mass victimization, according to a recent report by a team of disaster medicine researchers. This is a troubling reality since hospital preparedness is absolutely essential for the expedient and appropriate medical care for victims of mass casualty incidents.

Disaster medicine researchers recently found that incorrect assumptions are being made about existing medical capabilities to treat mass asualties. They learned that some state and local governments falsely assume health care systems are adequately preparing for incidents generating catastrophic casualty loads. Their findings substantiated that in numerous American cities the medical infrastructure is actually struggling simply to maintain everyday capacities. Too many hospitals have been forced to close, downsize, consolidate, or reconfigure.

The research team further reported that "this healthcare system financial crisis directly affects preparedness for mass casualty incidents in multiple ways." For example, most hospitals now use inventory procedures that provide for the minimum available storage of sterile supplies, vital equipment, and pharmaceuticals to meet immediate requirements. Hospitals have also reorganized their workforce with fewer healthcare workers to patients. Additionally, hospitals have more frequently experienced difficulties maintaining rosters of certified medical specialists.

The result of serious healthcare funding shortfalls is that hospitals have extremely limited surge capacity, even for normal fluctuations in patient volume. In many U.S. cities, hospitals regularly have severe shortages of beds for normal acute care. At these locations, hospital emergency departments are commonly filled to capacity during daily operations and must divert even critically ill emergency cases.

Adequate preparedness requires sustained, directed funding sources with controls that guarantee quality hospital preparations for a defined surge capacity. The researchers concluded that "funding methods must be identified and implemented through policy declarations, legislation, and regulations." As this is a matter of concern for the fire and emergency medical services, the CIPIC encourages senior fire and EMS leaders to actively endorse all efforts to publicly promote medical infrastructure readiness for mass casualty incidents. Department chiefs can also develop partnerships with their regional medical facilities to ensure understanding and support for mutual response capabilities and responsibilities. It should be expected that revision of respective response plans and procedures will probably be necessary as a result of the realistic capabilities and responsibilities of the partner hospitals.

Homeland Security Advisory System

Homeland Security Director, Tom Ridge, introduced on 12 March a new color-coded threat advisory system to provide "a national framework and a common vocabulary" so the government and private sectors can communicate the nature and degree of terrorist threats in preparation for an appropriate response. The advisory system characterizes appropriate levels of vigilance and preparedness in a series of graduated threat conditions. The protective measures corresponding to each threat condition will help the government and citizens decide what action they take to counter and respond to terrorist activity.

The Homeland Security Advisory System (HSAS) will enable the U.S. Attorney General, in consultation with the Homeland Security Director, to assign threat conditions that apply nationally, regionally, by sector, or to a potential target. Public announcements of threat advisories will assist in deterring terrorist activity, notifying law enforcement and state and local government officials of threats, informing the public about government preparations, and providing information necessary to respond to the threat. The HSAS establishes five threat conditions as follows:

• Condition Green: Low risk of terrorist attack.
• Condition Blue: General risk of terrorist attack.
• Condition Yellow: Significant risk of terrorist attack.
• Condition Orange: High risk of terrorist attack.
• Condition Red: Severe risk of terrorist attack.

The CIPIC considers the HSAS as a tool to combat terrorism and bolster critical infrastructure protection (CIP). The HSAS enhances CIP because each threat condition has associated protective measures to be implemented by the government and private sectors to reduce the vulnerabilities of critical infrastructures. Accepting that critical infrastructures are the primary target of terrorists, the announcement of "Condition Blue" or higher should cause leaders to reexamine existing countermeasures for their current ability to protect the target. Where protective measures are absent or ineffective, new measures should be prioritized and applied as soon as resources permit. Threat conditions higher than "Condition Blue" should provoke leaders to immediately emplace countermeasures for unprotected targets. Contact the CIPIC at 301-447-1325 for assistance in using the HSAS threat conditions for CIP purposes.

New Communications Infrastructure Program

Federal Computer Week reported that the Department of Defense (DOD) decided to fund the development of an experimental system to improve communications among state and local public safety agencies and DOD. According to a DOD deputy undersecretary, the "homeland security command and control (HSC2) system" will provide a secure, common communications backbone to ensure that emergency workers do not face the radio, telephone, and digital communications breakdowns that occurred after the 11 September attacks.

Historically, the lack of interoperability between systems used by the police, firefighters, and medical personnel has made it almost impossible to communicate with each other and with military personnel. "Frequently, it was difficult just to track where help was needed and should be given." This new "HSC2" system is basically a communications project to foster situational awareness by getting the networks together where needed. The undersecretary said a demonstration would take place during the month of April in New Orleans, but no date is available for final approval and fielding of the system.

Neighborhood Watch: An Instrument of Infrastructure Protection

Attorney General John Ashcroft believes Neighborhood Watch Programs across the country can help local governments weave a seamless web of terrorism prevention. Such programs have existed for about thirty years in cities across America providing a unique organization that brings together local officials, law enforcement, and citizens for community protection. In the past six months, they have become excellent examples of "homeland defense starting at home."

In the aftermath of 11 September, the need for strengthening and securing our communities has become even more critical. President Bush announced that, with the help of the National Sheriffs� Association, the Neighborhood Watch Program will be taking on a new significance. Community residents will be provided with information which will enable them to recognize signs of possible terrorist activity, and to know how to report that activity, making these residents a crucial element in the detection, prevention, and disruption of terrorism as well as crime.

The CIPIC proposes that local watch programs can be an instrument of critical infrastructure protection. Program participants could be briefed regarding what physical entities they should keep under additional observation for suspicious or unusual activity. By doing so in a dependable manner, the citizens will effectively augment whatever protective measures already exist. Their scrutiny will be especially valuable for those infrastructures that are not protected.

Department chiefs can capitalize on the CIP benefits of these programs by instructing local watch leaders regarding the department’s critical infrastructures that may reside in their neighborhood. This action puts extra "eyes" on those physical assets that are essential for survivability and mission success of firefighters and emergency medical technicians. Neighborhood watchdogs are a free protection resource that should not be disregarded. These residents have the potential to make a significant difference in the business of infrastructure protection.

Threat Advisory Extension

On 12 March, the National Threat Warning System published an extension to the Threat Advisory that expired a day earlier. Intelligence and other information indicate that both the capacity and the desire of Al Qaeda and other terrorist groups to attack U.S. interests here and abroad continues. They urge that law enforcers and all emergency first responders remain at an elevated state of alert for suspicious or unusual activity. Under the new Homeland Security Advisory System, this advisory corresponds to "Condition Yellow," which means that there is a significant risk of terrorist attacks.