University at Albany Center for Public Health Preparedness

Mass Evacuation to Rural Communities

Original Satellite Broadcast: 11/09/06

MR. SLOCUM: Good morning and welcome to the University at Albany center for public health preparedness grand round series. Before we start, I would like to remind you to please fill out your evaluations on-line. Your feedback is always helpful in the development of our programs, and continuing education credits are available. We’ll be taking your calls later in the hour. The toll-free number is 800-452-0662. You may also send your questions by fax at anytime during the program, that number is 518-426-0696. Today’s program is Mass Evacuation to Rural Communities. Our guests are Dr. Brian Gerber Assistant Professor in the division of Public Administration at the School of Applied Social Sciences at West Virginia University and Dr. Donald Rowe, Public Health Liaison at the University of Buffalo School of Public Health and Health Professions. Thank you both very much for joining us today.

DR. GERBER & DR. ROWE: My pleasure. Nice to be here, Peter.

MR. SLOCUM: Dr. Rowe I’d like to start with you, and ask you if you can you tell us a little about your organization out there in Western New York and some of the things you hope to accomplish.

DR. ROWE: I’d be happy to do that Peter. The Western New York Public Health Alliance is a nationally unique 501-C3 corporation. Its focus is to provide a regional partnership for public health, and in fact it involves the eight-county region of western New York, and that includes both urban and rural counties. It evolved from the western New York public health coalition that formed in the 1990s and now includes voting membership in this organization for hospitals, physician organizations, community-based organizations, Universities and of course the eight commissioners and directors of western New York in the health departments. And it really does serve, I think, to meet the mission of the organization.

MR. SLOCUM: And we have a slide on the mission, I know, but do you want to talk about that a little bit?

DR. ROWE: Sure. The mission in fact of the western New York Public Health Alliance is that in summary, through partnerships, effective partnerships enable an integrated, regional approach to achieve healthier communities. If we take this approach, if we establish good working collaborative partnerships, we can in fact achieve a vision, which is to improve the health, safety and wellness of the eight-county region of western New York.

All right. I understand you got a grant from the federal government to do this?

DR. ROWE: Yes, yes, we did. The alliance received a grant from the National Association of city and county health officials who obtained funding from the Center of Disease Control to establish a rural-advanced practice center focusing on emergency preparedness. Within that, we have a number of focus areas that we’re looking to obtain information and to provide some tools to those who might use this in the future. Some of those tools would include an evaluation of evacuation, migration of populations from urban centers to rural communities. We know that historically if it happens in a rural community, people will go to a place they feel comfortable, either far or near, but that’s where they will go. So we need to look at that. Also certainly in western New York, we have many cross-border issues, so we’ll have to deal with things like county-to-county, county-to-state, state-to-state, and in western New York, state-to-Canada. Those are issues we’re exploring in particular. Some of those are legal issues. Next week, Friday, there is a cross-border emergency preparedness legal conference, cross-border challenges. So if people are interested in the legal issues, look at the end of the program for some information about that.

MR. SLOCUM: Right. We’ll have resource identification at the end of the program.

DR. ROWE: That will be great. One of the other things is that many of the rural communities will need some assistance and training. We hope to provide the sort of tools that will enable them to prepare for this population surge to figure out when are they going to come, how long are they going to stay, what will they need to do to prepare for this? And give them some tools that will enhance their capacity to respond. The other part that I think is very, very important with this is that in order to accomplish some of these things, collaborations and partnerships sometimes with individuals with agencies outside your political jurisdiction is something that needs to be examined. We hope to provide a tool, a guide to collaborations and partnerships, maybe a step-by-step approach that counties can use. So in very summary form, these are the sorts of things that we hope to achieve.

MR. SLOCUM: In terms of a health event— I know you have looked at the western health association, what can you expect in an urban out-migration?

DR. ROWE: Well what we would expect based on history, and I think Dr. Gerber will look at it more in the future, is that urban residents if that is where the epicenter of the event occurs, will leave, most commonly by their own personal vehicles, and go to someplace that they perceive to be safe. That may be near; that may be far. It may be incident-dependent, but we’re looking to have measures that will give us some sense of how this will happen. I think if we perhaps look at the city of Buffalo and get a notion of the population density here, the Buffalo/Niagara region actually has a population of over 1 million people. The city of Buffalo, about 280,000 people. That’s a lot of people. If a large percentage of them decide to move, then the rural communities are going to be faced with “How are we going to handle them when they come here?.”

MR. SLOCUM: We certainly saw the overload on the transportation infrastructure with hurricane Katrina.

DR. ROWE: Absolutely. One thing we saw there in many cases was transportation gridlock. One of the values of what we hope to do here, is use the already existing of modeling software and database, available through subcontractors, who can predict flows of patterns, can redirect traffic so there will be a more orderly migration from the urban center outward.

MR. SLOCUM: That software and those tools, you think, will help some outward-lying communities predict, or the whole alliance, to predict what may happen and what kind of resources are impacted?

DR. ROWE: Yes, the alliance certainly would be able to benefit but also the regional planners, those involved in emergency preparedness, even others who have not been thought to be participants in this, will need to be brought into the fold for an effective response. If we look at the population map here with the notion that— the darker the color, the greater the population density. You can see from this map in just the eight-county region of western New York, we have a number of counties who are very sparsely populated. Allegheny county, for example, is considered 79% rural, and others as well. So I think this gives us some notion of where they’re going to go and then the limitations on the resources that these places may have.

MR. SLOCUM: That’s right. And so what is the alliance doing with this center to address these issues of mass evacuation, urban/rural?

DR. ROWE: One of the things we’re doing is working with a number of contractors who have specific expertise in mapping, planning software. They’ll be looking at developing metrics on measures that will enable us to better predict these migrations. You know, when will they occur, how long will this take, what motivates people to decide to evacuate or to stay, and we’ll put that in the form of a web-based, easily accessible tool, easy to use. I cannot emphasize that enough. Too much of the software right now I think is very challenging. This will be used for people to be able to go to and see what might be happening based on different scenarios.

MR. SLOCUM: I gather that you’re— while you’re planning for your alliance and something in your region, it’s something potentially expandable into a nationally available tool.

DR. ROWE: Absolutely. The intent is that this will not just benefit western New York. This advanced rural practice center that we’ll be developing has in fact a responsibility to put together tools that are applicable across the nation, we hope; perhaps even across into other countries such as Canada or Mexico .

MR. SLOCUM: Okay. That sort of leads naturally leads to your colleague here, Dr. Gerber, transitioning down to West Virginia. Can you talk a little bit based on past experiences and your studies, what do we know about evacuation?

DR. GERBER: We know quite a lot actually. There’s a lot of research on what motivates people to evacuate in the face of different types of hazards, ranging from natural disasters like hurricanes to accidental chemical releases at manufacturing plants or train derailments that might release chemicals. So it’s difficult to summarize in a sentence or two what’s known, but the way I would describe it is we know a lot about key factors that prompt people to either adhere to evacuation advisories or to self-evacuate, to spontaneously evacuate, things like somebody’s socioeconomic background, whether or not they have children in the home, prior experience. So if you have lived through a hurricane before, that might make you more likely to evacuate, those sorts of issues. One point I want to emphasize, one key factor that’s fairly consistent across a variety of situations, a variety of hazards, is the issue of perceived risk. To the extent that people perceive themselves to be vulnerable to a hazard, they’re more likely— in a general sense, they’re more likely to evacuate either adhering to an order or spontaneously or self-evacuating.

MR. SLOCUM: Okay. Certainly we saw that in Three Mile Island, a textbook case.

DR. GERBER: Yes, Three Mile Island is a great example because that accident, I guess the best way to describe it, this idea of perceived risk, the advisory was for a very small number of people to leave the area. I believe it was something like 3,500 people that were pregnant women and young children who were advised, and anywhere from about 140,000 to 200,000 people actually left the area. And why did they do that? Well, the essential issue is that this is an unknown hazard, people perceive themselves to be vulnerable and as a consequence they spontaneously or self-evacuated. This introduces the idea of an evacuation shadow, the idea that people will try to put distance between themselves and a hazard in order to mitigate the potential risk that they face.

MR. SLOCUM: So we know that people will evacuate, whether they’re mandated or public health people tell them to do so or not, and we call that, Spontaneous evacuation?

DR. GERBER: There are different types of evacuations, but in some cases there’s an advisory or even a mandatory order to evacuate. In other cases, people will not necessarily be at risk or at least potentially not be at risk and yet decide to evacuate themselves in any event and we describe that as self-evacuation or spontaneous evacuation.

MR. SLOCUM: Ok, and we have a number of examples where you looked at percentages of evacuees based on different types of events.

DR. GERBER: A lot of research on evacuation pertains to hurricanes because it’s such a big event that often dislocates lots of people.

MR. SLOCUM: Right. We’ve certainly had most of the experience and a lot of study of evacuation and response to natural events. How about terror events?

DR. GERBER: Absolutely. A lot of the good research is done on certain technological hazards or natural disasters like hurricanes. Much less is known about how the public might respond to a terror event, and there’s a little bit of research on that, and we’ll give some references at the end, some studies that have been done, but what I want to talk about today and a project that I worked on this past summer, was trying to understand how the public might react to different types of terror attack events, and that’s important because getting a sense of how the public might respond to an unfamiliar hazard like a terror event is important to the planning process and preparedness, especially when we’re talking about rural areas because presumably most experts suggest that typical terror targets are densely populated areas, basically urban areas, and to the extent that people might flow out of a densely populated area, in many cases they’ll be moving through rural areas and that’s an important contingency for planners to consider.

MR. SLOCUM: Right, and obviously in terms of our audience out here, everybody is thinking about getting ready for a 9/11 or a Pentagon attack, a big-city attack, but we also really need to focus on the potential for impact on rural areas.

DR. GERBER: Right. Absolutely.

MR. SLOCUM: What are some of the things you’re hoping to learn from the study as you begin to put it together?

DR. GERBER: Basically we did a study of residents of the metro D.C. Area and we were basically trying to get a sense— a couple of things. We wanted to get a sense of what the potential scale of a spontaneous or self-evacuation might be in the face of a terror attack in Washington. We wanted to also basically get a sense of whether or not the public response would be consistent across different types of attacks and we’re trying to get a sense of what the implications are in particular for rural areas because outside of D.C., surrounding the D.C. Metro area, you have a lot of rural areas in western Maryland, western Virginia, eastern West Virginia, Pennsylvania, etc. So in the event of a large-scale in D.C., that might precipitate the evacuation of this area, those surrounding communities will have to deal with that.

MR. SLOCUM: Your key findings, in summary?

DR. GERBER: I’ll go through the details in a moment, but in general we found that the public has a fairly high propensity when asked about their potential behavior, high propensity to want to evacuate from terrorism, if we think about terrorism as a hazard, and as a consequence of that propensity to evacuate, it’s likely that people will move in a variety of different directions away from D.C., and that’s going to have fairly significant implications if it occurs for rural communities that might have to receive evacuees.

MR. SLOCUM: And you’re going to get different people going different places based sort of on the kind of threat that it is?

DR. GERBER: Yeah. Basically what we looked at was in the study we basically tried to ascertain the scope of movement and where people might be inclined to go.

MR. SLOCUM: Okay.

DR. GERBER: And at a consequence of looking at some potential movement patterns where we think people might be likely to go, we see a fairly broad distribution of destinations throughout the country.

MR. SLOCUM: Okay. Let’s talk a little bit about the nuts and bolts. What methods did you use to do the study?

DR. GERBER: We did a random telephone survey, a random sample of households in the D.C. Metro area. We did 800 telephone surveys with counties in West Virginia, Virginia, and Maryland. We essentially conducted some short interviews with people over the telephone to get a sense of how they perceive a terror attack, and we also did some follow-up work by talking with county emergency managers in the region to get a sense of how they might be likely to deal with the problem of a mass evacuation of D.C.

MR. SLOCUM: Okay. And what type of information did you collect from the people you surveyed?

DR. GERBER: Sure. Essentially— I’ll just try to describe how we set up the survey interviews.

MR. SLOCUM: Okay.

DR. GERBER: Essentially we started out by asking people some basic questions like “What did you do on 9/11? How did you respond to 9/11?” we also asked— started out the interview by asking people about natural disaster events, and the reason for that is we wanted to get some baseline information on how people say they might behave in terms of evacuation of a natural disaster event, which is a little more familiar. We didn’t want to prime respondents to think about terrorism, which might be a little bit— people might respond a little bit differently. So we asked questions like “If you were going to evacuate, how would you do so?” overwhelmingly, people would— if they had to evacuate, most people are going to use their vehicles. Not a surprise. The Dr. Rowe mentioned Katrina, and you can think also to hurricane Rita, which happened a month later, where you have massive numbers of people in automobiles on the highways, and that creates its own set of problems. We wanted to get a sense of how reliant people are on automobiles, and overwhelmingly that’s the mode of evacuation that people are inclined to use. We also asked them, “If you were going to have to evacuate an area because of a natural event like a flood or potentially a hurricane that could hit that far up the east coast, would you have a place, a target destination in mind?”

MR. SLOCUM: And quite a few people do.

DR. GERBER: 60% of respondents said they had a specific target destination in mind. I would also note, as viewers can see, just over 40% said they did not have a target destination. This is important because— and this has been confirmed in other prior examples like hurricane events, lots of time people will get on the road, try to leave the area and not have a specific place to go, which again creates its own set of problems.

MR. SLOCUM: They might have family or friends, and that would be the 60% who know where to go, family and friends they can hang with for awhile.

DR. GERBER: Prior research shows in general when people have to evacuate, if they have a place in mind, they try and go and try tofind family or friends that they can stay with if they’re going to be dislocated for any meaningful period of time.

MR. SLOCUM: That 40% presents extra problems in rural communities because people are wandering the roads.

DR. GERBER: Absolutely.

MR. SLOCUM: We have an interesting map that breaks down survey responses by percentage and location.

DR. GERBER: Correct. Of those people that said they had a target destination in mind, we asked a follow-up question: "Can you name the city or state you’re going to?" and as the map there shows, we shaded in the states where people identified a location and those percentages indicate movement to the south, west or north, and in the yellow area on the screen there, that’s movement within the study area because, remember, we surveyed people in West Virginia, Virginia, Maryland, and that means a certain percentage of people that are leaving in the eastern pan handle of western Virginia are moving to another part of the state. They would stay within the state but move to the western part of the state.

MR. SLOCUM: And the shading reps the percentage of people from your study area that would head in that direction basically?

DR. GERBER: Correct. Correct. If they can, their preferred destination would be to move to one of those locations that was shown on the map, and we can break that down into even a little more detail in the study area. We have a second map that shows that the specific counties surveyed, as you can see, the distribution of movement is— it’s a fairly even distribution across— by direction, by the three directions moving away from the east coast there. People are going to move north/south, and west. And the thing that’s important is to the extent that people can move themselves through those areas, a lot of those areas are very rural, have limited infrastructure to deal with a large ingress of evacuees.

MR. SLOCUM: Okay. Now, you started with a natural disaster—

DR. GERBER: correct.

MR. SLOCUM: How did you tackle the question of terrorism?

DR. GERBER: So we wanted to get a sense of if you were going to evacuate, what would be your preferred destination, without thinking of terror events specifically because that might prompt different thoughts. So we asked about target destinations generally. We then asked a series of questions about three types of terror attack scenarios— a nuclear device being exploded in the D.C. Area; a dirty bomb being exploded in the D.C. Area, or a chemical attack. We wanted to get a handle on how people perceived themselves in terms of risk or vulnerability to such a hazard. We asked a series of questions: how likely people thought such an event were to occur in D.C., how vulnerable they or their family or significant others might be, and how likely it might entail multiple attacks because if you think of 9/11 at a series of conventional bombings, if you can think of the planes that way, obviously there were multiple attacks on that day. And what the survey showed is that fairly large percentages of respondents said these events were somewhat or very likely, as the slides on the screen showed—

MR. SLOCUM: And in this case, to interrupt— the blue is nuclear; orange is dirty bomb and yellow is chemical.

DR. GERBER: Right. And so a nuclear device being exploded in D.C. Was seen as least likely but people understand that that’s potentially the most dangerous, so it was seen as having the highest risk of causing harm to people, and also the lowest risk of having multiple attacks. But what those data show is that the perception of vulnerability is fairly high in the public, which has implications for how the public might respond because as I mentioned earlier when we look at events like Three Mile Island, even though it’s a long time ago, we have other examples of where people tend to respond based on how vulnerable they feel to a particular hazard.

MR. SLOCUM: And just one more clarification. How do you define the difference between a dirty bomb and nuclear explosion?

DR. GERBER: A dirty bomb, the core distinction is that a dirty bomb is essentially a conventional explosion which is used to disperse radioactive material. It in essence— it’s not a very efficient or effective way to do so. More deaths are likely to occur from the conventional explosion itself rather than radiation being spread, but really in essence it’s a terror tactic because it’s intended to spread fear or panic because obviously people tend to be more likely to be panicked when they’re aware that radiation has been spread.

MR. SLOCUM: Right, which gets us to this very or somewhat likely to evacuate question that you asked.

DR. GERBER: Yeah.

MR. SLOCUM: Why are people more likely to evacuate in response to nuclear threat, even though they may essentially be asked to stay in place.

DR. GERBER: At viewers can see, we asked— our critical question was to try to understand to what extent the public might spontaneously evacuate or self-evacuate in the face of these different types of terror attacks because as we said earlier, not a great deal is known about this particular problem. So the numbers on the screen indicate how many people said they would be very likely or somewhat likely to try to leave the area if one of these events occurred in the Washington, D.C. Area. So you see very large percentages of people indicating that they have essentially this initial reaction— their initial reaction would be to try to get out of the area. Not exactly surprised because as I mentioned earlier to the extent that people feel vulnerable or at threat, particularly with an unfamiliar, unknown hazard like a terror attack, people are going to try to use distance to limit their exposure to the harm that that might bring.

MR. SLOCUM: Okay. Did you also look at what type of criteria or information people used to make their decision?

DR. GERBER: Yes, absolutely. We asked respondents to say what kind of information would be important to your decision-making process as to whether or not you would evacuate? Not surprisingly, people report that they would look at media coverage or government announcements to give them a cue as to what to do in this situation.

MR. SLOCUM: And what happens if the news is blacked out, if they don’t have access to local news? You looked at that as well?

DR. GERBER: Yes, we did. In fact, the one potential— it depends upon the nature of a nuclear explosion, but there’s some potential that you could essentially knock out communications, other electronics from the explosion itself which might or very well would limit communication in the area. We asked people if you’re aware that something occurred but you didn’t know specific details in the case of the nuclear explosion, we asked them “what would you do? Would you be likely to stay in place and wait for more information or would you try to get out of the area immediately?” and even absent any specific information, about one-third of respondents said they would try to leave, which again indicates there is this likelihood in the public that that’s how people might respond; they might not know a lot of details. When you’re talking about a densely populated area like the Washington, D.C. Area, you’re talking about its impact on rural communities, you’re talking about a lot of people that would be leaving the area, and even if it’s only a third, that’s still presenting a fairly significant challenge to rural communities.

MR. SLOCUM: Right. I’m reminded of the fable, if that’s what it is, of people in Manhattan buying inflatable canoes and storing them in the closet is so they could be ready to get into the Hudson River, even if they didn’t know what it was.

DR. GERBER: That’s right.

MR. SLOCUM: Based on the findings, what should we anticipate?

DR. GERBER: In general, I want to emphasize that the study was a rough first cut at the problem because, as I mentioned, given that this is a fairly new threat for this country— obviously other countries have more experience with terrorism as a threat or as a hazard, but this was a rough first attempt to get a sense of what the scope or what the scale of the public response might be in terms of evacuation behavior, and given that people suggest that if they can they would try to move in a widely dispersed geographic pattern, given that even absent specific information, large numbers of people say they would try to move, that given that people feel themselves— when you ask them, they report that a fair amount or fairly high degree of vulnerability to this kind of hazard, it seems likely, based at least on this first study that there would— there’s a fairly high potential for a spontaneous or large number of self-evacuees leaving the area, which again that’s a problem in and of itself because examples like hurricane Rita, when you have large-scale evacuation events, those are dangerous events in and of themselves.

MR. SLOCUM: We saw the tragedy of nursing home residents being killed on the highway and other—

DR. GERBER: Just the evacuation itself can be a dangerous proposition.

MR. SLOCUM: Depending on the event, the public may be asked to shelter in place or to move or based on your study, what do you see as the balance and how do we need to work with people to get them to make the right kind of decisions—

DR. GERBER: It’s another important issue that we tried to tackle in this study, essentially people might be advised to shelter in place, which is basically the idea that for certain types of events like a chemical— accidental chemical release or intentional release of a chemical weapon, people can stay where they’re located, potentially trying to close off air flow coming into their building, and over time, over a fairly short period of time, that threat— the hazardous material will disperse in the air and it’s actually safer to stay where they’re at. For certain circumstances, that might be the advice I get. We asked people for each of our three attack scenarios, we asked people, "if you were told to shelter in place, would you adhere to that? We then asked a follow-up: If you were given the opposite advice, that you were advised to evacuate, what would you do? We found that large numbers of people in both cases said they would follow advice. But what’s interesting is, as the viewers can see, larger percentages of people say they’re very likely to adhere to an evacuation order and that’s a significant difference, so again this is just another piece of evidence that suggests that given a terror attack as a hazard, people are prone or show some kind of propensity to want to self-evacuate to minimize their vulnerability to a terrorism as a hazard event or disaster even.

MR. SLOCUM: Which is one reason I assume you characterize your finding as a chaotic large-scale evacuation because we’re talking about a third of the population basically ignoring advice and self-evacuating.

DR. GERBER: It could be a very large proportion of the population based on study results. As a consequence, if people do fear, say, multiple attacks, or they fear that they are in direct vulnerability, they might try to evacuate on very short notice. It’s important to realize that with a hurricane event, which is where we typically see really large-scale evacuations, you have a lot of warning, a lot of planning, a lot of ways to make those events work as smoothly as possible, not that they always do, but we have a lot of experience with that. A terror attack, if somebody were to successfully detonate a nuclear device in D.C., there’s no forewarning, likely I would suspect its likely going to be a panicked self-evacuation which, again, means that people might not have the capacity to be adequately prepared to deal with that kind of event.

MR. SLOCUM: Right, right. And of course if they’re anticipating a response to a shelter recommendation and get something else, which brings us back around, as everything does these days, to Katrina, where we saw the tremendous hazard of not having adequately executed plans in advance, do you think the public has confidence in our preparedness operations so far?

DR. GERBER: We did ask about that as well. We wanted to get a sense of— because trust or confidence in government is another important factor in people’s decision-making. As people process information, that’s relevant to how people might decide to respond to an event, and so we asked people how much confidence they had in the federal government to plan for, to prepare for natural disaster events and terror events, and unfortunately the public does not have a great deal of confidence. The numbers aren’t particularly great. Only small percentages say they have a great amount of confidence in federal evacuation planning, which again probably is relevant to people’s decision. If an event does occur, that’s likely relevant to the way they might behave if a real event, a terror event, does occur.

MR. SLOCUM: All right. Based on your findings and your observations from the study and people’s reactions, what are some of the main findings do you think that have lessons for the public health community?

DR. GERBER: Well, probably the biggest point, the most important point I would try to make, is that these kinds of catastrophic incidents are important to prepare for, even if they’re low-probability events. If you think of the attack event as a first-order problem, a problem in and of itself, the evacuation or potential large-scale spontaneous evacuation is sort of a second-order problem, a problem unto itself like we saw in Katrina or Rita, and it’s important that we do more work in this area to try to find— to try to get a better handle on the potential scale of these kinds of evacuation events because they’re likely to vary and it’s important for not only the emergency management community but the public health community to understand the potential implications for events on different scale.

MR. SLOCUM: Because we are going to get, absent some other— especially specific local news and directive, we’re going to get in that vacuum, a large-scale evacuation.

DR. GERBER: Yes, potentially. Potentially, that’s a realistic possibility to account for.

MR. SLOCUM: In some of the rural areas that you’re thinking about here in your study, what are some of the factors to keep in mind for those communities in dealing with this secondary threat?

DR. GERBER: Well, we’re also— myself and some colleagues at West Virginia University— what we’re also trying to understand is from this perspective because, in essence, being in West Virginia, we’re sort of on— at least our eastern panhandle is on the fringe of the D.C. Metro area; with the people in the eastern panel actually commuting into the D.C. Area to work, and at we’re a very rural state and a lot of the areas around us are rural, it’s important to understand the capacity to deal with ingress of evacuees. We like to think of it as a community’s capacity, surge capacity. The idea that a hospital surge capacity can be extended to a community, and there’s some basic issues that it’s important to account for in the planning process to think about what resource are available as you plan for catastrophic events or events of different scale, and those include, as are up on the screen, a variety of aspects of civil infrastructure but also include administrative resources as well. When I talk to emergency managers at the county level, especially in rural communities, one of the big issues or big challenges they have is actually having adequate amounts of personnel to manage an event. So even if you’re a rural community and you’re going to try to move people along, either on an interstate or a state highway, if the event is big enough and it’s a long enough time period, even that is going to be a challenge because of administrative or personnel resources— in lots of rural communities, there’s not a lot of people to do this kind of work.

MR. SLOCUM: That’s right. So an emergency agency or public health agency handling triple your normal population, your staff is not going to be able to do that.

DR. GERBER: Exactly right.

MR. SLOCUM: What about emergency services area, in terms of personnel?

DR. GERBER: The same sort of issue, both in terms of public health and— if you think of a catastrophic event that does precipitate a large evacuation from a public health standpoint, not only is there going to be the challenge of lending assistance to the area most affected— that’s a likely contingency, but just, say, the acute care problems that might occur from the evacuation itself, is a major consideration which is why it’s useful to think about what the community can do by itself and in conjunction with other communities to plan for, prepare for these kind of events.

MR. SLOCUM: Now, you have categorized different types of evacuation events or scenarios that rural communities should begin to think about?

DR. GERBER: Yes. I think the easiest way to describe it— I think there are a couple of basic issues. You can think of short-term or short duration evacuations. You can also think of— so if there’s a natural disaster event, a hurricane that might prompt people to leave only for a day or two, its one thing to plan for that kind of event. There are other larger-scale catastrophic events, not only a hurricane on the scale of Katrina or Rita, but the study that we did, which speaks to if we did have a large-scale terror attack, it might dislocate people for a longer period of time which would likely precipitate a longer duration evacuation event, and those evacuations might include contaminated persons, depending on what kind of hazard we’re talking about. So it’s useful, I think, in my perspective, useful for both the emergency response and public health communities to make sure their plans are sensitive to not only different types of events of different scale but think in terms of what an evacuation might look like in terms of its duration and if you’ve got contaminated persons involved, your assessment capability— not only the capability to decontaminate but possibility to— the capacity to assess who might need to be decontaminated.

MR. SLOCUM: Certainly not a rural communities but Baton Rouge experienced a huge change in the fabric of society as a result of the Katrina evacuation; school system impacts, all that kind of thing.

DR. GERBER: Absolutely. Unfortunately, that’s a nice illustration of the point that a community can become a receiving community. Baton Rouge, I’m not sure what the original city size was but the major long-term influx of evacuees from New Orleans basically put a massive strain on that community, its resources, from infrastructure to public health and so on, and hopefully other regions of the country won’t have to deal with those sorts of events, but it’s useful to think in those terms, that if you’ve got a large-scale event like that, how can you manage that sort of event effectively.

MR. SLOCUM: What are some of the specific things rural areas should be thinking about and anticipating in something like this?

DR. GERBER: Well. I think one point I like to make is that traditionally when we look at evacuation events or plan for them, there’s often a tendency to look at events from a transportation perspective and how you move people out of an area, and those sorts of issues, but there’s also a major concern that’s a little less studied, is how communities that are going to be those receiving communities, especially if it’s a larger-scaled event, how those receiving communities are prepared or equipped to handle an ingress, a large-scale ingress of evacuees.

MR. SLOCUM: All right. And how can some of those planning challenges be addressed? I would like to ask Dr. Rowe to chip in here a bit.

DR. GERBER: I’m sorry, if I could just say one thing quickly. In my estimation, when we’re talking about catastrophic events that might precipitate large-scale evacuations, and talking about terrorism specifically, if it’s a large-scale event, what’s absolutely essential is to develop regional coordination. Historically when we talk about regional coordination, we’re often talking about agreements to respond, mutual aid agreements to respond. I think we have to go much deeper than that in terms of coordination of a regional preparedness and regional response beyond mutual aid agreements but actually to develop mechanisms by which we can plan or prepare for to understand what resources on a regional basis to handle a problem because disaster events, in a sense, even though we have jurisdictional boundaries, state or within state, we have jurisdictional boundaries— if you’re talking about a large-scale disaster event— those boundaries become very meaningless very quickly and Dr. Rowe has a perfect illustration in terms of what I’m talking about.

MR. SLOCUM: Sounds like he’s writing your next grant for you.

DR. GERBER: That would be good! As long as I can get in on it.

DR. ROWE: But one of the several successes that the western New York Public Health Alliance has is the actual creation of the regional office of Public Health Emergency Preparedness which covers the eight-county region. That’s really significant because there are limited public health resources within— particularly the rural communities— but what happened is that each county took dollars they received from CDC, pooled them, and created a structure that enabled them not only to meet the CDC deliverables but to be able to train on the same equipment, the same supplies, to conduct regional exercises across the borders. I think the key issue here is not just to plan but to exercise the plan to see whether or not what you’ve suggested will work will in fact work, and what this does is that if an event should occur in any part of that region, all of these individuals who have been part of this regional office of Public Health Emergency Preparedness can mobilize to wherever the need is and there’s no learning curve; you have a firm collaboration and partnership by actually committing dollars, and it’s worked very, very well.

MR. SLOCUM: Because your county jurisdiction may begin and end at a certain border but the highway doesn’t. There’s no checkpoint, tollbooth pass from Allegheny to Wyoming County.

DR. ROWE: You’re absolutely right. The disease or episode doesn’t care about the boundaries. What people care about is how can they best be served? And one of the best ways to do that is through this effective collaboration and effectively using the resources that you have within that geographic area, to respond to that event. By coming together and working collectively together, you can do much more than trying to do it all on your own.

MR. SLOCUM: And you talk about the advanced— not just planning but practice, testing those things, brings to mind the problem with radio frequencies across lines. Sometimes within the same jurisdiction, emergency responders are on different frequencies and you have across rivers and counties different radio frequencies, which is unacceptable in an emergency.

DR. ROWE: There are many things. There’s a lot to do. I don’t think we should give the audience the notion that we’re there yet with all of this. There’s much more to do. For example, we have boundaries with Canada and Mexico . We have resources on both sides of the border, but there are challenges and how do we have access to them in either direction? We need to explore those sorts of things so that we can more effectively actually have mobilization of the real available resources, regardless of where it’s from.

MR. SLOCUM: One of the things that you talked about also, Dr. Gerber, in your study was the importance of looking at time frames and we talked a bit before about the duration of an emergency but the federal response setup is key to be able to show up in about 72 hours and ask any locals to hang on until then. Does that have implications for the whole regional approach we’re talking about?

DR GERBER: Yes, absolutely.

DR. ROWE: I think that’s the key thing. The message is that all emergency events are local, at least for 72 hours, and that may be true, and if you’re focusing only from a single-county perspective, that puts a tremendous drain. On the other hand, if you know through practice that you have access to other resources from nearby counties or wherever you need them, and you’re confident that you can receive those resources, your ability to respond is tremendously enhanced.

DR. GERBER: I would just follow up on that by saying when we think about disaster planning, typically in the issue of the 72-hour time frame, when we’re talking about the specific issue of evacuation events and rural communities, it’s really an issue of whether or not those evacuation events for a rural community fit the traditional model very well and they don’t necessarily because if a rural area becomes a receiving area, that might have very different— that community might have very different needs in terms of how it’s going to deal with that event and there’s the potential there to overwhelm— if you’ve got a large, unplanned evacuation without any forewarning like in the case of a terror attack, it’s very easy to see how that evacuation event might overwhelm local resources if the appropriate planning hasn’t been put into place.

MR. SLOCUM: And you also talk about the need for adjusting plans, depending on different kinds of events to anticipate, right?

DR. GERBER: Absolutely. I think one major challenge in the planning process is to figure out how flexible your plan is to accommodate your emergency operations plan is to accommodate not only different types of events but different scales of events as well.

MR. SLOCUM: All right. Concluding remarks for our audience before we get to a number of questions?

DR. GERBER: I would just say a couple of things real quickly: The main take away from the evacuation study, as I mentioned, it’s certainly a first take at this problem, but it does speak to the issue of preparing for catastrophic incidents. And it goes beyond terrorism, really. If there’s some kind of catastrophic event like we saw on the gulf coast last year, if those kind of disasters on that scale occur, it’s important to try to develop better regional response, better regional planning, better regional preparedness, and so really I think the findings provide support for the idea that for certain types of hazards, the public does have a real propensity— as we know from prior experience, there’s a real propensity to want to spontaneously evacuate and these results take us down that road as well, but it really points to the importance of developing better coordination mechanisms pre-event.

MR. SLOCUM: Let me just interrupt here and say to the audience that we’re ready to take calls now. The toll-free number is 800-452-0662. You may also spend questions by fax. We have some already. 518-426-0696. We do have a few minutes for calls. While we’re waiting a second, I want to review some of the web site resources that we have up there on slide that both of you have contributed to right here.

DR. GERBER: I can just say quickly—

MR. SLOCUM: Okay.

DR. GERBER: The first site there, the first web site, the study that we did this summer will be going up at that site. It’s not up there today. It will be up there shortly as we’re completing our final report, so in the next couple of weeks we’ll have that report. You asked me earlier about what’s known about terror events specifically. There are a couple other web sites that have studies that are relevant to how the public might respond or how to plan for these kind of events or what the scale of some of these kind of terror events might look like, including— there’s some material there on pandemics as well.

MR. SLOCUM: Okay.

DR. GERBER: Which sort of fits in nicely with this— with the issue that we have been talking about this morning.

MR. SLOCUM: Okay. And then the western New York alliance is up here, too, on this slide, right?

DR. ROWE: Yes, it is. I think the western New York public health alliance, you can in fact go and learn more about this organization by going to www.wnypha.org.

MR. SLOCUM: There it is on the screen.

DR. ROWE: Right. And you’ll get a sense about the successful collaborations that have been done. There’s a great deal of information available to you, and I’m sure the alliance would be more than happy to help others who would like to explore the route.

MR. SLOCUM: We’ll get to that question in a second but I have two questions I want to start working on here. You wanted to mention that the other slide was about the cross-border legal challenges, right?

DR. GERBER: I did want to talk about that because the emergency preparedness cross-border legal challenges are an issue for many people, because we think of it as just international issues. There are legal issues: county-to-county, county-to-state, how do you mobilize resources? What are some restrictions? The November 17th event will explore those with an incredible panel of people.

MR. SLOCUM: One question we got from Pennsylvania here is exactly that point, the evacuation out of the New York city, metropolitan area, much of it would head west into Pennsylvania, a rural part of the Susquehanna valley. Is there any planning going on to deal with that sort of thing?

DR. ROWE: In the country, to the best of my knowledge, each county receives dollars through CDC to do some emergency preparedness planning. My encouragement is that if those resources that you have are limited, look to find ways to partner with others who have some resources and do it in a more effective way than if you try to go at it alone. I think we have ample evidence now that the collaborative and partnership approach to these problems is likely to be far more successful than trying to attack these problems on your own.

MR. SLOCUM: Okay. One— quickly another question: did your study look at the special needs populations?

DR. GERBER: We did. We did ask some questions about whether or not there was a special needs person in the home and we asked the standard sort of potential issues from physical disabilities and so on, and—

MR. SLOCUM: I’m afraid we’re not going to have time to finish that. We had too much to cover. Good session. I want to thank you very much, both of you, for joining us, and thank the audience very much as well. I would ask you to please fill out your evaluations on-line. Your feedback is important as we develop new programs and continuing education credits are available. We hope you join us on December 14 for managing contemporary mass fatalities incidents with Dennis McGowan, the lead instructor of the national mass facilities institute. Please note that we’ll be adding an extra 15 minutes to that broadcast to allow more time for questions. It will start at 10 eastern and will ends at 11:15 a.m. The program is rebroadcast will also run the extra 15 minutes. I’m Peter Slocum and I’ll see you next time at the University of Albany center for public health preparedness public health grand rounds. Thank you very much.

DR. GERBER: Thank you