ADVANCEMENT OF THE SCIENCE
Crisis standards of care (CSC) is a system based on medical rationing, patient triage, and liability protection for the medical indus- try. Timbie et al. (2012) describes the ini- tiation of CSC in that a “hospital must alter care delivery, and shift from the individual approach to healthcare, which is intended to deliver optimum care to each and every patient, to one that seeks to do the most good for the most people with the resources at hand.” Emergency management contingen- cies should be arranged to avoid exceeding established threshold triggers and other indi- cator metrics to avoid the initiation of CSC (Sase & Eddy, 2021; Timbie et al., 2012). Additionally, the term mitigation is not equivalent to prevention and main points of focus are divided between traditional emer- gency management and public health man- dates. For example, the Federal Emergency Management Agency (FEMA, 2013) uses the term mitigation for sustained, long-range eorts to minimize the impact of future haz- ards, specifically those eorts traditionally associated with natural disaster or extreme weather. The term prevention is exclusive to counterterrorism and cybersecurity eorts (FEMA, 2013). A voluminous suite of federal emer- gency management doctrine springs from the National Preparedness System, driven by the National Preparedness Goal, associ- ated frameworks, and presidential directives, that in combination support the five mission areas of FEMA under the umbrella of the all- hazards-based NIMS. Emergency Support Functions (ESFs) provide federal assistance systems for public health and medical sys- tems, primarily ESF-9 (HHS, 2019b). First responders, emergency managers, and home- land security experts are trained to follow a FEMA mission area-defined emergency man- agement cycle, also referred to as a disaster lifecycle. The emergency management cycle has not changed significantly for decades, and its theoretical origin is traceable to a 1932 report (Carr, 1932; Neal, 1997; Rose et al., 2017). Extensive research exists on this topic except for the prevention mission area that is focused primarily on terrorism and inten- tional attacks. We added to the literature with the insertion of the public health approach to all-hazards readiness that emphasizes pre- vention through health systems protection, a population health focus, and the estab-
FIGURE 1
Fukushima Natural Disaster Trigger Events
Natural Disaster Trigger Events: Primary Causes
2011 Great East Japan Earthquake of a Magnitude 9
Human-Caused Hazards: Radiation Release Future Threats
Power Outage Reactor Coolant Loss
Potential Recriticality of Corium and Other
Ongoing Situation Discharge of Wastewater to the Pacific Ocean Vulnerability of Stored Contaminated Debris High Risk Involved With Decommissioning
Reactor and Spent Nuclear Fuel Meltdown
133-ft Tsunami Severe Flooding
Nuclear Debris Extreme Weather Intentional Attack Accident
Failed Preparedness and Mitigation
lishment of equity in agency performance through the eective and ecient utilization of NIMS/ICS training and exercise readiness systems (Sase & Eddy, 2016, 2021). Our previous findings that the terms risk and hazard should not be used interchangeably led to a fundamental lesson learned from the Fukushima nuclear disaster: by focusing on the likelihood (probability) of a natural disas- ter occurring, the emphasis on planning for potential and actual hazards (e.g., accidental or human-caused) associated with radiologi- cal inventories was overlooked (Eddy & Sase, 2015). FEMA also uses the terms hazard and threat essentially interchangeably and they are routinely presented together (e.g., threats and hazard), such as in the FEMA National Preparedness Goal that drives the National Response Framework and associated ESFs (FEMA, 2019, 2020). We clarify that risk is a probabilistic notion, only measurable in part and random in nature. We now reconsider the more than 1 decade-old Fukushima nuclear disaster, the resulting eco- logical crisis that is ongoing, and the numer- ous protracted mitigation challenges. This clarification is especially true in light of the likelihood of a trigger event initiating cascad- ing hazards, such as the events that occurred at the Fukushima Daiichi Nuclear Power Plant. Threat is more descriptive for planning, opera- tional, and response considerations, and is spe-
cifically tied to the severity of consequences, or loss and harm. Described in kind, a hazard is an event or substance, many of which are human-caused, accidental, and associated with industry and technology, though attacks are intentional and deliberate. Hazards are modifi- able, manageable, and mitigatable. Through the process of clarifying emer- gency response terminology, we have devel- oped an updated situational picture of ongo- ing threats separating natural disaster trigger events from the continuing and potential new global health consequences caused by the release of human-caused hazards in Figure 1. In recording the continuous environmen- tal hazards presented by the Fukushima nuclear disaster from the first days of the disaster—while the world became concur- rently embraced by the uncertainty of a changing COVID-19 pandemic threat hori- zon—we were compelled to reconsider tra- ditional disaster and emergency management doctrine and the traditional emergency man- agement cycles. Our intention was to develop a template for preparedness that dually serves as an active barometer to track incident pro- gression and escalation and serves as a guide for evolving response adjustment. Our Public Health, Healthcare, and Emer- gency Management Command and Support Supersystem Model (Figure 2) that follows the one-picture disaster cycle heuristic tra-
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Volume 85 • Number 7
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