Planning for the Worst Case Scenario

By David Lillard

A Friday morning in October, a beautiful sunny day. You’re driving down I-270 for an appointment, and you’re using the occasion to take a vacation day. On the way home, you’ll run a few errands, maybe check out that fly rod you’ve been coveting at the sporting goods store, then glide into the weekend like you haven’t done in . . . well, you can’t remember how long. South of the Frederick County line, you notice traffic going in the other direction—heavy traffic. That’s a lot of cars heading northwest for this time of day.

Come to think of it, there’s almost no one traveling in your direction. That’s when you realize you’ve had a media-free morning—no radio, television, newspaper. You turn on the radio, and a reporter is talking about biological agents: how they work, what type might have been used, the challenges of assessing the threat to the nation’s capital city. You turn up the volume, but the reporters aren’t saying anything about what happened—or where.

You switch stations to hear more talk about biological agents, anthrax, weaponized smallpox, children at risk, death rates. Still no one is saying what’s going on. A few more stations, and a traffic reporter describes the backup you see heading up I-270 toward Route 340 and, eventually, Jefferson County. The reporter says officials have not ordered an evacuation, but one is already underway. Major arteries leading away from Washington, D.C., are already gridlocked.

You bail. You pull off at the next exit and—you’re so polite!—you try to call to cancel your appointment. But the call won’t go through. No cell service. You try to call your wife at work. No service. Your car shuffles into the queue to get you onto northbound I-270, but from the looks of it, just getting back onto the freeway could take a long, long time. You try calling again; nothing. You look for an alternate route; you’re blocked in. You try the radio; people are talking about anthrax but no one is saying what’s up.

That’s when you start banging on the steering wheel; that’s when you hear yourself holler yourself hoarse. You’re panting for air when you’re jarred by the phone ringing.

“Can’t believe I got through. Where are you?”

“I don’t know; somewhere on 270—almost.”

“You better head home.”

“What the *&%&*@# you think I’m . . . what’s going on, anyway?”

“A white powdery substance in five buildings so far this morning in D.C., but no one knows what it is. A lot of people were taken to hospitals already. People are leaving the city. No one ordered an evacuation. It just started, so now officials have no choice but to help them go . . . anyway, I have the kids. They closed the school—we’re expecting 300,000 “guests” in the County tonight, and they wanted to clear the roads.”

“Good luck with that . . . 300,000 what?”

 “I’m at the market, before it’s picked clean.”

“Can you get me . . .” you start to say, but the connection is lost.

An hour later, you follow the lead of other stranded travelers and relieve yourself on the side of the highway. Three hours after that, you cross the Shenandoah River, still at a crawl. Along the way, the story unfolds on the radio: White powder, spread by little dust bombs in several buildings, no real rhyme or reason in the targets, lots of people being treated, two reported dead—both from heart attacks. Media reports that people carrying the substance on their clothing could accidentally “infect” people they come into contact with. Panic.

At the traffic light outside Bolivar, police and fire crews are interviewing people in cars. They send some of them into the national park parking lot. When it’s your turn, they let you pass with only a couple questions. At Halltown, the emergency-alert sign on Route 340, the one you laughed when they installed, says, “Charles Town hotels full. Follow evacuation route to I-81,” and “For Hospitals and Medical Assistance, call—”

At the Route 9/340 overpass near Charles Town, you look south and north, and see that the road is a parking lot. Downtown Chuck Town is wall to wall people, but remarkably calm. People are standing on sidewalks eating takeout. Traffic cops are at every corner. It’s not a jovial scene like a street fest, but not a zoo, either.

You walk in your front door and head for the fridge, into which an angel of mercy has placed 12 of your favorite ales.

The Situation Room

 A nondescript, squat office building in Bardane with a view of the scenic orchards of the USDA fruit research station: the Jefferson County Emergency Management Office’s operation center.

In a brightly lighted room, clean enough for surgery, 30 people sit at tables aligned in six neat rows—each person has a laptop in front of them and a phone on their ear. All of West Virginia’s 55 counties have similar operations—although few have such a sparkling new facility, still freshly painted.

The EMC is command central for emergency planning and coordination. It’s here that members of the emergency management committee, the decision makers of key agencies and organizations—hospitals, Red Cross, public health—huddle to coordinate response in crises.

A mass migration from Washington, D.C. through Jefferson County is something few county residents stop to ponder. But the county’s emergency planners and their counterparts in the Eastern Panhandle have planned for it for nearly a decade. They know that the Eastern Panhandle might be called into service as a staging area during an emergency, and hundreds of thousands of people could flood the Eastern Panhandle—many of them would want to stay put.

“DOH just closed Route 9 over the mountain,” someone in the situation room yells. Groans go up around the room. “Oh, that’s just great,” someone screams. Expletives erupt, two guys in the back room exchange a few heated volleys and go back to their computers.

Ten years ago, outside of coastal regions during hurricane season, this scenario was almost unthinkable. September 11, 2001 changed that. Nowadays Homeland Security and emergency management is planned and coordinated at every level of government. In West Virginia, this includes a state Division of Homeland Security and Emergency Management that coordinates and assists local emergency managers, as well as county HS/EM offices that coordinate local agencies—and host the operation center.

Barbara Miller, the county’s emergency manager, says the committee was activated for the inauguration of President Barack Obama. The internet and blogosphere had been abuzz with all sorts of threats by racist hate groups against the nation’s first African American president. If a fringe hate group were to commit a heinous act, the million people gathered in the capital would all be trying to leave at once. There are only so many routes out of the Washington Capital region, and the I-270/I-70 route is one of them.

“We prepare for 400,00 people moving through in just a few days,” said Mike Groves, vice president of patient care services at City Hospital and a member of the Berkeley County Local Emergency Planning Committee. “We would need to be able to meet their immediate needs, encourage them to continue west to Ohio or north—wherever they are being directed according to whatever plan was in place.”

In an anthrax event, or any incident involving a transmittable biologic agent or pathogen, local fire departments would be charged with ensuring that the contaminated or contagious are isolated from the population. The “Gateway to the Eastern Panhandle” would be an interrogation and decontamination turnstile.

“We try to make scalable plans that work for 5,000 or 400,000,” said Groves. “You have to ask, what’s the worst that could happen? Even though the probability is pretty remote. But a lot of people in the Eastern Panhandle spend a lot of time thinking and planning and talking about these scenarios,” he said.

In the situation room, several people huddle at one computer monitor. Both hospitals are out of ICU beds. It’s not anthrax, it’s heart attack. Displaced people are freaked out people—they don’t know where they’re going or where their loved ones are or what will happen to their pets. For this reason, local hospitals plan for a surge in patients—even if an evacuation were not a public health emergency. More heart attacks, more anxiety attacks. “People in those situations are under incredible stress that may have nothing to do with the incident,” Groves said.

At these times, every local agency is called into action. Law enforcement has to handle the crowds, the traffic, potential looting, and eruptions of stress-induced violence. Hospitals deal with a sudden surge; Red Cross mobilizes to provide temporary shelter; fire departments and emergency medical services are on full alert for the inevitable aftershocks that include more traffic incidents, bar fights—you name it.

“Denise,” someone in the situation room calls. “Denise!” City Hospital is requesting mental health workers, so Denise Ryan, coordinator of the Eastern Panhandle Medical Reserve Corps starts riffling through her data base of volunteers who are qualified to provide counseling in these emergencies.

The Medical Reserve Corps was created for exactly this situation. The September 11 attacks, as everyone remembers, were followed by anthrax attacks. At the time the deadly spores were unleashed in Washington, D.C., a Jefferson County direct-mail firm had a client who was a U.S. Senator. When an employee at the mail house opened a package that disbursed white powder throughout the facility, first responders sprung into action.

The health department began treating all 400 employees, said Pamela Holstein-Wallace, WV Homeland Security Region III Coordinator. The substance tested negative, but, she said, everyone involved realized there were gaps in their ability to respond. “We couldn’t get all the antibiotics administered; we didn’t have the personnel; we had no advance planning for this scenario.”

So public health officials and emergency management committee members started asking: How will we get all the medical professionals we need when we really need them? At the time, they didn’t even have a phone list.

And, in the past, when medical volunteers did arrive, there was no system in place to determine their skills and training, nor a way to assign them to specific duties. In some ways, the medical community was little better organized than ordinary citizens who respond to crises with an outpouring of supplies and offers to help.

“Often people volunteers just show up, sometimes adding to the confusion,” said Ryan. Holstein-Wallace tells the story of a flood in Southern West Virginia that devastated a community. “Here comes someone with a truckload of black bras!”

The January following the anthrax scare, President George W. Bush appealed to Americans to volunteer in his State of the Union address. That’s when local Medical Reserve Corps started to sprout to coordinate medical professionals who volunteer in crises and for public health initiatives.

The Eastern Panhandle Medical Reserve Corps started from scratch, building a data base of people and skills. Now, says Ryan, they have a reserve team of volunteer dentists, nurses, doctors, psychiatrists, even veterinarians.

“Now we can concentrate not only on recruiting volunteers, but getting them credentialed for specific disaster situations,” said Ryan.

If This Had Been an Actual Emergency

 At first blush, the whole apparatus seems layered with complexities. For example, Miller can’t pick up the phone and call a neighboring county to ask for police or fire department backups. By West Virginia law, her call goes to the state emergency management office, which puts out the call to the county in question.

But for the most part, what happens locally is handled locally. It’s your neighbors and friends, the people you see at the diner, who  are called upon to make decisions when they matter most.

Each incident has its own command structure. “In a flood,” said Miller, “the fire chief on the scene is incident commander. Everyone else is here to provide supporting services. The chief might conclude he needs more medicines or personnel. Members of the emergency planning committee can identify those resources, and the emergency management office can request them from the state.”

Even in a national emergency—in the anthrax evacuation scenario—local agencies, by and large, have to respond to local conditions on the ground and direct their requests for additional outside resources to the state. But as long as a situation is being managed within the borders of Jefferson County, it’s up to local agencies to figure out how to cooperate to manage an emergency.

No one knows what that next situation will be. Right now, swine flu is on everyone’s radar. A recent report by a special presidential advisory panel said swine flu could conceivably infect 30 to 50 percent of all Americans and, in some regions, tie up 100 percent of intensive care units’ hospital beds. It could result in tens of thousands of deaths. Unlike most flu strains, which kill some 30,000 people each year, swine flu would hit children and young adults especially hard.

While all eyes are on swine flu, hurricane season is upon us. “Disasters don’t unfold neatly,” says Holstein-Wallace. “Disasters are not clean cut. We’re always worrying about our current capabilities and resources for one potential disaster while keeping our eyes open for the next.”

To keep their heads in the game, they participate in training and maneuvers, much like a military unit. In table top exercises, they talk through responses to a given scenario. In full drills, they go live with a situation. In a recent table top, said Miller, the emergency management committee worked on a “cross-border” exercise with their counterparts Virginia. The scenario: “A guy had converted a fruit-spraying truck into an anthrax-spraying truck, and was driving down I-81.”

Are We Prepared?

 Spend enough time with these planners and you start to see the world as a disaster waiting to happen—or at least an emergency just around the corner. In one form or another, it is.

But most emergencies don’t come in the form of terrorists attacks or influenza outbreaks.

When a tractor trailer jackknifes on I-81, shutting the road in both directions for hours, someone has to spring into action to keep people and emergency vehicles moving north and south during the episode. The same is true when Mother Nature drops a foot of snow on the roads, cutting off access to the elderly or infirmed.

Or, at a more personal level, when a tree falls on your house or the kitchen catches on fire, what’s the plan? In 2008, when Shepherdstown Elementary School went into lockdown because an estranged husband had threatened violence against his wife who taught there, neither the school nor most parents had a plan. Also at Shepherdstown Elementary, when a popular art teacher was arrested for soliciting sex with children, parents were outraged at the school’s lack of communication and planning. MRSA too.

According to the experts, everyone needs a plan for continuity of operations. If your family had to leave home in a hurry or hunker down to wait out a flu pandemic, are you ready?

For merchants, when the shop you own can’t open because of disaster, what’s the plan to stay in business and not lose everything?

That’s why  emergency planners spend as much time promoting personal preparedness as they do planning for disaster. The reality is this: they are prepared. They know what they’ll do when crises hits. They know that whatever they plan for, the scenario will unfold without regard to the plans they’ve made. They know they will need more resources, and they know where they will look for them.

They worry about the rest of us—in part because they are local people serving local residents, but in part because when ordinary citizens are unprepared, they add to the crisis.

Miller’s agency and others recommend detailed family preparations, like keeping a “go kit” that contains important papers, bank account information, passports, extra reading glasses—again, whatever you might need if you have to leave in a hurry.

“Begin with a family fire-evacuation plan, and practice it,” said Miller. Then, begin to make plans for outside disasters like flu epidemics or worse.

“We recommend every family have enough supplies on hand to last two weeks without leaving the house,” she said. “You should have a two-week supply of prescriptions, snacks, nonperishable foods, water—whatever it takes to get you through it.”

September has been declared National Preparedness Month—not so the professionals can practice more, but as a way of reminding us that, to a large extent, safety and security are personal, family matters. The Emergency Management Center is hosting a series of informal Friday Lunch and Learn workshops about topics like assembling a kit, family preparedness, and taking care of pets in emergencies. Other agencies have similar plans.

At the Emergency Operations Center, down the hall from the situation room is a break room. There are comfy chairs, a treadmill, a nice flat screen TV. There is a kitchen, too. It’s set up for staff who might get stranded during an emergency. Other than the tubular fluorescents overhead, it’s quite homey. In the calm of the empty situation room, it’s easy to imagine families at their own tables, talking calmly walking, not running, down the fire ladder, and making checklists, grocery lists, contingency plans, while from the TV comes the sounds of a cheering crowd at a football game, from the oven the aroma of a roaster, and from outside float peels of laughter as the kids roll in a pile of leaves.

National Preparedness Month

September is National Preparedness Month, a time to learn more about emergency planning and, just as important, say local organizers, staying healthy. Here are some websites describing upcoming events and resources.

Ready.gov. Information flu, hurricanes, disaster planning—a slick site loaded with information.

Ready.wv.gov. Set for launch September 1, it’s the Mountain State-specific version.

Medical Reserve Corps. Excellent resource for people considering volunteering. www.medicalreservecorps.gov and for the Eastern Panhandle, www.orgsites.com/wv/eastern-panhandle-mrc/index.html

Jefferson County Office of Homeland Security and Emergency Management. www.jeffersoncountywv.org/OES.html

Where to Find Help in Jefferson County. A page from the West Virginia Office of Homeland Security has a printable list of emergency contacts. www.wvdhsem.gov/co_em_pages/counties/Jefferson.htm

Scrub Club, a kid’s site that uses cartoon characters, special effects, and neat sound effects to teach kids about germs, bacteria and other bad guys. Highly addictive for adults! www.ScrubClub.org.

Fight BAC, a colorful site about food safety, covering food storage, safe handling, and cooking, with links to many other food-safety websites. http://www.fightbac.org/

Clean Hands Coalition, a site that needs no further description—does it? www.cleanhandscoalition.org/resources.htm.

BAM, or Body and Mind, is a Center for Disease Control and Prevention-sponsored site for older kids covering a range of health topics in comic-book fashion. www.bam.gov.

Sope:  the wash-your-hands web site, offering up terrific sanitary tips like “flushing public toilets with your foot.” www.sope.net/index2.html.

A song for kids to scrub by. Rub–A–Dub: www.cleaning101.com/HandHygiene/hooray-for-handwashing/its-fun-to-scrub.mp3