IMPACT ON RECOVERY FOLLOWING MULTIPLE TROPICAL CYCLONES AND HURRICANES
The United States (US) and Caribbean regions remain vulnerable to the impact of severe tropical storms, hurricanes, and typhoons. In 2017, a series of hurricanes posed threats to residents living in inland and coastal communities as well as on islands isolated from the US mainland. Harvey, Irma, Jose, and Maria caused catastrophic infrastructure damage, resulting in a loss of electrical power and communications due to damaged or downed utility poles, cell towers, and transmission lines. Critical services were inoperable for many months. Emergency managers are public officials who are accountable to both political leaders and the citizens. During disaster events, emergency managers must prioritize areas of effort, manage personnel, and communicate with stakeholders to address critical infrastructure interdependences. Essential lifeline services (eg, energy and communications) were inoperable for many months, which led to increased attention from policy-makers, media, and the public.
COORDINATED EFFORT FOR STABILIZATION
The Federal Emergency Management Agency (FEMA) proposed a response tool, Community Lifeline, to improve assessment of disaster impacts and allow a broad range of stakeholders to prioritize actions with competing requirements.1 Critical services within a community that need to be stabilized following a disaster or incident are referred to as Community Lifelines. Community Lifeline serves as a framework during incident response and is a federally supported effort that is state managed and locally executed.2 The Community Lifeline framework was implemented with the purpose of providing oversight during initial response (eg, immediately after an incident). Select states and local emergency management departments choose to adopt the Community Lifeline framework into their daily operations. Community Lifeline integrates how incident information is organized and reported during a response to enable continuous operations of government and business function to promote economic security, human health, and safety.
The 2017 hurricane season identified the need for a dashboard to help advance multi-agency emergency response capabilities by allowing partners to visibly identify gaps across sectors and helped communicate resource needs across communities and governments. After the catastrophic impacts and infrastructure damage to key Lifelines were stabilized, it took many months to determine the operational status of health and medical services in impacted states and territories. As of August 2019, Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, Ohio, South Carolina, and Tennessee developed a Community Lifeline dashboard to help improve coordination and information sharing across governmental, nongovernmental, and private agencies. The Community Lifeline framework was implemented with the purpose of providing oversight during initial response (eg, immediately after an incident).
FRAMEWORK
Community Lifelines was designed as a response dashboard to facilitate efforts in terms of the scope, complexity, and coordination of emergency response across entire communities, including government, public, and private sector partners. This online platform can be viewed anywhere in the US to allow visualization of critical and noncritical functions at the state or local level. The Community Lifeline components align closely to the emergency support functions (ESF), and include the following domains: Safety and security; Food, water, and shelter; Health and medical; Energy (power and fuel); Communication; Transportation; and Hazardous materials.
During a disaster event, response personnel conduct an analysis of essential information for each Community Lifeline and assign a time-stamped impact statement that succinctly summarizes the incident status for each Community Lifeline. Each Lifeline has a specific icon that changes color to indicate response status: steady-state, no incident (blue), insufficient information to make a good determination (gray), disruption to critical services (red), solution to disruption identified and a plan of action with resources is being implemented (yellow), or stabilization (green).
STRENGTHENING PARTNERSHIP TIES
During a disaster or event, responders engage in response duties to protect the health and safety of affected communities. It is easier for partners in emergency response to work together if they are familiar with one another and their performance standards. The Community Lifelines framework is an example of FEMA’s recommendation to develop stronger relationships with critical partners and increase situational awareness to support rapid restoration of services after catastrophic incidents.2 The National Response Framework3 and the Recovery Federal Interagency Operational Plan4 emphasize the need to address the interdependencies and cascading impacts among critical Lifelines and cross-sector coordination. Coordination across agencies in terms of what elements fit into each Community Lifeline will also help disaster response and recovery.
INTEGRATION OF THE HEALTH AND MEDICAL LIFELINE
The integration of information from public health, hospitals, and medical sectors into a Health and Medical Lifeline (dashboard) is one example of how this framework can help coordinate surveillance of community health needs for critical care patients in hospitals with structural damage. Hospitals represent a community focal point in the midst of disasters.Reference Farmer and Carlton5 A report by the World Health Organization suggested that measures to ensure the functionality of health infrastructures (eg, hospitals and health-care facilities) should be a priority to provide care to affected communities following a disaster.6 The Health and Medical Lifeline includes: (1) medical care, (2) patient movement, (3) fatality management, (4) public health, and (5) medical supply chain. Through integration of all Lifelines into a single dashboard, it is possible to monitor response activities in near real-time so that emergency managers can attend to community priority needs to save lives, reduce injury, and assist disaster survivors.2
COMMUNITY LIFELINES TO DEPICT RECOVERY
As currently conceptualized, the Community Lifeline framework might not be as useful in the long-term recovery or rebuilding of communities. For example, the ability of a hospital to function relies on Lifelines to other basic services, such as water, electricity, and communications.Reference Mulyasari, Inoue and Prashar7 Coordination across critical infrastructure sectors is essential for continued operations and to decrease morbidity and mortality. It is important to develop strategies for the health and medical components to prepare for, withstand, and recover from disasters in both the short- and long-term.
Although the Community Lifeline framework was not designed for recovery operations, the system is flexible and scalable and can be used to track any size or type of event. Possible broad modifications to depict the status of recovery operations include: adding hues within the standard universal color scheme (eg, red, yellow, green), creating new recovery icons to indicate reconstruction, and applying miniature icons that specify the word “response” or “recovery” on top, within, or below the 7 Community Lifelines. An alternative modification is the inclusion of criteria definitions (eg, anytime a hospital is damaged or an emergency room is closed the Health and Medical Lifeline is colored yellow), so there is no confusion on operational status.
Information sharing across federal multijurisdictional and multidisciplinary agencies, as well as the private sector, can inform the algorithm and criteria for steady-state in recovery operations. This might require modifying capability gaps identified following the incident to increase situational awareness and inform the Community Lifeline process months after the incident.2 For example, national standards for public health preparedness planning introduced by the Division of State and Local Readiness (DSLR), Centers for Disease Control and Prevention (CDC) through the Public Health Emergency Preparedness (PHEP) cooperative agreement are reviewed annually with health departments. DSLR provides technical assistance (standards for developing priority preparedness capabilities and public health expertise) to help health departments strengthen their abilities to effectively respond to a range of public health incidents and build better prepared communities. Through the PHEP program, CDC established 15 capabilities that serve as national standards for preparedness planning, which have evolved since 2011 with input from subject matter experts from the practice community, allied federal agencies, and professional associations.8 Updates to the capabilities focused on aligning content with new national standards and public health priorities, and developing strategies to advance jurisdictional public health preparedness and response capacity.
CONCLUSIONS
Lessons learned from the 2017 hurricane season illustrate the need for improved emergency coordination across the federal, state, local, tribal, and territorial agencies. Adoption of the Community Lifelines framework helps partners and decision makers create an operational picture during response and recovery. Given the interdependency of the Lifelines, it is now possible for communities to recover from events quicker as Community Lifelines enables the continuous operation of critical business and government functions.
It is the hope that, whenever the next hurricane makes landfall, swift, coordinated stabilization and restoration efforts across sectors and partner agencies will occur to protect human health and safety, and economic security. Community Lifeline implementation helps build a culture of preparedness through engagement and coordination with a cross-sector approach. As greater awareness of the Community Lifelines continues, it is expected that more state and local health departments will implement this dashboard construct to assist them with responding to disasters or other events.
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IMPACT ON RECOVERY FOLLOWING MULTIPLE TROPICAL CYCLONES AND HURRICANES
The United States (US) and Caribbean regions remain vulnerable to the impact of severe tropical storms, hurricanes, and typhoons. In 2017, a series of hurricanes posed threats to residents living in inland and coastal communities as well as on islands isolated from the US mainland. Harvey, Irma, Jose, and Maria caused catastrophic infrastructure damage, resulting in a loss of electrical power and communications due to damaged or downed utility poles, cell towers, and transmission lines. Critical services were inoperable for many months. Emergency managers are public officials who are accountable to both political leaders and the citizens. During disaster events, emergency managers must prioritize areas of effort, manage personnel, and communicate with stakeholders to address critical infrastructure interdependences. Essential lifeline services (eg, energy and communications) were inoperable for many months, which led to increased attention from policy-makers, media, and the public.
COORDINATED EFFORT FOR STABILIZATION
The Federal Emergency Management Agency (FEMA) proposed a response tool, Community Lifeline, to improve assessment of disaster impacts and allow a broad range of stakeholders to prioritize actions with competing requirements.1 Critical services within a community that need to be stabilized following a disaster or incident are referred to as Community Lifelines. Community Lifeline serves as a framework during incident response and is a federally supported effort that is state managed and locally executed.2 The Community Lifeline framework was implemented with the purpose of providing oversight during initial response (eg, immediately after an incident). Select states and local emergency management departments choose to adopt the Community Lifeline framework into their daily operations. Community Lifeline integrates how incident information is organized and reported during a response to enable continuous operations of government and business function to promote economic security, human health, and safety.
The 2017 hurricane season identified the need for a dashboard to help advance multi-agency emergency response capabilities by allowing partners to visibly identify gaps across sectors and helped communicate resource needs across communities and governments. After the catastrophic impacts and infrastructure damage to key Lifelines were stabilized, it took many months to determine the operational status of health and medical services in impacted states and territories. As of August 2019, Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, Ohio, South Carolina, and Tennessee developed a Community Lifeline dashboard to help improve coordination and information sharing across governmental, nongovernmental, and private agencies. The Community Lifeline framework was implemented with the purpose of providing oversight during initial response (eg, immediately after an incident).
FRAMEWORK
Community Lifelines was designed as a response dashboard to facilitate efforts in terms of the scope, complexity, and coordination of emergency response across entire communities, including government, public, and private sector partners. This online platform can be viewed anywhere in the US to allow visualization of critical and noncritical functions at the state or local level. The Community Lifeline components align closely to the emergency support functions (ESF), and include the following domains: Safety and security; Food, water, and shelter; Health and medical; Energy (power and fuel); Communication; Transportation; and Hazardous materials.
During a disaster event, response personnel conduct an analysis of essential information for each Community Lifeline and assign a time-stamped impact statement that succinctly summarizes the incident status for each Community Lifeline. Each Lifeline has a specific icon that changes color to indicate response status: steady-state, no incident (blue), insufficient information to make a good determination (gray), disruption to critical services (red), solution to disruption identified and a plan of action with resources is being implemented (yellow), or stabilization (green).
STRENGTHENING PARTNERSHIP TIES
During a disaster or event, responders engage in response duties to protect the health and safety of affected communities. It is easier for partners in emergency response to work together if they are familiar with one another and their performance standards. The Community Lifelines framework is an example of FEMA’s recommendation to develop stronger relationships with critical partners and increase situational awareness to support rapid restoration of services after catastrophic incidents.2 The National Response Framework3 and the Recovery Federal Interagency Operational Plan4 emphasize the need to address the interdependencies and cascading impacts among critical Lifelines and cross-sector coordination. Coordination across agencies in terms of what elements fit into each Community Lifeline will also help disaster response and recovery.
INTEGRATION OF THE HEALTH AND MEDICAL LIFELINE
The integration of information from public health, hospitals, and medical sectors into a Health and Medical Lifeline (dashboard) is one example of how this framework can help coordinate surveillance of community health needs for critical care patients in hospitals with structural damage. Hospitals represent a community focal point in the midst of disasters.Reference Farmer and Carlton5 A report by the World Health Organization suggested that measures to ensure the functionality of health infrastructures (eg, hospitals and health-care facilities) should be a priority to provide care to affected communities following a disaster.6 The Health and Medical Lifeline includes: (1) medical care, (2) patient movement, (3) fatality management, (4) public health, and (5) medical supply chain. Through integration of all Lifelines into a single dashboard, it is possible to monitor response activities in near real-time so that emergency managers can attend to community priority needs to save lives, reduce injury, and assist disaster survivors.2
COMMUNITY LIFELINES TO DEPICT RECOVERY
As currently conceptualized, the Community Lifeline framework might not be as useful in the long-term recovery or rebuilding of communities. For example, the ability of a hospital to function relies on Lifelines to other basic services, such as water, electricity, and communications.Reference Mulyasari, Inoue and Prashar7 Coordination across critical infrastructure sectors is essential for continued operations and to decrease morbidity and mortality. It is important to develop strategies for the health and medical components to prepare for, withstand, and recover from disasters in both the short- and long-term.
Although the Community Lifeline framework was not designed for recovery operations, the system is flexible and scalable and can be used to track any size or type of event. Possible broad modifications to depict the status of recovery operations include: adding hues within the standard universal color scheme (eg, red, yellow, green), creating new recovery icons to indicate reconstruction, and applying miniature icons that specify the word “response” or “recovery” on top, within, or below the 7 Community Lifelines. An alternative modification is the inclusion of criteria definitions (eg, anytime a hospital is damaged or an emergency room is closed the Health and Medical Lifeline is colored yellow), so there is no confusion on operational status.
Information sharing across federal multijurisdictional and multidisciplinary agencies, as well as the private sector, can inform the algorithm and criteria for steady-state in recovery operations. This might require modifying capability gaps identified following the incident to increase situational awareness and inform the Community Lifeline process months after the incident.2 For example, national standards for public health preparedness planning introduced by the Division of State and Local Readiness (DSLR), Centers for Disease Control and Prevention (CDC) through the Public Health Emergency Preparedness (PHEP) cooperative agreement are reviewed annually with health departments. DSLR provides technical assistance (standards for developing priority preparedness capabilities and public health expertise) to help health departments strengthen their abilities to effectively respond to a range of public health incidents and build better prepared communities. Through the PHEP program, CDC established 15 capabilities that serve as national standards for preparedness planning, which have evolved since 2011 with input from subject matter experts from the practice community, allied federal agencies, and professional associations.8 Updates to the capabilities focused on aligning content with new national standards and public health priorities, and developing strategies to advance jurisdictional public health preparedness and response capacity.
CONCLUSIONS
Lessons learned from the 2017 hurricane season illustrate the need for improved emergency coordination across the federal, state, local, tribal, and territorial agencies. Adoption of the Community Lifelines framework helps partners and decision makers create an operational picture during response and recovery. Given the interdependency of the Lifelines, it is now possible for communities to recover from events quicker as Community Lifelines enables the continuous operation of critical business and government functions.
It is the hope that, whenever the next hurricane makes landfall, swift, coordinated stabilization and restoration efforts across sectors and partner agencies will occur to protect human health and safety, and economic security. Community Lifeline implementation helps build a culture of preparedness through engagement and coordination with a cross-sector approach. As greater awareness of the Community Lifelines continues, it is expected that more state and local health departments will implement this dashboard construct to assist them with responding to disasters or other events.
Acknowledgments
The author thanks Jefferson Oakes, former management analyst for FEMA Region IV, the Federal Emergency Management Agency, the Emergency Management Institute, and the National Emergency Management Executive Academy.
Disclaimer
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.