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by Walter G. Green III
Copyright 1998 by Walter G. Green III. All rights reserved. Permission to reproduce material from the JOURNAL is granted for academic research, library or other archives, or classroom instruction provided the source of material is acknowledged by appropriate citation.
INTRODUCTION
(1) This study examines the degree of integration of officers of emergency medical services in Virginia with disaster preparedness in their jurisdictions. Local disaster response depends on the jurisdictions' emergency services, including the emergency medical services. No previous research has examined the degree to which the emergency medical services in Virginia have prepared for disasters in conjunction with local emergency management agencies. This study describes current emergency medical services preparations in the context of five variables that may be indicators of integration with emergency management.
(2) Integrated community response is recognized by the Federal Emergency Management Agency as the basis of the Integrated Emergency Management System and Comprehensive Emergency Management. Comprehensive Emergency Management provides a theoretical foundation for disaster planning in communities, and defines four phases of disasters. Two of these, Preparedness and Response, require the involvement of public safety agencies (U. S. Federal Emergency Management Agency 1993, 1-8). The Integrated Emergency Management System provides a strategic and operational framework to translate Comprehensive Emergency Management into common approaches to deal with hazards (Drabek and Hoetmer 1991, xxi).
(3) These concepts have been understood by emergency medical services leaders for at least ten years. Erik Auf der Heide wrote in 1989 that disaster response problems were system problems involving breakdowns in how day-to-day emergency structures tried to respond to larger and more difficult events. He stressed that no single organization could address a disaster by itself, that the interdisciplinary actions of a variety of agencies interacted to create a solution (ix-x). In 1995 Auf der Heide again highlighted the importance of integration and pointed out that interagency and interdisciplinary planning remained a deficiency in readiness (ix).
(4) The Virginia Emergency Medical Services system offers an ideal environment for a study of integration. Local emergency medical services agencies serve a mixture of urban, suburban, and rural communities. These agencies include a variety of purely volunteer, volunteer supplemented by paid staff, governmental, and commercial services. Some 35,000 providers in over 700 agencies with over 2000 response vehicles provide services across the state.
METHOD
(5) The hypothesis of this study was that leaders of emergency medical services agencies would show a low level of integration with emergency management preparedness activities as measured by five variables on a survey questionnaire. A low level of integration in a functional area was arbitrarily defined as less than 30% "Yes" answers to a given survey question. A low level of overall individual integration was defined as "Yes" answers to two or fewer of the five questions by more than 50% of the respondents.
(6) I surveyed students in the 1997 and 1998 classes of the Virginia Emergency Medical Services Officer Training Course using a structured, written questionnaire. The Officer Training Course was introduced in 1997 to provide newly elected or appointed agency officers an overview of the programs administered by the Virginia Office of Emergency Medical Services. Six program presentations were made during each Course, with each session being offered twice. Students could attend four of the six presentations. The population surveyed was a convenience sample of those students attending the Disaster Management session.
(7) The questionnaire was distributed at the start of the Disaster Management session; respondents were asked to deposit it in a box as they left the classroom at the end. The questionnaire design ensured anonymity. The Questionnaire asked for "Yes" or "No" answers to five questions on the integration of agencies in their communities' disaster response system: (1) have you read your jurisdiction's emergency operations plan, (2) has your agency written its own disaster plan based on the city or county emergency operations plan, (3) have you participated in a drill or an actual disaster response in the past 12 months, (4) have you ever visited your jurisdiction's emergency operations center, and (5) have you completed either courses in disaster response taught by the Department of Emergency Services or Federal Emergency Management Agency home study courses?
(8) This method introduced potential sources of error. Administration during the Disaster Management session raises the possibility that respondents were more attuned to disaster response concerns and may have elevated the level of "Yes" replies over what might have been expected had the questionnaire been distributed in some other way. Second, the population was self-selected; they were there because of an interest in that presentation. Third, not all participants in the Course were sampled, only those in the Disaster Management sessions (57 of 115 in 1997 and 60 of 99 in 1998). And finally, there is no assurance that individuals attending either the 1997 or 1998 Courses were representative of all emergency medical services agencies. These limitations were accepted as reasonable given that the study is a preliminary examination of a topic not previously studied and that the study was not funded. If the results are not representative, the combination of increased awareness and self-selection would seem to argue that questionnaire responses should reflect a higher degree of preparedness integration that in the general population of all emergency medical services agencies.
(9) Because the data gathered in the study was nominal in nature (no numerical values can be assigned to either of the two possible responses of "Yes" or "No"), basic descriptive statistical methods were used to analyze the data. A database was created using SPSS software (SPSS 6.1 for Windows Student Version), and a statistical test of frequency was performed. I then used crosstabulation to compare specific variables that potentially showed relationships between planning and training.
DATA ANALYSIS
(10) A total of 99 participants completed the questionnaire, 44 in 1997 (of 57 attending for a response rate of 77.1%) and 55 in 1998 (of 60 attending for a response rate of 91.7%). The increased response rate in 1998 resulted from verbal reminders to complete and return the survey at the end of the session.
(11) When the responses were assessed, 57.6% of respondents had read the emergency operations plan (70.5% in 1997 and 47.3% in 1996), and 45.5% of the agencies reported having their own emergency plan (52.3% in 1997 and 40.0% in 1998). Officers had participated in a drill at a rate of 56.6% (61.4% in 1997 and 52.7% in 1998), and 33.3% had completed training courses (40.9% in 1997 and 27.3% in 1998). A high of 72.7% of officers had visited their community emergency operations center (77.3% in 1997 and 69.1% in 1998). In every category more "Yes" responses were received in 1997 than in 1998, indicating a possible difference between these two sub-populations. The questionnaire did not capture experience or position data that may explain this difference.
(12) A measure of the degree of officer participation in preparedness actions can be developed by totaling "Yes" responses as a score, with zero replies indicating a very low degree of integration, and five replies indicating a higher degree. The results were: five replies, 14.1% (20.5% in 1997, 9.1% in 1998); four replies, 18.2% (20.5% and 16.4% respectively); three replies, 18.2% (20.5% and 16.4%); two replies, 28.3% (22.7% and 32.7%); one reply, 11.1% (11.4% and 10.9%); and zero replies, 10.1% (4.5% and 14.5%). No attempt was made to weight the individual factors based on perceived importance.
(13) It appears there are clear differences between the 1997 and 1998 populations which may reflect the presence of more experienced individuals in the 1997 survey population. If values of three, four, and five "Yes" replies are used as an integration, 63% of the respondents are in this category in 1997 versus 41% in 1998.
(14) I examined three areas of the responses that appeared to be linked. First I crosstabulated responses to identify the relationship between an officer having read the jurisdiction's emergency operations plan and the agency having developed its own plan; 35.4% of the officers answered "Yes" to both. If the officer had not read the community plan (42.4% had not), it is possible his or her predecessors who prepared the agency plan also had not done so. Even if the writers of the plan were informed, an officer who had not read the emergency operations plan would have difficulty ensuring the execution of the agency plan would be in concert with the community's concept.
(15) I also crosstabulated having read the plan and participation in exercises or drills or actual disasters. Those individuals, 36.4%, who had both read the plan and participated in a drill or disaster should have performed their functions in concert with the plan and provided the most integrated response (allowing for the normal percentages of forgetfulness and reversion to daily habits when faced with an unusual event). At the same time those who had not read the plan, 42.4%, could be expected to have suboptimal responses and reduced learning in the drill situation.
(16) Finally, I crosstabulated participation in a drill with participation in Department of Emergency Services or Federal Emergency Management Agency training. Training should prepare participants for better performance in either a drill or a disaster, as well as making lessons learned in that experience more meaningful. At the same time participation in a drill reinforces and operationalizes the training received. Only 21.2% of the officers had done both.
(17) I administered the same questions to a panel composed of an emergency manager, an experienced volunteer rescue squad member, a former volunteer rescue squad officer, a former executive director of a regional emergency medical services council, and an experienced emergency medical services administrator. Each panel member was asked to answer based on their perception of ground truth of the percentage of agencies and officers who have actually performed the tasks in the questions.
(18) Panel members' mean assessment was that 15.0% of officers had read the jurisdiction emergency operations plan and that 6.8% of agencies had their own disaster plan. They assessed that 33.0% of officers had particpated in a drill in the last year and that 7.4% of officers had completed any disaster training. They estimated that 13.4% of officers had visited their jurisdiction's emergency operations center. Panel assessment of the integration of agency leaders is considerably lower than the officers' assessments, falling in the range from 6.8% to 33.0%, as compared to a range from 33.3% to 72.7% for the officers' self-assessment.
DISCUSSION
(19) The hypothesis was not proven. Using the 30% "Yes" response criteria, responses for all functions indicated at least a minimally acceptable level of integration with local emergency management preparedness programs. Although the completion of training courses in one year (1998) did fall below the criteria, the cumulative percentage of "Yes" replies met the criteria. Over 50% of the individuals surveyed did answer "Yes" to three or more questions.
(20) The values resulting from the surveys show three interesting characteristics. The 1997 survey results show a higher percentage of completion on all items. This appears reasonable as this was the first year in which the Officers Training Course was offered, which may have attracted the attendance of a more experienced group of officers (attendees actually included regional emergency medical services council executive directors and members of committees of the Governor's Emergency Medical Services Advisory Board). The 1997 data may not reflect a true picture of new officers serving initial appointments in their agencies, but rather more closely resemble an elite population.
(21) Second, there is a large disparity between what respondents reported and the assessment of agency readiness provided by the panel. This may be explained in at least four ways: (1) panel members are out of touch with realities in the field, (2) respondents responded how they felt the presenter would have wanted them to reply, (3) the respondents did not fully understand the questions, or (4) both respondent and panel answers are accurate but reflect a difference between an elite population of leaders and panel assessment of average performance. Further research is needed to determine the source of this disparity.
(22) Finally, if the values are an accurate reflection of the state of integration of better emergency medical services agencies with their jurisdictions' disaster preparedness activities, there are significant shortfalls that should be addressed. Even though the hypothesis set the integration level at 30%, this number should not necessarily inspire confidence.
(23) While the percentage of leaders who had visited their jurisdiction emergency operations center is high, other values do not reflect the same degree of integration. Of these individuals, 58% had read the basic document directing their response in a disaster, the emergency operations plan. Although 46% of the agencies report having their own disaster plan, 35% of the respondents were in agencies that had plans and had also read the emergency operations plan. In only these cases is it reasonable to expect that the agency's response will mesh with the community plan. Similarly, 36% of the respondents report having both read the plan and participated in a drill or actual disaster, and 21% had participated in both disaster-related training and a drill. If the cliche that "only perfect practice makes perfect" is true, it is reasonable to assess that planning and training for disaster response are not fully contributing to improved readiness.
CONCLUSION
(24) The issue of how well the emergency medical services are integrated into their community disaster response system is a significant one. This study indicates that, although some degree of integration has been achieved, significant shortfalls exist in how emergency medical services response training and planning match with local jurisdiction emergency management efforts. Further research is warranted to determine if data developed in this study is representative of a wider population.