**3. Emergency management**

Preparation and planning, mitigation, response, and recovery are the basic principles of emergency management [15]. It is called *emergency* management, but should really be called *disaster* management. Necessarily limited to first responders, the title emergency management gives an illusion of control that makes it both "a misnomer and an oxymoron" ([16], p. 5). Regardless of the size of the event's magnitude, management includes all those efforts before, during, and after to minimize physical, social, and economic damages. Both planned and improvised actions should be included [16].

Preparation occurs before the disaster and includes preventative measures [17]. Disaster preparation, then, can also raise the disaster threshold if the disaster is thus avoided. At least, effects are minimized through planned measures. In our example settlement, prevention of a storm may not have been possible, but prevention of harm was through city planning, weather warning systems, and flood-resistant housing and infrastructure. Food and fuel stores could only be built up before the flooding.

Mitigation also includes a component of prevention but is closer to the event than planning. Anything to minimize harms that are not prevented could be considered mitigation. This can be through the reduction of the effects of the hazard, vulnerability of those affected in harm's way. In Tucci, they could build up walls of sandbags to protect their homes. They could moor their boats securely. They could evacuate, or they may have been able to if they had made adequate plans and preparations. Clearly, all these components are intricately connected.

The response may be what we typically think of when we envision a disaster. This is the responders—firefighters, paramedics, police, military, municipal forces, and volunteers—dousing the flames, treating the wounded, rescuing the stranded, and searching for victims.

Recovery entails returning, rebuilding, restoring. It is regaining a sense of normalcy, if not returning exactly to the pre-disaster state. Tucci will never be the same. The coastline will be altered. Attitudes may change forever. Lives may be lost. Houses will have to be repaired or rebuilt. Few residents will rebuild their houses exactly as they were before the storm. Recovery should focus on learning from the disaster and improving those liabilities made apparent by the wind and waves. This applies not only to the repairs to physical structures but to emotional health and economic stability.

#### **3.1 From emergency management to disaster management**

Preparation, planning, mitigation, and recovery are all important management principles for crises of any magnitude. As complexity increases towards disasters, we focus on the response at the front lines. This is because this phase sees the most variation and inconsistency [18]. On the front and back ends, in planning and recovery, the skies are clear. There is time to think. Not so in response. The response is the result of planning and facilitates recovery. To be prepared for an emergency should be routine. Preparedness for a disaster does not automatically follow.

By definition, local resources are sufficient to respond to an emergency. When these resources are overwhelmed, either by supply (nature of the event) or demand (response capabilities), the situation is a disaster ([19], Ch1). Outside help is needed. Intra-agency communication and coordination are required, usually without the benefit of established relationships and protocols. As complexity increases, more emphasis must be placed on flexibility and coordination between teams.

When the crisis moves from emergency to disaster, flexibility becomes increasingly important in planning, preparation, and response. In disaster planning, people should be prepared not to respond to specific circumstances, but to be able to adapt to the unanticipated. Training for disaster, then, ideally trains flexibility, communication, and the ability to work across organizational boundaries [20, 21]. Some structure is necessary to create the ability to adapt the structure to the situation. Brandrud's [22] description of their successful system is excellent: "…[the] written preparedness and response plan was structured just enough to remind the health professional of their role and task, yet flexible enough to enable them to release their creativity to improvise solutions" (p. 811).

#### *Tuesday:*

*"Anyone got a charger?" The question was becoming a little repetitive. At first, the people that asked this were given sympathetic smiles and apologies. Now, if anyone dared ask, it was only met with grunts and grumbles. Part of 'the plan' involved keeping in touch with people by cell phone. There were only a handful of people who still had any battery life left on their phones, and no one had reception.*

*All but a few of the townspeople were crammed into the school for the night. It was loud. Fifty quiet conversations, a few crying babies, the howling wind, and the incessant rain added up. And the air was thick with sweat and sewer (the toilets had all overflowed). A dozen people were standing in a circle in the middle of the gym, sorting through a pile of walky-talkies.*

**9**

**Figure 3.**

*Principles in management when emergency becomes disaster.*

*Disaster Management: A State-of-the-Art Review DOI: http://dx.doi.org/10.5772/intechopen.94489*

*the city to take everyone out. If the rain ever stopped…*

will facilitate effective disaster planning and response (**Figure 3**).

**3.2 Disaster management: resource poor environment**

address each difficulty encountered in a disaster [25].

*The side door flew open with the outside coming inside, and a group of bodies in rain gear, dripping from head to toe. It was a crew from Uah, an even smaller town down the coast. They had got their whole village out last week and came here on a few all-terrain vehicles to lend a hand. Apparently, there was a team coming from* 

Crisis standards of care are a reflection of the flexibility needed to respond when resources are lacking for the situation's need [23]. The same standards employed in day to day operations, or even in an emergency (when an organization has the capability to manage it), will consume valuable assets (time, supplies, personnel, cognition) when the system is asked to perform beyond capacity. Awareness of the difference between disaster standards and the standards applied to usual operations

Natural hazards alone do not result in disaster, but rather the vulnerability of the populations of countries impacted [24]. The complexity and chaos of disasters make management challenging in many ways. Even the best plans will be unable to *Disaster Management: A State-of-the-Art Review DOI: http://dx.doi.org/10.5772/intechopen.94489*

*Natural Hazards - Impacts, Adjustments and Resilience*

and searching for victims.

economic stability.

The response may be what we typically think of when we envision a disaster. This is the responders—firefighters, paramedics, police, military, municipal forces, and volunteers—dousing the flames, treating the wounded, rescuing the stranded,

Recovery entails returning, rebuilding, restoring. It is regaining a sense of normalcy, if not returning exactly to the pre-disaster state. Tucci will never be the same. The coastline will be altered. Attitudes may change forever. Lives may be lost. Houses will have to be repaired or rebuilt. Few residents will rebuild their houses exactly as they were before the storm. Recovery should focus on learning from the disaster and improving those liabilities made apparent by the wind and waves. This applies not only to the repairs to physical structures but to emotional health and

Preparation, planning, mitigation, and recovery are all important management principles for crises of any magnitude. As complexity increases towards disasters, we focus on the response at the front lines. This is because this phase sees the most variation and inconsistency [18]. On the front and back ends, in planning and recovery, the skies are clear. There is time to think. Not so in response. The response is the result of planning and facilitates recovery. To be prepared for an emergency should be routine. Preparedness for a disaster does not automatically follow.

By definition, local resources are sufficient to respond to an emergency. When these resources are overwhelmed, either by supply (nature of the event) or demand (response capabilities), the situation is a disaster ([19], Ch1). Outside help is needed. Intra-agency communication and coordination are required, usually without the benefit of established relationships and protocols. As complexity increases, more emphasis must be placed on flexibility and coordination between teams.

When the crisis moves from emergency to disaster, flexibility becomes increasingly important in planning, preparation, and response. In disaster planning, people should be prepared not to respond to specific circumstances, but to be able to adapt to the unanticipated. Training for disaster, then, ideally trains flexibility, communication, and the ability to work across organizational boundaries [20, 21]. Some structure is necessary to create the ability to adapt the structure to the situation. Brandrud's [22] description of their successful system is excellent: "…[the] written preparedness and response plan was structured just enough to remind the health professional of their role and task, yet flexible enough to enable them to release

*"Anyone got a charger?" The question was becoming a little repetitive. At first, the people that asked this were given sympathetic smiles and apologies. Now, if anyone dared ask, it was only met with grunts and grumbles. Part of 'the plan' involved keeping in touch with people by cell phone. There were only a handful of people who still had any battery life left on their phones, and no one had reception.*

*All but a few of the townspeople were crammed into the school for the night. It was loud. Fifty quiet conversations, a few crying babies, the howling wind, and the incessant rain added up. And the air was thick with sweat and sewer (the toilets had all overflowed). A dozen people were standing in a circle in the middle of the* 

**3.1 From emergency management to disaster management**

their creativity to improvise solutions" (p. 811).

*gym, sorting through a pile of walky-talkies.*

*Tuesday:*

**8**

*The side door flew open with the outside coming inside, and a group of bodies in rain gear, dripping from head to toe. It was a crew from Uah, an even smaller town down the coast. They had got their whole village out last week and came here on a few all-terrain vehicles to lend a hand. Apparently, there was a team coming from the city to take everyone out. If the rain ever stopped…*

Crisis standards of care are a reflection of the flexibility needed to respond when resources are lacking for the situation's need [23]. The same standards employed in day to day operations, or even in an emergency (when an organization has the capability to manage it), will consume valuable assets (time, supplies, personnel, cognition) when the system is asked to perform beyond capacity. Awareness of the difference between disaster standards and the standards applied to usual operations will facilitate effective disaster planning and response (**Figure 3**).

#### **3.2 Disaster management: resource poor environment**

Natural hazards alone do not result in disaster, but rather the vulnerability of the populations of countries impacted [24]. The complexity and chaos of disasters make management challenging in many ways. Even the best plans will be unable to address each difficulty encountered in a disaster [25].

**Figure 3.** *Principles in management when emergency becomes disaster.*

Resources are defined as the organization's fundamental financial, physical, individual and organizational capital attributes [26, 27]. In resource-poor environments, the challenge is greatly magnified. The environments most often impacted by a lack of resources are those of a lower socioeconomic status. Poverty and disasters are strongly associated [19]. Developing countries are repeatedly subject to disasters resulting in reduced or negative development [19].

#### *Wednesday:*

*There was a lot of talk about fixing houses, repairing roads, upgrading the bridge. People didn't want to talk about the deeper issues. Most would never be able to afford anything more than patching the holes. Someone brought up the idea of building up on the hillside where the waves couldn't reach. But that was so utterly inconceivable. How would they build a new town if they couldn't even build new houses? Some would have to leave. Hard to live in a fishing village if your boat got washed away and you got no other way to make a living.*

More impoverished communities are more vulnerable to natural disasters due to a mixture of social, political, cultural and economic factors [28]. Residents within these poorer communities tend to live in environments more prone to hazards such as rural areas with limited access to resources. The reduction in resources results in a more extended reconstruction period and can further delay developmental lag [19]. For example, in 2001, both El Salvador and the United States were hit by earthquakes, resulting in \$2 billion in damages [19]. Although the same monetary value, the impact on each country's economy varied drastically. This \$2 billion in damages had minimal impact on the U. S. economy, whereas, in El Salvador it resulted in 15% of the countries GDP [19]. These financial setbacks to developing countries can create a cyclical impact of further delayed development lag and economic growth.

Beyond the economic impacts, developing countries also face higher casualty rates. Over 96% of disaster-related deaths in recent years have taken place in developing countries [29]. Disasters may bring about harm to poor, developing countries in many ways beyond death, injury and destruction [19]. Some of the numerous examples include an increase in crime due to poverty and desperation, damage to schools leading to longterm impacts on education and further employment, destruction to hospitals which increase the vulnerability of disease, and the impact to vital infrastructure such as roads, bridges and airports, which may take years to rebuild and further impact resource access [19].

For meaningful disaster preparedness, the focus must be on improving availability and access to resources. This improvement should be a continual improvement effort to implement these resources to the area permanently. This implementation will help to support improvement to the quality of life to those impacted and decrease the inequity of resources and support when faced by disasters. Improved governance, combined approaches on all government levels, empowering communities, assessing vulnerability, ensuring access to quality information, and increasing the resilience of livelihood and infrastructure within these environments will reduce poverty and increase the quality of life [29].

Climate change and sustainable development both also influence the frequency and severity of disasters, particularly in resource-poor countries. Climate change, and irresponsible use of natural resources such as deforestation, make the environment more susceptible to hazards and disaster [30]. Disasters related to natural hazards, such as floods, storms and earthquakes, have significantly risen over recent years [30]. Such an increase in disasters is likely to further the frequency and severity of the impacts on the resource poor countries. Sustainable development is crucial to help reduce this burden.

**11**

*Disaster Management: A State-of-the-Art Review DOI: http://dx.doi.org/10.5772/intechopen.94489*

Disasters are easily forgotten. The unfortunate truth is that the longer the distance in time and space from disasters, the less influence they have on preparedness and planning [31]. This is especially relevant to hospitals because of a number of other interactions. Perception of disaster preparedness is often quite different between planners and frontline workers, the latter decidedly less optimistic about the facility's state of readiness [31]. And the pressures and problems of everyday operations can easily push aside concerns for an unforeseeable event. The attitude of disaster preparedness needs to pervade all aspects of the organization in the face

Specific hospital management principles include, but are definitely not limited to, vulnerability analysis, communications, triage, surge capacity, psychosocial effects, and medicolegal issues [31]. Hospitals must consider the disaster and its effects not only on a massive influx of patients but on existing patients, as well as health care workers in and out of hospital [33]. Patient care may be complicated and compromised by issues of security, chemical or biological exposure, and capacity for definitive care [29, 34]. Typically, an 'all-hazards' approach is employed as a basis of preparation for crises of any nature. More advanced preparedness will be tailored to specific hazards [30, 35]. We cannot plan for every possibility, especially not every extreme and infrequent event covered in this textbook. Plans must be broad enough to allow adaptation as needed [22]. If plans are too narrowly focused the preparation may be

*Good thing we made it out when we did, although, an hour earlier would have been ideal. The leak that had been dripping constantly in the west corner of the gym turned into a stream, then a river, then the storm outside as the tiles gave way. The sick and the injured were evacuated first, down to Mayor Ros. Raj and me came on the last load. The hospital at Alec wasn't used to a hundred people at all, much less all within a couple hours. It was hard to tell who was who - doctors, nurses, housekeepers — might have been the president of the hospital — who were finding blankets, mopping up the incessant streams of muddy water, handing out* 

Hospital disaster planning has important ramifications for capacity-building. That is, the threshold for disaster, an event that overwhelms local abilities, is intricately connected to capacity. "If a disaster is defined as an event that outstrips the organization's ability to deliver healthcare, preparedness is a method of "vaccination," raising the threshold not only in disaster periods but also in normal day-to-

Disaster preparedness is also about building networks. Again it comes back to the definition of disaster that requires help outside the immediately-affected organization. Coordination and communication between agencies are important in the success or deficiency of disaster response [23, 31, 36]. Establishing and enhancing relationships between organizations cannot be done in the moment of need. This should be a high priority for any organization in this time of global connectedness. Whether for a hospital, a nation, or a single-family, Alexander's [32] words for current and future emergency managers applies here: "Nothing can substitute for

The worst possible outcome of preparedness activities is to engender complacency. A "paper plan syndrome" refers to passively placing confidence in a

*bottles of clean water, looking at cuts and bruises and sore throats.*

day function" ([31], p. xi). Disaster preparation is capacity-building.

personal relationships" ([32, 37], p. 10).

**3.3 Hospital disaster management**

of so many unseen but real hazards [32].

ineffective. Flexibility is key.

*Thursday:*
