The road less taken: Modularization and waterways as a domestic disaster response mechanism

Donald A. Donahue Jr, DHEd, MBA, FACHE; Stephen O. Cunnion, MD, PhD, MPH; Evelyn A. Godwin, MS, RN

doi:10.5055/jem.2013.0140

Authors

Donald A. Donahue Jr, DHEd, MBA, FACHE
Stephen O. Cunnion, MD, PhD, MPH
Evelyn A. Godwin, MS, RN

DOI:

https://doi.org/10.5055/jem.2013.0140

Keywords:

disaster response, surge capacity, medical care, humanitarian assistance

Abstract

Preparedness scenarios project the need for significant healthcare surge capacity. Current planning draws heavily from the military model, leveraging deployable infrastructure to augment or replace extant capabilities. This approach would likely prove inadequate in a catastrophic disaster, as the military model relies on forewarning and an extended deployment cycle. Local equipping for surge capacity is prohibitively costly while movement of equipment can be subject to a single point of failure. Translational application of maritime logistical techniques and an ancient mode of transportation can provide a robust and customizable approach to disaster relief for greater than 90 percent of the American population.

Author Biographies

Donald A. Donahue Jr, DHEd, MBA, FACHE

American Academy of Disaster Medicine, University of Maryland Baltimore County, University of Maryland University College; University of Pittsburgh Center for National Preparedness, Washington, DC

Stephen O. Cunnion, MD, PhD, MPH

Uniformed Services University of Health Sciences, Silver Spring, Maryland

Evelyn A. Godwin, MS, RN

University of Pittsburgh Center for National Preparedness, Alexandria, Virginia

References

Niska RW, Shimizu IM: Hospital preparedness for emergency response: United States, 2008. National Health Statistics Reports; No. 37. Hyattsville, MD: National Center for Health Statistics, 2011.

Rudowitz R, Rowland D, Shartzer A: Health Care in New Orleans Before And After Hurricane Katrina. Health Affairs, 2012; 31(12). Available at http://content.healthaffairs.org/content/25/5/w393.full. Accessed December 31, 2012.

Carollo K: Joplin, Missouri: Hospital deemed unsafe after tornado, all patients evacuated, 2011. Available at http://abcnews.go.com/Health/joplin-mo-hospital-evacuated-sustaining-extensivetornado-damage/story?id=13666314. Accessed December 30, 2012.

Esposito R, Childs D: Backup generator fails; NYU Medical Center evacuated, 2012. Available at http://abcnews.go.com/Health/superstorm-sandy-backup-generator-fails-nyu-medicalcenter/story?id=1759466. Accessed December 31, 2012.

Rittel HWJ,Webber MM: Dilemmas in a general theory of planning. Policy Sci. 1973; 4(2): 155-169.

Churchman CW: Guest editorial: Wicked problems. Manage Sci. 1967; 14(4): B141-B142.

Tomasino A: Public safety networks as a type of complex adaptive system. Proceedings in the 2011 International Conference on Complex Systems, Boston, MA, June 26-July 1, 2011: 1350, 1353. Available at http://necsi.edu/events/iccs2011/papers/77.pdf. Accessed December 30, 2012.

Drucker PF: Classic Drucker. Cambridge, MA: Harvard Business School Publishing Corp., 2006: 54.

Waldrop MM: Complexity: The Emerging Science at the Edge of Chaos. New York: Simon and Schuster, 1992.

Department of Homeland Security: National response framework, 2008. Available at http://www.fema.gov/pdf/emergency/nrf/nrf-core.pdf. Accessed December 30, 2012.

Shi L, Singh DA: Delivering Healthcare in America: A Systems Approach. Sudbury, MA: Jones and Bartlett, 2008.

Donahue DA, Godwin EA, Cunnion SO: Medical response capabilities to a catastrophic disaster: “House” or “house of cards?” J Homeland Security Emerg Manage. 2012; 9(2): 1-18.

Comfort LK, Boin A, Demchak CC: Designing Resilience: Preparing for Extreme Events. Pittsburgh, PA: University of Pittsburgh Press, 2010.

Carmona RH: ‘SURGE’ hospitals: A new concept in disaster medical care. Presented at the Symposium conducted at the Texas A&M University at the Medical Readiness Conference, College Station, TX, 2004.

American Hospital Association: Fast facts on US hospitals, 2009. Available at http://www.aha.org/aha/resource-center/Statistics-and-Studies/fastfacts.html. Accessed October 15, 2010.

Franco CE, Toner R,Waldhorn TV, et al.: The national disaster medical system: Past, present, and suggestions for the future. Biosecur Bioterror. 2007; 5(4): 319-325.

Mitleton-Kelly E (ed.): Complex Systems & Evolutionary Perspectives of Organisations: The Application of Complexity Theory to Organisations, Oxford: Elsevier, 2003.

Leonard EW: After the catastrophe: Disaster relief for hospitals. North Carolina Law Review. 2006; 85, 223-300.

Donahue, DA, Cunnion, SO, Balaban CD, et al.: The all needs approach to emergency response. Homeland Security Affairs. February 2012; 8(1). Available at http://www.hsaj.org/?article=8.1.1. Accessed December 30, 2012.

Flacks, AG: HHS’ Role in Medical Emergency Preparedness, New York: ASPR. 2007

Piggott WJ: National Disaster Medical System (NDMS). FEMA PowerPoint presentation to the Bureau of Public Health Emergency Preparedness & Response, Arizona Department of Health Services. n.d. Available at http://www.azdhs.gov/phs/edc/edrp/es/pdf/ndms_piggott.pdf. Accessed December 30 2012.

Spiritus-Temporis.com: Containerization. 2005. Available at http://www.spiritus-temporis.com/containerization/history.html. Accessed October 15, 2010.

Normeca: Normeca’s Web site, 2000. Available at http://www.normeca.com/normeca/products/norbase1.htm. Accessed October 15, 2010.

Hammerton, JA: The War Illustrated: No. 59. 2nd October, 1915. London: Amalgamated Press Limited, 1915.

British Medical Journal: Barge Ambulances for the Sick and Wounded. London: BMJ Publishing Group, 1915.

Federation of American Scientists: LHA-1 Tarawa class, 2010. Available at http://www.fas.org/programs/ssp/man/uswpns/navy/amphibiousassault/lha1tarawa.html. Accessed December 30, 2012.

American Society of Civil Engineers: Illinois—Navigable waterways, 2010. Available at http://www.infrastructurereportcard.org/node/178. Accessed October 15, 2010.

U.S. Army Corps of Engineer: Inland waterway navigation—Value to the nation. Institute for Water Resources, 2000. Available at http://www.spn.usace.army.mil/value_to_the_nation/InlandNavigation.pdf. Accessed October 15, 2010.

Honoré RL, Martz R: Survival: How a Culture of Preparedness Can Save You and Your Family From Disasters. New York: Atria Books, 2009.

Nachtmann H, Pohl EA: Emergency response via inland waterways, MBTC DOT 3008 / MBTC DHS, University of Arkansas, Fayetteville, AR, 2010. Available at http://ww2.mackblackwell.org/web/research/ALL_RESEARCH_PROJECTS/3000s/3008/MBTC%203008.pdf. Accessed October 15, 2010.

Ewing T: Role of National Labs in transportation security. Argonne National Laboratory. Presentation to the Joint AASHTO SCOTS/TRB ABE40 Meeting, Irvine, California, August 2007.Available at http://www.transportation.org/sites/security/docs/Ewing—ANL%20Role%20of%20National%20Labs%20in%20Transportation%20Security.pdf. Accessed October 15, 2010.

Kafalenos RS, Leonard KJ, Beagan DM, et al.: What are the implications of climate change and variability for gulf coast transportation? In Savonis MJ, Burkett VR, Potter JR (eds.): Impacts of Climate Change and Variability on Transportation Systems and Infrastructure: Gulf Coast Study, Phase I. 4-1 to 4F-27 [104 pp.]. Vol. Synthesis and Assessment Product 4.7. Washington, DC: US Department of Transportation, 2008. Available at http://nca2009.globalchange.gov/navigable-inland-waterways. Accessed April 10, 2013.

U.S. Army Corps of Engineers: Waterway Network. New Orleans, LA:Waterborne Commerce Statistics Center, 2006.

U.S. Department of Transportation: America’s Marine Highway Program, n.d.Available at http://www.marad.dot.gov/ships_shipping_landing_page/mhi_home/mhi_home.htm. Accessed October 15, 2010.

Oswald R, Bell Meservey K: U.S. national emergency medical response: Urgent need for emergency medical surge. Homeland Defense J. 2009; 7(1): 12, 14, 15.

Military Sealift Command: LMSR Fact Sheet, n.d. Available at http://www.msc.navy.mil/N00P/Savannah/fact-lmsr.htm. Accessed October 15, 2010.

Federal Emergency Management Agency: National response framework. Washington, DC: Department of Homeland Security, 2008. Available at http://www.fema.gov/pdf/emergency/nrf/nrfcore.pdf. Accessed October 15, 2010.

GlobalSecurity.org: Towboats, 2010. Available at http://www.globalsecurity.org/military/systems/ship/towboat.htm. Accessed October 15, 2010.

RAND Corporation: New equipping strategies for combat support hospitals. Available at http://www.rand.org/pubs/monographs/MG887.html. Accessed January 1, 2013.

Department of Defense: Operational requirements document (ORD) for Joint Interagency Civil Support Training Center (JICSTC). Department of Defense, 2004.

U.S. Air Force: Civil reserve air fleet, 2007 Available at http://www.af.mil/information/factsheets/factsheet.asp?id=173. Accessed October 15, 2010.

Waterways Council: Statement of Stephen D. Little on behalf of Crounse Corporation before the subcommittee on Water Resources and Environment, Committee on Transportation and Infrastructure, U.S. House of Representatives, April 15, 2010. 2010. Available at http://www.waterwayscouncil.org/WCIExtras/Steve_Little_Testimony.pdf. Accessed October 15, 2010.