Journal of Emergency Management

Volume 23, Number 2

Journal of Emergency Management — 2024-03-14

Leave Nobody Behind: Emergency Management in a More Inclusive Way

Including the maternal and infant needs in preparedness and sheltering: A case study emphasizing Hurricanes Ida and Ian

Sydney Dyck — 2024-03-14

Disasters pose significant and unique challenges for prenatal and postpartum women and birthing people along with their families, particularly within the immediate response and recovery timeframe. In this study, data pertaining to barriers and needs post-storm were collected from prenatal and postpartum mothers affected by Hurricanes Ida and Ian in 2021 and 2022, respectively. First, following the landfall of Hurricane Ida, researchers employed a systematic social media approach to gather data from families with infants under the age of 2 who had been impacted by the storm. After Hurricane Ian made landfall, researchers used a rapid-ethnographic approach to conduct both in-person and virtual data collection to similarly investigate the experiences and issues facing families with infants under the age of 2 at the time of this storm. Across the two deployments for data collection, data were gathered from 167 respondents through online surveys, in-person interviews, or virtual interviews. This mixed-methods approach allowed researchers to gather integral data surrounding the challenges mothers and their families faced during Hurricanes Ida and Ian, especially when co-occurring crises were taking place, such as the coronavirus disease 2019 pandemic and nationwide formula shortages. Contextual information was gathered through fieldwork observations regarding evacuation decision-making, unsafe feeding practices, and the lack of support for vulnerable populations, including prenatal and postpartum mothers, during disasters. This study highlights the needs prenatal and postpartum women and families have at times of disasters, the various ways that they may be vulnerable to adverse outcomes. Implications include potential policies and interventions to support these families in disasters.

Taking a shot at inequities in emergency response: COVID-19 pandemic spurs ongoing healthcare and community partnership to promote equity for children facing disaster

Elizabeth C. Kuhn — 2024-03-14

Evidence shows that responses to health crises often worsen existing disparities. As the approval of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine for people 12 years and older became imminent in the spring of 2021, our institution sought to meet the urgent need to vaccinate the young people in our community facing inequities in pandemic response. In this report, we describe our institution’s approach to responding to a rapidly emerging public health need and how we continue to leverage this framework to respond equitably to subsequent local health crises.

We recognized that groups of children who had been most impacted by the detrimental effects of the pandemic would also face significant barriers to accessing coronavirus disease 2019 (COVID-19) vaccines. To identify this at-risk cohort, we partnered with our public health department and the school district to use data to identify the zone improvement plan (ZIP) codes with the lowest adult SARS-CoV-2 vaccination rates, schools most often closed due to COVID-19 outbreaks, and schools with the highest percentage of students under-vaccinated against routine childhood diseases. We then partnered with our local school district and community organizations who were similarly committed to serving the children of our community (including museums, faith centers, and the zoo, among others), to develop and promote 50 COVID-19 vaccine clinic locations that were positioned to maximize access for populations of children at greatest need. Through these efforts, we administered 10,792 vaccinations to 6,981 unique patients. Of these, 8,503 were in Philadelphia with over one-third (37 percent) of vaccines given to people from our target ZIP codes, and non-White individuals represented 73 percent of the vaccine recipients.

Key lessons included utilizing available data to select where care delivery sites would be positioned, integrating with other responding organizations to coordinate efforts and avoid overlap, providing care to the whole family (not just children) when able, and developing a robust monitoring structure with iterative change to maximize impact for our target populations. Key challenges included navigating the balance between low attendance clinics in high-risk areas or areas that were difficult to access while striving to be resource-efficient and maximize our impact on vulnerable populations. In conclusion, recognition of the potential for disaster response to worsen existing disparities in healthcare should lead managers to include a specific focus on equity in their planning. Our experience demonstrates that coordinated, intentional response can successfully minimize disaster impact on our most vulnerable populations.

School disaster preparedness for children with access and functional needs

Mackenzie T. Sharp — 2024-03-14

Introduction: In California, 300,000 children with access and functional needs (CAFN) require in-school support. Concurrently, a noticeable increase in diagnoses points to the rise in CAFN prevalence, which has surged from 7.4 percent to over 8.6 percent in the last 3 years. This reveals the urgency behind scaling up disaster management planning and response for CAFN so that our emergency response remains proportional to the population’s needs. Simultaneously, the exacerbation of climate change and inequality has amplified the dangers posed by disasters, particularly among those with intersecting identities. Therefore, it is crucial to proactively address the nuanced and context-specific requirements of CAFN in emergency settings.

Methods: We conducted a qualitative study using interview data collected from teaching staff at a local high school. The feedback was organized into categorical codes using Atlas.ti and was subsequently used to develop policy recommendations.

Results: Our results concluded that while there are a variety of disaster mitigation strategies currently enacted in schools to protect disabled children, these alone are insufficient. Our analysis has identified specific gaps (relating to systems, mental health preparedness, and awareness) in existing policies and protocols. While CAFN teaching staff are motivated to serve their students, many cited concerns about the post-coronavirus disease 2019 educational landscape and noted increasing pressure, stemming in part from the identified gaps.

Discussion: As we recover from the pandemic, we now know more extensive policy is required to support CAFN students to prepare for both short- and long-term disasters that threaten academic success, emotional well-being, and safety. Policy recommendations have been generated to guide emerging policy toward promoting a more equitable educational landscape for CAFN students.

Evaluation of West Bank hospitals’ disaster preparedness plans using a mixed-methods approach

Basel Wafiq Amar — 2024-03-14

Background: When a disaster strikes, great damage may occur to the community and infrastructure in addition to injuries and loss of life. Hospitals are among the community centers that face great challenges during or after disasters. The purpose of this mixed-methods study was to evaluate the West Bank’s Palestinian government hospitals’ emergency preparedness plan.

Methods: A mixed-methods approach was applied at Palestinian government hospitals in the West Bank. The study targeted all healthcare providers and administrative personnel in the respective hospitals.

Results: A total of 298 participants responded to the study. The respondents included physicians (17.8 percent), nurses (45.3 percent), administrators (14.4 percent), and 22.5 percent from other categories. The analysis of variance test showed a significant impact on safety and security, availability of emergency management plans, readiness and training, emergency management disaster preparedness committee, communication, and warning and notification on disaster preparedness plans among West Bank government hospitals.

Conclusions: The degree of practice for safety and security measures by West Bank hospitals was high; the emergency management plan was a medium degree; the readiness and training of workers were at a medium degree; the disaster preparedness and emergency management committee was also at a medium degree; and finally, the degree of commitment of West Bank hospitals to communication procedures, warning, and notification in preparedness for disasters was medium.

Government response to the increase in gender-based violence during the pandemic in Canada: Lessons for addressing inequity in emergency management practice

Jean Slick — 2024-03-14

A harmful untended consequence of the protective public health orders issued during the coronavirus disease 2019 pandemic was an increase in gender-based violence (GBV). This study examined the response of federal, provincial, and territorial governments in Canada to GBV during the peak of the pandemic (between February 2020 and October 2021) through a review of relevant media releases. These documents were then assessed for evidence of effective crisis leadership and compared to established international guidance for addressing GBV in disasters and other humanitarian emergencies. Five major themes emerged from the media review with respect to government communications and actions. First, governments announced funding to organizations working in the domestic violence sector to help support their ability to adapt their services during the pandemic. Second, media releases described efforts undertaken by governments to expand several different types of support services for victims of GBV. Third, governments promoted awareness of the ongoing problem of GBV, as well as its increase during the pandemic. Fourth, government communications acknowledged heightened risk for some populations, including Indigenous women, lesbian, gay, bisexual, transgender, queer, and intersex populations, and those at risk of human trafficking. Fifth, legislative and policy changes were announced by some governments during the pandemic. An analysis of the timing of communications suggests that only the federal government and one third of provinces and territories took early action to address the increase in GBV during the pandemic, which is consistent with international guidance that calls for the use of the precautionary principle. Most of the governments responded to the GBV crisis late or not at all. Although the analysis of media releases alone is insufficient to establish the scope of government actions taken to address GBV during the pandemic, public communication related to ongoing threats is an expected crisis communication competency. This study offers recommendations for practice, which might help address gender inequity in disasters.

Health needs of a large cohort of newly arrived Afghan evacuee children following arrival in the United States

Lauren Palladino — 2024-03-14

Objective: In 2021, approximately 82,000 Afghan civilians were emergently evacuated to the United States (US). Almost half of them were children. This study describes the healthcare needs of all evacuee children referred for urgent or emergent care in two large health systems in the months following the evacuation, highlighting important considerations for emergency response in pediatric evacuee populations.

Methods: This is a descriptive cross-sectional study of all Afghan evacuee children referred for care at an urban quaternary care children’s hospital and an affiliated community hospital system between August 2021 and February 2022. Both were located near a military base that served as a temporary residential facility for evacuees immediately after their arrival in the US. Data were abstracted into a secure online database, and descriptive statistics were examined to identify trends in health status, diagnoses, and utilization.

Results: We identified 477 children and 681 individual encounters. Fifty-two children (10.9 percent) were medically complex and accounted for 30.1 percent of all visits. The most common diagnoses were traumatic injuries (93, 13.7 percent), respiratory illnesses (70, 10.3 percent), and complex chronic diseases (53, 7.8 percent). Proper patient identification, language access, and cultural engagement were key challenges.

Conclusion: Emergency response teams should be prepared to encounter a diverse range of common and increasingly complex pediatric health needs in disasters. Strategies such as employing cultural liaisons, expanding the availability of language services, and issuing standardized identification documents should be implemented.

COVID-19 racial disparities: Adding the social element to risk reduction and emergency preparedness strategies

Jayesh D’Souza — 2024-03-14

The coronavirus disease 2019 (COVID-19) pandemic has changed the world in many ways. The impact on vulnerable communities has been profound and worsened living conditions for those without proper housing, a steady job, or decent pay. Those most affected by the pandemic were women, children, older adults, immigrants, and the socioeconomically disadvantaged who belonged to non-White sociocultural groups. The literature provides strong evidence that those who identified as Black, Hispanic, Native American, Pacific Islander, and Asian suffered the most, especially, during the early years of the pandemic. Using Centers for Disease Control and Prevention weekly data, this study examines standardized coefficients in a path analysis model to determine the relationships between socio-cultural identity, age, time period, and region with pandemic-related deaths. The regression model used in this study confirmed the relationship between socio-cultural identity and COVID-19 deaths. The results convey the value of strengthening the social element in risk reduction and emergency preparedness strategies to reduce public health disruptions affecting vulnerable communities during future emergencies.

Assessment of Diversity, Equity, and Inclusion adoption efforts in state and local emergency management agencies

Arjola Balilaj — 2024-03-14

Diversity, Equity, and Inclusion (DEI) have emerged as pivotal dimensions in fostering productive and inclusive work environments. Many public organizations have come forward to embrace a DEI mindset. Since emergency management agencies (EMAs) serve a diverse population that may be vulnerable to disasters, they must recognize DEI in their efforts to create a diverse workforce as well as to serve the community. Although the best practices in DEI for public organizations have been well established, there is a dearth of literature regarding the DEI best practices in emergency management. The objective of this study is to begin to create or further define best practices for EMAs for the successful implementation of DEI, especially at the local level.

Engaging communities in the planning process: Conducting formative research for a web-based food distribution platform in a post-disaster setting

Elizabeth A. Dunn — 2024-03-14

As natural hazards amplify the persistence of food insecurity, the demand for evidence-informed interventions that increase resilience is needed. Developing a decentralized web-based platform to mobilize healthy food options in disaster-affected neighborhoods, designed to use real-time crowdsourced information, can help identify vulnerable populations and prioritize areas in need. A survey was administered using constructs from the Health Belief Model and Technology Accessibility Model, engaging Hillsborough County residents in the design thinking process to gauge community acceptance of a technology-based intervention during a large-scale disaster. Identifying barriers, wants, and needs of various population segments allows for more inclusive strategies for developing emergency management interventions. Results from the community survey validated the high likelihood of technology acceptance during disasters, with 90.9 percent of the respondents indicating that they would likely use a web-based food delivery service during disasters. Respondents had high levels of perceived self-efficacy and perceived ease of use with moderate levels of perceived usefulness and perceived threats. A majority of respondents (81.4 percent) agree that technology helps connect them to their community, with 83.6 percent agreeing that the internet would be useful for helping their community and 70.2 percent indicating they would feel comfortable ordering groceries online during a disaster. Whereas Hispanic survey respondents had higher levels of perceived threats; however, due to their perceived barriers were less likely to use the platform. By incorporating evidence-informed disaster management practices in the planning process, local governmental and nongovernmental organizations can develop more comprehensive plans and interventions to help communities prepare for, respond to, and recover from disasters.

The role of community connection in the practice of trauma-informed emergency management

Laura Kate Corlew — 2024-03-14

Trauma-informed practice in emergency management can aid professionals in addressing inequity and building trusting relationships with vulnerable and marginalized communities. As the field of emergency management begins to utilize principles of trauma-informed practice used by adjacent fields, it is useful to explore the benefits of cultivating a strong and positive psychological sense of community (PSOC) with engaged community partners, particularly those who have past experience with structural or systemic inequity, prejudice, and/or discrimination. Crafting trauma-informed policies and activities at every point in the emergency management cycle, practiced in active collaboration with community members, will help build a trusted community connection that can lead to smoother response and recovery efforts with communities that have historically struggled with equitable access. This paper reviews the elements of a strong, positive PSOC and principles of trauma-informed practice as they can be applied by emergency managers. These principles can further be applied to internal agency policies to support emergency managers who may themselves also experience trauma or burnout in the course of their careers.

Conflict by design: Stafford Act incompatibility with Alaska tribal sovereignty

John E. Pennington — 2024-03-14

The Robert T. Stafford Act unintentionally marginalizes Alaska’s Tribes and hinders their ability to exercise sovereignty following disasters. Although there has been significant academic analysis of the Alaska Native Claims Settlement Act since its passage in 1971, the monumental agreement that settled Alaska Native aboriginal land claims was not critically considered during the creation of the Stafford Act, nearly two decades later in 1988. The consequences have resulted in increased confusion and controversy as Alaska’s Tribes attempt to exercise their sovereign option following emergencies and disasters.

This paper is a summary of extensive research that explored the government-to-government relationship between Alaska’s Tribes and the Federal Emergency Management Agency (FEMA). It is intended to illuminate statutory and programmatic shortcomings emanating from the Stafford Act when applied to Alaska Natives, their tribal governments, and the greater Alaska Native Community. Effects of these shortcomings include, but are not limited to, the inability of most Alaska Tribes to sustain participation in certain FEMA disaster programs; undetermined impacts on local health and community well-being; and an overarching sentiment of abandonment during times of greatest need. Parallels can also be drawn to other United States (US) Tribes, Indigenous US islands, and circumpolar communities. This paper will assist the reader in recognizing the unique governing structures found throughout Alaska and the negative impacts of the Stafford Act on Indigenous self-determination and sovereignty in the face of increasing disasters and a changing climate.

Gender inclusive planning for disasters: Strategic planning to build adaptive capacity and resilience

Rebecca Morgenstern Brenner — 2024-03-14

How can gender and empowerment drive the development of a community’s adaptive capacity to disasters? Disaster plans can be used to allocate resources, instill processes, and reach goals; however, once in place, these plans can also be a determining factor to either empower or exclude. One of the 17 United Nations Sustainable Development Goals (SDGs), SDG 5, targets gender equality and empowerment for all women and girls. Under the lens of SDG 5, working toward this goal of equality and empowerment as part of disaster preparedness will improve the capacity of a community to respond and recover, ultimately reducing vulnerability for everyone. Intentionally building disaster management plans toward gender equality can be one of the key strategies that improves community resilience for all. In order to identify challenges and opportunities linking policy and practice, this paper shares a case study of disaster planning in Peru to understand mitigation strategies and explore gender equality as a tool to expand adaptive capacity.

Partnering with disability-led organizations to prepare and respond to public health emergencies

Alaina Whitton — 2024-03-14

Over a quarter of adults in the United States live with a disability, increasing their risk for severe outcomes from coronavirus disease 2019 (COVID-19). Additionally, people with disabilities face continuous barriers in accessing COVID-19 vaccinations. Disability-led organizations are catalytic partners for public health departments to reach and provide services to and build partnerships with people with disabilities. For this reason, the Centers for Disease Control and Prevention Foundation funded three disability-led organizations, two nationally focused and one locally focused, to partner with state and local public health agencies to identify and address barriers to COVID-19 vaccination and emergency response planning in their communities. These partners identified key strategies for inclusion in emergency response and vaccination planning, including creating accessible materials and messaging, ensuring the accessibility of vaccination sites, and addressing the historical mistrust between people with disabilities and health systems. Through this funding, 59 partnerships between disability-led organizations and disability or public health partners were formed with 26 memorandums of understanding being executed. This project provides actionable recommendations and illustrates that disability-led organizations are key public health partners in planning for and implementing strategies that benefit people with disabilities and the community more broadly.

Equity, isolation, and federal disaster recovery assistance: Geographic discrepancy in hurricane recovery

Daryl Schaffer — 2024-03-14

The strength of a storm, geographic location of impact, and population density dictate different response and fiscal efforts. During the last 3 weeks of September 2022, three different ocean-based storms impacted three different locations in the United States (US), which were 5,600 miles (9,000 km) apart from each other. Established case study methodology was used to contrast the meteorological data of the measured strength at impact on US shores, population density, and post-storm recovery financial allocation from the federal government for these three storms. The hypothesis was that a storm impacting a smaller geographic area with a larger population would receive greater federal financial support than a stronger storm impacting a larger area with a smaller population. Despite post-Typhoon Merbok (Alaska) being a deeper low-pressure storm and impacting more land area, it received only a fraction of the recovery funding when contrasted with Hurricane Fiona (Puerto Rico) or Hurricane Ian (Florida) but a significantly higher per capita due to its geographically isolated location and lower population density.

Differences in FEMA National Risk Index scores between rural and urban communities: Findings and implications for national policy, planners, and decision-makers

Emma Kerr — 2024-03-14

The National Risk Index (NRI) was created by the Federal Emergency Management Agency in 2021 to quantify county-level natural hazard risk. The NRI is presented as a percentile score from 0 to 100 and is calculated based on three components: (1) expected annual loss (EAL), the average economic loss resulting from natural hazards; (2) Social Vulnerability Index (SVI), the susceptibility of local population groups to the adverse impacts of natural hazards; and (3) community resilience, the local community’s ability to prepare for and respond to natural hazards. We hypothesized that the EAL component unintentionally obscures rural versus urban differences in natural hazard vulnerability and preparedness. We tested our hypothesis using publicly available NRI data for all rural (nonmetropolitan) and urban (metropolitan) counties in the United States. We found that the population-weighted average rural county had an NRI risk score equal to 54.9 (89.1 for urban counties). Follow-up analyses suggested that differing NRI scores between rural and urban counties were driven by greater EAL in urban areas (USD 12 M and USD 347 M EAL for the population-weighted average rural county and urban county, respectively). In contrast, SVI was the strongest predictor in linear regression models of county-level premature mortality rate and years of life lost (p < .001 in both models). We conclude that the NRI primarily communicates the potential economic loss of counties due to natural disasters and underestimates public health-related vulnerability and resilience. Community planners unaware of this finding may mistakenly overlook the needs of rural communities, leaving rural residents unnecessarily vulnerable to natural disasters. This imbalance could also lead to inequitable distribution of disaster planning resources across rural and urban counties, particularly if policymakers and individuals in charge of emergency preparedness rely on the NRI to identify areas at greatest risk.

Disability-inclusive data collection and survey outcomes that reflect the lived experiences of people with disabilities in emergencies or disasters

Dawn Skaggs — 2024-03-14

This article documents a disability-inclusive study conducted in partnership with disability-led community-based organizations in survey development and distribution. Information collection focused on the lived experiences of people with disabilities, their perceived impact, and their future expectations. Survey results from 413 individuals with disabilities document the disaster or personal crisis-related experiences and their subsequent impacts. Results from a selection of survey questions were identified for further exploration and their potential impact on disability-inclusive planning, response, and recovery, with a view to identifying potential variables that impact the disproportionate impact of disasters on people with disabilities. Perspectives provided by survey respondents, who were exclusively people with disabilities, overlapped with but did not necessarily align with what is known about emergency and disaster response systems. Study outcomes supported current recommended practices for inclusive planning with people with disabilities. The study supports the premise that accessibility, programmatic inclusion, and effective communication impact the lived experience of people with disabilities in disasters and warrant additional inquiry. Furthermore, the equitable and valued involvement of people with disabilities and disability-led organizations is essential in disaster research, policy, and practice that does not leave anyone behind. Research can, and should, be conducted in coordination with disability stakeholders and people with disabilities in order to generate useful and implementable policy and practice information. This inclusive approach should take priority over rigorous academic research methods and standards for principled and practical considerations.

Psychosocial crisis management: Assisting sensory-impaired individuals in case of disasters

Florentine Schmitz — 2024-03-14

Background: Psychosocial crisis management interventions do not sufficiently consider visually impaired and deaf individuals. There are difficulties in accessing the available interventions, and the effectiveness of these interventions seems questionable. The United Nations Convention on the Rights of Persons with Disabilities build on the premises of the inclusive participation in psychosocial intervention after disasters.

Objective: The objective of this study is to provide recommendations for psychosocial intervention for sensory-impaired individuals after disasters and to raise awareness for professionals working in the field of psychotraumatology.

Methods: A qualitative analysis of semistructured expert interviews and focus groups with professionals in psychotraumatology and sensory-impaired individuals was conducted. This research took place within the European Network for Psychosocial Crisis Management: Assisting Disabled in Case of Disaster (EUNAD), which is funded by the European Commission.

Results: There is a need for specific knowledge about how to meet the needs of individuals with sensory loss in order to provide psychosocial crisis management after a disaster. This aspect is not included in the existing psychosocial interventions.

Conclusion: The EUNAD recommendations are a start to fulfill the obligation to include sensory-impaired individuals in preparations for disaster interventions.

Under the radar: Examining how people experiencing homelessness sense impending disasters

Andrea Ramos — 2024-03-14

This study investigates the intersection of homelessness and disaster preparedness, focusing on how people experiencing homelessness (PEH) receive and respond to disaster-related information. The research emphasizes the critical roles of environmental cues and technology in alerting PEH to potential hazards. Environmental indicators, such as changes in the sky, wind patterns, and animal behavior, are commonly relied upon, although they can delay protective actions. Mobile phones serve as essential tools for accessing vital information, despite challenges related to affordability and charging access. The study also highlights the importance of trusted community members in disseminating information through informal networks. Using Lindell and Perry’s Protective Action Decision Model as a framework, this qualitative study examines the lived experiences of 41 unsheltered PEH. Key findings underscore the need for tailored communication strategies, integrating services and information into emergency plans, and establishing local government dashboards to enhance disaster preparedness and resilience among PEH. The study provides actionable recommendations for emergency management to better support this vulnerable population.

Developing a data-driven system for identifying socially vulnerable populations and neighborhoods across the United States

Katherine Ann Willyard — 2024-03-14

Due to increased efforts to bolster both equity and resilience to natural hazards, there is considerable interest in developing precise methods for identifying socially vulnerable populations. The objective of this paper is to explain issues with how common social vulnerability indices use United States (US) Census Bureau data for emergency management and how the Census’ new Community Resilience Estimates (CRE) program overcomes these concerns. Using the 2019 CRE as a case study, we demonstrate how small area estimates of the most socially vulnerable populations in the US can be used to make statistical comparisons. We find that the high social vulnerability population rate is greater in the South, small rural and isolated areas, and environmentally toxic communities. In developing a response to bolster community resilience to natural hazards, decision-makers should rely on the CRE program to quantify socially vulnerable populations.