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Public Health and Law Enforcement Response to the 2011 Joplin, Missouri Tornado
Dr. Joseph Costa, D.H.Sc., PA-C
Health Policy and Management
MPH 525
Allison Erickson
April 2013
Table of Contents
Chapter Page
1. Introduction
Natural Disasters
Tornados
2. Public Health and Law Enforcement Agencies
Public Health Response
Law Enforcement and Emergency Response
3. Public Health and Law Enforcement Collaboration
Coordinated Efforts
4. Volunteer Agencies
Missouri Volunteer Policy
Impact on Joplin Recovery
5. Recommendations
References...... 18
Chapter 1
Introduction
Natural Disasters
What Are They?
Natural disasters are known to take many forms from hurricanes to tornadoes, floods to droughts. According to the Institute of Oceanography (n.d.), “Anatural disasteris the consequence or effect of a natural, hazardous event, occurring when human activities and natural phenomenon become enmeshed.” These disasters have been researched and studied for hundreds of years in an attempt to allow preparedness from the local, state, and Federal authorities and agencies. It is well known that natural disasters are complicated. Although researchers and scientists have become grossly educated regarding these phenomena, there is a mutualrespect for how Mother Nature operates. Many natural disasters have been shown to be predicable given the vast amount of technology available, which aids in preparedness. However, the disasters that lack in predictability create chaos, confusion, and the need for rapid and efficient response from both government and public health officials.
Tornados
Joplin, Missouri
On Sunday, May 22, 2011, an Enhanced Fujita-5 (EF-5) tornado catastrophically struck the city of Joplin, Missouri. The Federal Emergency Management Agency (FEMA) (2011) reports that the tornado had excess winds of 200 miles per hour (mph), with a three-fourths mile wide base that traveled for six miles. As of May 27, 2011 there were a total of 161 fatalities with approximately 1,371 injuries and was reported as the most deadly United States tornado since 1947 (FEMA, 2011). The city was flooded with emergency responders to begin rescue operations and provide medical care and shelter for the Joplin residents. “The tornado overwhelmed the capabilities of the City of Joplin, Jasper County, and Newton County, requiring a massive response from Federal, State, country, local, private sector, non-profit, and voluntary organizations” (FEMA, 2011, p. 3). There were over 400 personnel from public safety organizations deployed to assist the community of Joplin with response and recovery operations.Kathleen Sebelius, the Department of Health and Human Services (HHS) Secretary, declared a public health emergency for the city of Joplin on Monday, May 23, 2011. The exploration of the Joplin tornado recovery effort will be accomplished through examining how different Federal and state preparedness plans offered a foundational support, as well as how public health and law enforcement agencies coordinated together.
Chapter 2
Public Health and Law Enforcement Agencies
Public Health Response
Agencies and Policy
Due to the community wide destruction the tornado caused the citizens of Joplin, public health agencies and officials stepped in. As Teitelbaum and Wilensky (2013) indicate, “The public health community enters a disaster situation and establishes prevention and control measures, collects critical data to support response, and works to meet short- and long-term needs of the population” (p. 238-239). Although many of the public health and medical professionals that respond to natural disasters come from Nongovernmental Organizations (NGOs), which will be discussed later, there are federal agencies responsible for effectively and efficiently aiding in the response to natural disasters.
After the September 11th attacks on America, the United States preparedness infrastructure had not fully taken shape (Teitelbaum & Wilensky, 2013). The Federal government embarked on a massive restructuring of responding to United States disasters, including natural disasters. This reorganization established the Department of Homeland Security (DHS) that focused on Federal preparedness and protection of the citizens of the United States. Under the DHS, the main office in charge of addressing public health preparedness is the Office of Health Affairs. The Medical Readiness Office, a subsection of the Office of Health Affairs, is responsible for working with the first responder community, providing health and medical security, and overseeing the health components of a contingency plan (Teitelbaum & Wilensky, 2013). Similarly, FEMA, which is a part of DHS, is responsible, “for much of the emergency disaster response activities at the federal level” (Teitelbaum & Wilensky, 2013, p. 240).
Under the HHS, there were health agencies that aided in the recovery response to the Joplin tornado. These agencies worked closely with Missouri’s health agencies to evaluate needs and effectively provide resources and services.One agency in particular agency is the Office of the Assistant Secretary for Preparedness and Response (ASPR). Teitelbaum and Wilensky (2013) express, “ASPR is responsible for ‘preventing, preparing for, and responding to adverse health effects of public health emergencies and disasters’” (p. 240). Additionally, the ASPR supports the state and local capacity during an emergency, like a natural disaster. For the Joplin tornado, specifically, many of the ASPR Hospital Preparedness Program (HPP) resources were sent to the community. “Planning, training and exercises funded through the HPP for hospitals and Federally Qualified Health Centers provided the infrastructure, in part, for the prepared response that occurred during the tornado” (ASPR, 2012).
Continuing, ASPR was responsible for coordinating the services offered by other Federal agencies and departments like the Centers for Disease Control and Prevention (CDC) and the U.S. Food and Drug Administration (FDA). The CDC worked to provide information and education to the citizens of Joplin regarding health protection during clean-up efforts (ASPR, 2011). An Incident Management Team from the FDA completed work on inspections of FDA-regulated industries, like food processing facilities and medical device and pharmaceutical manufacturers. These inspections were to ensure that FDA-regulated products were safe from contamination and harm.
Law Enforcement and Emergency Response
Local Teams
Law enforcement, whether state or local, provide much needed calm and organization after a devastating natural disaster. The teams that can be considered law enforcement include police, state patrols, fire department, and National Guard. When disaster strikes, law enforcement works with numerous first responders from the community to ensure the safety, health, and continuity of keeping the community functioning.
In addition to routine law enforcement, officers may be called on to assist with search and rescue, body recovery, and the distribution of essential supplies to survivors. Leaders of first responder organizations face unique challenges including high operational tempo, long hours, and diminished resources (Center for the Study of Traumatic Stress, 2013, p. 1).
There are numerous responsibilities that law enforcement agencies have when responding to a natural disaster. Such responsibilities include search and rescue efforts, crime and loitering prevention, and communicating with the community in an effective and efficient manner.
The EF-5 tornado that swept through the community of Joplin caused severe damage to several facilities, including St. John’s Regional Medical Center. In addition to the structural damage, the Empire District Electric Company of Joplin reported that 130 transmission poles had been lost, leaving approximately 18,000 customer without power. “The extreme destruction forced thousands of residents to find lodging with family or friends” (FEMA, 2011, p. 9). The structural and electrical damage hindered the work of local enforcement agencies. In addition to the hospital’s structural damage, limiting the use of ambulatory services, two of the fire departments in Joplin were severely damage. This damage to the fire department also hindered the local law enforcement’s ability to effectively perform necessary duties.
Strengths
Law enforcement agencies in and around the Joplin community were able to use instrumental tools to effectively respond to the crisis. These tools and initiatives were within the Missouri Homeland Security Region D counties and jurisdictions. According to FEMA (2011), “The Region D Regional Homeland Security Oversight Committee provided grants for the establishment and maintenance of regional response teams” (p. 12). Such grants, for example, were provided to the Southwest Missouri Incident Support Team (IST) allowing funding for equipment, training, and other activities to help in the preparedness of a disaster. Additionally, under the Region D Homeland Security Committee, city and county emergency management and response agencies received new incident command systems. Through the structures of the Region D Homeland Security, mutual aid agreements between the counties in Region D, including the city of Joplin and Jasper County, were activated. Crawford County sent nurses and portable vaccine refrigerators from the county health department. “Greene County sent 110 response personnel from the Sheriff’s Office, the Office of Emergency Management, the Highway Department, Building and Development Services, and Public Information (FEMA, 2011, p. 13).
All the effort and coordination provided from surrounding counties is known as “The Whole Community” response, which is part of the Presidential Policy Directive 8 (PPD 8) in National Preparedness. According to FEMA (2011) this directive, “states that effective responses to natural and man-made disasters require an ‘all-of-Nation’ approach that leverages all available capabilities in a coordinated and efficient way” (p. 10). The Whole Community approach was shown to be one of the primary reasons that emergency responders and law enforcement officials were able to effectively perform their duties.
As mentioned previously, two of the five fire departments were destroyed. Mutual and automatic aid from other fire departments from Southwest Missouri arrived immediately after the tornado hit. “The Southwest Missouri IST included a command-level officer who assisted with fire response operations” (FEMA, 2011, p. 16). The command-level officer used the Joplin Fire Department resources and the other fire personnel from surrounding communities to create a service call center and develop teams of fire and emergency responders to districts within Joplin.
Challenges
Continuing, the city of Joplin saw an influx of hundreds of law enforcement and emergency responders from surrounding states. Although the help was needed, FEMA (2011) presents that it caused difficulties in incident management. Through the Emergency Management Assistance Compact (EMAC), within 24 hours of the tornado, more than 800 police cars, 300 ambulances, 400 fire trucks, and 1,100 first responders had arrived from Illinois, Kansas, Oklahoma, and other surrounding states. As stated, the influx of mutual aid did benefit the response operations to the disaster, but it also presented several challenges.
First, man responders self-dispatched to Joplin and began performing tasks without coordinating with local incident command. Second, some responders lacked the equipment and training to conduct operations, particularly search and rescue, safely and effectively. Various search markings were used, rather than standard search markings. Consequently, some structures were searched multiple times as subsequent teams did not recognize the markings of the previous team(s) at the site. (FEMA, 2011, p. 15).
Not only did these challenges create confusion, but it also posed a safety risk for the law enforcement and emergency responder’s safety. Also, because of the rapid responses from surrounding law enforcement agencies, the Incident Action Plan was continually shifting and changing to accommodate the high numbers. This created a sense of disorganization among many of the groups.
Chapter 3
Public Health and Law Enforcement Collaboration
Coordinated Efforts
Rebuilding the Community
Public health officials and agencies, as well as law enforcement agencies must work together in a coordinated and collaborative fashion effectively solve the concerns that arise after a natural disaster. Federalism plays a key role in how both public health and law enforcement agencies collaborate with one another after a natural disaster.
This means that police powers, including the powers to regulate health and safety, are the responsibility of the states. The federal government supports public health preparedness domestically, as it must build relations globally to ensure an effective worldwide system for preparedness, information sharing, and collaboration in preventing, detecting, reporting, and responding to public health threats. (Teitelbaum & Wilensky, 2013, p. 245).
As aforementioned, the state of Missouri developed preparedness plans under the state’s Regional Homeland Security plan. However, compared to a national standard of homeland security, Missouri’s focuses on the unique needs of the state. In this case, Missouri has preparedness plans specifically for tornado relief efforts. Even though these preparedness plans have been developed and were put into action after the Joplin tornado, the state relied on public health services from the national level. The following sections will indicate some of the specific collaboration and coordination that occurred between public health and law enforcement officials.
Because the death toll of the tornado was far more than the local coroners could handle, the National Disaster Medical System Disaster Mortuary Operational Response Team (DMORT) sent approximately 100 personnel to Joplin. In addition, the Family Assistance Center Team assisted families in identifying victims and in returning remains to loved ones. The uses of a Disaster Portable Morgue Unit helped in efficiently and effectively identify victims and perform autopsy (ASPR, 2011). Due to the fact that the hospital facilities were not to be used for autopsy because of the structural damage, there was a temporary morgue established on the campus of Missouri Southern State University (MSSU). With an increased number of coroners, “law enforcement officers assisted fatality management operations by transporting bodies to the morgue” (FEMA, 2011, p. 17). With this coordination, FEMA (2011) reported that DMORT personnel and coroners were able to process two to three victims per day. Missouri Governor Jay Nixon directed the Missouri Highway Patrol to take responsibility for identifying the status of every individual on the missing persons list. With the coordination of public health officials and law enforcement responsibility, the fatality management operation was completed by June 4, 2011 (FEMA, 2011).
Next, the Administration for Children and Families (ACF) provided technical assistance supporting Missouri’s human services response efforts. This included restoration of child care service and emergency child care to allow Joplin’s child care infrastructure to be rebuilt. The tornado destroyed 17 child care centers; therefore, ACF coordinated Federal support to the Missouri Department of Social Services to meet the needs of the children and families (ASPR, 2011). Also, the Substance Abuse and Mental Health Services Administration (SAMHSA) worked alongside law enforcement and behavioral health authorities in establishing emergency accommodations for patients in mental health facilities damaged by the tornado.“SAMHSA worked with state authorities in Missouri, Oklahoma, and Kansas to make emergency arrangements for patients in need of medication assisted substance abuse treatment services after the clinic these patients used for treatment services was destroyed” (ASPR, 2011).
Chapter 4
Volunteer Agencies
Missouri Volunteer Policy
VOAD
Missouri’s Voluntary Organizations Active in Disasters’ (VOAD) main goals is to, “increase disaster recovery cooperation, coordination, communication, education, and to improve legislation dealing with disaster response, recovery and mitigation” (State Emergency Management Agency (SEMA), 2012). VOAD focuses its efforts on making sure every individual impacted by a disaster or tragedy receives the care and resources they need. However, a large part of VOAD strives for establishing effective and less duplicative services before a disaster strikes a community, or group of communities. Members of VOAD obtain membership if involved with any non-profit voluntary organization with a constitutional reference that supports an organized disaster response program.
Impact on Joplin Recovery
Specific Volunteer Efforts
The aftermath of the tornado created a mass number of volunteers from Missouri and across the United States. FEMA (2011) indicates that many of the volunteers were motivated to help Joplin with the recovery efforts through television broadcasts. However, “Many of these [volunteers] lacked the training, supplies, and affiliations necessary for disaster response operations” (FEMA, 2011, p. 18). To help with coordination and responsibilities of all volunteer organizations and personnel, AmeriCorps personnel from six teams helped establish and manage a Volunteer Reception Center on the MSSU campus. In its first 16 hours of operation, the Volunteer Reception Center received more than 3,000 volunteer intake forms. “By August 4, AmeriCorps’s volunteer management efforts had registered more than 46,778 people who performed more than 178,000 hours of volunteer work” (FEMA, 2011, p. 18). Additionally, AmeriCorps established a Missing Persons hotline on the campus of MSSU. After the United Way’s information line became overwhelmed with the call volume for information about resources and services post tornado, AmeriCorps provided an additional remote call support to service phone calls. As the building blocks of the Whole Community approach, AmeriCorps created strong illustration at how volunteer organizations support the organizations from the Federal, state, and local level.
Due to the vast amount of Joplin residents displaced from their homes, the American Red Cross provided shelter, food, and health services. To be precise, the American Red Cross (2011) reports that 3,414 individuals stayed in the shelter, 179,752 comfort and clean up kits were distributed, 85,339 meals were served, 21 emergency response vehicles were utilized, and 6,488 mental health consultations and 5,696 health services consultations were performed. In addition, the American Red Cross provided blood donations to a hospital in Pittsburg, Kansas to help Joplin tornado victims.