Ready and Smart

Health promotion is mostly linked to primary prevention - things to do to protect health in the first place, avoiding the development of illness or injury. Further, the term is often associated with lifestyle habits such as diet, exercise, stress management, avoiding smoking, and so forth. In the late 1990s, and accelerating after 9/11, health promoters have increasingly become engaged in what has come to be called emergency preparedness. Of course there have been hospital emergency departments and ambulance services for decades, but the more recent concept of emergency preparedness encompasses an array of threats, including natural disasters, infectious disease outbreaks, such as pandemic flu, and ever more hideous manifestations of terrorism. While emergency preparedness incorporates much more than health promotion, it has a role to play as we try to assure people have the best health possible in the face of the worst that nature and mankind can throw at them.

Preparedness is challenging for many reasons. For one thing, we try to be prepared for any emergency. Not long ago I worked on a team with school systems in a project to build their preparedness. A first step was for schools to identify any particular threats beyond the universal ones like severe weather or a shooter. One school system was down river from a dam showing signs of breakdown. Making repairs on the dam was a multi-year process, and until completed, persons and buildings below were at risk. If the dam failed, students would have to be bused out of harm’s way. Another system had schools in the flight path of a major airport while another school system was in a terrorism target zone near a major military base. Such a broad range of potential emergencies means that there is no universal preparedness template. Every community needs a unique plan.

Another reason emergency preparedness is challenging is because the key participants don’t have routine established patterns of working together. For example, if there was a serious bomb threat at a public school, the community response would need to include principal, superintendent, teachers, parents, police and fire departments, emergency medical services, news media, health care system, and local government. These players do not routinely work together. They don’t have integrated dispatch and communication systems. There is no obvious way to organize so that everyone knows what to do and who is in charge. Many communities have designed and practiced emergency plans, but it is very difficult to maintain the ability to spring into action according to the plan. Federal and state units of homeland security have worked hard to enhance community readiness. Most officials believe we are better prepared than we were 10 years ago, but no one really wants to put it to the test.

In addition to the primary response to community crises, there is also the consideration of mental health implications for responders and residents. Depending on the circumstances of an emergency, often the response workforce as well as immediate victims and community residents are emotionally traumatized. If the situation arises where hundreds or thousands of people experience extreme stress and anxiety, the mental health system is asked to find a way to respond to a sudden surge of clients. This also has to be part of a response plan.

The work of community preparedness illustrates how interdisciplinary the worked has become. Planning has gone beyond first responders to include new participants, such as engineers. Engineering tools and techniques are used to guide resource flow and organizational dynamics. Computerized expert systems are being harnessed to guide contingency flow charts in response to varying threats and circumstances. The skill set needed to respond in complex circumstances is found in a wider and wider range of professional expertise.

In the Spanish language, there is a common phrase “Estoy listo,” which means “I am ready” or “Estan listo?” “Are you ready?” Spanish speakers will also use listo to mean smart -“Este chico es listo,” “That boy is smart.” In emergency preparedness we have to be both ready and smart.