Sustained Resilience: Immediate Disaster Case Management (IDCM) program operated by BCFS Health and Human Services’ Emergency Management Division

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Katrina’s Landfall

The 29th of August in 2005 would become a day to go down in American history. Hurricane Katrina was making landfall during the early morning hours. The Category 3 storm brought sustained winds of 130 miles per hour to the residents of New Orleans and hundreds of communities located along the Gulf Coast states of Louisiana, Mississippi and Alabama. After several intense hours, the winds subsided, the storm moved inland and weakened, but devastation from the flooding from failed levees had just begun. Thousands would lose their lives and tens of thousands of people would be displaced from their homes in what would become the costliest hurricane in U.S. history and the fifth deadliest.

In the months and years that followed this catastrophic event, the lessons learned were many. Despite the delivery and application of an enormous volume of resources, almost four years after the storm, in April of 2009, thousands of individuals were still in need of social services that would enable their full recovery.

Trailer homes, funded by the Federal Emergency Management Agency (FEMA) and initiated by the Louisiana Recovery Authority (LRA), had been deployed to assist residents that had lost their homes. As these trailer homes were never intended to be a permanent solution, a new pilot program known as the Louisiana Disaster Case Management Pilot (DCMP) was launched to assist people still living in FEMA temporary housing units. The goal of the pilot was to assist displaced residents with aspects related to long term recovery, including the transition to permanent housing and accessing available resources that addressed financial, legal and healthcare needs.

Lessons Learned The Hard Way

According to a 2010 independent study, “Navigating the Road to Recovery,” the efficacy of the Louisiana DCMP pilot program faced many obstacles: “Despite concerted effort by participating agencies, the implementation of the DCMP was fraught with challenges. As a result, the pilot could not be implemented as intended, leaving the needs of many clients not fully met.”

The report went on to document significant problems regarding communication, coordination, and financing of the program. “The stop and start of recovery initiatives led to serious discontinuities in client recovery, so the authors recommend that federal and state governments consider a single, longer-term recovery initiative that seamlessly acknowledges the stages of human recovery. Improvements in how federal and state governments identify and locate affected residents, consider needs and vulnerabilities in planning, and ensure continuity of services are critical to ensure high-quality disaster case management.”

The answer? The creation of a new federal program that leveraged the outcomes of the Louisiana DCMP program. The program came to be known as the federal Immediate Disaster Case Management program, or IDCM.

Inception of ICDM

Working in conjunction with FEMA, the new IDCM program would be administered by the United States Department of Health and Human Services, through the Administration for Children and Families (ACF). Within ACF, a department known as the Office of Human Services Preparedness and Response (OHSEPR) would be responsible for activating the program once certain disaster impact criteria had been met under a Presidential Disaster Declaration.

In 2014, the contract to provide these services for OHSEPR came up for renewal. With a lengthy track record of successful emergency response deployment operations on behalf of state and federal clients, BCFS Health and Human Services’ Emergency Management Division (BCFS EMD) submitted a proposal and was awarded a five-year contract to provide IDCM services.

Preparations Commence

Quickly, the program was off and running. EMD established a management team and within 60 days employed and developed nine case management teams consisting of 30 case managers each. Months of team coordination and distance-based training soon followed. Members of the IDCM team come from across the country and represent all ten ACF regions.

In late summer of 2015, a full-scale IDCM disaster exercise was held at Silver Cliff Ranch, the BCFS-owned and operated wilderness camp in Nathrop, Colorado. Case managers were provided a mock “activation order” by EMD. Hundreds of designated case management personnel were then flown to Denver from across the country on a single day and were transported by EMD buses on a three-hour journey into the mountains. Over the following four days, the “ACME” exercise, which was scenario-driven and included real-world examples of actual client situations, the IDCM team was able to effectively implement disaster case management training at a higher level than any delivered training in the program’s history.

The exercise was attended by representatives from FEMA, ACF, and uniformed members of the United States Public Health Services (USPHS), a government agency that operates under the leadership of the Surgeon General’s office to ensure public health functionalities during major disasters. The exercise was an incredible success.

The BCFS IDCM team was now ready for action. All that was needed was a mission assignment. In the spring of 2016, that opportunity came.

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Record-Breaking Rainfall

The night of April 17, 2016 began with heavy rain forecast in the southeast part of Texas. On this night and for several consecutive nights, Harris County and the many other counties that make up the greater Houston metropolitan area were situated within a steady stream of upper level moisture coming in from the Gulf of Mexico. As this tropical air mass intermingled with cooler air approaching from the northern portions of Texas, thunderstorms developed rapidly. Instead of quickly exiting the area as they usually do, these clusters of storms seemed to maintain a constant, almost static, presence over the region. As the thunderstorms intensified, their eastward motion slowed almost to a dead stop. As the storms remained, they dumped several million gallons of rain on unsuspecting residents of a 14-county area.

As the initial rains fell, many residents thought the storms would pass and things would go back to normal soon. Little did they know that within 12 hours the water from the nearby Brazos River, Colorado River, and numerous local bayous would swamp thousands of homes. The following day, after being rescued from swift moving waters by teams of first responders in special flood response watercraft, many of these same homeowners would be sleeping on cots in emergency shelters set up in nearby schools. Some watched the contents of their homes – their life’s belongings – washed into a river of debris that only a few hours earlier had been the roadway through their neighborhood. Other flood survivors in rural areas were left helpless as their livestock perished or were stranded by the floodwaters.

The flooding was record-setting for the Houston area. As a result, the federal government issued a Presidential Disaster Declaration for dozens of counties across the region. While the state of Texas does have significant local case management capacity, as time passed and the demand for case management services reached record levels, the local case management capacity was outstripped. It was at this point, several weeks after the floods subsided, that state officials determined federal case management assistance would be needed.

The BCFS IDCM team received a 90-day Mission Assignment task order on May 26, 2016. By June 5, nearly 60 BCFS personnel were providing desperately needed services to residents of the counties impacted by the storms. Using a combination of centralized case management services and deployable case management strike teams, the IDCM group fanned out into a dozen communities that were most impacted by the floods. Sixty total personnel were initially deployed; an additional twenty personnel would be deployed a few weeks later.

It would become an IDCM deployment operation that would alter the face of the federal IDCM mission profile. 

Changing The Mission Profile

The cyclical phases of emergency management include Preparedness, Response, Recovery, Mitigation and Prevention.

In the emergency management world, the Response phase of any incident is usually short-lived. Response operations include application of response resources. An Incident Command Post is established as a location where response operations are coordinated. Supplies, equipment and personnel are organized and utilized in a manner that is designed to save lives and protect property. Incident Action Plans are drafted and distributed daily in order to capture required response objectives, organizational structure and personnel assigned to specific tasks. Situation Reports are also created and distributed daily, as a means of tracking operational success toward the established mission objectives outlined in the Incident Action Plan.

The Recovery phase, on the other hand, is where the heavy lifting begins. It is generally characterized by a slower pace, as recovery operations can continue for several years. Recovery operations rarely utilize the same tools as the Response phase. True to form, during previous IDCM deployments a different contractor had applied a typical recovery approach to their recovery efforts on behalf of OHSEPR. The results were disappointing and ineffective.

The BCFS IDCM team would take a much different approach. BCFS would, for the first time, apply a response-oriented approach to recovery operations. The results? A vast improvement in the coordination and application of IDCM case management resources, which allowed BCFS to assist thousands of affected residents in a much shorter time frame.

Powerful Results

EMD disaster case managers spread out across the Houston-area and 11 surrounding counties, helping flood survivors on a daily basis for months at a time. For each flood survivor, some experiencing their darkest hour, their disaster case manager served as a single point of contact for all their questions, advocating for them with multiple social service organizations and government partners, to help them achieve the best possible outcomes in their individual recovery process.

EMD disaster case managers were the go-to resource for flood victims to receive assistance meeting their needs for housing, furniture, appliances, utilities, employment services, transportation, health and wellness, senior services, access and functional needs services, legal assistance and more.

The positive impact on the affected communities was tremendous. Based on the results listed above, feedback from our federal partners has been very positive.

The highly successful work performed by BCFS Health and Human Services’ Emergency Management Division to ensure sustained resilience for the Houston-area will have a lasting impact for years to come.charlie-rosenberg-3-2

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Prepared For Emergency Management

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With more than a decade of experience responding to natural disasters and humanitarian crises, BCFS Health and Human Services’ Emergency Management Division (EMD) is a recognized nonprofit leader in emergency management, incident management, disaster response, public health and medical emergency response, mass care, medical sheltering and planning for vulnerable populations.

In addition to our top-tier incident management expertise, EMD has built an extensive inventory of resources that allows us to provide customized logistical, communications, and mobility support that meets the unique needs of our partners in federal, state and local government and private industry. We maintain a fleet of more than 90 support vehicles and trailers including:

  • Tractor Trailers
  • Commercial Buses
  • Mobile Command Platforms
  • Ambulances
  • Fire Engine
  • Mobile Medical Unit
  • Box Trucks
  • 1-Ton and 1-1/2-Ton Trucks
  • Generators
  • Light Towers
  • Laundry Trailers
  • Shower Trailers
  • Toilet Trailers
  • Forklifts
  • Polaris ATVs
  • Mast Trailers

EMD also provides state-of-the-art communications support for responses of any size. Our communications resources include VHF, UHF, and 700/800 MHz radio equipment, satellite voice and data devices, and cellular voice and data devices.

EMD’s stock of life-saving emergency supplies and warehouse resources are always at-the-ready to be deployed to:

• Erect a self-contained compound the size of a small city with the capability to shelter thousands of disaster survivors simultaneously, complete with sleeping cots, medical triage equipment, hygiene kits, and shower, toilet and laundry facilities

• Care for disaster survivors who need medical care and those that have access and functional needs

• Supplement local first-responder’s capabilities, including fire departments, police departments and search and rescue teams

NO MATTER HOW BIG OR SMALL THE MISSION TASKING, OUR GOVERNMENT AND PRIVATE INDUSTRY PARTNERS REST ASSURED THAT BCFS EMD HAS THE RIGHT TOOLS IN THE TOOLBOX TO RESPOND.

Planning for Worst Case Scenarios

Mass fatality incidents are not a pleasant subject, nor one upon which few people would want to dwell. But like all disastrous events, failure to plan for catastrophes like mass fatalities may result in additional confusion, trauma and distress to those involved.

So we plan, we train and we exercise what we’ve learned. Exercises are an essential element of disaster preparedness, allowing us to practice skills, discuss potential issues, and appScreen Shot 2016-03-04 at 3.23.59 PMly our knowledge to real-world scenarios. But how do you exercise a mass fatality event?

The Texas Department of State Health Services, Health Services Region 8 (HSR 8) contracted with BCFS Health and Human Services’ Emergency Management Division (BCFS EMD) to hold a full-scale mass fatality exercise in San Antonio. A full-scale exercise allows participants to apply the skills acquired at training sessions in scenarios that are meticulously crafted to be as realistic as possible.

The exercise was a collaborative effort between HSR 8, BCFS EMD, the Texas Department of Public Safety’s Highway Patrol State Crash Reconstruction Team Section and the San Antonio Fire Academy.

The exercise involved a constructed scenario of a crash between a 15-passenger van and a Southern Pacific train. The train, part of the Fire Academy’s training center, provided the real- world “feel” for the exercise. To add to the reality, bodies (plastic mannequins) had disaster injury make-up (moulage) applied by BCFS Health and Human Services’ moulage artists.

Participants, including the Bexar County Medical Examiner’s Office which played an active leadership role during the exercise, were tasked with performing a search and recovery effort. Victims were located, appropriately handled, and carried to a storage location. Evidence such as personal effects were gathered and categorized to be returned to the victims’ family members.

Screen Shot 2016-03-04 at 3.24.09 PMThe Crash Reconstruction Team led a training prior to the exercise on protocols for scene investigation and evidence collection. The BCFS EMD forensics team led a presentation of search and recovery protocols, and facilitated the train crash simulation to ensure a safe learning environment. Participants represented a variety of disciplines, including fire, law enforcement, public health, justices of the peace, healthcare and EMS.

“Collaboration is essential when dealing with a large-scale event like this,” said Kari Tatro, EVP/COO– Administration, Education & Emergency Operations. “Ensuring that everyone knows their roles and responsibilities, and practices together before a crisis, allows us to respond seamlessly in real events.”

Even in death, we seek to serve with respect and care to those in need.

Whole Community Planning

It’s easy to find checklists and guides on how to build a personal emergency preparedness kit (visit Ready.gov, for starters), but it’s not quite as clear what individuals can do after their disaster kit is assembled. Many questions remain unanswered, like “how can I connect to others in my community during a disaster,” “what will other groups be doing during disaster recovery,” and “how can I get involved and contribute during disaster response?”

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Take a closer look at steps you can take to ensure personal preparedness, and the line becomes blurred between personal and communal preparedness. What one person packs in their disaster kit may directly impact others in their household, as well as their neighbors. We all live and function in the context of the environment around us, so why would we plan for emergencies in a vacuum? Personal preparedness planning becomes more effective and holistic as it grows to include the bigger picture of “whole community planning.” But what exactly is whole community planning?

If you’ve ever been to a potluck, you have whole community planning experience.

Every potluck has a coordinator: a contact person who facilitates and sometimes makes special requests or delegates tasks and responsibilities. This person uses what they know about what is needed for the event and what exists in their community. In whole community emergency management planning, this contact person is your emergency manager.

“Whole community” planning means not asking the baker to bring steak to the potluck.

Everyone in the community is invited and many people attend. Potluck attendees understand what they will contribute and receive from others. Each guest evaluates their abilities and resources: their availability to attend, the ingredients they have or can acquire, the skills and time they have to prepare a dish, what they are good at or enjoy making, and the additional equipment or supplies that they can bring along. Each guest understands the importance of sharing this information in advance, so that there are enough resources (chairs, plates, cups, and a variety of food items to eat). When you attend a potluck, you bring your needs (the desire to eat and socialize) as well as your skills, resources and assets (equipment, food and time).

The same thing happens in a whole community approach to emergency management planning: Community members evaluate what works well in their communities on a daily basis, assess their needs and resources, and commit to being part of a collaborative and inclusive activity.

You’re invited to the potluck:

As you conduct your personal preparedness planning use “whole community” thinking.

  • Your needs may be similar to the needs of another community member.
  • Your resources may be essential to another community member. The neighbor with the accessible vehicle may be able to help evacuate more people than just themselves. The durable medical equipment from an adult day program would be very useful to people who were evacuated to a shelter. One person’s cultural and linguistic knowledge and the translation dictionary they packed in their preparedness kit may help a first responder communicate with someone who doesn’t speak English. The generators typically used by an outdoor adventure business could support the needs of many community members. The children’s books packed by a prepared mother may help a classroom of children evacuated to a shelter.

We all contribute to the “potluck,” and we must conduct emergency preparedness the same way. Whole communities are prepared when the whole community participates.