The Most Effective Ways To Prepare For Disaster
NEAL CONAN, host:
This is TALK OF THE NATION. I'm Neal Conan in Washington.
Preparation, tough building codes, seawalls, training and repeated drills prevented an even worse disaster in Japan. But if the best-prepared country in the world can be overwhelmed by earthquake, tsunami and now a nuclear crisis, how ready are we here in the United States?
We get earthquakes, too; and floods, tornadoes, hurricanes, major fires. The federal government counts more than 50 natural disasters every year across the country and that does not count possible nuclear accidents, terrorist attacks or other events we'd normally consider unthinkable.
We'll talk with some of the people whose job it is to think about and plan for these worst case scenarios.
What kind of disaster plans are in place in your town, where you work or in your home? And if you work in an ER, is your hospital ready? 800-989-8255, email firstname.lastname@example.org. And you can send us your comments at our website. That's at npr.org. Click on TALK OF THE NATION.
Later in the hour, the definition and threat of mercenaries. But first, contingency plans for disaster, and we begin with the medical aspects.
Sheri Fink is a senior fellow with the New America Foundation. She studied medical care and hospital preparedness in large-scale emergencies. She won a Pulitzer Prize for her New York Times Magazine story profiling a New Orleans hospital in the days following Hurricane Katrina, and joins us here in studio 3A. Very nice of you to come in today.
Dr. SHERI FINK (Senior Fellow, New America Foundation): Pleasure.
CONAN: And local hospitals, of course, are where most Americans would turn if they were victims in a massive disaster. If a disaster on the scale we've seen in Japan were to hit somewhere in the United States, would you feel confident that hospitals are ready?
Dr. FINK: There is a lot of work left to do to improve our preparedness on the hospital level. And it's very - in the U.S. we have a very scattered system, so individual hospitals are their own fiefdoms in a way. There are private hospitals, public hospitals; and each one of them is sort of responsible for emergency preparedness. And there's just not a lot of oversight on a national level of how prepared the various hospitals are.
CONAN: And one of the major - you know, fundamental issues would seem to be: Are they ready to generate their own power if needed?
Dr. FINK: That is one of the big vulnerabilities we have in this country. So, hospitals are required to have backup generator systems. But, for example, there is no requirement that they have to be able to keep an air conditioning system functioning. So we saw that problem with Hurricane Katrina, where it was very hot and you couldn't treat patients in hospitals that went over a hundred degrees. Heating systems don't have to be powered by the backup generators.
So even you can imagine a wide range of disasters could knock out the power. There are also many hospitals in flood zones that don't have elements of those backup power systems above flood level.
So these are things that we don't yet have requirements on a national level to get hospitals up to the kind of preparedness that perhaps we would like in this country. And there's the big question of who pays for that.
CONAN: And who pays for that. And that's - the answer is, we don't know yet, if anybody. But what are the lessons do you derive from the disaster in Hurricane Katrina?
Dr. FINK: Well, I think that's one of the major ones.
The other one is that we really need to think about these things, and it's wonderful that we're having this discussion today in advance of when they happen because leaving these, sort of crisis situations and the very tough decisions about, you know, who do you treat first when you have a big load of people coming into a hospital...
CONAN: That's the triage.
Dr. FINK: ...with injuries - the triage. Not something that we really think about on a day-to-day basis. But we don't want to leave that to frontline health workers who are stressed.
And it's also a conversation that experts are beginning to have, but really hasn't been opened up to the general public very much. What are the kinds of ethical principles? What are the kinds of principles that we want to apply to making decisions like that? And that's something that has only happened in a few communities in the U.S., where the public has been invited into that conversation.
CONAN: And let's get back to triage for a just a minute. This requires some very difficult decisions by some people who would be under enormous stress. Do people practice these kinds of decision making?
Dr. FINK: Not enough. In fact, just yesterday a whole issue of a medical journal came out that had a few triage plans that they sort of sent out there, as they said, straw men to see what people are going to think about them. These are triage plans specifically for a nuclear incident; more like a, you know, a terrorism kind of nuclear-attack incident, but with some resonance to what we're seeing in Japan.
And so, there's some very, very difficult decisions to be made and these are things that, you know, people are still throwing out there as models. There is by no means one way that everybody agrees upon that this should be done. And certainly most doctors, nurses, people at hospitals haven't practiced these. They aren't even aware of some of the decisions that they might have to make.
For example, who do you let into your hospital, if your hospital is overwhelmed? Do you take some people off of life support equipment to make way for others who may have a better chance of survival? Would we want to do that as a society? What kind of effects would that have on societal trust?
These are things that - you know, the conversation is really just beginning.
CONAN: And there's not just nuclear issues. N1H1 - well, it didn't turn out to be as bad as people feared, but it raised a lot of issues over what we would do in the face of a pandemic.
Dr. FINK: That is exactly what caused a lot of people to start looking at this issue and making plans. And so now - in fact, some cities do have some plans that they've put in place, these drafts, that they hurriedly put in place when H1N1 looked like it might be a very severe pandemic and like we wouldn't have enough ventilators to go around; which we wouldn't in a severe respiratory pandemic, in a severe flu pandemic.
And so these issues are very real. We hope they never come up but there is the possibility that they will. And so, how much effort do we put into preparing for these sort of, you know, worst case, high impact, high lethality, but low probability events? That's a very difficult question in these austere times.
CONAN: What we're coming to call black swan events. 800-989-8255. Right now we'd especially like to hear from those of you who work in hospitals and emergency rooms. How ready are you for disaster?
And we'll start with Bill(ph). Bill with us from Chicago.
BILL (Caller): Hi, Neal. Great topic. I actually had worked for about five years as a police and fire dispatcher in the city of South Bend, Indiana. And one thing that struck me with all the disaster drills that were done in our communities, they were all scheduled. They were a week's notice, two week's notice. We knew exactly when they were going to happen.
And I wonder if there are communities that have actually prepared, and hospitals especially, where the sudden influx of people and the very likely possibility that relief staff would not be able to get back to the hospital to relieve the personnel that were there. And I'll take my comments off the air. Thank you.
CONAN: All right, Bill. Thanks very much for the call. So, how realistic are even preparatory drills?
Dr. FINK: That's a very good question. I was speaking with someone recently who works on the hospital accreditation - with a hospital accreditation company. And they have in recent years, some of them - and there's no national requirement for hospitals to have particular types of disaster preparedness plans. So his company is working really hard trying to make some better requirements for drills and things like that. And he said, you know, we really don't know how much of this is vaporware and how much of this is real.
We don't even know, first of all, how to test whether hospitals are following their plans, let alone whether those plans really would, you know, promote preparedness - or to what extent would they? And can we come up with better drills and better plans?
So there's a lot of need for, you know, learning from these drills and taking those lessons. Learning from the disasters and taking those lessons and improving these kinds of standards.
It used to be, for example, very common that you would do drills on paper and now there's more of a push to have drills that - you know, perhaps they aren't as good as the ones that our caller would have, you know, has suggested, but at least where there's real people running around and acting it out.
CONAN: What about supplies? Do hospitals lay in supplies of - for example, we hear about the efficacy of iodine in the case of a radiological event. You can take it to prevent the amount of radioactive iodine going into your thyroid and causing, maybe 20 years down the road, thyroid cancer. Do they stockpile things like iodine and the other things they might need in a disaster?
Ms. FINK: So iodine is useful, I understand, only if it's given very quickly after a disaster. So you need to have that not stockpiled at some central location but right on the scene, I think within four hours. If it's after that time period, it's not very useful.
It's also only useful for radioactive iodine, and there are other types of isotopes where it's not effective. In fact, with our strategic national stockpile, if you go on the website, which is a stockpile of things that may be useful countermeasures in case of different types of emergencies, there are really only four types of countermeasures - iodine is one of them - that could possibly be effective in a type of a radiological emergency or nuclear emergency.
And what our country's leaders know and have recognized increasingly is that we really don't have very many countermeasures, very good countermeasures, to respond to incidents like this. And so in fact just last year Health and Human Services Secretary Sebelius announced that there was going to be sort of an improved effort at, you know, developing new countermeasures.
In terms of - and so there's been some money. For example, the FDA announced recently a $70 million initiative to try to get some of these new ideas through the regulatory process more quickly.
In terms of stockpiling even normal things that hospitals need on a daily basis, we are in such a financial climate that there's a concept called just-in-time delivery that applies to lots of businesses, the way they get their inventory, not having a lot on hand. And hospitals do this too, which makes them very vulnerable to disasters.
CONAN: Any disruption in transportation - traffic jams, for that matter. And that gets back to the issue of money. Hospital preparedness funds allocated since 9/11, we learned, have been cut back. What kind of changes realistically can be made now?
Ms. FINK: Yeah, there was a whole program that started after 9/11 to help hospitals, you know, purchase some of the things that they might need, and unfortunately it has been cut in this next year's budget.
So that's a little worrisome. I also noticed that with the stimulus program that we had recently, there was really not much in there at all in terms of improving our hospital preparedness or public health preparedness, and that, I think, may have been a missed opportunity.
So I think we as a society need to think about how much do we want to prioritize this. We talked about triage. In these fiscal times, do we want to continue to build the things that we need in place to be resilient in multiple types of disasters or attacks?
CONAN: Sheri Fink, thanks very much for your time, appreciate it. Sheri Fink, a senior fellow at the New America Foundation, a contributor to ProPublica. Wait a minute. I may have let you go too soon. I think we're going to keep you with us, if you don't mind.
Ms. FINK: Not a problem.
CONAN: Sheri Fink's going to stay with us. She's currently working on a book on hospital disaster preparedness in the United States, and she joined us here in Studio 3A. When we come back, more of your calls. What kind of disaster plans are in place in your town where you work or in your home? 800-989-8255. Email email@example.com. Stay with us. It's the TALK OF THE NATION from NPR News.
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CONAN: This is TALK OF THE NATION. I'm Neal Conan in Washington.
From time to time, a big city will close off the downtown area for a major disaster drill for first responders. That's not always possible. So the Texas Engineering Extension Service built Disaster City, a 52-acre training facility in College Station, Texas, with full-scale buildings and trains and piles of rubble.
There's a collapsed movie theater and a strip mall, all designed to give rescue workers real-life training for natural disaster, terrorist attacks and other crises.
Given the ongoing crisis in Japan, we're talking today about disaster preparedness in the United States. What kind of disaster plans are in place in your town, where you work or in your home? Give us a call, 800-989-8255. Email firstname.lastname@example.org. You can also send us your comments at our website. That's at npr.org. Click on TALK OF THE NATION.
Our guest is Sheri Fink, a senior fellow at the New America Foundation, where she studies preparedness within the medical community. And joining us now from a studio at UCLA is John Wallace, a professor there in the School of Engineering and Applied Science, and nice to have you with us today.
Professor JOHN WALLACE (UCLA): Thank you, nice to be with you.
CONAN: And from what we've heard in recent days in Japan, building codes are quite stringent and indeed may have saved a lot of lives in the past week or so.
Prof. WALLACE: Probably very true. Their codes are probably a little more stringent than we have here in California say, in Los Angeles and San Francisco. The Japanese do a lot of large-scale and full-scale testing on shake tables that can simulate earthquakes. So they do a lot to prepare.
CONAN: And you say not quite as stringent as we do. What kind of innovations do they incorporate in some of their buildings that we have yet to incorporate in ours?
Prof. WALLACE: They tend to incorporate new technology faster than we do in the U.S. Their big five construction companies have, you know, a lot of incentive to be seen, you know, pushing the frontiers of science and engineering, whereas in the U.S. it's much more associated with how much does it cost. And in some cases they're not quite as concerned about that.
CONAN: We're told that they had, for example, the more recent buildings constructed with basically rubber mats at the bottom to help isolate the building from any shocks, obviously from an earthquake. Do we have those kinds of structures in our buildings?
Prof. WALLACE: Yes, we do. There's a significant number of base-isolated type structures in the U.S. and several - one right here on the UCLA campus. So we definitely have integrated that type of technology. It's been around for 25 or so or 30 years.
CONAN: And the hydraulic pistons that can help reduce the amount a building sways?
Prof. WALLACE: Yes, that as well. Introduced quite some time ago, fairly common for higher-end construction projects where, for example, you're trying to -cost I don't want to say is no issue, but you're trying to save a historically significant structure, or you're trying - a rapid response facility, and you're pushing for a much higher performance than you would for your typical building.
CONAN: What kinds of techniques might we adopt that they have used in Japan? And you say theirs are a little tougher than ours. Obviously California is pretty vulnerable to earthquakes too.
Prof. WALLACE: We are - we do adopt and are using most of the approaches or all of the approaches that they use. They're just using them in a more regular basis. It's much more common than it is here in the U.S. so far.
CONAN: And do they retrofit old buildings on a regular basis?
Prof. WALLACE: They do as well. And we also do that here, particularly in California and other areas of the country that are prone to damage. We were just talking about hospital facilities. In California, acute care facilities have a required seismic upgrade that's going on between, oh, over the last 10 years and into the next 20 years.
CONAN: And let's see if we can get some more callers in on the conversation, and let's turn to Lena(ph), Lena with us from Paradise in California.
LENA (Caller): Hi there, Neal. How are you?
CONAN: I'm good, thanks.
LENA: We had a large wildfire here in Butte County, 2008 - actually had two large wildfires. And our local hospital that work with also it's my community hospital that I go to, had backup generators to treat the patients and run all the emergency equipment. That wasn't the problem.
The problem was the generators were not hooked up to the heating and cooling systems, and when the heat in the hospital got over a certain temperature - I want to say right around 85, 90 degrees - the hospital had to shut down per, I believe, probably JACO, the joint accreditation program, because a lot of the chemicals, drugs, IVs, medications were no longer considered good at a certain temperature.
And so after closing for two to three days, it cost millions of dollars to open back up because everything had to be thrown out, restocked, and then we had to be reaccredited and have - or not reaccredited but recalibrate all of the equipment, all of the medication. It was a nightmare.
And I believe since then the hospital has included the heating and air system on the backup generators because of that very reason. It wasn't a matter of life and death for patients, but it was a huge cost.
CONAN: And when the hospital had to shut down because of the heat, did all the patients have to be moved elsewhere?
LENA: Quite a few of them had to be moved. We actually - it wasn't just the heat. We also had the fire approaching from the canyon. And it wasn't really close, but we get winds in that canyon. So if they picked up, there was a possibility of it getting pretty quickly to the hospital.
CONAN: And Sheri Fink...
LENA: I don't know if they moved all of the patients or most of the patients or the non-ambulatory patients. But yeah, there were a lot of areas that had to take on our patients. It was a nightmare.
CONAN: Sheri Fink, what she's talking about, not hooking the electrical, backup electrical generator system to the heat and air conditioning, that's exactly what you were talking about.
Ms. FINK: Exactly. And it costs money to do that because you have to have bigger generators. But of course, on the other side, you just explained some of the costs, and then of course moving patients is a risk to patients.
So - and particularly if you then add flooding on top of that, how do you get them out? How long does it take to airlift patients out? It took a very long time in New Orleans, and patients died.
CONAN: Lena, thanks very much for the call.
LENA: Thank you.
CONAN: John Wallace, getting back to structural techniques, new materials keep being invented by various kinds of sciences, and are those being incorporated in buildings? Should they be incorporated more quickly?
Prof. WALLACE: They are being incorporated, higher-strength materials, more ductile or deformable materials. Typically they cost more. So it's, again, usually a higher-end client that's using that type of materials.
And slowly we're doing research so that we feel more comfortable in the design process for these materials so that we can incorporate them into typical buildings.
I mean, without that research, we can't apply all of the older research to these new materials, and therefore it takes some time until we can learn what we need to do to support developing provisions in a building code to incorporate that material.
CONAN: And you keep saying higher-end buildings and buildings where, of course, you have first responders, and the buildings they work in need to be held to a higher standard. But if you think about the scale of the disaster in Japan and translate that to California, I assume that would be very worrisome.
Prof. WALLACE: It is, and you know, higher-end clients could include people like Microsoft and Hewlett-Packard and Intel and people that have campuses of (unintelligible) important buildings that are key to their economic survival.
But the concern here amongst many of the engineers on the West Coast is the cost in terms of, you know, a loss of - not so much the loss of life but the loss of an economic setup. Like if your house or your office building is no longer usable after an earthquake, it's going to have a huge long-term economic impact on the area.
And our standards at this point for typical buildings are to prevent collapse, not to make sure that the building is usable after an earthquake.
CONAN: But to make sure that the people who are in it can walk away from it.
Prof. WALLACE: That's right. And you have to ask: Is that the standard we should be shooting for?
CONAN: All right. John Wallace, thanks very much for your time today. We appreciate it.
Prof. WALLACE: Glad to be with you.
CONAN: John Wallace, professor at the Henry Samueli School of Engineering and Applied Science at UCLA, joined us from a studio at UCLA. And here's an email from Eric(ph) in Denver: I have a number of items at my house for disaster planning. We maintain an extensive first aid kit, enough food and water for three to four months, and have up-to-date bug-out bags for my wife, daughter and myself.
My question is while it's understandable to want to flee, and there are some disasters that destroy one's ability to stay put, but what's the advice on how long one should bunker down in the event of a large-scale emergency? I'm not sure. Sheri Fink, you have any advice for him? I guess it depends.
Ms. FINK: It depends, and there was a study that was done not long ago showing that very few people in the country are like this emailer. So very few of us even know - you know, ask yourself: Do you have a plan? How would you meet your loved ones? Do you have supplies? Not many people do.
Some communities do offer advice about that. I know in California, but it's good idea. And I think it also points to that need to really get the public involved and engaged because, really, studies have shown that in the acute aftermath of a crisis, it's how we treat each other, our neighbors, our family members, that really makes the difference in life and death in those early hours. And so it's very important, this community component and all of us thinking about, you know - I mean, go to your hospital and find out, do they have their generators hooked up to the air-conditioning and heating system? It's something that we, as citizens, can all take part in.
CONAN: Sheri Fink, do you have bug-out bag?
Ms. FINK: I have a go bag, I call it.
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Ms. FINK: But that's because I've often gone to respond to various emergencies. But even I need to be more prepared here at home. I will accept that. All of us probably do.
CONAN: We've been talking about civilian training. Joining us now from the studios at WNPR - at NPR West in Culver City, California, is Mark Benthien. He directs the Great California Shakeout and serves as director of outreach at the Southern California Earthquake Center.
Nice to have you with us today.
Mr. MARK BENTHIEN (Director for Outreach, Southern California Earthquake Center): Good to be here.
CONAN: And for those of us who've never lived on the West Coast, what is the Great California Shakeout?
Mr. BENTHIEN: It is now our annual, statewide earthquake drill, in its fourth year coming up this October. And it's the chance for everybody to practice how to protect themselves during an earthquake. And we also hope that it's become so big that people are talking about earthquakes even when there aren't earthquakes in the news because of this big drill. And we - last year, we had 7.9 million participants, and a lot of them are schools, business, government agencies, individuals and families.
CONAN: Well, what actually happens?
Mr. BENTHIEN: People practice the recommended action, which is called drop, cover and hold on, where you drop to the ground before the earthquake drops you. You take cover underneath something, if possible, or cover your head and neck with your arms, get down low. And if you are under something, hold onto it, because the earthquake can be moving the furniture around, and you want to make sure that you're still under it.
CONAN: Is this a drill set for one certain day during the year?
Mr. BENTHIEN: It's always on the third Thursday of October now. This year, it'll be October 20th, at 10:21. However, it's also happening in other parts of the country, and much sooner than that, in April, April 28th. The Great Central U.S. Shakeout is happening with 11 states in the Central U.S. and South U.S., Southern U.S. participating, and they already have one million participants registered.
CONAN: And these are - well, this happen at schools? Does it happen in hospitals? Are these realistic drills to say, and now how are we going to deal with all those people who got hurt?
Mr. BENTHIEN: It doesn't quite go that far. Now, there's also, in the Central U.S. this year, a national-level exercise coordinated by FEMA and many others that does practice that aspect of how the government agencies and the first responders - firefighters and others - will respond to deal with a large Central U.S. earthquake, the New Madrid Scenario Earthquake. It's this year or next year, the bicentennial of very large earthquakes that happened back in 1811 and 1812. And because of that, all this is happening.
CONAN: And I just wonder if - does the drill change if there are other factors involved? Obviously, tsunamis in Japan could easily be in California, as well.
Mr. BENTHIEN: Yeah. We are starting to add in tsunami elements to the Great California Shakeout, where people near the coasts are encouraged to - after they drop, cover, hold on, just like in an earthquake, they would feel if they were by the coast - during the strong shaking, get down so they are not knocked down. But then immediately practice a evacuation to higher ground or get as far away from the coast as you can. So we're encouraging people to add that to their plan, as well.
CONAN: Well, we wish you the best of luck. And thanks very much for being with us.
Mr. BENTHIEN: Oh, you're welcome.
CONAN: And, again, it's the third - it's on October.
Mr. BENTHIEN: October 20th this year in California, and April 28th in the Central U.S. And people can go to shakeout.org to register for both drills.
CONAN: Mark Benthien is director for outreach at the Southern California Earthquake Center and executive director of the Earthquake Country Alliance, and he joined us from our studious at NPR West in Culver City, California.
You're listening to TALK OF THE NATION, from NPR News.
And let's go next to Rye(ph), Rye with us from Denver.
RYE (Caller): I am. Thank you for taking my call.
CONAN: Sure. Go ahead, please.
RYE: Just wanted to touch base about the federal preparedness and the federal availability of real experts in dealing with these kinds of disaster situations, which is all controlled through northern commands here in Colorado. The fact that there are entire military units that are trained in rescue situations for - what they refer to as CBRNE events, which is chemical, biological, radioactive, nuclear and high-yield explosive events.
But these are units within the Army, the Marines, all kinds of different units that actually practice the rescue of people in disaster situations. They - and go so far as to have regular drills and even have a portion of a base on the East Coast which is devoted - which has simulated collapsed buildings and other situations that allow our military to train to rescue people in these kinds of situations. And the fact that they're available at very short notice with a call from any governor in our country and even, in some situations, available to Canada in the event of a disaster.
CONAN: We've seen that, obviously, in Japan. And I guess the facility you talked about in the East Coast, similar to that disaster city we were hearing about in Texas a little earlier.
But Sheri Fink, it raises a question. One of the lessons after, I guess, both Katrina and 9/11, was that first responders in those crisis had radios that could not communicate with each other. And I don't know if the military is being integrated into that, as well. But there was a lot of money allocated after 9/11 to coordinating electronic communications.
Dr. FINK: Yeah. I think the country's getting better. As I've learned, there are still places where interoperable communications haven't yet been achieved, and so that's still a goal. And there are still needs to be some money put toward that.
But the caller's absolutely right. There are more and more drills where there are, sort of, integration across these levels of government, federal, state, local, including the military. And that's what I think we've really learned from our recent history. And we've had so many disasters in recent years. It's been kind of unusual. But we've learned that drilling, practicing, getting those links between people at different levels of government is really important, and then that public level that needs to come in, as well.
CONAN: This time, Sheri Fink, I can thank you very much for your time today and mean it. Appreciate your effort, and thank you for joining us here.
Dr. FINK: Thank you.
CONAN: Sheri Fink is a senior fellow at the New America Foundation, a contributor to ProPubica and won the Pulitzer Prize for her New York Times magazine story chronicling the New Orleans hospitals response in the days after Hurricane Katrina, was kind enough to join us here in Studio 3A.
Coming up with reports that Libya's Moammar Gadhafi has unleashed mercenary troops on his own people. We'll talk with the U.N.'s point man on mercenaries.
Stay with us. I'm Neal Conan. It's TALK OF THE NATION, from NPR News.
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