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An innovative approach to capability-based emergency
operations planning
Mark E Keim
a
a
Office for Environmental Health Emergencies; National Center for Environmental Health;
Centers for Disease Control & Prevention; Atlanta, GA USA
Published online: 01 Jan 2013.
To cite this article: Mark E Keim (2013) An innovative approach to capability-based emergency operations planning, Disaster
Health, 1:1, 54-62, DOI: 10.4161/dish.23480
To link to this article: http://dx.doi.org/10.4161/dish.23480
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Disaster Health 1:1, 54–62; January/February/March 2013; © 2013 Landes Bioscience
RESEARCH PAPER
54 Disaster Health Volume 1 Issue 1
Correspondence to: Mark E Keim; mjk9@cdc.gov
Submitted: 09/24/12; Accepted: 01/02/13
http://dx.doi.org/10.4161/dh.23480
Introduction
The leadership in each jurisdiction of the world has been
described as legally, morally and politically responsible for ensur-
ing that necessary and appropriate actions are taken to protect
people and property from the consequences of emergencies and
disasters.
1
Since emergencies often evolve rapidly and become too
complex for effective improvisation, a government can success-
fully discharge its emergency management responsibilities only
by taking action beforehand. This requires emergency operations
planning in advance of the disaster event.
According to the US Federal Emergency Management
Agency, an emergency operations plan (EOP) serves the follow-
ing functions:
2
1. Assigns responsibility to specific organizations and indi-
viduals for carrying out specific actions at projected times in any
emergency that exceeds the capacity of any one agency.
2. Sets forth lines of authority and organizational relation-
ships, and shows how actions will be coordinated.
3. Describes how people and property will be protected in
emergencies and disasters.
4. Identifies personnel, equipment, facilities, supplies and
other resources available.
5. Identifies steps to address specific mitigation concerns dur-
ing response activities.
6. Cites legal basis, acknowledges assumptions and states
objectives.
Unfortunately, EOPs that combine operational require-
ments with best practices are difficult to create. Most officials
This paper describes the innovative use information technology for assisting disaster planners with an easily-accessible
method for writing and improving evidence-based emergency operations plans.
This process is used to identify all key objectives of the emergency response according to capabilities of the institu-
tion, community or society. The approach then uses a standardized, objective-based format, along with a consensus-
based method for drafting capability-based operational-level plans. This information is then integrated within a relation-
al database to allow for ease of access and enhanced functionality to search, sort and lter and emergency operations
plan according to user need and technological capacity.
This integrated approach is oered as an eective option for integrating best practices of planning with the eciency,
scalability and exibility of modern information and communication technology.
An innovative approach to capability-based
emergency operations planning
Mark E Keim
Oce for Environmental Health Emergencies; National Center for Environmental Health; Centers for Disease Control & Prevention; Atlanta, GA USA
Keywords: public health preparedness, disasters, emergency operations plan, capability-based planning, information technology,
objective-based planning, Homeland Security Presidential Directives, O2C3 planning
throughout the world have limited knowledge, experience and
time for developing, evaluating or improving the quality of emer-
gency operations plans. There is a need for not only planning
guidance, but also tools that assist emergency operation planners
to write well-organized, evidence-based EOPs. Table 1 lists a
series of challenges for effective and efficient emergency opera-
tions planning.
Recently, there has been a great deal of interest in designing
computer tools to help people work together more effectively. In
effort to meet the growing global need for an effective emergency
operations planning tool, the author has conceived a process for
innovative use of a relational database that applies modern theories
of planning and coordination using a platform of currently avail-
able information technology. This manuscript will describe the
planning tool and explore its past and potential future applications.
Background
Principles of effective emergency operations planning. Effective
planning allows people’s needs, preferences and values to be
reflected in decisions. A basic principle of good planning is that
individual, short-term decisions are coordinated in order to sup-
port strategic, long-term objectives. Planning is a social activity
—that is, it involves people, and the results are affected by those
who are involved and how they participate in the process. Good
planning does more than simply identify the easiest solution to a
particular problem. It can be an opportunity for learning, devel-
opment and consensus building. How stakeholders are involved
is a key factor in the effectiveness of a planning process. A good
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www.landesbioscience.com Disaster Health 55
RESEARCH PAPER
RESEARCH PAPER
• Establishing specic, measurable tasks for various inci-
dent management functional activities, and directing efforts to
accomplish them, in support of defined strategies.
• Documenting results to measure performance and facilitate
corrective actions.
Capability-based planning. Capability-based planning is also
the foundation for which the US Homeland Security Exercise
Evaluation Program (HSEEP) and other federal preparedness
initiatives are based.
6
Capabilities, (or the abilities to perform a
particular task), provide the common framework used for relat-
ing and comparing disparate elements of an emergency response
organization.
7
The objective-based approach, when used alone,
may imply a degree of certainty regarding the disaster hazard or
threat that not be attainable. This unpredictability is best met by
planning to accomplish those objectives which we are actually
capable of achieving. Homeland Security Presidential Directive
8 (HSPD 8) was the first mandate that Federal, State, local and
tribal entities, their private and non-governmental partners, and
the general public should adopt a capability-based planning
approach for EOPs.
8
Populations at risk for disasters face a vast range of hazards
within a nearly infinite set of scenarios. This unpredictability is
poorly suited to scenario-based approaches to risk management.
9
While the hazards that cause disasters may vary greatly, fortu-
nately the potential public health consequences and subsequent
public health and medical needs of the population do not.
2,10
For example, warfare, chemical releases, floods, hurricanes and
earthquakes all displace people from their homes. These hazards
require the same sheltering capability with only minor adjust-
ments based on the rapidity of onset, scale, duration, location and
intensity. Regardless of the hazard, disasters can be seen as caus-
ing 15 public health consequences that are addressed by approxi-
mately 35 categories of public health and medical capabilities.
10,11
And not all public health consequences are completed by public
planning process usually begins with the most general concepts
and leads to increasingly specific plans, programs and tasks,
resulting in integration between each part.
3,4
There are several key approaches to effective emergency opera-
tions planning that have been offered in order to improve the
efficiency of plan-writing and to facilitate quality and timely
execution of the plan.
These approaches have been described as O2C3 and include
the following characteristics:
3
• Operational-level planning
• Objective-based planning
• Capability-based planning
• Consensus-based planning
• Compliant with local, national and international prepared-
ness strategies, guidelines and best practices.
Operational-level planning. Operational plans describe short-
term ways of achieving objectives and explain how, (or what por-
tion of), a strategic plan will be put into operation during a given
period of time. Operational plans describe response operations as
compared with the other functions within the incident command
system. They are not intended to be administrative, intelligence
or logistic plans that describe support functions.
Objective-based planning. Objective-based planning
can serve as an effective tool for making progress by ensuring
that participants have a clear awareness of what they must do
to achieve or help achieve an objective. Homeland Security
Presidential Directive 5 (HSPD-5) established a National
Incident Management System (NIMS) in the US. Management
by objectives is an essential component of NIMS communicated
throughout the entire ICS organization and includes:
5
• Establishing incident objectives.
• Developing strategies based on incident objectives.
• Developing and issuing assignments, plans, procedures, and
protocols.
Table1. Challenges of effective emergency operations planning
Challenges of the planning process
Emergency operations planning is often time-consuming and difficult to sustain
Many planners throughout the world have limited knowledge and experience for developing, evaluating or improving the quality of emergency
operations plans
Plans must address a broad range of hazards and contingencies, (tending toward a voluminous document), yet must also be user-friendly and easily-
accessible during the disaster response phase
Response activities must be well-integrated with other governmental and non-governmental agencies and institutions and based upon scientific
evidence
Populations at risk may face many vastly different hazards and threats with a nearly infinite set of scenarios
Challenges of the planning format
Many plans tend to focus on content (or tasks) rather than the process (or management/coordination system)
Many plans lack clear indicators of performance and outcome or measures of effectiveness
Many plans are cumbersome. Comprehensive EOPs tend to be extremely large documents that are difficult to navigate
Some plans describe response strategies and fulfill legal regulations, but do not address operational problems
Detailed operational-level plans are often not integrated into the overall provincial, national or international strategies or response guidelines
Paper plans are bulky and difficult to distribute
Adapted from Keim 2010.
3
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56 Disaster Health Volume 1 Issue 1
• Integration of objective-based and capability-based planning
• User-friendly plan viewing by subsequent planners and
responders
• Discrete plan elements to be entered, sorted and searched
within a relational database
Plan elements may be considered as essentially comprised of
both relational and non-relational data.
Non-relational planning data includes items associated with a
FEMA-recommended “Basic Plan”—consisting of the following
elements:
2
• Introductory material
• Purpose of the plan
• Current situation and assumptions
• Concept of operations
• Organizational diagrams and assignment of responsibilities
• Administration and logistics
• Plan development and maintenance
• Authorities and references
• Maps and gures
This information though valuable for plan development and
maintenance has less utility during an emergency response when
time is limited. This information is largely narrative. It is there-
fore not advantageous nor is it necessary to use a relational for-
mat. It is instead held summarily under a few tabs, webpages or
headings in the EOP as non-relational data.
Relational data includes those plan elements described within
a FEMA-recommended “Functional Annex”.
2
An operational
plan, (otherwise known as an OPLAN),
22
draws directly from
strategic plans to describe agency and program missions and
goals, objectives, and activities. An operational plan addresses the
following questions: Who? What? Where? and When? Table 2
describes the enhanced functionality offered when an operational
plan is represented as discrete elements of information within a
relational database.
The functional annex (or OPLAN) contains a listing of
response capabilities necessary to mount an effective response
to all-hazards. This information is best organized according to
a cascading network of planning elements, for each individual
capability. These elements include: strategic objectives; opera-
tional objectives; activities, (or tasks); responsible parties; and
standard operating procedures. Table 3 describes each one of
these plan elements.
Each capability is associated with one or more strategic
objectives that reflect the desired state of affairs intended to be
achieved. Each strategic objective is then related to one or more
operational objectives, which are, in turn, related to activities that
accomplish each operational objective. Each activity is then associ-
ated with a responsible party and a standard operating procedure
(SOP) for how the activity will be accomplished. This hierarchi-
cal format cascading from each capability is referred to as the
acronym, “S-O-A-R-S” and is depicted in Figure 1.
Table 4 represents an example of how this S-O-A-R-S format
would be used to depict the hierarchy of plan elements for the
capability of “Water, Sanitation and Hygiene.” This example is
based upon the Sphere international standards for humanitarian
assistance.
12
health staff. For example, public works and other government
agencies are also involved in the provision of safe water, sanitation
and shelter.
Consensus-based planning. The US Federal Emergency
Management Agency (FEMA) recommends a team-based
approach to writing EOPs.
2
Consensus-based decision-making is
a group decision making process that not only seeks the agreement
of most participants, but also to resolve or mitigate the objections
of the minority to achieve the most agreeable decision. Consensus
is usually defined as meaning both general agreement, and the
process of getting to such agreement. Consensus-based deci-
sion-making is thus concerned primarily with that process. As a
decision-making process, consensus aims to be: inclusive, partici-
patory, cooperative, egalitarian and solution-oriented. HSPD-8
charged all federal agencies involved in emergency response to
participate in emergency planning on a “consensus-basis.”
8
Compliance with local, national and international strate-
gies. It is important that EOPs are compliant with local, national
and international strategies, guidelines and best practices. On
an international basis, examples of these guidelines and best
practices may include Standards for Humanitarian Assistance;
12
Handbooks of Disaster Medicine;
13
or Guidelines for Pandemic
Influenza Preparedness and Mitigation.
14
In the US, these national strategies are directed by Presidential
directives. As a form of executive order, a Presidential Directive
has the full force and effect of law. Presidential directives related
to emergency operations planning include HSPD-5
15
and
HSPD-8.
8
More specific guidelines are also available for diseases
such as pandemic influenza.
16
An Innovative Approach to O2C3
Emergency Operations Planning
In recent years, large numbers of people, (including emergency
responders), have acquired direct access to computers. Therefore,
we now have, for the first time, an opportunity for vastly larger
numbers of people to use computing and communications capa-
bilities to help coordinate their work. For example, specialized
software has now been developed to (1) support multiple authors
working together on the same document, (2) help people dis-
play and manipulate information more effectively in face-to-face
meetings, and (3) help people intelligently route and process elec-
tronic messages.
17
An innovative approach is here proposed that serves to inte-
grate an all-hazard approach with widely-accepted principles of
emergency operations planning, (namely O2C3).
3
This approach is comprised of the following three components:
1. A format to organize plan information.
2. A method to collect and negotiate plan information.
3. A platform to deliver plan data.
Plan format. It is important to apply a standardized format
for organizing plan information. This standardization of plan
format allows for:
• Inter-operability of different plans and plan elements.
• Hierarchical organization of plan elements so as to avoid
redundancy or omissions.
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www.landesbioscience.com Disaster Health 57
to planning. This workgroup will then perform the following
tasks:
1. Collect background data and references.
2. Perform an inventory of capabilities.
3. Draft strategic and operational objectives for each of the
capabilities.
4. Develop the EOP template in a standardized format.
5. Convene and lead plan-writing workshops among a larger
group of planners.
Data collection. The planning method begins with a collec-
tion and review of any pre-existing EOPs for that jurisdiction.
This important step is responsible for instilling an evidence-base
for assumptions, capabilities and objectives of the plan. Other
planning references, guidance and best practices should also
be gathered together. In developing nations, the Sphere Project
handbook
12
or the UNHCR Handbook for Emergencies
19
are good general references. In the US, this may include the
National Preparedness Guidelines
8
and the CDC Public Health
Preparedness Capabilities list.
11
At the institutional level this
Planning method. A planning method is a logical and repro-
ducible way to write a plan. Guidelines for this standardized
approach should be taught to all participants of the planning
workshop. Ideally use of a training curriculum for local planners
and trainers appears to impart sustainability of planning efforts
using this standard approach. There are two main steps in the
planning method: preparation and plan-writing. Figure 2 depicts
the six main steps necessary to prepare for plan-writing.
Preparation for planning. Creation of a planning workgroup.
Creation of a planning workgroup comprised of local planners
is a critical step to ensure adequate preparation, a sustained
progress and on-going maintenance of the planning pro-
cess. The workshop should be comprised of 5–10 individuals
able to represent discussions regarding all of the capabilities.
Workgroup members should have a general working knowledge
of the response capabilities of the institution or jurisdiction
doing the planning. Workgroup members should also receive a
brief training involving the principles of O2C3 planning as well
as the method, format and platform for this intended approach
Table2. Examples of enhanced EOP functionality when formatted within a relational database
Functionality Examples
Quick searches for specific plan elements
Planners quickly search and skip to different EOP elements during their workshop deliberations.
Responders quickly access the specific parts of the plan without thumbing through pages of
information not relevant to their own tasks.
Filtering and sorting of plan elements according
to any parameter:
(i.e., capabilities, objectives, activities and respon-
sible parties)
EOP may be filtered to view at either a strategic level (objectives only) or at an operational level
(activities only).
Each response entity may sort the EOP to gather, (in one view), all of their own agency-specific
activities that would otherwise be scattered in multiple locations throughout a traditional EOP
Assign and link additional indicators of
performance or outcome with each plan element
Planners may correlate quality control parameters, (such as timing, cost, accuracy, % comple-
tion, etc.) to various plan elements for purposes of monitoring and evaluation.
Recombine or update discrete plan elements in
order to address previously unforeseen circum-
stances
If procedures change during the response due to new information, (e.g., new drug availability or
new response partners), the EOP may be easily updated to integrate these changes in multiple
locations throughout the entire plan.
Integration of EOPs with interactive Web 2.0
posting and online applications
The planning process may be crowd-sourced for remote participation in plan preparation, EOP
writing and maintenance.
EOPs may be made available online as not only relational databases, but also as applications
that interact with the responder for communication in both directions.
Table3. Working definitions for plan elements
Planning element Working definition Simple description
Capability
Ability to achieve a desired operational effect under specified standards and conditions
through combinations of means and ways to perform a set of tasks
Ability
Objectives A projected state of affairs which a person or a system plans or intends to achieve Goal
Strategic objective A general statement of the end goal Why
Operational objective Specific goals that constitute the means for attaining the strategic goal What
Activity A set of actions which accomplish specific goals How
Responsible parties Individuals or groups assigned responsibility for accomplishing an activity Who
Standard operating
procedure (SOP)
A set of instructions covering those features of operations that lend themselves to a definite or
standardized procedure without loss of effectiveness.
When
Where
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58 Disaster Health Volume 1 Issue 1
Developing the EOP template. Once capabilities and their asso-
ciated strategic and operational objectives are drafted, the next
task for the planning workgroup is to place these plan compo-
nents into a template for use during the plan-writing process.
This EOP template will then be used to guide the work of a larger
group of plan stakeholders during subsequent plan-writing work-
shops. In its simplest form, this template may be developed as a
matrix like the example in Table four. Such matrices allow for
easy viewing by workshop planners of the relationships between
the capabilities, objectives, activities, responsible parties and
SOPs. This template is then completed by the participants dur-
ing subsequent planning workshops.
In this application, the subject matter content of the EOP
template serves as a dynamic platform for delivery of planning
guidance for the end-user/planner(s) to review, and revise accord-
ing to local conditions, capability and capacity. As a general rule
of thumb, planning input cascades from international/national
input down to locally originated input planning proceeds from
strategic objectives, to operational objectives, to activities and
then finally to responsibilities and SOPs. Typically over 90%
of strategic objectives and operational objectives can be accept-
ably generated from national and/or international standards.
Most commonly, around 50% of activities may be derived from
national or international guidance. Sections for responsible par-
ties and SOPs are left entirely open in the EOP template since
nearly 100% of these are specific to the local jurisdiction writing
the EOP.
Convening the plan-writing workshop. Participants of the work-
shop. After the background materials and references are collected
and plan template is complete, it is time to convene a larger
group of stakeholders to write the plan. According to O2C3
principles, these stakeholders should be comprised of persons
may include documents such as HICS
20
or proprietary busi-
ness continuity planning guides. These guides may be aug-
mented with hazard-specific guidelines such as the DHHS
guidelines for pandemic planning and preparedness,
16
or
guides related to mass casualty management, bioterrorism
response, etc. Data collection should also include the perfor-
mance of a risk assessment. Recognizing that the planning
process will apply an all-hazard, capability-based approach,
it is not necessary, (nor is it always possible), to accurately
prioritize or quantify the probability and impact of poten-
tial hazard scenarios. It is merely necessary to identify a list
of potential hazards that may threaten the population. By
using an all-hazard, capability-based approach, communi-
ties prepare for and respond to disasters by applying their
own capabilities to address any hazard.
Capability inventory. The next step in preparation for
plan-writing is to perform a capability inventory. Capability-
based planning involves a functional analysis of critical
operational requirements according to scenarios. In the case
of health sector EOPs, capabilities are based on the potential
public health consequences caused by the disaster hazard.
Once the required capability inventory is defined, the most
cost-effective and efficient options to satisfy the require-
ments, (i.e., objectives and activities), can then be sought.
7,21
Table 5 lists consequences and public health capabilities that
are most commonly addressed in a disaster response. The range
of public health consequences actually varies little among disas-
ter hazards.
2,3
The implementation of public health capabilities
varies more according to the severity of disaster consequences,
(a.k.a. hazard impact), of the disaster, rather than according to
the hazard itself.
Other sources for listings of capabilities exist in the form of
Sphere Handbook.
12
These capabilities may also evolve over time
according to changing demands and resources made available
before, during and after the disaster response. Thus, planning
should be seen as an iterative and on-going process that is easily
revised and updated.
Drafting objectives. Once capabilities have been identified,
objectives are then written that describe the desired goals for
implementing each capability. Using existing planning guid-
ance and references, the planning workgroup should draft stra-
tegic and operational objectives for each of the capabilities in
the EOP. These draft objectives will then be reviewed by the
larger group of plan-writers during the subsequent planning
workshop. In some cases, (e.g., for capabilities included in the
Sphere handbook), it may be possible for the workgroup to also
draft some of the activities as well. Following are examples of
useful resources for drafting public health and medical objec-
tives and activities:
• Sphere international standards for humanitarian assistance.
12
• Hospital Incident Command System (HICS).
20
• Critical benchmarks of the US Department of Health and
Human Services (DHHS) National Hospital Preparedness
Program (HPP).
22
• HHS Pandemic Inuenza Planning and Preparedness
Guidance.
16
Figure 1. Cascade for S-O-A-R-S formatting of EOP relational plan elements.
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www.landesbioscience.com Disaster Health 59
is therefore critical to the success of the EOP
during a real response.
Process for the workshop. Workgroup lead-
ers will serve as facilitators for consensus-
based approach to planning. During the
plan-writing workshop, workgroup leaders
will facilitate a step-by-step review and dis-
cussion of each capability and associated
strategic and operational objectives. The draft
capabilities and objectives will be accepted,
accepted with revision, or rejected by the
workshop participants.
The next step will involve populating the
plan with further details to include activities
for accomplishing each operational objec-
tive, responsible parties for each activity and
when appropriate standard operating proce-
dures (SOPs) for performing each activity.
The facilitators will guide the participants
through an orderly consensus-based process
of reviewing objectives and then proposing, discussing and writ-
ing activities for each objective. It is extremely important that the
facilitation ensure that there adequate discussion and negotiation
of each point in the plan. It has been said that, “the process of
planning is more important than the resultant plan.”
3
That is
to say that the elements of discussing, informing, learning and
negotiation that take place during the planning process are much
more valuable for ensuring a well-coordinated response than any
subsequent plan intended to merely document this critical deci-
sion-making. This point allows for a more centralized planning
that will actually be expected to participate in the emergency
response.
3
These individuals should also be of sufficient seniority
and authority in the response system that they can make com-
mitments for their own respective areas of responsibility as they
negotiate and write the plan during the workshop. This is a criti-
cal requirement since it may be tempting to assign more junior
staff to participate in the plan-writing workshop. However, more
junior members may not have as complete understanding of their
own department or have the authority to speak on its behalf.
Having the right people involved in the plan-writing workshop
Table4. Example of S-O-A-R-S plan format the capability of “Water, Sanitation and Hygiene”
Capability Strategic objective Operational objective Activity Responsible party SOP
Water, Sanitation
and Hygiene
An adequate
supply of clean
water is accessible
to all people.
A sufficient quantity of water
is available to all people.
Ensure that the maximum distance from
any household to the nearest water
point is 500 m.
Public works Etc.
Ensure that the average water use for
drinking, cooking, and personal hygiene
in any household is at least 15 L per per-
son per day.
Water is of sufficient quality
to be potable and used for
hygiene.
Ensure there is low risk of fecal contami-
nation.
Sanitarian Etc.
Use a sanitary survey to indicate the risk
of fecal contamination.
Ensure there are no fecal coliforms per
1000ml at the point of delivery.
People are able to safely col-
lect, store, and use sufficient
quantities of water.
Ensure each household has at least two
clean water collecting containers of
10–20 L
Central supply Etc.
Ensure water collection and storage con-
tainers have narrow necks and/or covers
(or other safe means of storage, drawing,
and handling).
Figure 2. Six main steps necessary to prepare for plan-writing.
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60 Disaster Health Volume 1 Issue 1
Table5. Public health consequences and capabilities associated with all disasters
Public health consequences Capabilities that promote health
Common to all consequences
Emergency Operations Coordination §
Resource management
Information Sharing §
Social services
Responder safety and health §/Occupational health and safety
Business continuity
Volunteer management
Deaths
Fatality management §/Mortuary care
Social services
Mental health services
Illness and injuries
Health services
Mental health services
Injury prevention and control
Public health surveillance § / Epidemiological investigation
Disease prevention and control
Medical countermeasure dispensing §
Medical material management and distribution §
Public health laboratory testing §
Medical surge §
Non-pharmaceutical interventions §
Loss of shelter
Mass Care §/Shelter and settlement
Social services
Security
Loss of personal and household goods Replacement of personal and household goods
Loss of sanitation and routine hygiene
Sanitation, excreta disposal and hygiene promotion
Non-pharmaceutical interventions §
Disruption of solid waste management Solid waste management
Public concern for safety
Risk communication
Public information
Security
Increased pests and vectors Pest and vector control
Loss or damage of health care system/services
Health system and infrastructure support
Reproductive health services
Health services
Worsening of chronic illnesses Health services
Loss of water
Water, sanitation and hygiene (WASH)
Health services (e.g., hospitals, dialysis units)
Loss of power
Food safety
Health services (e.g., healthcare facilities and home care)
Food scarcity Food safety, security and nutrition
Toxic exposures
Risk assessment
Population protection measures (evacuation/shelter-in-place)
Health services
Hazmat emergency response
Responder safety and health §/Occupational health and safety
(Table adapted from Keim, 2006
10
Entries marked as § are adapted from CDC 2011
11
).
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www.landesbioscience.com Disaster Health 61
guidance to be developed according to national standards and
strategies in the form of objectives and activities that may then be
iterated locally to develop more specific actions that will imple-
ment the guidance.
Plan platform. A plan platform is the media used to store and
display plan data. The ideal platform is one that is:
• Easy to use and distribute.
• Accessible when needed.
• Preserves plan data and.
• Technologically appropriate for the user.
Different plan users have different needs regarding how they
can and should look at a plan. When the SOARS format is used
to organize the EOP, it may then be represented in a variety of
platforms according to the needs and preferences of the user.
Using a simple matrix or a more complex version of relational
database, the plan is also easily revised and updated through
an iterative process before, during and after the disaster. Since
2001, this approach has been used in a variety of platforms with
increasing levels of complexity.
In its simplest iteration, both non-relational and relational
components of the plan can be represented in narrative form. In
this form, the SOARS format is depicted as text with cascading
headings and subheadings for capabilities, objectives, activities,
responsible parties and SOPs. In this example, word proces-
sor software, (such as Microsoft Word
©
), and paper print-outs
become the main platform for storing and displaying EOP data.
Responders engaged in highly austere field conditions may need
waterproof hard copies, with checklists and tools related to their
particular role. Plan users at all levels in underdeveloped areas
or users that possess limited computing skills may prefer this
platform.
The SOARS format also easily lends itself to representation
as a spreadsheet-based interface for quickly viewing and manip-
ulating the plan. In this case a spreadsheet software program,
(such as Microsoft Excel
©
), would serve as the main platform for
the EOP. This platform is particularly useful for facilitating the
planning workshops, when users need easy access and clear view-
ing of the plan hierarchy and an ease of movement throughout
the plan.
The scalable and modular characteristics of the SOARS for-
mat also allows for ease of use in relational databases that have
search/sort/filter capabilities. In this case the platforms may range
from simple more static forms of databases, (such as Microsoft
Access
©
), to more sophisticated and dynamic web-based data-
bases, (such as Microsoft .NET
©
framework and Microsoft SQL
2000 Enterprise Manager
©
Software).
Utilizing a simple form-based interface, which can be accessed
globally through a secure Internet interface, users are now able
to design custom surveys and easily distribute these surveys to a
handheld format on a pocket PC platform.
In a more sophisticated application, use of the SOARS for-
mat to organize the EOP has also accommodated a platform
use of Microsoft .NET
©
framework and Microsoft SQL 2005
Enterprise Manager
©
software to deliver a combined online
knowledgebase and document management interface based on
portal user management, form-based questionnaires, document
management and XML/XSL content integration mechanisms
without enhanced full-site search functionality.
Discussion
In the long run, the dramatic improvements in the costs and
capabilities of information technologies are changing, (by orders
of magnitude), the constraints on how certain kinds of commu-
nication and coordination can occur. Together, these changes
may soon lead us across a threshold where entirely new ways of
organizing human activities become desirable.
In 2006, for example, the US Department of Homeland
Security based development of a National Planning and Execution
System on the following likely assumptions: that ‘net-centricity’
will continue to evolve and mature and that “a net-centric archi-
tecture” “will enable secure, collaborative, web-enabled, parallel
planning” And, furthermore that, “Technology and tools that
save significant time and increase the quality of planning will be
developed and fielded.”
18
Since 2001, prototypical models using this system of stan-
dardized planning format, method and platforms have proven
as a useful adjunct for facilitating an efficient process of EOP
development and execution. This innovative use of a relational
database has been used successfully in over 100 planning work-
shops to write local, state, provincial and national level EOPs in
the US and abroad. This same process has been used to facilitate
emergency operations planning among 20 different nations,
and in ten different languages. The approach is widely scalable
according to the size of jurisdiction. At its smallest application,
this process has been applied at the single-community level in
the USA, at the district-level in several eastern Africa nations
and at the national-level for small island developing nations
with populations spanning from 15,000 to 150,000. This
same approach has also been used for developing provincial-
level plans in SE Asia and for planning mass gatherings with
70 million visitors in China.
18-20
Finally, the same process was
recently used to develop a national contingency plan for the
entire USA.
21
The expected outcome of this approach is to integrate the fol-
lowing critical elements of an effective EOP:
2,3,5,6,8,11,22
• Inter-operability of different plans and plan elements.
• Hierarchical organization of plan elements so as to avoid
redundancy or omissions.
• Integration of objective-based and capability-based planning.
• Facilitation of a consensus-based approach among opera-
tional-level plan-writers.
• User-friendly plan viewing by subsequent planners and
responders.
• Discrete plan elements to be entered, sorted and searched
within a relational database.
• Use of information technology to improve distribution,
access and utilization of EOPs.
• Improving practical approaches to management by objec-
tives as mandated by the National Incident Management System.
• A framework for improving integration of National
Preparedness Guidelines, Target Capabilities and the National
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62 Disaster Health Volume 1 Issue 1
consensus-based method for drafting capability-based opera-
tional-level plans applies is the currently-held best practice for
planning. Use of a relational database for O2C3-based emergency
operations planning offers an effective option for integrating best
practices of planning with the efficiency, scalability and flexibility
of modern information and communication technology.
Disclosure of Potential Conflicts of Interest
No potential conflicts of interest were disclosed.
Incident Management System within local, state and national
planning efforts.
Conclusion
An innovative approach to emergency operations planning is nec-
essary in order to fully engage the utility and efficiency of modern
information and communication technology. An O2C3 approach
that uses a standardized, objective-based format, along with a
References
1. ICISS. The Responsibility to Protect, Report of the
International Commission on Intervention and State
Sovereignty (ICISS), December 2001. Available at url:
http://responsibilitytoprotect.org/ICISS%20Report.
pdf Last accessed on September 21, 2012.
2. Federal Emergency Management Agency. SLG 101:
Guide for All-Hazard Emergency Operations Planning,
Federal Emergency Management Agency (FEMA),
September 1996. Available at url: http://www.fema.
gov/pdf/plan/0-prelim.pdf Last accessed on September
21, 2012.
3. Keim ME. O2C3: A unified model for emergency
operations planning. Am J Disaster Med 2010; 5:169-
79; PMID:20701174; http://dx.doi.org/10.5055/
ajdm.2010.0019.
4. Christen H, Maniscalco P. The EMS Incident
Management System. Upper Saddle River: Prentice-
Hall, 1998.
5. Department of Homeland Security. The National
Incident Management System. Washington, DC.
December 2008 Available at url: http://www.fema.gov/
pdf/emergency/nims/NIMS_core.pdf. Last accessed on
September 21, 2012.
6. Department of Homeland Security. The Homeland
Security Exercise and Evaluation Program (HSEEP).
Washington, DC. February 2007. Available at url:
https://hseep.dhs.gov/support/VolumeI.pdf. Last
accessed on September 21, 2012.
7. Davis, P.K., Analytic Architecture for Capabilities-
Based Planning, Mission-System Analysis, and
Transformation, RAND MR-1513-OSD, 2002.
8. Department of Homeland Security. National
Preparedness Guidelines. Washington, DC September
2007. Available at url: http://www.fema.gov/pdf/emer-
gency/nrf/National_Preparedness_Guidelines.pdf Last
accessed on September 21, 2012.
9. Henry R. Defense Transformation and the 2005
Quadrennial Defense Review. Parameters 2005-2006;
5-15.
10. Keim M, Giannone P. Disaster Preparedness in Disaster
Medicine; Ed., Greg Ciottone. Publisher Mosby. 2006.
11. Centers for Disease Control and Prevention. Public
Health Preparedness Capabilities: National stan-
dards for state and local planning. March 2011.
Available at url: http://www.cdc.gov/phpr/capabili-
ties/Capabilities_March_2011.pdf. Last accessed on
September 21, 2012.
12. Anonymous. Sphere Handbook. The Sphere Project,
Humanitarian Standards in Disaster Response, 2004.
Available at url: www.sphereproject.org/ Last accessed
on September 21, 2012.
13. de Boer J, Dubouloz M, eds. Handbook of Disaster
Medicine. The Netherlands: International Society of
Disaster Medicine, 2000.
14. World Health Organization. Pandemic influenza pre-
paredness and mitigation in refugee and displaced
populations. Second edition, May 2008. Available at
url: http://www.who.int/diseasecontrol_emergencies/
HSE_EPR_DCE_2008_3rweb.pdf. Last accessed on
September 21, 2012.
15. Department of Homeland Security. Homeland Security
Presidential Directive 5. Management of Domestic
Incidents. February 2003. Available at url: http://www.
fas.org/irp/offdocs/nspd/hspd-5.html Last accessed on
September 21, 2012.
16. US Department of Health and Human Services.
Planning and Preparedness, Available at url: http://www.
pandemicflu.gov/. Last accessed on September 21,
2012.
17. Malone T, Crowston K. The Interdisciplinary Study
of Coordination, ACM Computing Surveys, 26 (1),
87-119, March, 1994. Available at url: http://ccs.
mit.edu/papers/CCSWP157.html. Last accessed on
September 21, 2012.
18. Centers for Disease Control and Prevention. Global
Health in Laos: Influenza. Available at url: http://www.
cdc.gov/globalhealth/countries/laos/. Last accessed
December 31, 2012.
19. Yi H, Zheng’an Y, Fan W, Xiang G, Chen D, Yongchao
H, et al. Public health preparedness for the world’s
largest mass gathering: 2010 World Exposition in
Shanghai, China. Prehosp Disaster Med 2012; 27:1-
6; PMID:22575344; http://dx.doi.org/10.1017/
S1049023X12001252.
20. Sun X, Keim M, He Y, Mahany M, Yuan Z. Reducing
the risk of public health emergencies for the world’s
largest mass gathering: 2010 World Exposition,
Shanghai China. Disaster Health 2013; 1:0 - 8; http://
dx.doi.org.
21. US Department of Health and Human Services.
Newborn Screening Contingency Plan (CONPLAN)
July 2010. Available at url: http://www.cdc.gov/
ncbddd/documents/NBS-CONPLAN.pdf Last
accessed December 31, 2012.
22. Department of Homeland Security. Integrated
Planning System. January 2009. Available at url: http://
www.hlswatch.com/wp-content/uploads/2009/01/dhs-
integrated-planning-system-january-2009.pdf. Last
accessed on September 21, 2012.
23. United Nations. High Commissioner for Refugees.
Handbook for Emergencies. 3rd edition. 2007.
Available at url: http://www.unhcr.org/publ/
PUBL/471db4c92.html Last accessed on September
21, 2012.
24. Kaiser Permanente. Hospital Incident Command
System. Incident Planning and Response Guides.
Available at url: http://www.hicscenter.org/pages/arti-
cles.php?mod=6. Last accessed on September 21, 2012.
25. NATO Research and Technology Board. Panel On
Studies, Analysis and Simulation (SAS), Handbook in
Long Term Defense Planning, 2001.
26. Department of Health and Human Services.
Healthcare Preparedness Capabilities: National guid-
ance for healthcare system preparedness. January
2012. Available at http://www.phe.gov/Preparedness/
planning/hpp/reports/Documents/capabilities.pdf Last
accessed on September 21, 2012.
Downloaded by [180.178.107.54] at 09:33 03 September 2015
