JEM V20 N7 COVID-19 Special #3

Journal of EMERGENCY MANAGEMENT J E M Emergency Planning and Response Risk Management Disaster Recovery Business Continuity ® Volume 20 • Number 7 Special Issue on COVID-19 ISSN 1543-5865 JEM_V20N7_COVER1 3/14/2022 11:40 AM Page 1

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Emergency concerns cross borders—whether you are down the street or across the world. Today, being connected is more important than ever. Membership in IAEM connects you to emergency managers and disaster response professionals from all levels of government, as well as military, private sector, and volunteer organizations around the world. Join the #IAEMstrong Movement for Emergency Managers Join IAEM today and enjoy great member benefits. Members have exclusive access to: IAEM Jobs Board — Whether you are planning to hire or are looking for your next opportunity, the IAEM Jobs Board is the place for skilled emergency management professionals to build their organizations or further their career. Professional Certification — Becoming an Associate Emergency Manager (AEM®) or a Certified Emergency Manager (CEM®) gives you a critical competitive edge, while ensuring that your skills are sharp and your knowledge base is deep—a key to continued success! IAEMconnect – IAEM’s online EM community to help practitioners find their specific network within our broad profession! www.iaem.org Visit our website to see why membership in IAEM is the right choice for Emergency Management professionals Registration is Open! IAEM_FPg_Memb-MeetingAd_0223.pdf 1 2/16/23 1:14 PM

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The Transcultural Conflict and Violence Initiative has established itself as a hub of national and international security expertise and peace-building strategies. Our research has been presented to policy makers in the U.S and abroad, including at the White House, the U.S. State Department, the Department of Justice, NATO, the United Nations Security Council, U.S. Central Command, the F.B.I., the National Center for Analysis of Violent Crime and multiple metro-area police departments. Our experts are cited in national and international media. This include outlets such as CNN, Fox, MSNBC, NBC, NPR, PBS, the Wall Street Journal, Huffington Post, the New York Times, Newsweek, USA Today, Christian Science Monitor, International Business Times, Nigerian Times, the Atlantic, Newsweek, Rolling Stone and Voice of America. Faculty and students have recently published books with Oxford University Press, Columbia University Press, etc. Issues Focus Our interdisciplinary group of more than 20 faculty and doctoral students study the causes of and solutions to conflict and violence around the globe. Technological Transformations GSU scholars examine cutting-edge developments in AR, machine learning, data extraction, and online media campaigns. Worldwide Threats MENA-based groups, unstable states, and populations threatened by natural and man-made disasters. Solving Violence TCV explores governmental, technological, interpersonal, and media strategies to identify and respond to conflict and violence situations occurring around the globe. Critical Concerns • Radicalization and recruitment online • Information warfare • Political mobilization, political violence and terrorism • Biological and chemical weapons TRANSCULTURAL CONFLICT AND VIOLENCE College of Arts & Sciences

Enhance your education with a STUDENT SUBSCRIPTION to Journal of Emergency Management If you are a student in Emergency Management, you need to learn about the latest research and practice in this complex field. Professors and future employers expect your complete mastery of the current EM/DR/BC literature and its application in the field. Enhance Your Education, Subscribe Today! Published bi-monthly, every issue of Journal of Emergency Management is packed with information that will keep your education on track. Topics include: - Latest reseach and practice in emergency planning and response - Current topics in disaster recovery and business continuity planning - Emergency preparedness and response legislation - Emergency management today, tomorrow and in the future - Emergency communications - Preparation and evacuation of persons with disabilities, and more! - Over 500 peer-reviewed articles available online on an expansive range of topics. To start your student subscription to the Journal of Emergency Management, visit our website at: www.emergencymanagementjournal.com and create a user on our system. Then purchase a student subscription to the journal via the subscriptions tab. There are several options available including onlineonly, print-only and print plus online. Student subscriptions start at $99.50.* For fastest service, call us toll-free at 800-272-3227 Ext. 108, outside North American 781-899-2702. (* Canadian and Foreign rates higher due to increased postage costs for the print journal.) www.emergencymanagementjournal.com Scan here to access the current issue of Journal of Emergency Management now! 13210_NEW_JEM_STUDENT_AD_V10 10/29/2019 11:45 AM Page 1

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J E M Print Subscription Rates (Rates in US dollars): Individual: US $312; Canada $321; Foreign $387 Corporate: US $427; Canada $436; Foreign $494 Libraries: US $461; Canada $470; Foreign $506 Student Rate: US $99.50; Canada $111.50; Foreign $124.50 Single issues: US $75; Canada $100; Foreign $150 Subscription Information: Online, visit our website at www.emergencymanagement journal.com. By mail, submit your complete name, address, and zip code, attention: Journal of Emergency Management, Subscription Department, 470 Boston Post Road, Weston, MA 02493. Please enclose check, purchase order, or credit card number and expiration date with authorization signature. Student Rate requires photocopy of current student ID along with payment. Subscribers notifying the publication of an address change must submit an old mailing label and their new address, including zip code. No claims for copies lost in the mail may be allowed unless they are received within 90 days of the date of issue. Claims for issues lost as a result of insufficient notice of change of address will not be honored. Manuscript Submittal/Author Information (See Call for manuscripts) Quotations and Reprints: Quotations from Journal of Emergency Management may be used for purposes of review without applying for permission as long as the extract does not exceed 200 words of text, and appropriate credit is given to the Journal. Authorization to photocopy items for internal use of specific clients is granted by Weston Medical Publishing, LLC, provided the appropriate fee is paid directly to: Copyright Clearance Center (CCC), 222 Rosewood Drive, Danvers, MA 01923, USA, 978-750-8400. CCC should also be contacted prior to photocopying items for educational classroom use. Multiple reprints of material published in Journal of Emergency Management can be obtained by filling out the reprint order form in the publication, by calling 781-899-2702, or visit our Web site at www.emergencymanagementjournal.com. Trademarks and Copyrights: Journal of Emergency Management is a registered trademark of Weston Medical Publishing, LLC. All materials are ©2022 by Weston Medical Publishing, LLC. All rights reserved. Postal Information: Postmaster: Send address changes and form 3579 to: Journal of Emergency Management, 470 Boston Post Road, Weston, MA 02493. Disclaimer: The publisher and editors are not responsible for any opinions expressed by the authors for articles published in Journal of Emergency Management. Copyright 2022. Quotation is not permitted except as above. Duplicating an entire issue for sharing with others, by any means, is illegal. Photocopying of individual items for internal use is permitted for registrants with the Copyright Clearance Center, 222 Rosewood Drive, Danvers, MA 01923. For details, call 978-750-8400 or visit www.copyright.com. For electronic or hard copy reprints visit our website www.emergencymanagementjournal.com or www.emergencyjournal.com. 12234 02/23/22 Rev ax Published bimonthly by Weston Medical Publishing, LLC 470 Boston Post Rd., Weston, MA 02493 • 781-899-2702, Fax: 781-899-4900 E-mail: [email protected] • Web site: www.emergencyjournal.com or www.emergencymanagementjournal.com ISSN 1543-5865 Publisher Richard A. DeVito, Jr. Publisher Emeritus Richard A. DeVito, Sr. President Emeritus Eileen F. DeVito Editorial Coordinator Deborah Rines [email protected] Peer-Review Manager Allyson King [email protected] Advertising Manager Richard A.DeVito, Jr. [email protected] Sales & Marketing Director Richard A.DeVito, Jr. [email protected] Subscription Manager Brenda DeVito [email protected] 12234 3/11/2022 8:06 AM Page 1

J E MEDITORIAL BOARD Barbara Audley, DPA Western Washington University (Ret.), Bellingham, Washington Paul Barnes, PhD Head, Risk and Resilience Program Australian Strategic Policy Institute Canberra, Australia’ Richard A. Bissell, PhD Professor, University of Maryland– Baltimore County, Baltimore, Maryland B. Wayne Blanchard, PhD, CEM Past Director, Higher Education Project Emergency Management Institute, Federal Emergency Management Agency (FEMA), Department of Homeland Security, Emmitsburg, Maryland Hilda J. Blanco, PhD Research Professor; Interim Director, Center for Sustainable Cities, Sol Price School of Public Policy, University of Southern California, Los Angeles, California Paul A. Bott, EdD President, Paul Bott Associates, Inc., Los Alamitos, California Michael W. Brand, PhD Associate Professor, University of Oklahoma Health Sciences Center, College of Medicine, Department of Psychiatry and Behavioral Sciences, Oklahoma City, Oklahoma Anthony E. Brown, PhD, MPA Associate Professor and Coordinator, Oklahoma State University, Stillwater, Oklahoma Lucien G. Canton, CEM, CPP, CBCP Emergency Management Consultant, San Francisco, California Stephen Stuart Carter, MS Instructional Coordinator and Adjunct Faculty, Mid-Atlantic Center for Emergency Management, Frederick Community College, Frederick, Maryland Steven J. Charvat, CEM Emergency Management Director, University of Washington, Office of Emergency Management, Seattle, Washington George W. Contreras, DrPH(c), MEP, MPH, MS, CEM, EMTP Assistant Director, Center for Disaster Medicine; Assistant Professor, Institute of Public Health, at New York Medical College; Adjunct Associate Professor, John Jay College; Adjunct Professor, Metropolitan College of New York New York, New York John B. Copenhaver Chairman and CEO, Contingency Management Group, Alpharetta, Georgia Russell J. Decker, PhD, CEM Deputy Director, Ohio Emergency Management Agency, Columbus, Ohio Daniel E. Della-Giustina, PhD Professor, Industrial and Management Systems Engineering, Safety & Environmental Management Program, College of Engineering and Mineral Resources, West Virginia University, Morgantown, West Virginia Raymond V. DeMichiei, BA, EMT-P Deputy Director; WMD Coordinator, City of Pittsburgh, Office of the Mayor, Emergency Management Agency, Pittsburgh, Pennsylvania J. Eric Dietz, PhD Professor, Computer and Information Technology; Director, Purdue Homeland Security Institute, Purdue University, West Lafayette, Indiana Amy K. Donahue, PhD Professor and Department Head, Department of Public Policy, University of Connecticut, West Hartford, Connecticut Thomas Drabek, PhD John Evans Professor, Emeritus, Department of Sociology and Criminology, University of Denver, Denver, Colorado 12235 02/23/22 Rev aae William L. Waugh, Jr., PhD Editor-in-Chief Professor Emeritus, Department of Public Management & Policy, Andrew Young School of Policy Studies Georgia State University, Atlanta, Georgia 12235_12235.qxd 3/11/2022 8:05 AM Page 1

Roger E. Glick, MS, MBA, CEM, FACHE Fire & Emergency Management Consultant, RPA, a Jensen Hughes Company, Plainville, Connecticut Kay C. Goss, CEM Graduate Faculty, Metropolitan College of New York, University of Nevada at Las Vegas; Senior Fellow, National Academy of Public Administration; Board of Directors, Epsilon Pi Phi, Council for Accreditation of Emergency Management Education, Alexandria, Virginia Vincent E. Henry, CPP, PhD Professor and Director, Homeland Security Management Institute, A DHS National Transportation Security Center of Excellence, Long Island University, Southampton, New York Attila J. Hertelendy, PhD COVID-19 Special Issue Editor Associate Professor, Florida International University, Miami, Florida Thad Hicks, PhD, CEM, MEP COVID-19 Mental Health Special Issue Editor Professor of Emergency Management & Criminal Justice, Mount Vernon Nazarene University, Mount Vernon, Ohio Peter J. Hotez, MD, FAAP, PhD Founding Dean, National School of Tropical Medicine; Texas Children’s Hospital Endowed Chair in Tropical Pediatrics; Professor, Departments of Pediatrics and Molecular Virology & Microbiology, Baylor College of Medicine, Houston, Texas Andrea Jennings, DrPh, RN Senior Nurse Researcher, Geriatric Research Education and Clinical Center, VA Northeast Ohio Healthcare System, Cleveland, Ohio David Johnston, PhD Director, Joint Centre for Disaster Research, Massey University, Wellington, New Zealand Naim Kapucu, PhD Professor and Director, University of Central Florida, Orlando, Florida Karl Kim, PhD Professor, Urban and Regional Planning, University of Hawaii, Honolulu, Hawaii Daniel J. Klenow, PhD Professor, Department of Emergency Management, North Dakota State University, Fargo, North Dakota Bruce Lindsay, PhD Analyst, Congressional Research Service, Library of Congress, Washington DC John Roderick Lindsay, MCP Assistant Professor and Chair, Department of Applied Disaster and Emergency Studies, Brandon University, Brandon, Manitoba, Canada Valerie Lucus-McEwen, CEM, CBCP Professor, Emergency Services Administration, California State University, Long Beach, California David A. McEntire, PhD Associate Professor, University of North Texas, Denton, Texas Robert K. McLellan, MD, MPH Occupational Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire Edith F. Neumann, PhD Professor; President, TUI Institute of Learning, Touro University International, Cypress, California William C. Nicholson, JD Department of Criminal Justice, North Carolina Central University, Durham, North Carolina Corinne Peek-Asa, MPH, PhD Professor, Associate Dean for Research, Occupational and Environmental Health, College of Public Health, The University of Iowa, Iowa City, Iowa Danny M. Peterson, PhD Professor of Practice, Arizona State University, Mesa, Arizona Scot Phelps, JD, MPH, Paramedic, CEM/CBCP/MEP Professor, Emergency Management Academy, New York City, New York Brenda D. Phillips, PhD Dean, College of Liberal Arts and Sciences, Indiana University South Bend, South Bend, Indiana John C. Pine, EdD Director, Research Institute for Environment, Energy and Economics, Appalachian State University, (Ret.) Boone, North Carolina Randy Rapp, DMgt, PE Associate Professor, College of Technology, Purdue University, West Lafayette, Indiana Fernando I. Rivera, PhD Hurricane Maria Special Issue Editor Professor of Sociology and Director of the Puerto Rico Research Hub at the University of Central Florida, Orlando, Florida Scott Robinson, PhD Associate Professor and Bellmon Chair of Public Service, University of Oklahoma, Norman, Oklahoma Havidan Rodriguez, PhD Director, Disaster Research Center, University of Delaware, Newark, Delaware Abdul-Akeem Sadiq, PhD Assistant Professor, Indiana University Purdue University, Indianapolis, Indiana Robert O. Schneider, PhD Associate Vice Chancellor International Programs, University of North Carolina at Pembroke, Pembroke, North Carolina Robert M. Schwartz, PhD Professor of Emergency Management and Homeland Security, Center for Emergency Management and Homeland Security Policy Research, The University of Akron, Akron, Ohio Gary Leonard Simon, MD, PhD Professor of Medicine (Infectious Diseases), Biochemistry, and Molecular Biology, George Washington University Medical Center, Washington, DC Neil Simon, MA President, Incident Mitigation LLC, Southfield, Michigan Susan M. Smith, EdD, MSPH Associate Professor, Department of Applied Health Sciences, Indiana University, Bloomington, Indiana Christine Springer, PhD Professor and Director, Executive Master of Science in Crisis and Emergency Management, University of Nevada Las Vegas, Las Vegas, Nevada Richard T. Sylves, PhD Professor, Political Science Department, University of Delaware, Newark, Delaware Derin Ural, PhD Professor in Practice, and Associate Dean of Student Affairs, College of Engineering, Department of Civil, Architectural and Environmental Engineering, Coral Gables, Florida Steven Weinstein, MPH, PhD Environmental, Health & Safety Specialist, Abbott Laboratories, MediSense Products, Bedford, Massachusetts 12235_12235.qxd 3/11/2022 8:05 AM Page 2

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Seeking to accelerate our vision to be the exemplar catalyst for innovation and advancement of the profession of public health, locally and globally, the University of South Florida College of Public Health invites applications for a non-tenure earning teaching pathway faculty position at the rank of Assistant Professor to join our program in Global Disaster Management, Humanitarian Relief and Homeland Security. Ranked 16th nationally among public health degree programs by the 2022 U.S. News & World Report, the USF College of Public Health is a leader in the revolution that is revising traditional public health curricula, transforming the educational experience to meet the needs of 21st Century public health scholars and practitioners. This is a special opportunity to join a dynamic interdisciplinary faculty actively engaged in shaping the future of public health through innovative curricula, transformational research and community partnerships designed to create positive collective impact on at risk populations. In a changing world where people are vulnerable to natural disasters and acts of violence, the need for formal training programs designed to enhance the knowledge base of public health and other disaster management professionals is growing. To fill this gap, the GHH program prepares students at the undergraduate, masters and doctoral levels to recognize, assess, evaluate, and respond to global or local disasters. We seek an individual with experience in the area of emergency management, humanitarian relief, and/or global health security to join the college concentration of Global Disaster Management, Humanitarian Relief and Homeland Security (GHH). The University of South Florida is a high-impact global research university dedicated to student success. USF has numerous research and health care partnerships through agreements with hospitals and not-for-profit organizations in the metropolitan Tampa Bay area to include the James A. Haley Veterans Hospital, Tampa General Hospital and Moffitt Cancer Center (NCI-designate), as well as many other clinical, social and community based organizations. Over the past 10 years, no other public university in the country has risen faster in U.S. News and World Report’s national university rankings than USF. Serving more than 50,000 students on campuses in Tampa, St. Petersburg and Sarasota-Manatee, USF is designated as a Preeminent State Research University by the Florida Board of Governors, placing it in the most elite category among the state’s 12 public universities. USF is a member of the American Athletic Conference. With more than 16,000 employees, the University of South Florida is one of the largest employers in the Tampa Bay region. At USF you will find opportunities to excel in a rich academic environment that fosters the development and advancement of all employees. We believe in creating a talented, engaged and driven workforce through on-going development and career opportunities. We also offer a first-class benefit package that includes medical, dental and life insurance plans, retirement plan options, tuition program and generous leave programs and more. To learn more about working at USF please visit: Work Here. Learn Here. Grow Here (https://www.usf.edu/work-at-usf/index.aspx). Part of USF Health, which includes the core colleges of Medicine, Nursing, Public Health, and Pharmacy, and the schools of Biomedical Sciences and Physical Therapy & Rehabilitation Sciences, the College of Public Health was founded in 1984 as the first college of public health in Florida and consists of a multidisciplinary faculty of 84 scholars, professionals and leaders serving the educational needs of more than 4,500 students in bachelors, master’s and doctoral degree programs. COPH is organized into four Strategic Areas: Global and Planetary Health; Interdisciplinary Science and Practice; Policy, Practice and Leadership; and Population Health Science. Our faculty select their strategic area of interest and are encouraged to engage in transdisciplinary research and teaching with faculty from across the college. We are transforming curricula and degree programs at all levels; we are engaging in translational research and the translation of that research to practice; and we are committed to public health workforce and systems development, locally and around the world. In addition, COPH is the home of several Centers that conduct inter-professional research, policy and practice. See the COPH website at http://health.usf.edu/publichealth/ to learn more about our dynamic and innovative faculty and College. USF Tampa is located in a dynamic and growing metropolitan area of over three million residents and offers a wide-range of cultural, artistic, athletic and recreational activities, excellent public schools, close proximity to Gulf of Mexico beaches, and an affordable cost of living. See directions below to access the USF Careers posting for position minimum and preferred qualifications. Closing Date: Positions will remain open until filled. Review of complete applications will begin April 17, 2023. Salary & Benefits: Nationally competitive salary with excellent benefits. To apply: Candidates must complete an online application and upload the documents listed below to be considered for this position. Please visit www.usf.edu and access “Work at USF” and then click on Access Careers@USF and search for Job Opening ID 33279. Documents to be uploaded with the application include a letter of application addressing the advertised minimum and preferred qualifications for the position to which applying, a CV, and a list of three references. Review of application will not begin until all required documents are uploaded into Careers. References will not be contacted without notifying applicants in advance. According to Florida law, search records, including applications and search committee meetings, are open to the public. USF is an Equal Opportunity, Affirmative Action, and Equal Access institution. Applicants who need disability accommodations in order to participate in the selection process should notify Sheri Shakes at (813) 974-6494 or TDD (813) 974-1758 at least five working days in advance of need. ASSISTANT PROFESSOR, GLOBAL DISASTER MANAGEMENT AND HUMANITARIAN RELIEF

JEMCONTENTS JEM_19-4-00-TOC-samp_J 14/09/21 4:12 PM Page 5 EDITORIAL n Biosafety and infectious disease occupational health training from the NIEHS Worker Training Program: A historical look at capacity building that supported a COVID-19 response ........................................................................9 Eric Persaud, DrPH, MEA Deborah Weinstock, MS Demia S. Wright, MPH FEATURE ARTICLES n Recognizing and mitigating against COVID-19 consequence management impacts in emergency management organizations............................................................ 19 Michael Prasad, BBA, CEM® n Weaponizing mutual aid: Can a pandemic or biological attack turn our strongest emergency management tool against us? ...................................................................................... 29 Benjamin Thomas Greer, JD n COVID-19 data driven planning: The SouthEast Texas approach ............................................................................... 39 Adam Lee, MS Lori Upton, RN, BSN, MS, CEM Magdalena Anna Denham, EdD Jeremiah Williamson n Nonprofit capacities and emergency management during the COVID-19 pandemic: Insights from a Taiwan-based international nonprofit organization............................................. 57 Chin-Chang Tsai, PhD ChiaKo Hung, PhD Wei-Ning Wu, PhD n Innovative public health staff augmentation concepts during a global pandemic ............................................................... 71 Valerie Beynon, MA, CEM, FPEM Susan James, AA Amy Graham, BS Danielle Baxter, MPA Christina Stenberg, MPH, MEP n Applying the novel IDEA model for instructional health risk and crisis communication to explore the effectiveness of the COVID-19 crisis communication in Cameroon................... 77 Henry Ngenyam Bang, PhD JEM-TOC.indd 1 11/03/22 7:35 PM

JOURNAL LIBRARY RECOMMENDATION FORM Please forward this form to your librarian, library liaison, or serials review committee I recommend that the library subscribe to Journal of Emergency Management ® ISSN: 1543-5865 I recommend this journal for the following reasons: q REFERENCE: I will regularly use this journal, and will also suggest articles to colleagues and students. q BENEFIT TO LIBRARY: The journal’s high quality content will benefit the research and teaching needs of our institution. q MY AFFILIATION: I am a member of the editorial board and/or a regular contributing author and I strongly endorse this journal, and will use it regularly. q OTHER: ________________________________________________________________________ Please include this journal in your next serials review meeting with my recommendation to gain access to this journal for our library. Thank you. Signature: ____________________________________________ Date: ________________________ Name: _______________________________________________ Position: _____________________ Dept: _________________________ Tel: ___________________ Email: _______________________ INFORMATION FOR LIBRARIES Purchasing Options: Online Only Subscription – Journal of Emergency Management ® is available online with complete file of back issues. Print Subscription with Online Access – Hard copy of Journal of Emergency Management ® plus access to the online edition with complete file of back issues. Print Only Subscription – Hard copy of Journal of Emergency Management ®, no access to the online edition. Site License: Information needed for single or multiple site licenses: Subscriber Type, Country, Number and address of physical sites, Number of FTE’s per physical site (full and part time students, employees including faculty, staff, affiliated researchers). Online access is supported via IP address authentication or referring URL. Archive access after cancellation: Access to the back issues is available if the subscription is maintained. If the subscription is subsequently cancelled, archive access is also cancelled. More information about all purchasing options can be found online at www.emergencymanagementjournal.com or call 781-899-2702 x 108 for special quotes or assistance. Weston Medical Publishing, LLC 470 Boston Post Road, Weston, MA 02493 781-899-2702, Ext. 108, Fax 781-899-4900 www.pnpco.com 13124 Rev. f 3/07/19 13124_Layout 1 3/11/2022 8:04 AM Page 18

13274 05/26/22 Rev.A Stay up to date! Visit www.emergencymanagementjournal.com and sign up as a user to receive free alerts of new articles published. To subscribe to JEM, visit www.emergencymanagementjournal.com, Register as a user and click on “Subscription Information” link to order your subcription, or contact 781-899-2702 ext.108 or email: [email protected] for immediate service. CALL FOR PAPERS Sustainability and Climate Change in Emergency Management The Journal of Emergency Management (JEM) Editorial Review Board invites the submission of original research, papers, and case studies supporting a special issue titled: Emergency Management, Climate Change and Sustainability – Integrating New Research to Mitigate Disasters and Protect the Planet. The special issue will focus on the intersection of Emergency Management and Climate Change as well as the trend toward integrating new, leading edge, sustainability research and practice into pre-disaster planning and mitigation and post-disaster reconstruction. The special issue will be led by guest editor, Professor Attila J. Hertelendy, PhD, MHA, MS, who has extensive experience as an emergency management and disaster medicine practitioner and an academic researcher with the Global Consortium on Climate and Health Education, Columbia University, Mailman School of Public Health. Dr. Hertelendy is joined by current Editor-in-Chief, Dr. William L. Waugh, Jr., who will team up with a special group of peer reviewers focused on reviewing research and content as quickly as possible to disseminate real time information to the field. We will have a series of guest editors who will share their thoughts on the changing role of emergency managers. Background We present this call for papers with a statement. Climate change is real and ongoing. This special issue will not debate the cause of climate change. The focus is on the future integration of emergency management and sustainability research to manage the effects of climate change through risk mitigation and loss prevention at the emergency management level. This special issue will present the latest research and practice as emergency managers integrate with sustainability committees across the globe to mitigate the trend towards rising frequency and intensity of major weather events across the US and the world. This special issue will be a must-read for those in emergency management, government, sustainability, and public health professions. The goal is to create a reference work that can be utilized by those in the field including actionable research, case studies, and practical applications. This special issue will be available as a print issue and a “living issue” will be updated continuously online as new manuscripts are received. All manuscripts will be processed through the standard JEM double-blinded peer-review process. Journal of Emergency Management invites academics and professionals in private and public organizations to submit papers for this special issue and suggests the following partial list of topics for submission: ■ Exploring the Intersection of Climate Change, Emergency Management, and Public Health ■ Legislative and Public Policy Changes to Improve Pre- and Post-Disaster Sustainability and Resilience ■ Emergency Managers and Their Integration with Community Sustainability Committees ■ Cost Effective Mitigation Techniques that Enhance Local Community Sustainability and Resilience ■ Educating Politicians on the Importance of Integrating Sustainability into Pre-Disaster Mitigation Efforts ■ Integrating Established and New Practices to Mitigate Disaster Losses in At-Risk Populations and Underserved Communities ■ Improving Resilience Utilizing State-of-the-Art Sustainability Practices at the Local, State, and Federal Level ■ Health Resiliency and Climate Change Policy ■ Public Private Partnerships in Climate Change and Health Education ■ Catastrophic Planning and Response through the Sustainabilty and Resilience Lens Review Process: We will conduct a quick initial review of submissions to assure a fit with the type of articles published in this special issue. A full double-blinded peer-review will follow. If you want to be considered for the pool of reviewers for this special issue, please send an email of interest and your CV or short resume to [email protected]. Manuscript Submission and Information: Author information and manuscript submission is available on the Journal of Emergency Management Manuscript Submissions page located here: https://www.wmpllc.org/ojs/index.php/jem/pages/view/Manuscript Deadlines: Manuscript submissions will be accepted through the end of Q4-2022 and will be placed in the special issue of JEM. Article Types: We will review articles across the spectrum including original papers, research, best practices, creative solutions, brief communications, short reviews of existing programs, as well as creative solutions. Additional documented modalities for managing the topics above will be reviewed with the goal of sharing useful cutting edge tools to improve and/or address emergency management and sustainability research to manage the effects of climate change through risk mitigation and loss prevention. Article Length: Our traditional article length limit is 3,500 words. We will address length limitations on a per article basis. Additional Media Formats: We will accept non-paper based submissions (video, powerpoint, etc) as long as they include the standard JEM abstract format, all citation details, and all rights are cleared and assignable. Please contact our office for more details. Help: Questions may be directed to the email above or to our offices at 781-899-2702 Ext. 114 or 108, Monday - Friday, 9am-4pm EST. 13274_CFP_EM_and_Climate_Change 5/26/2022 11:29 AM Page 1

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9 Journal of Emergency Management Vol. 20, No. 7 Special Issue on COVID-19 Biosafety and infectious disease occupational health training from the NIEHS Worker Training Program: A historical look at capacity building that supported a COVID-19 response Eric Persaud, DrPH, MEA Deborah Weinstock, MS Demia S. Wright, MPH BACKGROUND The COVID-19 pandemic demonstrated that large segments of the workforce—many of which were not previously considered or valued—are needed to keep the economy moving and critical societal functions going. From first responders to bus drivers, this expanded essential workforce needed training to build a solid knowledge of infectious disease protection practices. However, most workplaces had no existing plan or training for infectious disease exposure control. The National Institute of Environmental Health Sciences (NIEHS) Worker Training Program (WTP) was able to immediately respond with health and safety curricula, resources, and course delivery based on decades of building capacity for disaster and infectious disease response. WTP was initiated under the Hazardous Substance Basic Research and Training Program authorized by the Superfund Amendments and Reauthorization Act of 1986 (42 USC 9660a), in response to the growing concerns about hazardous waste cleanup endangering worker health.1 NIEHS WTP, at the National Institutes of Health (NIH), funds nonprofit organizations throughout the United States (US) to provide health and safety training to prepare workers who may be exposed to hazardous materials at work or while assisting with emergency response. Additionally, some grants are awarded to small businesses to develop e-learning products through the Small Business Innovative Research program.2 WTP’s network reaches a wide variety of industries and occupations, such as construction; environmental remediation; manufacturing; industrial; health care; first responders; retail; and federal, state, and municipal employees. The organizations provide training not only to the traditional workforce but also to the groups that can be hard to reach or may not have easy access to health and safety education, such as day laborers, Native Americans and Alaska Natives, and un- or underemployed individuals. WTP also funds the National Clearinghouse for Worker Safety and Health Training (the Clearinghouse) to develop training resources and provide technical assistance to WTP-funded organizations and the public.3 WTP aims to empower workers to take actions that improve safety and health in their workplaces and can lead to organizational change.4 WTP’s model includes extensive training of worker-trainer or peer instructors, resulting in a cadre of trainers across occupations and industries. These trainers can further disseminate training and education within their workplaces and communities, increasing the sustainability of meeting local or regional training needs and building the program’s nationwide capacity for response to ongoing and new hazardous work situations and emergencies. WTP funding also supports the development of curriculum and other occupational safety and health training materials. DOI:10.5055/jem.0663 Journal of Emergency Management Vol. 19, No. 8 9 Special Issue on Puerto Rico Hurricane Maria, similar to other recent emergency events, continues to remind emergency management of the continuous threats communities encounter. Years prior to Hurricane Maria, Puerto Rico was experiencing dire economic conditions which accelerated when the government declared bankruptcy in 2014. Austerity measures were put in place to confront the growing public debt resulting in higher taxes, a crumbling infrastructure, and economic restrictions impacting pensions and other social services. On top of these economic struggles, Puerto Rico experienced catastrophic damages from Hurricanes Irma and Maria. The aftermath of these storms and the subsequent experiences with seismic events and the COVID-19 pandemic are reminders of the complexities emergency management is currently facing. As the frequency and intensity of major weather events continues to rise there is a need for a holistic understanding for emergency managers to better mitigate, prepare, response, and recover to disasters and emergency situations. This special issue provides such understanding. Grounded on the nexus between energy, water, and food, this collection of manuscripts explores the emergency management challenges faced in Puerto Rico in relation to several areas of inquiry, including housing, agriculture, the hospitality industry, communication, health and mental health, public health, and access to healthcare services. These studies not only identify some of the challenges faced in these contexts but provide recommendations and tools to use in future emergencies. It touches on disaster population displacement, of particularly importance to Puerto Rico, which has seen its population decline from 3.7 million in 2010 to 3.3 million in 2020 with an accelerated exodus after Hurricane Maria. Other topics include disaster planning and response to vulnerable populations such as those in correctional facilities. The issue also raises awareness of inclusive governance for long-term recovery plans and processes. In addition to practical guides and outreach tools to handle other hazards triggered by Hurricane Maria such as landslides. The pre- and post-experience of Puerto Rico from Hurricane Maria, while unique in its challenges and scope, does provide an example of the changing nature of events that emergency management needs to contend with. Economic struggles coupled with the aftermath of hurricanes, landslides, drought, tornadoes, floods, and pandemics reveal how cascading disaster and emergency events provide the context in which emergency management operates. This special issue raises the awareness of this reality and provides a comprehensive look, not only of the challenges, but potential solutions and recommendations on how to deal with the ever-changing nature of emergency management. Fernando I. Rivera, PhD, Professor of Sociology and Director of the Puerto Rico Research Hub at the University of Central Florida. He has established an ongoing research program in the fields of medical sociology/sociology of health, race and ethnicity, and the sociology of disasters. He has studied the differential patterns of health among Puerto Ricans in the United States and investigated factors associated with disaster resilience, restoration and resilience in coupled human-natural systems, and climate migration. DOI:10.5055/jem.0601 Editorial JEM Analysis of pre- and post-disaster management and recovery in Puerto Rico from Hurricane Maria Fernando I. Rivera, PhD, Special Issue Editor Rivera_Editorial_JEM.qxd 9/15/2021 2:18 PM Page 9 01-SA-Weston-JEM#210079.indd 9 12/03/22 11:13 AM

10 Journal of Emergency Management Vol. 20, No. 7 Special Issue on COVID-19 WTP’s first large-scale disaster response followed the terrorist attacks on September 11, 2001 (9/11). WTP responded to the occupational safety and health training needs of cleanup workers, emergency responders, and others at risk of exposure to hazardous substances in the debris.5 In the following years, the National Response Plan (NRP) was developed, a guide on how the nation responds to disasters and emergencies. The NRP evolved into the National Response Framework (NRF) and NIEHS WTP was included in the framework under the Worker Safety and Health Support Annex, allowing the Occupational Safety and Health Administration to request training assistance during a disaster. This role in the NRF supports WTP as a recognized and trusted partner in Federal disaster response efforts.6 Also under Homeland Security Presidential Directive-8, crane operators, heavy equipment, and other workers were recognized as first responders under the title, “skilled support personnel” highlighting the need for disaster health and safety training for workers that WTP grantees have relationships with.7 Over time, WTP has responded to various disasters and crises facing workers nationally and has taken an all-hazards approach to emergency response. In this, WTP recognizes that workers need training to protect themselves against multiple types of hazards and focuses on developing key knowledge and skills that can be used in a variety of responses. This has included responding to multiple infectious disease events, delivering biosafety trainings across worker populations with exposure risk (Figure 1). Figure 1. Timeline of capacity building of NIEHS WTP for infectious disease response. IDRT refers to the Infectious Disease Response Training Program. 01-SA-Weston-JEM#210079.indd 10 12/03/22 11:13 AM

11 Journal of Emergency Management Vol. 20, No. 7 Special Issue on COVID-19 EARLY TRAINING ON INFECTIOUS DISEASES Some WTP grantees provided training to prevent Lyme disease and Hantavirus to construction workers in the late 1990s and early 2000s. With the promulgation of the blood-borne pathogen standard in 1991, that became another key health and safety course for WTP grantees.8 When safer needlestick legislation was passed in 2000, some grantees began delivering modules on safer needle selection in the healthcare sector. First receiver courses, to protect hospital-based first receivers of victims from mass casualty incidents involving the release of hazardous substances were provided as early as 2004. ANTHRAX RESPONSE 2001 One week after the 9/11 terrorist attacks, a series of anthrax attacks occurred in the US. Letters containing anthrax spores were mailed to news media offices and US Senators and resulted in the deaths of five people, including two postal workers.9 The incidents brought to the forefront the need to enhance US biological warfare preparedness and prepare workers for exposure to biological contaminants.* WTP held a workshop following the 9/11 and anthrax responses, reflecting on lessons learned from individuals who delivered training and actively participated in cleanup or remediation.8 The workshop session on biological and chemical threats and anthrax response aimed to understand training revisions necessary for future infectious disease events. The issues considered included looking at longerterm health effects of exposure rather than just immediate health outcomes; broadening the reach of audiences beyond cleanup workers and first responders; addressing misinformation for those instructing training; keeping training materials up-to-date with the latest anthrax-monitoring guidance; rethinking personal protective equipment and protective measures; and revisiting the appropriate level of response for the typical worker, who is not an emergency responder, to be engaged in. Conclusions critical to WTP future planning included that training materials should be “evergreen,” which refers to keeping materials flexible and current to reflect the most up-to-date science and technology, and that anthrax training materials can form the basis of curriculum for other and future infectious disease agents. AVIAN AND SWINE INFLUENZA OUTBREAKS IN 2006 AND 2009 WTP awarded four avian influenza (Avian Flu) preparedness training supplemental grants in 2006,10 supporting the development of biosafety tools and curricula to protect high-risk workers who were preparing for and responding to the outbreak. The highrisk workers were defined as health care workers, emergency responders, and poultry workers. By this time, the Clearinghouse had been developing and distributing training tools, slide sets for several years that provide health and safety guidance for those who involved in a specific type of disaster response and cleanup activities. The Clearinghouse developed “Protecting Yourself from Avian Influenza” in response to the need for worker safety awareness level training using federal agency standards and guidance, such as Occupational Safety and Health Administration and National Institute for Occupational Safety and Health.11 The Clearinghouse Avian Flu training tool, available in English and Spanish, provided awareness level education and training for funded organizations and the broader occupational safety and health community to use. The tool included modules on avian influenza awareness; working in avian influenzainfected areas; and controlling general hazards such as animals and insects, blood-borne hazards, heat and cold stress, and confined spaces. The training tool contained in-depth instructor notes on the slides which were made available through the Clearinghouse’s webpage. The tool covered avian influenza basics and symptoms and transmission, specific hazards and protective measures for high-risk workers, coping with traumatic stress, and general risks to injury and illness. Representatives from the US Department of Agriculture (USDA) Animal and Plant Health *Dates in headers are representative of when an event first occurred. An event response may go beyond the year provided. 01-SA-Weston-JEM#210079.indd 11 12/03/22 11:13 AM

12 Journal of Emergency Management Vol. 20, No. 7 Special Issue on COVID-19 Inspection Service (APHIS), other USDA agencies, the Environmental Protection Agency, and the North Carolina Department of Agriculture provided feedback on the training tool during a meeting in April 2007, as these agencies and organizations would be involved in a response. Obtaining their expertise and input was critical and supported buy-in for using the tool. In September of 2007, approximately 300 representatives from government, labor, and industry convened for an NIEHS and USDA APHIS sponsored conference, “Protecting Avian Influenza Responders.” The conference brought together agencies and organizations likely to be involved in an avian influenza response to discuss, coordinate, and participate in a practice exercise for such an event.11 Presentations and breakout sessions focused on sharing online tools, training, and outreach and communication initiatives. The Clearinghouse also developed “Protecting Yourself from H1N1 in the Workplace” in response to the safety and health awareness needs for responders to Swine Flu (the H1N1 virus) in November 2009.12 WTP was able to adapt the Avian Flu training tool for the needs of workers at risk to H1N1. The H1N1 training tool followed a similar module outline as the Avian Flu training tool, including H1N1 basics, assessing the risks of exposure to H1N1 in the workplace, and methods to prevent infection. From the years 2009 to 2011, the funded organizations trained more than 1,900 workers for H1N1 in the workplace. MOLD REMEDIATION TRAINING FOLLOWING HURRICANES KATRINA (2005) AND SANDY (2012) Communities were devastated from flooding and water damage following the hurricane disasters of Katrina in 2005 and Sandy in 2012.13,14 Water damage to buildings and homes following hurricanes can lead to conditions where mold, a biohazard, can grow. Molds can also produce a number of biochemicals that are harmful to human health.15 WTP recognized the need to prepare workers who were engaged in smallscale mold cleanup and treatment of flood damage, and had held workshops in 2004 to develop guidelines for the protection and training of workers engaged in maintenance and remediation work associated with mold. Additionally, WTP received federal disaster funding after both hurricanes to complete activities such as providing health and safety training to recovery workers and their supervisors, providing technical assistance as needed, and participating in a mold task force.13,14 WTP trainers from grantee organizations responded locally to educate cleanup workers and those in the affected community on hurricane and flood response health hazards.16,17 Site assessments found mold to be among the most hazardous issues workers were facing in hurricane and flood response efforts.14 After hurricane Katrina, the Clearinghouse created “Safety Awareness for Responders to Hurricanes: Protecting Yourself While Helping Others,” and after Sandy, created “Mold Cleanup and Treatment Orientation” and a guide “NIEHS Disaster Recovery: Mold Remediation Guidance, Health and Safety Essentials for Workers, Volunteers, and Homeowners.” Overall, WTP trained more than 23,000 workers after Hurricane Katrina, and more than 6,000 after Hurricane Sandy.14 The Clearinghouse provided tens of thousands of booklets for distribution in multiple languages. The mold cleanup training and resources from WTP provided urgently needed health and safety information to cleanup workers, homeowners, and business owners. These hurricane and flood response training tools and curricula have proved invaluable as WTP and its funded organizations have been called to support cleanup and recovery efforts following other major hurricanes, such as Matthew (2016), Harvey (2017), and Maria (2017). The responses have included onsite training for vulnerable communities and day laborers in the immediate days and weeks following a storm and training for organizations involved in the long-term recovery process.18-20 As of May 2021, the Clearinghouse has distributed 150,916 hurricane and flood booklets in English, Spanish and Vietnamese, and 62,354 mold booklets. EBOLA VIRUS DISEASE PREPAREDNESS TRAINING 2013-2020 Congressional funding via the Centers for Disease Control and Prevention (CDC) provided WTP with Ebola emergency supplemental appropriations in 01-SA-Weston-JEM#210079.indd 12 12/03/22 11:13 AM

13 Journal of Emergency Management Vol. 20, No. 7 Special Issue on COVID-19 2014 for worker health and safety training activities during the Ebola outbreak.21 With input from key stakeholders, WTP and the Clearinghouse conducted a needs assessment and gap analysis and developed training tools for both awareness and operations-level infectious disease response courses.22 The resulting report discussed gaps in integration between public health, medical, occupational health, and worker safety activities; the lack of protective guidance informing the full spectrum of workers; and the difficulty of sustaining a high level of readiness and worker competency. WTP worked to address these gaps as it implemented the Ebola Biosafety and Infectious Disease Response Worker Training Program (IDR), funding eight grantees to deliver courses on Ebola and prepare for future infectious disease events.23 The program trained workers across occupations and industries who may be exposed to infectious diseases. Over the life of the IDR program (June 2016–May 2020), the funded organizations trained approximately 44,000 workers in 1,900 courses with more than 165,000 contact hours, with in-person training occurring across the US and Puerto Rico.24 Over 40 new curricula were developed under this program. The gap analysis also indicated a need to clarify the use of pathogen safety data (PSD) resources for workers who have a potential for exposure to infectious agents. WTP created a PSD Guide to address this gap.25 The PSD Guide reviews existing PSD resources, their strengths and limitations, and explains how to access them. An accompanying training module was also developed. The IDR-funded organizations reported two common challenges for training delivery.21 First, there was a lack of motivation for infectious diseases that are not in the news from organizations. Second, it was difficult to get the commitment of workers and organizations for longer courses needed to provide operational-level training and in some instances for shorter awareness level training. Additionally, researchers involved in one WTP-funded grant program found that without an apparent threat of Ebola or other highly infectious diseases, public interest was reduced, and government resource allocations shifted elsewhere.26 Efforts to sustain training beyond the program’s duration included certification of training courses for continued education credits and integrating infectious disease topics into broader curriculum and other programs.22 Due to sustained funding over the multiple program years, IDR organizations were able to quickly add in information and deliver training on new infectious diseases as they arose, such as Zika in 2015- 2016 and COVID-19 in the program’s final months. The IDR program demonstrated the importance of continued capacity building and regular funding support to respond to infectious disease events. The capacity and funding allow immediate delivery of training courses and give workers access to the education and skills they need to protect themselves from exposure. COVID-19 PANDEMIC In March 2020, the federal government declared a state of emergency due to the COVID-19 pandemic.27 First responders, healthcare workers, and a variety of other frontline essential workers were at the highest risk of exposure to SARS-CoV-2. The COVID-19 pandemic also demonstrated health disparities in working conditions, as lower income and essential workers were at greater risk of exposure to SARS-CoV-2, and the chronic health conditions that are associated with higher severity of COVID-19 are disproportionately found in occupations and industries with stressful working conditions.28 At this time, WTP had nearly 30 years of hazardous waste worker and emergency response experience and nearly two decades of infectious disease preparedness and response training, capacity building, and lessons learned. The program was in a position to immediately develop, implement, and disseminate occupational safety and health and infection control training to the breadth of worker sectors facing exposure. WTP mounted a rapid, robust response through congressional supplemental funding from the Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 and through other WTP funding mechanisms. In March and April 2020, the Clearinghouse created training tools on general awareness and on essential and returning 01-SA-Weston-JEM#210079.indd 13 12/03/22 11:13 AM

14 Journal of Emergency Management Vol. 20, No. 7 Special Issue on COVID-19 workers.29 WTP further created technical resources for grantees such as a Train-the-Trainer course, best practices, factsheets, and webinar presentations and funded grantee organizations to deliver training and develop technological tools to train workers. WTP conducted a COVID-19 needs assessment in mid-2020 to explore COVID-19 training efforts and challenges.30 The needs assessment findings included that all Ebola IDR program grantees noted that the transition to COVID-19 was relatively easy. The grantees were able to build on the Ebola curricula and use their cadre of infectious disease trainers to begin their COVID-19 health and safety response. Many grantees noted that general NIEHS WTP funding helped them transition and continue training during the COVID-19 pandemic. In the needs assessment and regular grantee meetings, WTP grantee organizations also stated many challenges that had to be addressed as they trained their worker populations, several similar to those discussed during the Anthrax response. Some audiences were difficult to reach, and others had issues with technological fluency, comfort, and accessibility for training in an online setting, which was required for many audiences due to restrictions on face-to-face interactions. Other topics included broadening the reach of audiences, addressing misinformation, keeping training materials up-to-date, and understanding guidance and best practices for personal protective equipment and protective measures. Overall though, trainers and organizations rose to the occasion and adopted virtual technology or instituted safe in-person practices to successfully continue sharing important information with impacted workers, including new audiences previously unreached by grantees.30 As of May 2021, more than 70,000 workers have been trained on COVID-19 by WTP grantees. WTP and the Clearinghouse continue to develop and share resources as the pandemic shifts, such as fact sheets on vaccines and the selection and use of portable air cleaners to protect workers from exposure to SARS CoV-2. Additionally, WTP recently funded COVID19 Recovery Centers, which will partner with local businesses, community organizations, and worker centers to assess COVID-19 health risks, train workers, and promote resilience and recovery by connecting communities facing disadvantage to social services, referrals for housing and food, and accessibility to COVID-19 vaccinations.31 UNDERLYING THEMES: RESILIENCE AND RESEARCH IN DISASTERS Throughout the COVID-19 pandemic, mental health has been a great concern for first responders and essential workers, with the unusually long and arduous demands of them. Many grantees delivered resiliency training to support their worker populations, based on curricula developed in earlier years. Following the 9/11 response, WTP began to emphasize the need to address responder mental health in some of their programs. Following the 2010 BP Oil Spill response, WTP recognized the need to address unmet mental health and resilience needs among clean-up workers. With funding from the Substance Abuse and Mental Health Services Administration, they developed behavioral health training for communities impacted by disasters by launching the Gulf Responder Resilience Training Project in 2012.32 Awareness-level training materials were developed for disaster-impacted workers, including those in response, recovery, and rebuilding activities; supervisors; and care providers, such as community care centers, health-care facilities, and disaster recovery centers. Since then, WTP and its grantees regularly integrate disaster resilience materials into broader training programs and disaster responses. In a randomized clinical trial, researchers found that Hurricane Sandy disaster workers who participated in the Disaster Worker Resiliency Training Program had reduced mental health symptoms at a 3-month follow-up.33 The use of the resilience training in multiple disasters, including COVID-19, demonstrates the ongoing importance of this curriculum and the need to integrate this topic into future infectious disease events. Additionally, the ability of researchers to implement studies and collect environmental health data during disasters has been a focus for NIEHS for 01-SA-Weston-JEM#210079.indd 14 12/03/22 11:13 AM

15 Journal of Emergency Management Vol. 20, No. 7 Special Issue on COVID-19 Table 1. Lessons learned from WTP’s infectious disease response programs Topic Lesson learned Example from WTP’s response from Ebola and COVID-19 When infectious diseases are not an apparent threat When infectious diseases are not an apparent threat, training becomes less of a priority by employers and workers, public interest is reduced, and government resource allocations shift elsewhere. Under WTP’s Ebola IDR program, which mostly occurred in the years following the height of the epidemic in the US, grantees found it difficult for organizations and workers to commit to the longer courses that are needed for operations-level training. In some cases, was even difficult for them to commit to the shorter awareness-level training. Stable funding of an infectious disease response training program When there is stable funding of an infectious disease response training program, organizations can quickly pivot and respond to a new infectious disease event. If that is not in place, immediate supplemental funding allows for a more robust early response with increased capacity to delivery worker health and safety training. Six grantees were still funded under the WTP Ebola program through May 2020 and reported that the grant infrastructure, training curricula, and connections helped them transition easily to the COVID-19 response. Training curricula and train-thetrainer programs Development of a training curriculum or slides and delivery of a train-the-trainer program by a central/ funding organization allows for sharing across the occupational health and safety network and is instrumental in disseminating key knowledge to unions, businesses, community organizations, and other partners. All training organizations must work to keep the training curricula up-to-date (or “evergreen”) as the science progresses and clarify facts versus myths for trainees. At the beginning of COVID-19, the combination of NIEHS training tools and training programs developed by previously funded infectious disease grantees created a national network prepared to respond quickly. Training tools have needed several updates throughout the pandemic, and WTP and grantees have revised to explain developing issues, such as worker protection and vaccines. Pathogen safety data resources Pathogen safety data (PSD) resources for workers clarify the use of existing materials for workers and organizations, teach workers how to research the characteristics of infectious pathogens that they may be exposed to, and help organizations develop infectious disease risk assessments and control plans. The lack of PSD resources was identified as a gap at the beginning of the WTP Ebola IDR program, so WTP developed a PSD Guide and a PSD Training Module. These materials clarify the use of PSD resources currently available for the development of infectious disease occupational exposure control plans across industries. Skills-based training Ongoing hands-on, skills-based training and practice drills give workers experience in how to properly put on or take off personal protective equipment without contamination. This is a critical skill during a highly infectious disease event but is not a regular activity for many workers. WTP grantees under the Ebola IDR program delivered more than 140 operations-level infectious disease response courses that were between 8 and 40 hours in length, between June 2016 and March 2020. These courses provided hands-on skills to workers, helping to keep them ready for the next infectious disease event. Reach to broad worker population sectors The health and safety training provided to workers should reach a large variety of sectors that are at risk for exposure to the infectious disease. Under Ebola IDR and COVID-19, WTP grantees reached first responders and healthcare workers, but also an extensive list of other worker sectors including environmental service workers, sanitation workers, and domestic cleaners; construction trades; death care; airline and airport workers; public transportation workers; grocery and retail workers; food processing workers; manufacturing workers; and nail salon technicians. 01-SA-Weston-JEM#210079.indd 15 12/03/22 11:13 AM

16 Journal of Emergency Management Vol. 20, No. 7 Special Issue on COVID-19 several years. To address this, the NIEHS developed the Disaster Research Response (DR2) Program, focusing on improving timely research in response to disasters and public health emergencies.34 WTP has worked closely with DR2 over the years, including bringing partners together during disaster recovery, developing a guide for researchers involved in disaster responses, and helping conduct training workshops in partnership with local, state, and federal agencies; universities and research institutes; industry; and community groups to strengthen local capabilities for conducting research.35 DR2 has played an important role in NIH’s COVID-19 response, compiling survey tools and disseminating researchers” findings. This partnership helps ensure that impacted workers and communities needs are considered in disaster research, including during biosafety emergencies. CONCLUSION NIEHS WTP has been building its capacity to respond to infectious disease and biosafety events over nearly three decades. WTP has gathered lessons learned throughout that may support future occupational safety and health biosafety responses (Table 1). With sustained funding, technical resources, and a network of nationwide programs, WTP can remain in a position to provide occupational safety and health and infection control training that protects at-risk worker populations. Specific disaster-related funds for worker health and safety training such as during Hurricanes Katrina and Sandy, the Deepwater Horizon oil spill, Ebola, and COVID-19 greatly increased WTP’s capacity to support training delivery and development of technical assistance resources, including preparedness for future infectious disease events. Additionally, the Clearinghouse has played an important role in the creation and dissemination of training materials, lessons learned, and reports that enable WTP resources to reach a wide audience in a timely manner (Figure 2). WTP implemented a nimble and timely response to the novel SARS-CoV2 virus and COVID-19 disease. The response was based on years of disaster and biosafety curricula development, increased grantee expertise and capacity, lessons learned, and trusted partnerships with a wide variety of health and safety leaders. WTP quickly and effectively filled COVID-19 knowledge gaps with training resources, funded grantees to implement training across the country, and ensured vulnerable populations were included. WTP will continue to implement lessons of past responses to prepare for future infectious disease outbreaks, as it built off previously developed resources, infrastructure, and training capacity to swiftly respond to the COVID-19 pandemic with the delivery of occupational health and safety and infection control training programs. Table 1. Lessons learned from WTP’s infectious disease response programs (continued) Topic Lesson learned Example from WTP’s response from Ebola and COVID-19 Vulnerable population outreach Education and outreach to vulnerable and hard-toreach communities can help ensure people receive accurate health and safety information when their job or personal situation does not allow them to participate in traditional training. NIEHS and WTP grantees have developed outreach beyond the classroom during COVID-19 that includes podcasts, videos, fact sheets, social media events, and technical assistance. Mental health and resilience It is important to address mental health and disaster resilience needs of responders and community members and integrate these resources into infectious disease and broader disaster training programs. WTP developed the Responder and Community Resilience training tool after the Gulf Oil Spill in 2012. Since that time, the course has been delivered by many grantees and integrated into disaster response trainings after hurricanes, within the WTP’s Ebola IDR program, and during COVID-19. 01-SA-Weston-JEM#210079.indd 16 12/03/22 11:13 AM

17 Journal of Emergency Management Vol. 20, No. 7 Special Issue on COVID-19 ACKNOWLEDGMENTS The authors thank and appreciate Sharon D. Beard, MS, Jim Remington, Kathy Ahlmark, Kevin Yeskey, MD, Jonathan Rosen, MS, CIH, and Amber Mitchell, DrPH for their review and support. The authors wish to acknowledge NIEHS and NIH leadership for their support of WTP’s disaster response and biosafety efforts over the years. Conflict of interest: The authors declare no conflict of interest. Eric Persaud, DrPH, MEA, Contractor, National Institute of Environmental Health Sciences, Bethesda, Maryland. ORCID: https:// orcid.org/0000-0003-4577-7975. Deborah Weinstock, MS, MDB Inc, Washington, DC. Demia S. Wright, MPH, Worker Training Program, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina. ORCID: https://orcid.org/0000-0002-5895-702X. REFERENCES 1. Superfund Amendments and Reauthorization Act of 1986: US Public Law 99-499, 1986. 2. National Institute of Health: Small business innovation research. Available at https://sbir.nih.gov/. Accessed August 9, 2021. 3. National Institute of Environmental Health Sciences: National clearinghouse for worker safety and health training. Available at https://tools.niehs.nih.gov/wetp/. Accessed May 20, 2021. 4. The National Institute of Environmental Health Sciences Worker Training Program: Worker education and training program (WETP) logic model. Available at https://tools.niehs.nih.gov/ wetp/1/12FallMeeting/wetp_logic_model.pdf. Accessed September 3, 2021. 5. Slatin C, Dunn ML: From SARA to homeland security: The NIEHS worker education and training program confronts challenges of environmental cleanup. New Solut. 2006; 16(1): 65-86. DOI: 10.2190/6kl9-5x3j-f61m-kapa. 6. National Institute of Environmental Health Sciences: National response and disaster recovery. Available at https://www.niehs.nih. gov/careers/hazmat/disaster_response/index.cfm. Accessed August 9, 2021. 7. The White House: Homeland security presidential directive/ HSPD-8. Available at https://georgewbush-whitehouse.archives. gov/news/releases/2003/12/20031217-6.html. Accessed September 3, 2021. 8. National Institute of Environmental Health Sciences: Learning from disasters: Weapons of mass destruction preparedness through worker training. Available at https://www.niehs.nih.gov/ news/events/pastmtg/assets/docs_n_z/technical_workshop_report_ wmd2002_508.pdf. Accessed March 22, 2021. 9. Centers for Disease Control and Prevention: Follow-up of deaths among US Postal service workers potentially exposed to Bacillus anthracis–District of Columbia, 2001-2002. MMWR Morb Mortal Wkly Rep. 2003; 3(52): 937–938. 10. The National Institute of Environmental Health Sciences Worker Training Program: H1N1 (swine), pandemic, and avian influenza. Available at https://tools.niehs.nih.gov/wetp/index. cfm?id=538. Accessed March 22, 2021. 11. The National Institute of Environmental Health Sciences Worker Training Program: Avian Influenza Conference. Available at https://www.niehs.nih.gov/news/events/pastmtg/hazmat/2007/ avian_flu_conference/index.cfm. Accessed March 22, 2021. Figure 2. Resources from National Clearinghouse training tools and booklets. 01-SA-Weston-JEM#210079.indd 17 12/03/22 11:13 AM

18 Journal of Emergency Management Vol. 20, No. 7 Special Issue on COVID-19 12. The National Institute of Environmental Health Sciences Worker Training Program: Protecting yourself from H1N1 in the workplace. Available at https://tools.niehs.nih.gov/wetp/public/ hasl_get_blob.cfm?ID=8349. Accessed March 22, 2021. 13. National Institute of Environmental Health Sciences: Disaster response training: From WTC to Katrina five years of lessons learned. Available at https://www.niehs.nih.gov/news/events/past mtg/assets/docs_n_z/wetp_fall_06_awardee_meeting_report_508. pdf. Published 2006. Accessed May 20, 2021. 14. National Institute of Environmental Health Sciences: NIEHS hurricane sandy response report. Available at https://tools.niehs. nih.gov/wetp/public/hasl_get_blob.cfm?ID=9939. Published 2013. Accessed May 20, 2021. 15. Solomon GM, Hjelmoroos-Koski M, Rotkin-Ellman M, et al.: Airborne mold and endotoxin concentrations in New Orleans, Louisiana, after flooding, October through November 2005. Environ Health Perspect. 2006; 114(9): 1381-1386. 16. The National Institute of Environmental Health Sciences Worker Training Program: Mold exposure. Available at https://tools. niehs.nih.gov/wetp/index.cfm?id=327. Accessed March 22, 2021. 17. National Institute of Environmental Health Sciences: Hurricanes & floods. Available at https://tools.niehs.nih.gov/wetp/ index.cfm?id=2472. Accessed June 28, 2021. 18. National Institute of Environmental Health Sciences: Floods, mold, and health—Worker training program answers the call. Available at https://factor.niehs.nih.gov/2017/10/feature/feature1-wtp/index.htm. Accessed September 3, 2021. 19. National Institute of Environmental Health Sciences: Hurricane recovery support in Puerto Rico and US Virgin islands. Environmental factor. Available at https://factor.niehs.nih.gov/2018/3/feature/ feature-2-recovery/index.htm. Accessed September 3, 2021. 20. National Institute of Environmental Health Sciences: Mold and health classes help Hurricane Florence workers, residents. Available at https://factor.niehs.nih.gov/2019/4/community-impact/ mold-and-health/index.htm. Accessed September 3, 2021. 21. National Institute of Environmental Health Sciences: Ebola biosafety and infectious disease response worker training program a multisector, all-hazards approach to biosafety preparedness. Available at https://www.niehs.nih.gov/careers/assets/docs/wtp_infec tious_disease_program_20172018.pdf. Accessed March 18, 2020. 22. The National Institute of Environmental Health Sciences Worker Training Program: Ebola biosafety and infectious disease response training needs assessment and gap analysis for the NIEHS worker training program. 2015. Available at https://tools.niehs.nih.gov/wetp/ public/hasl_get_blob.cfm?ID=10521. Accessed September 3, 2021. 23. The National Institute of Environmental Health Sciences Worker Training Program: Ebola biosafety and infectious disease response training program. Available at https://www.niehs.nih.gov/careers/hazmat/training_program_areas/ ebola/index.cfm. Accessed March 22, 2021. 24. The National Institute of Environmental Health Sciences: NIEHS worker training program fiscal year 2020 overview. Available at https://www.niehs.nih.gov/careers/assets/docs/wtp_ factsheet_overview_2020.pdf. Accessed May 20, 2021. 25. The National Institute of Environmental Health Sciences: Pathogen safety data guide. Available at https://tools.niehs.nih.gov/ wetp/public/hasl_get_blob.cfm?ID=10823. Accessed March 18, 2020. 26. Herstein JJ, Biddinger PD, Gibbs SG, et al.: Sustainability of high-level isolation capabilities among US Ebola Treatment Centers. Emerg Infect Dis. 2017; 23(6): 965–967. 27. The White House: A letter on the continuation of the national emergency concerning the coronavirus disease 2019 (COVID-19) pandemic. Available at https://www.whitehouse.gov/briefing-room/ statements-releases/2021/02/24/a-letter-on-the-continuation-of-thenational-emergency-concerning-the-coronavirus-disease2019-covid-19-pandemic/. Accessed June 28, 2021. 28. Faghri PD, Dobson M, Landsbergis P, et al.: COVID-19 pandemic: What has work got to do with it? J Occup Environ Med. 2021; 63(4): e245-e249. 29. National Institute of Environmental Health Sciences: COVID19. Available at https://tools.niehs.nih.gov/wetp/covid19worker/. Accessed April 27, 2020. 30. The National Institute of Environmental Health Sciences Worker Training Program: Worker training program COVID-19 training needs assessment. Available at https://tools.niehs.nih.gov/ wetp/public/hasl_get_blob.cfm?ID=12361. Published 2020. Accessed March 22, 2021. 31. Freeman K: COVID-19 resilience and recovery for workers, communities. Available at https://factor.niehs.nih.gov/2021/5/community-impact/workers/index.htm. Accessed June 1, 2021. 32. National Institute of Environmental Health Sciences: Responder and community resilience: Training resources. Available at https:// tools.niehs.nih.gov/wetp/index.cfm?id=2528. Accessed September 3, 2021. 33. Mahaffey BL, Mackin DM, Rosen J, et al.: The disaster worker resiliency training program: A randomized clinical trial. Int Arch Occup Environ Health. 2021; 94(1): 9-21. DOI: 10.1007/s00420-020- 01552-3. 34. National Institute of Environmental Health Sciences: Disaster research response (DR2) program training and education. Available at https://www.niehs.nih.gov/research/programs/disaster/trainingeducation/index.cfm. Accessed August 9, 2021. 35. National Institute of Environmental Health Sciences: Emergency support activation plan researcher deployment guide. Available at https://tools.niehs.nih.gov/wetp/public/hasl_get_blob. cfm?ID=11006. Accessed August 9, 2021. 01-SA-Weston-JEM#210079.indd 18 12/03/22 11:13 AM

JEM 19 Journal of Emergency Management Vol. 20, No. 7 Special Issue on COVID-19 Recognizing and mitigating against COVID-19 consequence management impacts in emergency management organizations Michael Prasad, BBA, CEM® ABSTRACT Disasters should no longer be considered along a linear timeline, where response follows preparedness, recovery follows response, and mitigation follows recovery—even if those disaster cycle phases overlap. The spiral aspects of these disaster cycle phases require communities to be in the response phase at the same time as the recovery and also mitigation phases. Emergency management (EM) organizations should use COVID-19 as the basis for a new normal as to their own continuity of operations and government. Their current model for staffing and supporting incident management is not sustainable for a long-term pandemic. The approach to any EM’s organizational response to COVID-19—and the “reset/restart” of any suspended internal actions and activities—should be consistently applied across the board through all missions, all lines of service, etc., and conducted along a standardized project-management approach, with Specific, Measurable, Attainable, Realistic, Timely (SMART) goals assigned, tracked, and reported in summary and detail by utilizing a stalwart construct from emergency management through planning, organizing, equipping, training, and exercising. The EM organization’s role in their community, conducted through their people, products, and services—the tactical objectives and missions which that EM organization performs, will need to continue to adapt, not only for existing missions but also for new ones created by this pandemic as well. Key words: pandemic, continuity of operations, consequence management, planning, organizing, equipping, training, exercising INTRODUCTION For the disaster cycle phases of before, during, and after incidents, emergency managers are trained by the Federal Emergency Management Agency (FEMA) to progress through each phase in a linear manner— with overlaps between adjacent phases for many incident types.1 They follow the recovery continuum from the National Disaster Recovery Framework (NDRF) (Figure 1). Fakhruddin et al.3 noted that the transition from response to recovery for pandemics follows a spiral pattern, rather than a linear one (Figure 2). With a long-term pandemic, communities are in the response phase at the same time as their recovery and mitigation phases.4 The State of New Jersey, for example, had a disaster declaration for Hurricane Ida in 2021 during this pandemic. They still have emergency declarations from other storms still active, going back to Hurricane Irene from 2011.5 A paradigm shift has been created for emergency management organizations in their own continuity of operations/government: not only are they coping with their own workforce being impacted by the pandemic, but their incident staffing patterns and missions are much more elongated than for other disaster types. METHODS The normal response staffing pattern for incident command is to utilize an organizational model constructed from existing subject-matter expert staff, who have other day-to-day roles and responsibilities, imported staff from other groups and entities, and/ or dedicated emergency management staff who have day-to-day roles in the other disaster cycle phases of preparedness, recovery, or mitigation.6 All of these staffing resources are subject to adverse impacts from this pandemic. Emergency management organizations are also familiar with utilizing a preparedness model from the United States Department of Homeland Security for DOI:10.5055/jem.0680 02-SA-Weston-JEM#220006.indd 19 15/03/22 1:25 PM

20 Journal of Emergency Management Vol. 20, No. 7 Special Issue on COVID-19 their threat and hazard identification and risk assessment (THIRA) for the organizational construct of mission-related response projects based on what occurred during this COVID-19 pandemic including baseline business continuity operations. These should have been constructed using POETE—planning, organization, equipment, training, and exercising.7 The 2019 National Threat and Hazard Identification and Risk Assessment Overview and Methodology report published on July 25, 2019—well before this current pandemic—indicated that a pandemic scenario was of national concern.8 And the world had very recently experienced past significant multinational pandemics— not to COVID-19’s scope and scale with H1N1, H1N9, and Ebola—all of which required changes to protocols and procedures in limited areas. In most organizations, Figure 2. Fakhruddin et al.’s spiral pattern of a pandemic, with its multiple waves of variants.3 Figure 1. NDRF’s Recovery Continuum.2 02-SA-Weston-JEM#220006.indd 20 15/03/22 1:25 PM

21 Journal of Emergency Management Vol. 20, No. 7 Special Issue on COVID-19 only specific business units were impacted, and/or specific geographies were impacted. For example, the American Red Cross had only limited workforce impact from the two influenza pandemics, which also only impacted them in limited geographic areas. Even more distinctly, Ebola impacted the American Red Cross in only parts of Texas, within the United States.9 This current pandemic incident is very different from previous pandemics.10 All of the Red Cross operational units across the globe were adversely impacted.11 Novel Coronavirus has in its definition that it is new—and the whole world appears to be starting from scratch as to treatment, mitigation, and possible cures/vaccines. This virus continues to spread very rapidly and has a high mortality rate. COVID-19 had a higher mortality in 2020 than the seasonal flu and even deaths from cancer.12 The public health response through governmental intervention has been novel as well. All of these factors impact any emergency management organization in its: n constituent base: customers, workforce, partners, and the public; n logistics: facilities, systems, equipment, and supplies; n succession planning and strategic planning; n methods and messages to communicate to its workforce and the public, including elected/appointed officials. THE POETE PROCESS: APPLICABLE FOR ALL LINES OF BUSINESS POETE is a workflow to help guide emergency managers in readiness for a specific threat or hazard. As a checklist-type construct, it is applicable to all lines of business within an organization. Using POETE is a comprehensive way to organize for not only response but also the other Disaster Cycle Frameworks/Phases, which are recovery, mitigation, protection/prevention/ preparedness as well.13 Local government can be in a response mode overall or in specific departments, while their emergency management organization is operating normally. For example, the county’s health department may be actively operating COVID-19 testing sites, vaccination clinics, etc., while their emergency management group is not in response mode. The reverse is true as well. For example, a county’s emergency management organization may be highly impacted internally by staffing callouts, etc. even if they are not actively involved in the Incident Command System operational periods for COVID-19 testing sites, vaccination clinics, etc. Those emergency management organizations need to see applicability for the POETE process, no matter what their organization has as its own missions. This article highlights the fact that all of their subdivisions/lines of business are now operating in all of the various disaster cycle phases, not just their public-facing response ones, if any. Business Continuity of Operations (COOP) is a prime example of how every line of business must be continuously preparing for disasters, capable of operating during a disaster, recovering from any disaster, and finally mitigating against future disasters. Pandemic incidents, as Chemical, Biological, Radiological, Nuclear, and high yield Explosives (CBRNE) Events, are no different— the same axioms and adages apply.14 RESULTS AND DISCUSSION Emergency management organizations need to review and revise their POETE, not just add more organizational staffing, in order to fully support this pandemic and the concurrent disasters which will occur. Emergency management staff, including first responders, have a history of believing they are impervious the adverse impacts of disaster, even pandemics.15 This is the exact opposite of what occurs during a CBRNE incident: the more exposure and the greater the risk. The COVID-19 pandemic has also taken a significant toll on the mental health and wellness of first responders and others in emergency management, where the long-term results and adverse impacts are still to be discovered.16 Planning for the longer term While certain geographic areas of the United States and the world may ebb and flow on the easing 02-SA-Weston-JEM#220006.indd 21 15/03/22 1:25 PM

22 Journal of Emergency Management Vol. 20, No. 7 Special Issue on COVID-19 and tightening of vaccination requirements, mask usage, sheltering-in-place, and other restrictions, those restrictions may once again return if the contagion spread increases or starts up again. Planning needs to be COVID-19 neutral, in the sense that plans should not have on-off switches depending on when social distancing is lifted, when it may return, when a geographic area has a reduction in cases or when they surge, etc. Consistency is key with the topline objectives of any mission planning, in the following order: Life Safety, Incident Stabilization, and Property Protection. Not everyone is reacting and responding to this pandemic in the same was as others, even in the same communities. Emergency management staff with children and/or older relatives living with them and those with pre-existing medical conditions17 conduct themselves differently18—especially when they have too much information, including misinformation.19 n Inconsistent and evolving/changing protocols and procedures—even for activities of daily living—are impacting everyone. Shortages and hoarding of basic supplies continue and surges up and down, depending on workforce impacts at suppliers. For example, COVID-19 outbreaks in meat packing plants can impact the meat supply in the entire nation.20 All constituent groups are impacted and can be impacted in very different ways from each other. n Fraud and scams can impact the public as well as any organization. Vigilance through the continued monitoring and reaction to false information being disseminated when confronted and amplification of alert messaging are both a must. The organization’s name reputation and goodwill are tangible assets that must be protected as well.21 Disinformation campaigns against both public health officials and emergency management organizations are also possible threats. Other incidents will not wait for this pandemic to end. In 2020, the United States saw major wildfires, hurricanes, tornadoes, multifamily fires, and other incidents impact missions and emergency management organizations themselves. There was an extremely active Hurricane Season in 2021, which will probably be more severe for years in the future, due in part to climate change.22 Wildfires, additional tornadoes, and other natural disasters will occur again and can strike anywhere at any time. There is also the continued threat of terrorism and other non-natural incidents— including cyber/technology hazards—which will have an adverse impact on missions for other types of incidents and the emergency management organization itself. n Hurricanes: many local, state, and country governmental emergency operations’ plans have not been revamped for COVID19 impacts. Hurricanes are notice events, but there are multistate complexities and public health impacts, not just the new COVID-19 impacts but non-COVID-19 ones such as mold, medical needs sheltering, disabilities/access, functional needs support, etc. Follow-on flooding impacts, along with sustained power outages— impacting communications as well— are concerns to apply to the COVID-19 Concept of Operations. n Wildfires: these are no-notice events and can escalate quickly beyond the initial jurisdictional geography. Evacuations, mass care, search, and rescue—all of these missions and more are complicated by COVID-19. n Heat waves: where the electrical power grid is impacted, they will have a greater impact to operations as more of the workforce is now dependent on electricity and connectivity to the internet, as many more staff are working remotely/ virtually. 02-SA-Weston-JEM#220006.indd 22 15/03/22 1:25 PM

23 Journal of Emergency Management Vol. 20, No. 7 Special Issue on COVID-19 Organization—continued workforce impacts As of July 9, 2020, 3 million people in the United States had confirmed positive cases (.08 percent). By July 19, 2021, this number was more than tenfold the previous amount at more than 34 million people, more than 10 percent of the total US population.23 That means just under 90 percent had not yet contracted the virus, as of that timeframe. Note that the current groups of vaccines do not actually fully prevent someone from becoming infected with the COVID-19 virus.24 Social distancing and other governmental restrictions on business closures, group assemblies, etc. were designed to slow the contagion spread, not stop it. Those mitigation efforts were designed to reduce the surge on medical facilities, even while many locations were adding public heath capacity through federal assistance. n There is no researched conclusion that someone who contracts COVID-19 can neither contract the same strain/variant again nor spread it again to others. In fact, research is now indicating that only temporary partial immunity exists and declines significantly after 6 months.25 It appears that the initial promise of herd immunity upon a set percentage of immunized people is not achievable with COVID19, given the rapid spread of variants which are not covered by the vaccines and non-pharmaceutical interventions.26 Some viruses mutate over time, so people who are infected with one strain can become infected later with another, as it has been with the current COVID-19 variants or the seasonal flu. As of October 2020, an individual in Nevada was identified as having contracted two different strains of COVID19 over a 42-day time period, becoming the first person in the United States to have been identified as contracting COVID-19 twice.27 It is logical to conclude that antibody testing efforts produce no practical, consistent results that can be utilized for full-scale changes in actions/behavior by those individuals who hold COVID-19 antibodies, and additionally, there are some efficacy questions about certain anti-body tests themselves.28 n Some studies have shown that asymptomatic people have been able to spread the virus to others.29 n Contact tracing initially was quickly overwhelmed in February 2020, leading to community spread and forcing public health officials to invoke emergency powers. It had been a key element in the Federal plans—and therefore further delegated/modeled to the states/territories/ tribal entities—to “reopen” America. With vaccines now available, the focus has moved away from that mission. n Now that successful vaccines have been created, not everyone will immediately get vaccinated, nor is it currently known how long the vaccination remains effective. n Research has shown that Sweden’s attempt at herd immunity via no restrictions on social distancing, etc.—without a vaccine—was devastating, recording 4,500 COVID-19 deaths as compared to Norway and Finland, who recorded 600 deaths combined.30 n Workforce is needed not only for response surge activities but day-to-day roles, which can be impacted by COVID-19 restrictions such as travel restrictions, enhanced reliance on technology, etc. Those roles need COOP backups as well. Staff will still have their “normal” time off requirements, in addition to the possibility of sheltering-in-place/self-quarantining. Add the additional factors of varying levels of staff’s willingness to respond/ work—especially in person in high-impact 02-SA-Weston-JEM#220006.indd 23 15/03/22 1:25 PM

24 Journal of Emergency Management Vol. 20, No. 7 Special Issue on COVID-19 high/risk areas—and an enhanced need for overall staff wellness and duty of care. n Workforce career and professional development: there are COVID-19 impacts to workforce training and experience, especially field work currently necessary for promotion. For example, FEMA’s Emergency Management Institute suspended in-person courses for more than a year.31 Red Cross CPR training had to be suspended for in-person training, then modified for a virtual instructor, and now is a combination of online and socially distanced in-person instruction.32 Succession planning and retention need to be revamped for a “new” normal. Equipment—sporadic facility and systems impacts, including logistics/supply An organization must be prepared for sporadic site closures or reductions in capabilities, especially in highly impacted geographies. Facility outage could be due to internal factors including lack of staffing, internal systems, or supply outages, as well as external factors such as governmental lock-down, travel restrictions, etc. Internal computer systems access and use can still be compromised by viruses/attacks as well adversely impacted by planned updates/upgrades; and systems technical support may not be scheduled or completed due to lack of staffing, supply chain inventory issues, etc. Lack of normal facility operating supplies—toilet paper, for example—as well as shortages in newly designated personal protective equipment (PPE) items, including masks, gloves, hand sanitizer, thermometers, etc., can take a facility offline as well. Without a comprehensive, coordinated, and consolidated view on facility usage including updates and enhancements across all applicable lines of business, this resource will not fully support all missions. For example, standards for PPE usage at a facility must be consistently applied across all lines of business—and applicable to paid and volunteer workforce equally as well—and maybe even for customers/constituents. An emergency management organization may need to provide PPE to its clients and partners, for the safety of its own workforce. The same concept applies to equipment purchasing, especially COVID-19-related equipment. Subdivisions/Lines of Business within any organization can also potentially be bidding against themselves when seeking third-party vendor relationships for equipment and, thus, the standing need for coordinated logistics systems.33 They may not be taking advantage of local/state/federal support of the logistics stream available from governmental organizations, which may be available to that local organization during this pandemic response. The financing of any equipment—as well as workforce—utilized by an emergency management organization requires a constant and consistent funding stream. And unlike the federal or state governments, most local emergency management organizations probably cannot borrow limitless funds or raise taxes to fund equipment/ supplies/staff/missions. Training—workforce training has changed for everyone New workforce personnel and occupational health and safety training for this pandemic have impacted every emergency management organization today. These protocols and procedures will be continuously adapting and changing, as the pandemic moves across the different pandemic intervals. As noted previously, some workforce members may be in the response phase, while others are in recovery. While many emergency management organizations had already been migrating away from inperson training for cost-savings and time away from work reasons, COVID-19 accelerated this effort. Many groups scrambled and cancelled/postponed/ established in-person trainings, which created gaps in workforce training. This was also applicable for any revenue-generating training elements that the emergency management organization may have been providing to other groups or individuals: fees for fire service training courses, for example. n Documentation and learning management systems also need to be modified to adapt 02-SA-Weston-JEM#220006.indd 24 15/03/22 1:25 PM

25 Journal of Emergency Management Vol. 20, No. 7 Special Issue on COVID-19 to virtual learning classes temporarily or permanently, in lieu of in-person classes. Train-the-trainer modules need adaptation as well. n Consistency between training systems, lines of business training requirements, etc.—both internally and externally are needed. For example, training on the use of PPE must meet external standards and guidelines as well as be consistently applied across internal lines of business, employees vs. partners/customers, etc. Exercising: practice, assess, and start the POETE process again The changes described in the previous steps of POETE can be significant to any emergency management organization. Practicing how they will be implemented can improve performance, workforce satisfaction and retention, and the public’s perception of how well the emergency management organization is working through the pandemic or any other disaster. While much of this pandemic response has been “do first, document later,” there is a very specific need to review the lessons learned,34 revise the plans, and then exercise those plans using the redefined organization that needs to be pretrained, as well as understanding any new equipment needed as well. Very few emergency management organizations conducted continuity exercises—one of the National Exercise Program’s 2021-2022 Principal’s Strategic Priorities (PSPs)—which was already at a low level of participation before COVID-19: only five percent of states and local governments exercised a continuity PSP in 2019.35 Exercising validates the planning process and provides a feedback loop for the workforce to significantly reduce gaps in plan coverage—the “What If’s?” of Consequence Management Planning. Proper After-Action Reporting and Improvement Planning (AAR/IP) is critical to both exercises and real-world implementation of change management to ensure improvement for the future. A comprehensive exercise process will include AAR/IP reporting to senior management to help start the POETE process again. CONCLUSION As expected, the elevated impacts from COVID-19 coupled with other disasters have already impacted the nation’s higher density population centers, if not the entire country. The entire planet has now passed through multiple series of community spread waves from the novel coronavirus pandemic which started in 2019. The world continues to see the actions—and some would say inaction—of government missions for public health, balanced against economic and social health. The varying levels of preparedness as well as response and mitigation were very different across the globe: no governmental organization, nongovernmental organization, or individuals were fully prepared for this pandemic. While emergency management organizations plan for disasters in an all-hazards approach, they tend to plan and staff for them as silos—they do not plan for them to occur simultaneously and overlap each other, even though they frequently do. They are neither currently staffed properly for the duration of this pandemic nor the concurrent disasters which will come in the future. The use of POETE as a continuous improvement tool can be applied to the emergency management organization itself, and at any point in the disaster cycle phases. Regardless of which project management methodology is utilized,36 long-term continuity of operations is critical for emergency management organizations. In an almost Nostradamus-like way, journalist Paula Froelich wrote a piece for the NY Post back on January 18, 2020, focusing on the wildfires ravaging Australia and how there were other mega disasters, which she described as worldwide hazard clusters waiting just around the corner. In her article, the final possible catastrophic incident—after an asteroid hitting the earth—was a contagion, and she noted “. . . the Coronavirus that originated in China spread to Japan and Thailand. While the world is getting better at containing these outbreaks, it’s only a matter of time before one breaks through and causes global devastation.”37 Emergency management organizations can become more resilient to COVID-19 or any other long-term and long-duration disasters, especially in their consequence management efforts for continuity 02-SA-Weston-JEM#220006.indd 25 15/03/22 1:25 PM

26 Journal of Emergency Management Vol. 20, No. 7 Special Issue on COVID-19 of operations. Resiliency will carry the organization forward in defense of any other hazards. It takes a systematic and systemic approach to solve this—and one that utilizes Specific, Measurable, Attainable, Realistic, Timely (SMART) goals along the POETE construct should be applied. Regardless of the “What If’s”—the organizational impacts from COVID-19 are basically the consequence management aspects, which all organizations need to organize, align, and collaborate with others. They need to provide a consistent and continuous reporting mechanism to their leadership for the mission shifts in this new environment— regardless of the next phase or which interventions are implemented and when. Governmental entities— especially those without an internal Emergency Management organization or lead—should also follow these constructs established through emergency management for COVID-19 consequence management for their own business continuity. ACKNOWLEDGMENT Figure 1 is in the public domain, as a product of the US federal government. Figure 2 is covered by a Creative Commons license for non-commercial use. This work is licensed under the Creative Commons Attribution-Noncommercial-No Derivatives 4.0 International License. To view a copy of this license, visit http://crea tivecommons.org/licenses/by-nc-nd/4.0/ or send a letter to Creative Commons, PO Box 1866, Mountain View, CA 94042, USA. Michael Prasad, BBA, CEM®, Certified Emergency Manager, Senior Research Analyst, Barton Dunant Emergency Management Training and Consulting, Fanwood, New Jersey. ORCID: https://orcid.org/0000- 0002-2596-5015. REFERENCES 1. Federal Emergency Management Agency: An introduction to the national incident management system. Independent study course is-700B. Available at https://training.fema.gov/is/courseoverview. aspx?code=IS-700.b. Accessed February 21, 2022. 2. Federal Emergency Management Agency: The recovery continuum. Independent study course 2200. Available at https://emilms. fema.gov/IS2200/groups/139.html. Accessed February 21, 2022. 3. Fakhruddin B, Blanchard K, Ragupathy D: Are we there yet? The transition from response to recovery for the COVID-19 pandemic. Prog Disaster Sci. 2020; 7: 100102. DOI: 10.1016/j. pdisas.2020.100102. 4. Barnett DJMD, Rosenblum AJ, Strauss-Riggs K, et al.: Eadying for a post-COVID-19 world: The case for concurrent pandemic disaster response and recovery efforts in public health. J Public Health Manag Practice. 2020; 26(44): 310-313. DOI: 10.1097/ PHH.0000000000001199. 5. State of New Jersey Office of Emergency Management: NJOEM public assistance program. Available at http://ready.nj.gov/pro grams/public-assistance-program.shtml. Accessed January 13, 2021. 6. Kaye AD, Cornett EM, Kallurkar A, et al.: Framework for creating an incident command center during crises. Best Practice Res Clin Anesthesiol. 2021; 35(3): 377-388. DOI: 10.1016/j.bpa.2020.11.008. 7. Federal Emergency Management Agency: Threat and Hazard Identification and Risk Assessment (THIRA) and Stakeholder Preparedness Review (SPR) guide. Available at https://www.fema. gov/sites/default/files/2020-07/threat-hazard-identification-riskassessment-stakeholder-preparedness-review-guide.pdf. Accessed July 19, 2021. 8. Federal Emergency Management Agency: 2019 National threat and hazard identification and risk assessment (THIRA) overview and methodology. Available at https://www.fema.gov/media-librarydata/1563998211160-f5da0c60ffeb239845d2e577c953f136/2019NT HIRA_20190725_508c.pdf. Accessed July 19, 2021. 9. Smith CL, Hughes SM, Karwowski MP, et al.: Addressing needs of contacts of Ebola patients during an investigation of an Ebola cluster in the United States—Dallas, Texas, 2014. MMWR. 2015; 64(5): 121-123. 10. Pitlik SD: COVID-19 compared to other pandemic diseases. Rambam Maimonides Med J. 2020; 11(3): e0027. DOI: 10.5041/ RMMJ.10418. 11. Ponce-Blandón JA, Jiménez-García VM, Romero-Castillo R, et al.: Anxiety and perceived risk in red cross volunteer personnel facing the coronavirus disease 2019 pandemic [original research]. Front Psychol. 2021; 12(4611). DOI: 10.3389/fpsyg.2021.720222. 12. Begley S, Empinado H: It’s difficult to grasp the projected deaths from COVID-19. Here’s how they compare to other causes of death. 2020. Available at https://www.statnews.com/2020/04/09/ its-difficult-to-grasp-the-projected-deaths-from-covid-19-heres-howthey-compare-to-other-causes-of-death/. Accessed July 19, 2021. 13. Federal Emergency Management Agency: National preparedness goal. Available at https://www.fema.gov/media-librarydata/1443799615171-2aae90be55041740f97e8532fc680d40/National_ Preparedness_Goal_2nd_Edition.pdf. Accessed July 19, 2021. 14. Coleman CN, Bader JL, Koerner JF, et al.: Chemical, biological, radiological, nuclear, and explosive (CBRNE) science and the CBRNE science medical operations science support expert (CMOSSE). Disaster Med Public Health Prep. 2019; 13(5-6): 995- 1010. DOI: 10.1017/dmp.2018.163. 15. Graham EL, Khaja S, Caban-Martinez AJ, et al.: Firefighters and COVID-19: An occupational health perspective. J Occup Environ Med. 2021; 63(8): e556-e563. DOI: 10.1097/JOM.0000000000002297. 16. Vujanovic AA, Lebeaut A, Leonard S: Exploring the impact of the COVID-19 pandemic on the mental health of first responders. Cogn Behav Ther. 2021; 50(4): 320-335. DOI: 10.1080/16506073.2021.1874506. 17. Sabourin KR, Schultz J, Romero J, et al.: Risk factors of SARS-CoV-2 antibodies in Arapahoe county first responders— the COVID-19 arapahoe SErosurveillance study (CASES) project. J Occup Environ Med. 2021; 63(3): 191-198. DOI: 10.1097/ jom.0000000000002099. 18. Knezek EB, Vu T, Lee J: A study of emergency medical service personnel and law enforcement official willingness to respond to disasters. Risk Hazard Crisis Pub Pol. 2021; 12(4): 393-417. DOI: 10.1002/rhc3.12212. 19. AARP: 10 myths about the coronavirus you shouldn’t believe. Available at https://www.aarp.org/health/conditions-treatments/ info-2020/coronavirus-myths.html. Accessed July 19, 2021. 20. Dyal J, Grant M, Broadwater K, et al.: COVID-19 among workers in meat and poultry processing facilities—19 states, April 2020. MMWR. 2020; 69: 557-561. DOI: 10.15585/mmwr.mm6918e3. 21. 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27 Journal of Emergency Management Vol. 20, No. 7 Special Issue on COVID-19 model developed for responding to food scares? Front Public Health. 2020; 8: 369. DOI: 10.3389/fpubh.2020.00369. 22. Ornes S: Core concept: How does climate change influence extreme weather? Impact attribution research seeks answers. Proc Natl Acad Sci USA. 2018; 115(33): 8232-8235. DOI: 10.1073/ pnas.1811393115. 23. Johns Hopkins University & Medicine: Corona Virus Resource Center. Available at https://coronavirus.jhu.edu/. Accessed February 21, 2022. 24. Rita Rubin MA: COVID-19 vaccines vs variants—determining how much immunity is enough. J Am Med Assoc. 2021; 325(13): 1241-1243. DOI: 10.1001/jama.2021.3370. 25. Sewell HF, Agius RM, Kendrick D, et al.: COVID-19 vaccines: Delivering protective immunity. Br Med J. 2020; m4838. DOI: 10.1136/bmj.m4838. 26. Barker P, Harley D, Beck AF, et al.: Rethinking herd immunity: Managing the COVID-19 pandemic in a dynamic biological and behavioral environment. NEJM Catal. 2010. Available at https://catalyst. nejm.org/doi/full/10.1056/CAT.21.0288. Accessed February 15, 2022. 27. Tillett R, Sevinsky J, Hartley P, et al.: Genomic evidence for a case of reinfection with SARS-CoV-2. SSRN. DOI: 10.2139/ssrn.3680955. 28. Weinstein M, Freedberg K, Hyle E, et al.: Waiting for certainty on COVID-19 antibody tests—At what cost? N Engl J Med. 2020; 383(6): e37. DOI: 10.1056/NEJMp2017739. 29. Tan J, Liu S, Zhuang L, et al.: Transmission and clinical characteristics of asymptomatic patients with SARS-CoV-2 infection. Fut Virol. 2020; 15: 373-380. DOI: 10.2217/fvl-2020-0087. 30. Giesecke J: The invisible pandemic. Lancet. 2020; 395(10238): e98. DOI: 10.1016/S0140-6736(20)31035-7. 31. Flavelle C, Kanno-Youngs Z: FEMA, racing to provide virus relief, is running short on Front-Line staff. The New York Times. April 3, 2020. Available at https://www.nytimes.com/2020/04/03/climate/femastaff-shortage-coronavirus.html. Accessed January 12, 2022. 32. American Red Cross: CPR training. Available at https://www. redcross.org/take-a-class/cpr/cpr-training. Accessed January 12, 2022. 33. Feldman A: States bidding against each other pushing up prices of ventilators needed to fight coronavirus, NY governor Cuomo says. Forbes. March 28, 2020. Available at https://www.forbes.com/sites/ amyfeldman/2020/03/28/states-bidding-against-each-other-pushingup-prices-of-ventilators-needed-to-fight-coronavirus-ny-governorcuomo-says/?sh=347fd5a7293e. Accessed January 12, 2022. 34. Knutson NC, Kavanaugh JA, Li HH, et al.: Radiation oncology physics coverage during the COVID-19 pandemic: Successes and lessons learned. J Appl Clin Med Phys. 2021; 22(3): 4-7. DOI: 10.1002/acm2.13225. 35. Federal Emergency Management Agency: National exercise program validating our nation’s preparedness overview of the 2021- 2022 cycle. Available at https://www.fema.gov/sites/default/files/ documents/fema_nep-2021-2022-overview-booklet_0.pdf. Accessed January 13, 2022. 36. Müller R, Klein G: The COVID-19 pandemic and project management research. Project Manag J. 2020; 51(6): 579-581. DOI: 10.1177/8756972820963316. 37. Froelich P: The next mega disasters that could happen at any moment (and kill us all). 2020; New York Post. Available at https:// nypost.com/2020/01/18/the-next-mega-disasters-that-could-happenat-anymoment-and-kill-us-all/. Accessed July 19, 2021. 02-SA-Weston-JEM#220006.indd 27 15/03/22 1:25 PM

GENERAL INFORMATION SCOPE Journal of Emergency Management (JEM) is a vehicle for academics and practitioners to share field research. In addition to scientific studies and program descriptions, we will consider letters to the editor, guest editorials, and book reviews. Individuals desiring to contribute should not hesitate to make inquiries, even if they are unfamiliar with procedures for writing and submitting manuscripts. Our goal is to provide original, relevant, and timely information from diverse sources; to publish with absolute integrity; and to serve as effectively as possible the needs of those involved in emergency management. If your research will help us achieve these goals, we would like to hear from you. MANUSCRIPT SUBMISSION Manuscripts submitted for consideration must not have been previously published (other than as an abstract) and must not be under consideration for publication elsewhere. 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REPRINTS Single reprints may be purchased online at www.emergencymanagementjournal.com; click on the "Abstracts" link and select year of publication to view all abstracts and purchase your selection. Reprints in quantities of 100 or more may be ordered from JEM, 470 Boston Post Road, Weston, MA 02493; telephone: (781) 899-2702; fax: (781) 899-4900. AUTHOR RESPONSIBILITY The corresponding author is responsible for ensuring that all individuals named as coauthors have made a major contribution to the manuscript. Authorship credit should be based on significant contributions to all of the following: 1) conception and design, or acquisition of data, or analysis and interpretation of data; 2) drafting of the manuscript or critical revision of the manuscript for important intellectual content; and 3) final approval of the submitted manuscript. Each author must declare his or her contribution to the manuscript on the copyright transfer form from the JEM editorial office. 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Consent forms should be mailed or faxed to the JEM editorial office. REFERENCES References are organized in AMA format; that is, they are to be cited numerically in the text and in consecutive order, including the first three authors followed by et al., and listed at the end of the article in the following format: Journal articles— 1. Mudd P, Smith JG, Allen AZ, et al.: High ideals and hard cases: The evolution of opioid therapy for cancer pain. Hastings Cent Rep. 1982; 12(2): 11-14. Books— 1. Bayles SP (ed.): Nutritional Supplements and Interactions with Analgesics. Boston: GK Hall & Co., 1978. Book chapters— 1. Martin RJ, Post SG: Introducing alternative prescribing strategies. In Smith J, Howard RP, Donaldson P (eds.): The Oncology Management Handbook. Madison, WI: Clearwater Press, 1998, pp. 310-334. Web sites— Health Care Financing Administration: HCFA Statistics at a glance. Available at: www.hcfa/gov/stats/stahili.htm. 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JEM 29 Journal of Emergency Management Vol. 20, No. 7 Special Issue on COVID-19 Weaponizing mutual aid: Can a pandemic or biological attack turn our strongest emergency management tool against us? Benjamin Thomas Greer, JD ABSTRACT A functional mutual aid system allows the effective cost sharing of resources and the swift mitigation of loss of life and property. COVID-19 has illuminated weaknesses in our mutual aid framework. Weaknesses could potentially allow abuse and the misuse of these unifying instruments. By designing our response system in an insightful and nuanced fashion, we are able to affectively lend aid to those in need. Our mutual aid systems allow us to be forward thinking—it challenges us to anticipate what could happen and how we should respond. This article will articulate challenges COVID-19 has posed in our mutual aid system and will propose potential improvements to better enhance our aid agreements for future pandemics. Key words: mutual aid agreements, Emergency Management Assistance Compact (EMAC), COVID-19 INTRODUCTION The mutual aid system is the heart and soul of our local, state, and national emergency management responses. Properly crafted mutual aid agreement allows jurisdictions to maximize their available assets while minimizing financial investment. The cost and resource sharing is conducted with the understanding that in times of need, they will likely get assistance from neighboring jurisdictions. They outline the resource and logistical framework by which each party will provide the needed assistance.1 Many jurisdictions do not maintain sufficient resource levels to be self-reliant when major disaster events occur. This lack of self-reliance creates an interdependence where mutual aid becomes a necessity to augment resources.2 A fundamental assumption currently incorporated into our mutual aid concept is, not all partners will be affected by an incident at the same time and to the same extent, thus providing flexibility of resource allocation and distribution of assets; however, pandemics and biological attacks have the ability to affect numerous state, federal, and international jurisdictions simultaneously. A poorly drafted or a limited scope agreement can allow nefarious political, unanticipated, or nondisaster response factors to seep into decision-making, permitting illintentioned application effectively weaponizing our national response’s strongest tool. Emergency management and disaster aid should be void of corrupt political influence and arbitrary decision-making; however, too often this is not the practice. By carefully analyzing and forecasting anticipated needs for a given event, drafters of aid agreement can attempt to better articulate the burdens and cost obligations borne by each party in the transaction. Depth and clarity included in an agreement can remove havens for political abuse and retribution of our emergency assets. This article will examine how infectious pandemics or a widespread biological attack challenges our existing mutual aid framework and will analyze whether our current mutual aid agreements are properly drafted to address reasonably foreseeable costs and resource challenges during an infectious disease or biological attack emergency response. In order to gain better insight into the possibilities for the improvement of existing state and federal emergency mutual aid agreements, I applied contextual real-world experience with crises and emergency public behavior, social and operational emergency response structures, while overlaying a legal analysis DOI:10.5055/jem.0644 03-SA-Weston-JEM#210067.indd 29 12/03/22 11:23 AM

30 Journal of Emergency Management Vol. 20, No. 7 Special Issue on COVID-19 of strategic contractual terms contained in the analyzed agreements. I have supplemented this research foundation with semistructured interviews with the California Governor’s Office of Emergency Services regional and state emergency management subject matter experts. Through these interviews, I was able to gain detailed insight into the mutual aid agreement formation and interstate aid process. While the mutual aid agreements and emergency response structure within California may not be applicable to all US jurisdictions, the issues examined in this paper are likely to be present in most, if not all, jurisdiction’s aid agreements. DISCUSSION A well-crafted and insightful emergency management mutual aid plan is one of our strongest tools in fighting natural, man-made disasters, or terrorist biological attacks Effective large event emergency response demands a well-coordinated and communicated plan—a plan that has been tailored for the intricacies and unique demands of that event. After responding to a wide range of catastrophic events, local, state, and federal agencies have experienced the value of a strong aid network and the pain of an outdated or poorly constructed framework. Immediately following the 1994 Northridge earthquake, local jurisdictions in California realized a need to formalize their asset allocations and sharing protocols to be better positioned to respond to future events. The California Office of Emergency Services Coastal, Southern, and Inland Regions developed an intrastate coordinated emergency management concept called the Emergency Mangers Mutual Aid system. The demonstrated successes helped lay the political groundwork for a national model. Hurricane Katrina in 2005 triggered the Federal activation of the Emergency Management Assistance Compact (EMAC), and while EMAC helped to facilitate the movement of unprecedented amount of goods, resources, and personnel, the response highlighted inadequacies and calls for improvement. Terrorist attacks of September 11, 2001. The terrorist attacks of September 11, 2001 illuminated a number of weaknesses in our national preparedness. The carnage inflicted by the hijackers quickly overwhelmed the local response capacity.3(p397) While many of the responding agencies had mutual aid agreements in place, they were either seldom-used or in their design—specifically in their communications planning. In their after-action report, the Fire Department New York stated, “[B]efore September 11, the FDNY had rarely requested mutual aid from departments outside the city to support fire operations. The Department had no process for evaluating the need for mutual aid, nor any formal methods of requesting that aid or managing it.”4(p36) The World Trade Center and the lower Manhattan region would eventually receive tens of thousands of emergency response personnel and volunteers wanting to assist in the rescue and recovery effort. This was the largest terrorism-related mass casualty event in the United States history; one the existing mutual aid system was not design to handle. Response organizers were overwhelmed by the enormity of the event and overrun by number of self-deploying first responders, emergency personnel, healthcare practitioners, and private citizens wanting to help. If robust aid agreements were in place, agreements with clear instructions for the timing of incoming assets, these personnel would have been able to fully integrate in a coordinated and orderly fashion quicker with ongoing operations. Hurricane Katrina, August 2005. Another seminal emergency management event further highlights the need to for a robust and forward-thinking aid response design occurred along the United States gulf coast in 2005. Hurricane Katrina, a Category 5 tropical cyclone, killed between 1,245 and 1,836 people and was tied with Hurricane Harvey as the costliest natural disaster in US history.5 In the weeks following Hurricane Katrina, Louisiana, New Orleans, specifically received significant law enforcement and public safety mutual aid. Resources came from across the nation, including California, Michigan, Nevada, New York, and Texas. This multistate response was crucial in maintaining a consistent and sustained recovery effort. Local authorities were fatigued, over 03-SA-Weston-JEM#210067.indd 30 12/03/22 11:23 AM

31 Journal of Emergency Management Vol. 20, No. 7 Special Issue on COVID-19 worked, and suffered declining moral.6 The mutual aid response was structured, so responding jurisdictions would accept refugees into their home jurisdictions for shelter. The diaspora saw evacuees settle in all 50 states and in over 18,700 different zip codes.7 An essential function of emergency mangers is to properly forecast and anticipate problems, which are likely to occur during a response. Both of these disaster events failed to anticipate and adequately address foreseeable challenges; specifically, how to manage and utilize a large number of spontaneous volunteers/ emergency management personnel and how to shelter a large number of displaced persons.8 Managing Spontaneous Volunteers in Times of Disaster and Mass Care/Emergency Assistance Planning and Operations are concepts now extensively addressed as a part of FEMA’s Emergency Management Professional Program.9 Emergency management is a form of art and not a science. We utilize science as a color in our art palette; however, honestly analyzing successes and failures of past events has continually proven to be the most transformative and influential factor to the evolution of emergency management. Not properly anticipating challenges can create confusion and delay medical or disaster relief.10 Mutual aid response and agreements share common premise, design, and characteristics. A public health emergency’s mutual aid-designed response can best be visualized as a concentric ring of responding assistance originating from a central focal point of the disaster event. Mutual aid operations are founded on the concept of the affected jurisdiction fully committing their resources before making a request of resources of another jurisdiction. This analysis does not turn on the actual exhaustion of resources before requesting, but it does anticipate full mobilization and commitment of available resources to the emergent event. Requests for specialized or scarce items may have a higher likelihood of being filled at the state or federal level; however, the requesting procedure would remain the same. The incident command would request an asset, if the request could not be filled locally it would be requested from the next concentric jurisdictional ring until the asset is located. For example, a simplistic request structure could be local, regional, state, federal, and international. Very few jurisdictions can change the requesting order. The best example of the alternate requesting order would be requests originating from tribal sovereign nations. Due to their sovereign nation status, they can request aid directly from their federal counterparts while still maintaining the ability to seek assistance from their region and state. Coordination of these requests is crucial to ensure an order is not filled twice unnecessarily encumbering superfluous resources. Regardless of the nature of the emergency and type of aid rendered, Master Mutual Aid Agreement’s (MMAA) provide a critical preincident framework, establishing the rules, processes, and procedures to be implemented in times of great need. MMAAs are intended and designed to be multifunctional agreements, meaning they can support all emergency management missions. While MMAAs would ideally be agreed upon in advanced of an incident, they can be formed during or after an incident is needed. All levels of government, nongovernmental organizations (NGOs), and private sector entities are eligible to join these instruments.2 Intrastate mutual aid—California. California Intrastate mutual aid is generally seen as a voluntary commitment to provide aid between and among local jurisdictions and the state under the terms and conditions set forth in the California Disaster and Civil Defense Master Mutual Aid Agreement (CDCDMMAA).11 Intrastate mutual aid follows the same concentric ring model previously discussed, just within the state’s jurisdictional authority. This MMAA formalizes the command-and-control framework of each impacted jurisdiction; each entity retains control of its facilities, personnel, and resources12 but has the flexibility to receive or render assistance without expectation of reimbursement from the receiving jurisdiction.13 Before the creation and adoption of the CDCDMMAA, California’s mutual aid was a haphazardly fashioned patchwork of regional cooperative agreements. These agreements were often incongruent containing conflicting and/or confusing language, making a smooth and effective disaster 03-SA-Weston-JEM#210067.indd 31 12/03/22 11:23 AM

32 Journal of Emergency Management Vol. 20, No. 7 Special Issue on COVID-19 response very difficult. On Monday, January 17, 1994, the newly enhanced and expanded California mutual aid response was tested—it passed with distinction but raised new social science questions. At 4:31 am, a magnitude 6.8 earthquake centered under the community of Northridge in the San Fernando Valley shook the entire Los Angeles metropolitan area. Moderate and severe damage to infrastructure was widespread, including collapsed buildings and highway overpasses. The earthquake killed dozens, forcing thousands to seek hospitalization, and temporarily or permanently displaced 80,000 to 125,000 people.13 Jurisdictions affected by the Northridge earthquake benefited from the recently updated and redesigned California emergency response system. Lessons learned from the 1989 Loma Prieta earthquake and other significant earthquakes informed California’s emergency managers to immediately activate the intrastate mutual aid network in efforts to maintain essential lifesaving operations. A series of key questions emerged from the Northridge earthquake; “some organizations learn and correct deficiencies and advance and go out and learn some more. Others do not.”14 Why do jurisdictions fail to correct experienced or foreseeable deficiencies? During a post-disaster conference held by the National Earthquake Hazards Reduction Program (NEHRP), discussing the success from the Northridge event, the conference committee openly questioned jurisdiction’s root motivations and reluctance to adopt proven strategies and tactics. Specifically, the committee asked: Public officials and emergency responders could benefit from research on how and why some organizations learn and apply the lessons they learn. More research would be useful on the extent to which research findings and lessons learned in previous earthquakes have been implemented in (1) the impacted jurisdictions and agencies; (2) other at-risk jurisdictions and agencies; and (3) jurisdictions hit by a (new) earthquake. Research could tell us what factors lead to validation and adoption by certain agencies and jurisdictions of response methods or measures determined valuable or desirable. Why are some cities, counties, states and even nations more likely than others to adopt new practices that enhance their response capabilities?14 The group found that the nature of emergency management response can be and has been affected by political and social factors in given locales—vulnerability resulted from political marginalization.15 Interstate, regional, and international mutual aid. While intrastate mutual aid can be entered into or modified at any time by willing parties, interstate mutual aid agreement necessitates special authority granted by Congress. The United States Constitution states, “No state shall, without the consent of the Congress, . . . enter any agreement or compact with another state, or with a foreign power.”16 1992’s Hurricane Andrew demonstrated need for a formalized national aid framework. Post-Andrew, Congress approved the creation of the EMAC.16 EMAC’s primary function was to address three critical aspects of aid assistance: (1) who bears the burden of liability; (2) applicable reimbursement rates; and (3) who maintains the command and control of the response.16 EMAC’s full design was implemented during 2005’s Hurricane Katrina. Epidemiologists along with other national and state public health experts were deployed to assist in the storm’s aftermath.16 While this was generally accepted and positive systematic development, the challenges Katrina posed highlighted additional areas in need to analysis and improvement. While not originally intended to be a key aspect of EMAC, Article II of the legislation attempted to address and inoculate mutual aid from political whims and retribution. Each party state entering into this compact recognizes that many emergencies transcend political jurisdictional boundaries and that intergovernmental coordination 03-SA-Weston-JEM#210067.indd 32 12/03/22 11:23 AM

33 Journal of Emergency Management Vol. 20, No. 7 Special Issue on COVID-19 is essential in managing these and other emergencies under this compact. Each state further recognizes that there will be emergencies which require immediate access and present procedures to apply outside resources to make a prompt and effective response to such an emergency. This is because few, if any, individual states have all the resources they may need in all types of emergencies or the capability of delivering resources to areas where emergencies exist.17 EMAC has been ratified by United States Congress17 and is law in all 50 states, including the District of Columbia, Puerto Rico, Guam and US Virgin Islands, and the Northern Mariana Islands.18 A biological attack or infectious pandemic has the ability to activate any one of the mutual aid types (local automatic mutual aid; local mutual aid; regional, intrastate, or statewide mutual aid; interstate mutual aid-after declaration; interstate mutual aidprior to or without a declaration; and international mutual aid).2 States also have the authority, without Congressional approval provided their own legislation permits, to enter regional “nonbinding” agreements such as the Pacific Northwest Emergency Management (Alaska, Idaho, Oregon, Washington, British Columbia, and the Yukon Territory) and International Emergency Management Assistance Memorandum of Understanding (six new England states with five eastern Canadian provinces). All forms of mutual aid must contemplate and attempt to address foreseeable challenges a biological attack or infectious pandemic would pose. Without a properly designed MMAA, a welldesigned biological agent or infectious pandemic can lead to the “weaponization” of our mutual aid system. The pandemic spread of the novel coronavirus has yet again challenged our emergency management response design and capabilities. A foundational premise currently incorporated into the mutual aid system is, all partners will not be affected by an incident at the same time and to the same extent, thus providing flexibility of resource allocation and distribution to combat and mitigate the disaster event. Unlike fires, earthquakes, flooding, or hurricanes, infectious pandemics and biological agents have the unique ability to affect multiple jurisdictions equally and simultaneously. The Pandemic and All-hazards Preparedness Act (PAHPA)19 is a relatively new and important addition to a comprehensive federal mutual aid structure. This preparedness program’s primary purpose was to protect from “threats from exposure from infectious diseases, natural disasters or chemical, biological, radiological or nuclear (CBRN) agents.”20 Originally passed by Congress in 2006 and reauthorized in 2013, the Act “establish[es] overarching preparedness goals for essential federal, state, and local public health and medical capabilities to increase accountability and incentivize regional coordination.”19 Specifically, “increasing the preparedness and response capabilities and the surge capacity of hospitals and health care facilities” and “ensuring coordination of federal, state, local and tribal planning.”19 Typically, laws directing activities of federal agencies contain sunset provisions. To ensure the continuity of programmatic effect, reauthorization is required in advance of its expiration date. Most of the provisions in PAHPA were set to expire in September 2018. The Senate Health, Education, Labor and Pensions (HELP) Committee started the reauthorization process with a set of hearings on January 17, 2018.20 The Chair of the HELP Committee, Senator Alexander, commented, “I look forward to a timely, bipartisan reauthorization of this crucial legislation to ensure we are prepared to respond to natural disasters like hurricanes, and protect Americans against bioterror attacks and infectious disease outbreaks, like the Zika virus or a pandemic influenza.”20 PAHPA expired on October 1, 2018 without reauthorization. Many of the pandemic integration planning efforts and assistance programs were forced to pause or cease. Concurrently with the expiration of PAHPA, Congress was debating the adoption of separate legislation titled the Pandemic and All-Hazards Preparedness and Advancing Innovation Act (PAHPAIA). Adopted 03-SA-Weston-JEM#210067.indd 33 12/03/22 11:23 AM

34 Journal of Emergency Management Vol. 20, No. 7 Special Issue on COVID-19 on June 28, 2019,21 this version had many detractors concerned the legislation-enumerated lofty goals but failed to address many of the fundamental challenges pandemic is likely to pose compounded by reduced funding levels, which ensured many of the recommendations could not be achieved.22 Many saw the lack of mandatory integration of PAHPA into the mutual aid response and paltry levels of funding as signs the legislation was politically motivated and never designed to be implemented.22 Failing to mandate or fully integrating a strong public health and pandemic mutual aid response leaves this response/mitigation mechanism open to political abuse and misuse based on politics and election cycles. While not mandated by Congress, a strong public health/pandemic mutual aid response framework remains a viable option for states to include in their aid agreements. The foundational basis of any contractual agreement is to clearly articulate the duties, liabilities, and obligations of the contracting parties. Each contracting jurisdiction should clearly and cogently articulate their expectations. A party would be able to construct their terms and conditions based on their state and societal values. A state with ample resources could offer to lend public health personnel with the caveat the receiving jurisdiction must impose a statewide mask and social distancing policy to ensure their personnel are “properly” protected as determined by their state’s health officials regardless of the desires or analysis of the receiving jurisdiction. The lending state would have the ability to protect their resources and personnel at the standards and conditions they choose based on any justification including political factors. While the requesting jurisdiction would retain the option to accept or reject the assistance, this would create an untenable aid framework, completely negating the EMAC Article II’s attempt to remove this insidious potential. The objective of mutual aid agreements is to standardize and effectuate the efficient movement of resources to areas of need, based on likelihood of use and need absent political and nonemergency management influences. Allowing well-healed and fully funded jurisdictions uneven bargaining position toward smaller jurisdictions who fail to have the money or resources could weaponize mutual aid turning our greatest emergency response tool against us. Mutual aid agreements should be analyzed and updated to address likely biological and pandemic affects and requirements. Pandemics or biological attacks will test emergency manager’s ability to accurately evaluate and forecast the impact an outbreak may have in their jurisdiction. Pandemics are likely posing new and previously unanswered questions our current mutual aid system was not specifically designed to address. While unable to anticipate all challenges future events will pose, policy makers and emergency managers should attempt to anticipate and address some of the foreseeable challenges likely to transpire. The following are just a few of the novel questions biological and pandemic events may present. Legal commitment—Can a jurisdiction decline to send mutual aid to a jurisdiction responding to a biological or pandemic disaster event?. Interstate cooperation is a national priority and assumed by the Interim National Preparedness Goals established under the Homeland Security Presidential Directive 8.16 However, under the EMAC’s article IV: Limitations: “Any party state requested to render mutual aid . . . shall take such action as is necessary to provide and make available the resources covered by this compact . . . provided that it is understood that the state . . . may withhold resources to the extent necessary to provide reasonable protection for such state.”23 While a state is not required to send assistance, provided they have an articulable need to provide reasonable protection for their home jurisdiction, once a resource is assigned out of state that asset cannot be recalled by the lending jurisdiction until the receiving jurisdiction demobilizes that asset. This could create a moral and professional dilemma for a lending jurisdiction. If the requesting jurisdiction implements less restrictive protective measures, the lending jurisdiction would be exposing their personnel to an unnecessary level of risk or injury or illness. During a rapidly progressing and developing emergency such as a pandemic, jurisdictions may be reluctant to send 03-SA-Weston-JEM#210067.indd 34 12/03/22 11:23 AM

35 Journal of Emergency Management Vol. 20, No. 7 Special Issue on COVID-19 valuable assets or personnel to an EMAC partner with the looming prospect of potential need in their home jurisdiction. That jurisdiction could artificially create a justification to deny mutual aid assistance to preserve the resource for their potential use later. Failing to reasonably respond could exposed them to future retribution in a time of need—weaponizing the mutual aid relationship. These questions are layered and multifaceted. A decision to send help or deny a request is never singular in its analysis; we may never truly know the core genesis of a decision. However, the spirit of mutual aid agreements is to make a strong united national effort—an effort that transcends geographical borders and political allegiances. An effort that declares saving lives and assisting our fellow man is one of the noblest things we can do in our lifetime. A well-designed, nuanced, and insightful aid response can restrain pettiness and moral weakness, helping people to answer the “better angels of our nature.”* An agreement should address how to properly calculate reimbursable “use” in a biological or pandemic event? A fundamental axiom of contract law holds, and ambiguous or uncertain terms in a contract will be construed against the party that caused the uncertainty to exist.25 That is to say, the drafter of the contract should not benefit from ambiguous terms they were in control of articulating.26 While no party will be punished if the agreement is deemed to be a jointly drafted agreement (where the terms and conditions of an agreement have been crafted and negotiated by both parties); very few, if any, of our aid agreements would qualify. Many of the obligations and reimbursement rates are predetermined and presented as a “take it or leave” option. Our state and national aid agreements contain numerous terms the complexities of a pandemic or biological attack could render ambiguous. Mutual aid agreements must specify how the receiving jurisdiction will compensate the lending jurisdiction. Under certain circumstances, mutual aid costs may be reimbursable. Individuals providing mutual aid will be responsible for maintaining logs, timesheets, and vehicle maintenance receipts required for reimbursement. Associated costs incurred may be eligible for reimbursement under the Natural Disaster Assistance Act when a state of emergency has been proclaimed under the Robert T. Stafford Disaster Relief and Emergency Assistance Act and where there is a Presidential Declaration. Generally, the cost to repair extraordinary damage to a jurisdiction’s vehicle or asset, when the asset was used in the performance of a specific disaster assignment, will be borne by the requesting jurisdiction. Normal wear and tear are noncompensable. The unique circumstances a biological or infectious pandemic event would pose could legitimately alter the standard reimbursement rates for assets and personnel. What type and kind of use during a pandemic is considered “normal,” noncompensable, and what type and kind of use would be considered extraordinary creating liability for the receiving jurisdiction. In 2007, The Public Health Law Program of the Centers for Disease Control and Prevention begun analyzing the need for a robust public health best practice guidelines and mutual aid legal framework.16 The report concluded while public health officials have initiated discussions with governor’s offices and emergency management offices domestically and internationally, very few questions have been answered. Lack of judicial interpretation of key terms and the lack of national uniformity continues create ambiguity.16 An agreement should address demobilization and sanitation of resources in an infectious disease pandemic environment. As defined by the National Incident Management System Guidelines for Mutual Aid published by US Department of Homeland Security— FEMA, demobilization is defined as, “The orderly, *Lincoln, “First Inaugural Address of Abraham Lincoln,” [Abraham Lincoln, who used the phrase in his First Inaugural Address on March 4, 1861, on the eve of our Civil War.“I am loath to close. We are not enemies, but friends. We must not be enemies. Though passion may have strained, it must not break our bonds of affection. The mystic chords of memory, stretching from every battle-field and patriot grave to every living heart and hearth-stone, all over this broad land, will yet swell the chorus of the Union, when again touched, as surely they will be, by the better angels of our nature.” (emphasis added)].24 03-SA-Weston-JEM#210067.indd 35 12/03/22 11:23 AM

36 Journal of Emergency Management Vol. 20, No. 7 Special Issue on COVID-19 safe, and efficient return of an incident resource to its original location and status.” “. . . original location and status [emphasis added].”2 How the lending jurisdiction defines, “status” is a critical aspect of operation of this section. Equipment rates and reimbursement costs are commonly based on hourly or daily use. These along with, fuel, maintenance, a cost for loss, damage and repairs should be clearly enumerated to avoid confusion among the contracting parties. The cost of post-pandemic sanitation for some items, which would not normally need sanitation, may render them expendable and not worth rejuvenating for future use. These items should be identified and enumerated in an agreement. One asset that is often rendered expendable, based on the lender’s standards of sanitization, is cots. The cost (labor and materials) of sanitizing cots often exceeds the price of replacement. The list of “expendable” items in a biological or infectious disease event is likely to be significantly larger than other disaster events due to increased and expensive sanitation, which may exceed items’ replacement cost. An agreement should address demobilization and quarantine of exposed personnel. How an agreement defines the operable term “status” would be dispositive of how personnel are treated or quarantined when returning home from deployment. Generally, personnel pays including salary, overtime, backfill costs, and other associated employee-related costs (including insurance, retirement contributions, and worker’s compensation) are addressed in the joint agreement. Under the EMAC, requesting jurisdictions must articulate the expected time they intend to encumber the asset. Under Article II: Party State Responsibilities section B(2), “The amount and type of personnel, equipment, materials and supplies needed, and a reasonable estimate of the length of time they will be needed; . . . .”23 Under a biological attack or pandemic response, state agencies may recommend a 14-day quarantine once personnel return from field duty or if the employee has encountered a person COVID-19-positive regardless of time spent on scene/ assignment. One could argue that the 14-day quarantine period is directly related to the deployment, and therefore, associated costs should be covered by the requesting jurisdiction. For example, if emergency services coordinators (ESC), through an EMAC agreement, were sent to a nearby state for 5 days of in-field operations, when demobilized and returned to their home jurisdictions, they are likely to require to be quarantined for 14 days. Therefore, the requesting jurisdiction would be liable for 19 days the ESC’s salary and associated costs. Without a preagreed standard the contract parties are to apply—ie, Center for Disease Control prevailing guidelines or the best practices in the field— the lending jurisdiction could reasonably articulate any condition or demand, as long as it is agreed upon between the parties. Which agency should pay the salary, overtime, and backfill costs of that resource while they are quarantined? Should they be permitted or required to work in a limited capacity while in quarantine? Are they required to quarantine at home, potentially exposing their family, or are they permitted to quarantine in a hotel? Who pays for the quarantine location/hotel? Answers to these questions are best answered and articulated in advance, absent political pressure, and general chaos of a disaster-event. An agreement should address infected or death of personnel. The dangers and environmental hazards responders are likely to encounter during an incident, requiring a through and complete contemplation of how to prevent, mitigate, and ameliorate foreseeable hazards. While obvious items such as personal protective equipment and respiratory equipment along with associated training on proper equipment use are common, less common and tangential harms should be addressed such as cancer, adverse reaction to vaccinations, transmission of infectious diseases to family or loved ones, and the ability of high-risk individuals to decline an assignment. Many of our law enforcement and first responders have codified legal presumptions addressing enumerated diseases—declaring that if contracted, the illness is presumed to have been contracted while on duty. This legal presumption places the employee in a more favorable position when seeking workers compensation and other healthcare and retirement bene03-SA-Weston-JEM#210067.indd 36 12/03/22 11:23 AM

37 Journal of Emergency Management Vol. 20, No. 7 Special Issue on COVID-19 fits. Responding to a biological or infectious pandemic is likely to infect a disproportionate number of emergency responders compared to civilians. Mutual aid agreements should clearly articulate—even to the extent if personnel test positive for the associate illness—a legal presumption the illness contracted while on duty, easing evidentiary burden when seeking worker’s compensation. This issue has been of significant debate for the September 11 responders who have contracted life-long and fatal illness after responding to the World Trade Center terrorist attacks.27 As articulated in the National Incident Management System Guidelines for Mutual Aid, “[B]y identifying potential shortfalls and capability gaps through planning and exercises, jurisdictions can work with partners to establish mutual aid agreements as part of their preparedness actions.”2 Post-disaster, MMAs are reviewed for effectiveness, and the post-COVID-19 analysis may provide both valuable insight into incongruences in our existing response framework and an opportunity to better perfect our mutual aid system.16 As emergency management agencies, state and federal, begin to analyze their response to the COVID-19 pandemic, managers should analyze the affect, if any, these ambiguous sections had on their effectiveness and timely response and invest time and resources in addressing and forecasting additional unarticulated friction points. State and federal emergency mangers should hold joint meetings to update EMAC and other mutual aid agreements to reflect what has been learned. As the world grows in population and complexity, with increased global travel and communal integration, urbanization, changes in land use, and greater exploitation of the natural environment, the likelihood of pandemics has increased.28 Ensuring that our emergency management’s most powerful tool is designed to effectively respond to this ever increasing threat is paramount. CONCLUSION A functional mutual aid system allows the effective cost sharing of resources and the swift mitigation of loss of life and property. State and national mutual aid systems were never intended to be a static operational framework. They were, and are, organic evolving organisms that require attention, analysis, and modification when insight and facts demand an evolution. COVID-19 has illuminated weaknesses in our mutual aid framework—weaknesses that could potentially allow and abuse and misuse of these unifying instruments. The better we as homeland security agencies can anticipate the burdens and obligations associated with an event, the better we can tailor our agreements to address the actual foreseeable needs, hopefully eliminating the breeding ground for ignorance-induced harm and politically influenced decisions. By designing our response system in an insightful and nuanced fashion, we can effectively lend aid to those in need. Our mutual aid systems allow us to be forward thinking—it challenges us to anticipate what could happen and how we should respond. COVID-19 has provided us another opportunity to analyze and improve our emergency response. Benjamin Thomas Greer, JD, Master’s Degree Program, Center for Homeland Defense and Security, Naval Postgraduate School, Monterey, California. ORCID: https://orcid.org/0000-0003-3194-9713. REFERENCES 1. 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38 Journal of Emergency Management Vol. 20, No. 7 Special Issue on COVID-19 7. Quigley B: Six months after Katrina: Who was left behind then and who is being left behind now? Global Action on Aging, February 21, 2006. Available at http://globalag.igc.org/armedconflict/coun tryreports/americas/sixkatrina.htm. Accessed April 15, 2020. 8. White HP: Understanding the role of spontaneous volunteers in disaster: The case study of the World Trade Centre on 9/11. Emergency Management diss., Auckland University of Technology (AUT), 2016. Available at https://pdfs.semanticscholar.org/45ca/06f e80970ce41f1fd332f366e9c7e47379e4.pdf. Accessed April 15, 2020. 9. US Department of Homeland Security – Federal Emergency Management Agency (FEMA): Managing spontaneous volunteers in times of disaster: The synergy of structure and good intentions. Available at https://www.fema.gov/pdf/donations/ ManagingSpontaneousVolunteers.pdf; US Department of Homeland Security – Federal Emergency Management Agency (FEMA): National Preparedness Course Catalog. Available at https://www. firstrespondertraining.gov/frts/npccatalog?catalog=EMI. Accessed July 17, 2020; US Department of Homeland Security – Federal Emergency Management Agency (FEMA): Emergency Management Professional Program (EMPP). Available at https://training.fema. gov/empp/. Accessed July 17, 2020. 10. McCammon S: The Cajun Navy: Heroes or hindrances in hurricanes? National Public Radio, September 22, 2018. Available at https://www.npr.org/2018/09/22/650636356/the-cajun-navy-heroesor-hindrances-in-hurricanes. Accessed April 15, 2020. 11. California Emergency Services Act: Article 11 added by Stats. 1970, Ch. 1454. §8615 Art. 11 – Mutual Aid. 12. California Emergency Services Act: Article 11 added by Stats. 1970, Ch. 1454. §8617 Art. 11 – Mutual Aid. 13. County of Los Angeles: Operational area emergency response plan. 2018, 77. Available at https://www.caloes.ca.gov/ AccessFunctionalNeedsSite/Documents/LA%20County%20OA%20 Emergency%20Response%20Plan.pdf. Accessed April 15, 2020. 14. National Earthquake Hazards Reduction Program (NEHRP): Proceedings of the NEHRP Conference and Workshop on Research on the Northridge, California Earthquake of January 17, 1994. 1994, IV-41. Available at https://curee.org/conferences/Northridge/Proceedings/ Volume_IV_Social_Services_and_Emergency_Management.pdf. Accessed April 15, 2020. 15. National Earthquake Hazards Reduction Program (NEHRP): Proceedings of the NEHRP Conference and Workshop on Research on the Northridge, California Earthquake of January 17, 1994. 1994, IV-67. Available at https://curee.org/conferences/Northridge/Proceedings/ Volume_IV_Social_Services_and_Emergency_Management.pdf. Accessed April 15, 2020. 16. Stier DD, Goodman RA: Mutual aid agreements: Essential legal tools for public health preparedness and response. Am J Public Health. 2007; 97(Suppl. 1): S62–S68. DOI: 10.2105/AJPH.2006.101626. 17. Emergency Management Assistance Compact (EMAC): Public law 104-321, Article II: General implementation. 1996. Available at https://www.emacweb.org/index.php/learn-about-emac/emac-leg islation. Accessed April 15, 2020. 18. Emergency Management Assistance Compact (EMAC): Available at https://www.emacweb.org/. Accessed April 15, 2020. 19. 109th Congress, United States Senate: Public law 109-417, S. Rept. 109-319—Pandemic and All-Hazards Preparedness Act 109th Congress (2005-2006). Available at https://www.congress.gov/ congressional-report/109th-congress/senate-report/319/1. Accessed April 15, 2020. 20. Riley K: Senate health committee begins re-approval process for nation’s hazards preparedness law. Homeland Preparedness News, January 18, 2018. Available at https://homelandprepnews. com/countermeasures/26278-senate-health-committee-begins-reap proval-process-nations-hazard-preparedness-law/. Accessed April 15, 2020. 21. 116th Congress, United States Senate: S.1379—Pandemic and All-Hazards Preparedness and Advancing Innovation Act of 2019 (2019-2020). Available at https://www.congress.gov/bill/116thcongress/senate-bill/1379. Accessed April 15, 2020. 22. Ollstein AM: ‘There is no surge plan’: Despite warnings, congress failed to fully fund pandemics bill. Politco, March 28, 2020. Available at https://www.politico.com/news/2020/03/28/congresspandemic-bill-coronavirus-152580. Accessed April 15, 2020. 23. Emergency Management Assistance Compact (EMAC): Public law 104-321, Article IV: Limitations. 1996. Available at https:// www.emacweb.org/index.php/learn-about-emac/emac-legislation. Accessed April 15, 2020. 24. Lincoln A: First inaugural address of Abraham Lincoln. Yale Law School Lillian Goldman Law Library, The Avalon Project – Documents in Law, History and Diplomacy, March 4, 1861. Available at https://avalon.law.yale.edu/19th_century/lincoln1.asp. Accessed April 15, 2020. 25. Royal Neckwear Co. v. Century City, Inc.: 205 Cal.App.3d 1146, 1988. 26. Sands v. E.I.C., Inc.: 118 Cal.App.3d 231, 1981. 27. Lippmann M, Cohen MD, Chen LC: Health effects of World Trade Center (WTC) dust: An unprecedented disaster’s inadequate risk management. Crit Rev Toxicol. 2015; 45(6): 492–530. DOI: 10.3109/10408444.2015.1044601. 28. Madhav N, Oppenheim B, Gallivan M, et al.: Pandemics: Risks, impacts, and mitigation (Chapter 17). In Jamison DT, Gelband H, Horton S, et al. (eds.): Disease Control Priorities: Improving Health and Reducing Poverty. 3rd ed. Washington, DC: The International Bank for Reconstruction and Development/The World Bank, 2017. Available at https://www.ncbi.nlm.nih.gov/books/NBK525302/. 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JEM 39 Journal of Emergency Management Vol. 20, No. 7 Special Issue on COVID-19 COVID-19 data driven planning: The SouthEast Texas approach Adam Lee, MS Lori Upton, RN, BSN, MS, CEM Magdalena Anna Denham, EdD Jeremiah Williamson ABSTRACT This coautoethnographic case study used the OpenSource Public Health Intelligence process to explore and share the South East Texas Regional Advisory Councils’ (SETRAC) experience in collecting, processing, disseminating/visualizing, and analyzing COVID19 data during the pandemic in the largest national medical setting in the United States. Specifically, it details the production of Business Intelligence reports powered by PowerBI both with general publics and with Regional Healthcare Preparedness Program (HPP) Coalition Coordinators, County Judges and City Mayors, Texas Department of State Health Services (DSHS) executive leadership, the Offices of the Texas Governor, and the Federal Pandemic Task Force led by the US Vice President, in order to provide a foundation for situational awareness, inter-regional collaboration, allocation of scare resources, and local, regional, and state policy decisions. It highlights best practices in risk and crisis communications during the COVID-19 response, underscores cross-sector collaboration and standardization of data collection for effective planning and response, discusses pervasive data revealed during the analysis, and evaluates collaborative and feedback processes that have implications for the Health Care System and Homeland Security Enterprise information sharing. Key words: risk and crisis communications and the public right to know; interoperable communications in Homeland Security Enterprise and healthcare systems, COVID-19 data collection, tracking, visualization, analysis, and information-sharing INTRODUCTION Crisis and Emergency Risk Communications (CERC) and information sharing Crisis and risk communications have been used interchangeably although there are differences between the two concepts. For example, Covello1(p359) defined risk communication as a “process of exchanging information among interested parties about the nature, magnitude, significance, or control of risk,” where the distinguishing factor is the impending nature of the event. Crisis communications consist of public messaging about the ongoing state of an event after it has occurred, agency or system actions to address it, state of resources, or situational updates on critical decisions to maintain awareness and public relations.2 With respect to health emergencies, in recent years, both risk communications and crisis communications have been merged into more integrated CERC frameworks, notably by the US Department of Health and Human Services Centers for Disease Control and Prevention.3 Indeed, in mass public health events, crisis and risk communications take center stage.4 During public health emergencies, efficient communication strategy as well as accurate, specific, sufficient, consistent, and understandable information is critical to address needs and expectations of the community and to enhance trust.5 As Heath and O’Hair6(p7) echoed, “the quality of crisis and risk communication indicates the responsiveness of community to individual needs and concerns.” Accordingly, Coombs7 stressed that the COVID-19 DOI:10.5055/jem.0642 04-SA-Weston-JEM#210066.indd 39 12/03/22 7:18 PM

40 Journal of Emergency Management Vol. 20, No. 7 Special Issue on COVID-19 pandemic added new concerns for crisis communication efforts because of its unique and protracted crisis demand. Notably, communicative demands created by the pandemic underscore new challenges placed upon health crisis communicators to appropriately assess levels of anxiety, empathy, efficacy, fatigue, reach, and threat.7 Moreover, when discussing the role of CERC communicators during the pandemic, Ratzen et al.8 highlighted their role in competing for attention, amidst media outlets and citizens’ sources of misinformation and disinformation, in establishing a trusted and one authoritative voice as a source of accurate and clear information, and in fighting false information by attenuating inaccuracies, leveraging scientific evidence, and facilitating health literacy by creating online platforms that are easy to access and understand. Lack of said strategies portends increased public reliance on media channels frequently based on political preferences, which further compound the misinformation and disinformation dilemmas.9 Thus, researchers have cautioned that public trust in institutions that are perceived to be providing reliable information is paramount.10,11 Conversely, lack of trust and credibility can have detrimental effects on crisis communication efforts.12-15 Finally, risk and crisis experts, eg, Heath and O’Hair, have advocated that the linchpin of risk and crisis communication strategies in a social system are the system’s organizational ability to create coalitions and “meaningful partnerships that respond to the concerns and needs of community members for information and to bring collective wisdom and judgment to bear on that problem.”6(p7) Beyond risk and crisis communications to maintain relations with affected publics and to address community needs, the health system represents one of the 16 US critical infrastructure components, ie, Healthcare and Public Health, otherwise defined as “systems and assets, whether physical or virtual, so vital to the United States that the incapacity or destruction of such systems and assets would have a debilitating impact on security, national economic security, national public health or safety, or any combination of those matters.”16(p7) The agencies, organizations, and institutions that comprise the system, many of them private, represent a vast network of coexisting interdependencies in what is now referred to as Homeland Security Enterprise (HSE). Relaying CERC in a complex operational and multijurisdictional environment of the HSE requires systems in critical sectors such as Healthcare and Public Health to engage in information-sharing; in fact, Information-Sharing and Dissemination has been placed on the national safety and security agenda by the Homeland Security Presidential Directive 8 and identified as one of the 37 target capabilities under the Prevent Mission area.17 Subsequently, the National Strategy for Information Sharing and Safeguarding18 firmly placed information sharing in the national policy focus. The study that follows represents an analysis of CERC and information-sharing processes during the COVID-19 pandemic by a nonprofit Texas organization with a legacy of building partnerships, planning, preparedness, and operational capabilities aimed at alleviating public heath disaster risk and its consequences. Study context The Omnibus Rural Health Care Rescue Act, passed in 1989 by the Texas Legislature, directed the Bureau of Emergency Management of the Texas Department of Health to develop and implement statewide emergency medical services (EMS) and trauma care system, designate trauma facilities, and develop a trauma registry to monitor the system and provide statewide cost and epidemiological statistics.6,19 Regional Advisory Councils (RACs) formed under this Act are the administrative bodies responsible for trauma system oversight within the bounds of a given Trauma Service Area in Texas. Each of the 22 RACs is tasked with developing, implementing, and monitoring a regional emergency medical service trauma system plan.20 Each RAC has the same objectives—to reduce the incidence of trauma through education, data collection, data analysis, and performance improvement. Typically, this is accomplished via the provision of educational programs and performance improvement efforts designed to offer every provider guidance and motive to reduce the 04-SA-Weston-JEM#210066.indd 40 12/03/22 7:18 PM

41 Journal of Emergency Management Vol. 20, No. 7 Special Issue on COVID-19 incidence of trauma, as well as improve outcomes of trauma patients. SouthEast Texas Regional Advisory Council (SETRAC) specifically has been the designated RAC for the Greater Houston area (nine counties in total) for 25 years. As needs in Texas and the nation have grown, so it has the scope of SETRAC’s mission. As a nonprofit 501c3 corporation and the regional healthcare coalition, the SETRAC is currently the lead for 25 counties in Texas, established under the federal Healthcare Preparedness Program.19 SETRAC’s mission is to develop and sustain a powerful coalition of providers, responders, and other healthcarerelated partners to save lives and improve health outcomes through research, education, and collaboration. The preparedness side of SETRAC is the Regional Healthcare Preparedness Coalition (RHPC) under contract with Texas Department of State Health Services (DSHS).21 The RHPC is a network of healthcare agencies, EMS and response partners, public health officials, and jurisdictional authority within 25 counties in Texas. Specifically, those counties comprise Angelina, Austin, Brazoria, Chambers, Colorado, Fort Bend, Galveston, Hardin, Harris, Jasper, Jefferson, Liberty, Matagorda, Montgomery, Nacogdoches, Newton, Orange, Polk, Sabine, San Augustine, San Jacinto, Tyler, Walker, Waller, and Wharton. Currently, the RHPC comprises 187 healthcare facilities, more than 900 Long Term Acute Care (LTAC) facilities, and 250 EMS agencies and serves a population of 9.3 million Texans. SETRAC’s scope consists of developing systems of care for stroke, cardiac, perinatal, and disaster preparedness and response. SETRAC is also the Lead RAC for a 25-county geographical area that is responsible for the Emergency Medical Task Force (EMTF). EMTF comprises Ambulance Strike Teams, Strike Team Leaders, Ambulance Staging Managers, RN Strike Teams, Ambuses, and Mobile Medical Units. Each of these components includes not only the equipment and supplies but also the rostering and deployment of trained individuals specific to their discipline. Since its creation, SETRAC has trained 38,256 people, established 26 committees, facilitated the planning of 337 projects, and spearheaded three campaigns: Stop the Bleed; Identify, Credentialing, and Access Management (ICAM); and Spot A Stroke. Currently, SETRAC provides training and education on Stop the Bleed, WebEOC, EMResource, EMTrack, Decontamination, Catastrophic Medical Operation Center (CMOC), HID personal protective equipment (PPE), Exercise Design (ED) and facilitation, Spill Response, and PAPR. The pediatric and trauma committees also provide educational sessions for the purpose of data collection to approximately 200 people per year. Every year SETRAC offers training courses throughout the year that assess capabilities, which need to be tested in a full-scale exercise for all stakeholders in the region with approximately 300 facilities participating every year. In 2019 alone, SETRAC trained over 20,000 personnel throughout hospital systems, schools, and businesses. Moreover, SETRAC’s exemplary role in crisis response has been documented during the catastrophic Hurricane Harvey flooding. Its CMOC operations prior, during, and after the storm coordinated and oversaw a total of 773 missions.19(p1) During the impending pandemic crisis of 2020, the organization was well positioned to serve as a clearinghouse for crisis and risk communications to the public and information-sharing within its broad coalition. Furthermore, SETRAC supported the creation of situational awareness; interregional collaboration; allocation of scarce resources; local, regional, and state policy decisions; and maintaining a common operating picture for the healthcare system lifelines for the region, for the state of Texas, and nationally. METHOD AND PROCESS We selected an established process for intelligence cycle, eg, Lowenthal,22 to trace and frame our experiences in collecting, sorting, analyzing, visualizing, and disseminating COVID-19 data during the pandemic. Three of the four authors are permanent members of SETRAC and contributed to this case study research. Thus, our case study adopted a coautoethnographic lens of a practitioner-researcher.23 Coautoethnography has been accepted as a useful method in disaster research.24 Our intelligence process aligns with open-source intelligence (OSINT) 04-SA-Weston-JEM#210066.indd 41 12/03/22 7:18 PM

42 Journal of Emergency Management Vol. 20, No. 7 Special Issue on COVID-19 production. OSINT has been defined as “produced from publicly available information.”25 Nationally, the value of OSINT is growing as underscored in HSE by the creation of the national open-source center in 2005 under the office of the Director of National Intelligence.26 In the case of infectious disease outbreaks, OSINT has been used globally in surveillance systems, and its application has become ubiquitous in public intelligence capabilities.27 Just as within HSE writ large, within a complex system of Healthcare and Public Health sector interdependencies, information has the potential of becoming actionable intelligence suitable for driving decision-making and for public review when it follows the following steps: (a) requirements, (b) collection, (c) processing and exploitation, (d) dissemination/visualization, and (e)  analysis.22 Inarguably, feedback has an iterative anatomy and can occur within any of the said stages. Requirements Identifying areas in which intelligence is needed is grounded in policy priorities, and at the national security level, these priorities rest with the policy maker. A critical piece of requirements is, thus, to focus collection on areas that will make the greatest contribution.22 In the HSE environment, requirements tend to be categorical and generic, and Congress makes planning decisions through statutory requirements of DHS programs.28 In the initial stages of the COVID-19 pandemic, the priority requirement with respect to Healthcare and Public Health sector centered on medical surge capacity. Medical surge capacity was included as one of the nation’s target capabilities and has been defined as “the capability to rapidly expand the capacity of the existing healthcare system (long term care facilities, community health agencies, acute care facilities, alternate care facilities and public health departments) in order to provide triage and subsequent medical care. This includes providing definitive care to individuals at the appropriate clinical level of care, within sufficient time to achieve recovery and minimize medical complications.”17(p449) Since early March 2020, researchers, eg, Ferguson et al.,29 underscored the need to flatten the curve of the pandemic as one of the mitigating strategies to maintain critical care bed capacity. As confirmed COVID-19 infections were being identified throughout the nation in February, on March 10, 2020, SETRAC initiated an Essential Elements of Information (EEI) request to hospitals and healthcare partners. Having been through the H1N1 outbreak previously, SETRAC knew the importance of trending cases and quickly adapted their previous influenza-like illness (ILI) data collection set to include COVID-19 specific data points. The initial COVID-19 report included a series of questions pertaining to suspected and confirmed COVID-19 cases in healthcare facilities. This report query was completed online via the EMResource application which the hospitals can access through the SETRAC website. On March 11, 2020, the Harris County Judge and City of Houston Mayor made the difficult decision to close the Houston Livestock Show and Rodeo, after a visitor to the rodeo became ill and subsequently tested positive. This information triggered additional actions by SETRAC, including monitoring of daily bed availability reports. A bed report in Southeast Texas is a series of questions pertaining to bed availability, ie, how many ICU beds are available, Monitored Medical Surge Beds, Nonmonitored Medical Surge Beds, etc. The hospitals and healthcare facilities have completed this report in training, exercises, and other responses over the years, and the process has become a second nature for many of them. On March 24, Texas Governor Greg Abbott issued an Executive Order (EO) requiring all hospitals licensed under chapter 241 of Texas Health and Safety Code to complete daily reports of hospital bed capacity,30 thus setting official state requirements. This EO served to validate and codify the request for information SETRAC was requesting from hospitals. It is noteworthy that at the time of the EO, no standard form existed at the national or state level. Initially, the EO30 only required all licensed hospitals, and state-run hospitals to report. In July, requirements shifted and reporting was expanded to include long-term acute care hospitals, military hospitals, and specialty hospitals, such as oncology, orthopedic, and women and children’s hospitals. However, 80-90 percent of the COVID-19 numbers were 04-SA-Weston-JEM#210066.indd 42 12/03/22 7:18 PM