Saturday, November 14, 2015

The Role of First Responders

Responder Role in Disasters and other Emergencies
By John Fisher



Who are first responders?

The first people on the scene in an emergency or natural disaster are usually police officers, firefighters, and paramedics, or emergency medical technicians (EMT). As first responders, they are trained to react quickly in emergencies. Their first responsibility is to make sure people are safe, which may include evacuation, rescue, crowd control, and medical attention. Suppressing fires and controlling other hazards is usually left to firefighters while police officers secure the area by redirecting traffic and keeping bystanders away. In these roles, they serve as “a calming force, keeping panic and disorder to a minimum” (US Legal, 2010). Paramedics and EMTs are most often associated with fire departments, many of which require their people to have both fire and medical training. SWAT teams may also contain trained paramedics.

Natural disasters spare no one. Matthew Tobia (2013) points out the ferocity of storms like Hurricane Andrew or Katrina, and, more recently, Superstorm Sandy.  “The same forces that move homes off their foundations or burn them to ashes don’t just make left turns around fire stations, sparing them from destruction.” Instead, firefighters and police, paramedics and EMTs learn to deal with disasters with the tools at hand. This requires they prepare for the worst scenarios and hope for the best. In addition, to preparing themselves it also is vital they prepare the communities in which they live, including their own families.

Because first responders usually live in the communities they serve, they know their communities well. They know the streets and buildings, and they understand the people and the local government. This gives them the advantage, like in Joplin where not a street sign was standing after the 2011 tornado, of being able to respond knowingly and effectively.  When a community is leveled they may have little to work with, but they use their resourcefulness to meet the needs of their community. Often this will require the joint effort of other agencies and community members.   

One specialized role is that of the fire marshal. A fire marshal, in the United States and Canada, is often a member of a fire department but may be part of a building department or a separate department altogether. Fire marshals' duties vary but usually include fire code enforcement and/or investigating fires for origin and cause. Fire marshals may be sworn law-enforcement officers and are often experienced firefighters. Fire marshals may carry a weapon, wear a badge, wear a uniform or plain clothes, and make arrests pertaining to arson and related offenses, or, in other localities, may have duties entirely separate from law enforcement, including building- and fire-code-related inspections. In many areas, the fire marshal is responsible for enforcing laws concerning flammable materials.

What is the role of the National Guard and Coast Guard in disaster situations?

The Army National Guard, the Air National Guard, and the U.S. Coast Guard provide vital support during natural disasters. The Army National Guard and Air National Guard have over 300 thousand members in more than 1,800 National Guard units located in 2,700 communities across the United States. While the National Guard receives military training for wartime service, they also are trained in emergency response skills and answer the call when their service is needed to deal with disasters. The Coast Guard is made up of active duty, reserve, and civilian personnel and protects the coastal boundaries of the United States. They performed a vital role in the BP spill cleanup in 2010 and respond in all disasters along our coastal shores.

While the National Guard is under the jurisdiction of the federal government when called up for war, they usually serve under state governments and can be called up by the state governor in response to disasters. State National Guards work cooperatively with local authorities during emergencies and natural disasters. National Guard troops help reinforce dams and dikes threatened by floods, work to contain forest fires, and assist community rebuilding efforts after hurricanes and tornadoes. Because Guard members have unique skills like flying helicopters and airplanes and driving trucks, they serve a vital role in transporting supplies, injured and sick people, and emergency materials (US Legal, 2010).

What is the role of hospitals in a disaster?

The role of hospitals in the community response to disasters has received increased attention, particularly since the terrorist attacks of September 11, 2001. Hospitals must be prepared to respond to and recover from all-hazards emergencies and disasters. The continued progress of our medical response system in all-hazard emergencies and disasters depends in large part on the future guidance and support from government institutions (Sauer, 2009).

In many communities, hospitals have not been integrated well into the community disaster response system and thus may not be prepared to safely treat mass casualties from disasters and incidents involving hazardous materials.  Of particular concern is keeping health care workers safe. Healthcare workers may be exposed to chemical, biological, physical or radioactive hazards while providing care to patients who arrive at the hospital for triage following an incident involving hazardous materials. Safeguarding health care workers who deal with emergencies is critical in performing the mission to save lives and protect the public. The few cases of Ebola to come to the United States in 2014 from Africa showed how unprepared hospitals were to deal with a pandemic.  Knowledge about the means to protect health care workers and understanding of emergency response planning essentials will help keep healthcare workers safe from hazardous materials and provide for the treatment of casualties of disasters (OSHA, 1997).

Unlike other institutions, hospitals need to be on 24/7 standby and have essential resources to respond to disasters (Rodak, 2012, OSHA, 1997). These resources should include:
  • Comprehensive community disaster plans for a wide range of potential events, each with diverse action requirements;
  • Training and drills including practice of the Incident Command System (ICS);
  • Back-up generators;
  • Effective communications systems including a line between the incident and hospital;
  • Personal protective equipment that staff can use to avoid exposure and limit contact with infected patients;
  • Decontamination units, which include trained physicians, nurses, aides, and support staff;
  • Decontamination procedures and designated decontamination areas with necessary equipment;
  • Stockpiled medical supplies and pharmaceuticals;
  • Disease surveillance systems including air monitoring and controls to prevent the movement of airborne substances through ventilation and duct work;
  • Access to information on diseases and hazardous toxic materials;
  • Surge capacity to treat an influx of patients and plans for treating non-disaster patients;
  • Alternative facilities in case of contamination of the hospital’s emergency department; and
  • Post-emergency critique of the hospital's emergency response.
What training and education do first responders have?

Following 911 critics called for better training of first responders to deal with emergencies of the size of the impact of a terrorist attack.  Critics noted that first responders were completely unprepared for biological and chemical weapons of mass destruction (Heritage, 2002).

Nine days after the September 11th attacks, to Congress President George W. Bush announced that he would create the Office of Homeland Security to coordinate the efforts of more than 40 federal agencies in order to prevent future terrorist attacks. The Office was created nearly a month after the attacks with Tom Ridge, the former governor of Pennsylvania, as the first the first director. On January 24, 2003, Ridge became the first Secretary of the U.S. Department of Homeland Security.
While at first Homeland Security served primarily as a coordinating body, it later emerged as the principal civilian protector of the country inside and outside its borders. Its stated goal is to prepare for, prevent, and respond to domestic emergencies, including terrorism, human-caused disasters, and natural hazards. One role is to train first responders and prepare the public for emergencies.

The Federal Emergency Management Agency (FEMA) is an agency in the Department of Homeland Security (DHS). It trains in the areas of firefighting and emergency management, through the National Fire Academy and the Emergency Management Institute. The Federal Law Enforcement Training Center coordinates training for police officers. In preparing for a disaster, police officers and firefighters trust in their training and capitalize on their knowledge of a community. Exercises simulating disaster situations (large- and small-scale events) help better prepare officers and firefighters and allow them to fully understand the resources and response needed for each event. First responders know their communities best and interact with residents on a daily basis. This knowledge gives them the ability to provide valuable situational awareness to response and recovery groups coming in to help (Hylton, 2013).

What is NIMS?

The National Incident Management System (NIMS), established in March 2004 and revised in 2008, is “a systematic, proactive approach to guide departments and agencies at all levels of government, nongovernmental organizations, and the private sector to work together seamlessly and manage incidents involving all threats and hazards—regardless of cause, size, location, or complexity—in order to reduce loss of life, property and harm to the environment” (FEMA, 2015).

The purpose of NIMS is to provide a common approach for managing incidents. It promotes a flexible but standardized set of incident management practices with emphasis on common principles, a consistent approach to operational structures and supporting mechanisms, and an integrated approach to resource management. NIMS is the foundation of the National Preparedness System (NPS), providing for a unified approach in building and delivering the core capabilities across all five mission areas (Prevention, Protection, Mitigation, Response, and Recovery). 

Incidents typically begin and end locally, and they are managed daily at the lowest possible geographical, organizational, and jurisdictional level. As incidents become larger success may depend on the participation of many jurisdictions, levels of government, non-governmental agencies, and all responders. These instances necessitate effective and efficient coordination across this broad spectrum of organizations and activities. By using NIMS, communities are part of a comprehensive national approach that improves the effectiveness of emergency management and response personnel across the full spectrum of potential threats and hazards (including natural hazards, terrorist activities, and other human-caused disasters) regardless of size or complexity. NIMS is a “whole community” approach, involving community members, first responder agencies, public and private sectors, and non-governmental and non-profit organizations (FEMA, 2015).

The National Incident Management System (NIMS) Training Program defines the national NIMS training program as it relates to the NIMS components of preparedness, communications and information management, resource management, and command and management. It specifies the National Integration Center (NIC) and stakeholder responsibilities and activities for developing, maintaining, and sustaining NIMS training. The NIMS Training Program outlines responsibilities and activities that are consistent with the National Training Program, as mandated by the Post-Katrina Emergency Management Reform Act of 2006. This program integrates with FEMA training offered through the Emergency Management Institute (EMI) and United States Fire Administration (USFA). The National Exercise Program (NEP) is the Nation’s overarching exercise program. All interagency partners have adopted the Homeland Security Exercise and Evaluation Program (HSEEP) as the methodology for all exercises that will be conducted as part of the NEP (DHS, FCD 1, Nov. 2007, p. 7).

NIMS also provides for effective resource management and mutual aid across jurisdictions and levels of government. As a condition of receive Federal Preparedness grants and awards, local, state, territorial, and tribal nation jurisdictions must implement NIMS procedures and report using NIMS guidelines. NIMS Alerts announce the release of new NIMS guidance, tools, and other resources. FEMA Regional NIMS Coordinators act as subject matter experts regarding NIMS for the local, state, territorial, and tribal nation governments within the 10 FEMA Regions, as well as for the FEMA Regional Administrator and staff. The Incident Command System (ICS) has been established to provide standardization through consistent terminology and established organizational structures (FEMA, 2015).

What is interoperability communications and why is it so important?

During the terrorist attacks on the World Trade Center on September 11, 2001, soon after the south building collapsed warnings were sent out to police radios to vacate the north building. Most police were able to vacate the building but over 121 firefighters were left in the North Tower to die. In total 411 first responders died that day: 343 firefighters from the New York City Fire Department, 37 police officers of the Port Authority of New York and New Jersey Police Department (PAPD); 23 police officers of the New York City Police Department (NYPD); and 8 emergency medical technicians and paramedics from private emergency medical services.

Most firefighters did not get the police warning. The firefighter radio system failed frequently during the morning.  Even if it had been reliable, it wasn’t linked to the police system. In addition, police and fire commanders didn’t communicate with each other during the event  (Dwyer, 2002).

Interoperability communications is "the ability to exchange and make use of information" between agencies like the police and fire departments. It also applies to communications within organizations. Timmons (2007) indicates that radio communications is not the only interoperability failure. Since 9/11 first responder agencies have made headway by purchasing equipment that works among agencies. In addition, the equipment and systems are able to provide signals in remote locations or impenetrable building structures. However, other communication problems result from dysfunctional relationships among agencies, first responder stress in difficult situations, insufficient training and poor procedures and policies.

Interoperability communications can be enhanced by improving, not only equipment and systems, but also human behaviors and relationships. Areas of focus for training, according to Timmons (2007), are sensory overload, cognitive bias, speech center deficit, and suppressed emotions. Sensory overload occurs as soon as first responders arrive at the scene, where they are required to make critical decisions and give commands to others. Cognitive bias occurs when people disregard information that disconfirms their preconceptions. This can lead to an incomplete operational picture. Stress can alter voice pitch and inflection when talking on the radio.  This is speech center deficit. Finally, first responders learn to be calm in an emergency situation. This is not always good because suppressing natural emotional responses can lead to elevated blood pressure and increased stress levels, disrupting communications, and inhibiting relationships.

What is the difference between an emergency and a disaster?

A disaster is “an occurrence disrupting the normal conditions of existence and causing a level of suffering that exceeds the capacity of adjustment of the affected community…. A disaster occurs when hazards and vulnerability meet” (WHO, 2002). A disaster is a sudden calamitous event bringing great damage, loss, or destruction.

The difference between disaster and emergency is fairly big, although an emergency situation can certainly feel like a disaster to those involved. A disaster will likely affect more people and/or will have more devastating consequences than that of an emergency. A disaster is an emergency situation if noticed ahead of time. However, not all emergencies will reach the level of disasters.
An emergency is defined as an unforeseen combination of circumstances or the resulting state that calls for immediate action; an urgent need for assistance or relief.

Ken Jorgustin (2012) wrote: “When I think of disaster and emergency, I consider a disaster to be widespread, regional, or wider. Examples of a disaster may be the consequences of severe weather such as a hurricane, tornado, or flooding. An economic meltdown followed by a rapid devaluation of currency would be considered a disaster, affecting countless millions of people. An emergency is a situation that requires immediate attention, a situation that could lead to disaster if left alone or unattended. Or, maybe it won’t, although it may seem like it to you nonetheless.”

Any disaster that arises from the physical phenomena—hurricanes, floods, earthquakes, tornadoes, tsunamis—can be deemed a natural disaster. Human-caused disasters may also be the direct result of natural conditions. For example, the floods that devastated New Orleans during Hurricane Katrina in August 2005 were caused by levees that burst, but it was the hurricane’s wind and rain that caused the excess of water. Likewise, fires which may destroy wildlands and communities may be human-caused or could result because of dry conditions and electrical storms. The San Francisco fires in April 1906 were caused by broken gas lines resulting from a major earthquake.

While natural disasters can strike anywhere, the poor usually suffer more than the rich, because they lack the resources to rebuild or to relocate. Infrastructure is usually better in wealthier communities and countries. The poor in New Orleans were hardest hit because they built on the low ground and didn’t have the means to evacuate.  On January 12, 2010, a 7.3 magnitude earthquake struck Haiti, killing more than 220,000 people and injuring over 300,000. The massive earthquake, the biggest the region had seen in 200 years, left more than 1.5 million people homeless, and resulted in an immense humanitarian crisis.  The devastation was compounded by poor building practices and weak infrastructure.

In the United States, government agencies can assist those who have lost their homes and possessions. Numerous federal and state government agencies (including non-governmental agencies) provide help to those in need when disaster strikes, but often that assistance covers only part of what is needed. Also, it is difficult to get protection such as homeowner’s insurance in areas prone to damage from floods or hurricanes (US Legal, 2010).



Terrorism is a human-caused threat that is unpredictable and can cause great loss of life and property. The recent terrorist attacks in Paris, France on November 13, 2015, where more than 100 people died, served as a tragic reminder of September 11, 2001, the worst terrorist attack in history. On September 11, 2001, a succession of four coordinated assaults was launched by the al-Queda in the New York City and Washington DC areas. Four planes were hijacked by 19 men and two of those planes, American Airlines Flight 11 and United Airlines Flight 175, collided into the north and south towers of the NYC World Trade Center, which collapsed within two hours and led to the destruction of nearby buildings as well. The third plane, American Flight 77, targeted the Pentagon in Virginia while the last one, United Airlines Flight 93 whose aim was the Capitol in DC, crashed into a field in Pennsylvania when the passengers tried to overpower the hijackers. These catastrophic events led to the deaths of about 3,000 people.

Terrorism is the systematic use or threatened use of violence to intimidate a population or government and thereby effect political, religious, or ideological change.  Terrorist organizations in the United States today use techniques such as hijacking, bombing, diplomatic kidnapping and assassination to assert their demands (US Legal, 2010).

What do first responders do in a disaster?

Emergencies happen very frequently whereas disasters may occur only once or twice in the life of a first responder. Handling emergencies (like car accidents, house fires, and response to crime) helps prepare first responders to deal with disasters.  The role of first responders in responding to a disaster is very similar to the day-to-day role of public safety and supporting the community. Because first responders know their communities and interact with residents on a daily basis they can respond quickly to a heightened crisis situation such as in a disaster. For example, understanding unique community features, like demographic and language characteristics, allows law enforcement officers to help outside emergency management teams in a disaster. Their presence and support in the community in a disaster has a calming effect that helps people respond more appropriately.

During a disaster, police officers play a key role in many operations, including search and rescue, evacuations, door-to-door checks, and maintaining overall public safety within the community. In addition to being involved in some of these same functions, firefighters and paramedics are involved in suppressing fires, handling hazardous materials, and first response medical care and transportation to hospitals. These are critical actions that support not only their own communities but neighboring towns as well (Hylton, 2013).

In the following excerpt, Roberto Hylton (2013) describes first responders working with college students following a tornado. “An EF-3 tornado impacted the nearby college campus and devastated neighborhoods and infrastructure. Emergency services were stretched to the max. Officers worked relentless hours, 48 hours straight in some cases, setting up and supporting emergency response and rescue operations. The scene was chaotic with debris and terrified college students, but the right training helped officers maintain public safety and conduct lifesaving missions.”

How are first responders organized in a disaster? What is the Incident Command System (ICS)?

The National Incident Management System (NIMS) has adopted the Incident Command System (ICS) and mandated its use by first responders in emergencies and disasters. The Incident Command System is a standardized management tool for meeting the demands of small or large emergency or nonemergency situations. It represents "best practices" and has become the standard for emergency management across the country. ICS may be used for planned events, natural disasters, and acts of terrorism.

In the 1960s and 1970s, first responder agencies noted that high cost of wildfires in Arizona and California. Property damage ran into the millions, and many people died or were injured. Studies indicated that response problems were often related to communication and management deficiencies rather than lack of resources or failure of tactics. In a meeting in 1968 Fire Chiefs in Phoenix, Arizona formulated the ICS concept, based on the management hierarchy of the US Navy.  During the 1970s, ICS was fully developed during massive wildfire suppression efforts in California and following a series of catastrophic wildfires in California's urban interface. ICS was developed mainly for firefighting of wildfires in California and Arizona but was quickly adopted nationwide.

The ICS is a management system designed to enable effective and efficient domestic incident management by integrating a combination of facilities, equipment, personnel, procedures, and communications operating within a common organizational structure, designed to enable effective and efficient domestic incident management. A basic premise of ICS is that it is widely applicable. It is used to organize both near-term and long-term field-level operations for a broad spectrum of emergencies, from small to complex incidents, both natural and manmade. ICS is used by all levels of government—Federal, State, local, and tribal—as well as by many private-sector and nongovernmental organizations. ICS is also applicable across disciplines. It is normally structured to facilitate activities in five major functional areas: command, operations, planning, logistics, and finance and administration (FEMA, 2008).

The following chart shows the Incident Command System (ICS) structure:



Source: FEMA. 2008, May). ICS Review Materials.

The Incident Commander is technically not a part of either the General or Command Staff. According to FEMA (2008), the Incident Commander is responsible for overall incident management, including:
  • Ensuring clear authority and knowledge of agency policy.
  • Ensuring incident safety.
  • Establishing an Incident Command Post.
  • Obtaining a briefing from the prior Incident Commander and/or assessing the situation.
  • Establishing immediate priorities.
  • Determining incident objectives and strategy(ies) to be followed.
  • Establishing the level of organization needed, and continuously monitoring the operation and effectiveness of that organization.
  • Managing planning meetings as required.
  • Approving and implementing the Incident Action Plan.
  • Coordinating the activities of the Command and General Staff.
  • Approving requests for additional resources or for the release of resources.
  • Approving the use of participants, volunteers, and auxiliary personnel.
  • Authorizing the release of information to the news media.
  • Ordering demobilization of the incident when appropriate.
  • Ensuring incident after-action reports are completed.
Command Staff
The Command Staff is assigned to carry out staff functions needed to support the Incident Commander. These functions include interagency liaison, incident safety, and public information.
Command Staff positions are established to assign responsibility for key activities not specifically identified in the General Staff functional elements. These positions may include the Public Information Officer, Safety Officer, and Liaison Officer, in addition to various others, as required and assigned by the Incident Commander.

General Staff
The General Staff represents and is responsible for the functional aspects of the incident command structure. The General Staff typically consists of the Operations, Planning, Logistics, and Finance/Administration Sections.
General guidelines related to General Staff positions (FEMA, 2008) include the following:
  • Only one person will be designated to lead each General Staff position.
  • General Staff positions may be filled by qualified persons from any agency or jurisdiction.
  • Members of the General Staff report directly to the Incident Commander. If a General Staff position is not activated, the Incident Commander will have responsibility for that functional activity.
  • Deputy positions may be established for each of the General Staff positions. Deputies are individuals fully qualified to fill the primary position. Deputies can be designated from other jurisdictions or agencies, as appropriate. This is a good way to bring about greater interagency coordination.
  • General Staff members may exchange information with any person within the organization. Direction takes place through the chain of command. This is an important concept in ICS.
  • General Staff positions should not be combined. For example, to establish a "Planning and Logistics Section,” it is better to initially create the two separate functions, and if necessary for a short time place one person in charge of both. That way, the transfer of responsibility can be made easier.
What role do first responders play in preparing and helping the public for emergencies and disasters?

Responding to disasters is a shared responsibility, and those in law enforcement are aware that emergency management planning is for all hazards and that it takes a team effort to keep our communities safe (Hylton, 2013).

The law enforcement community has two vital roles in responding to disasters: As first responders during times of crisis, and providing for the safety and security of the community (Hylton, 2013).  Firefighters, emergency medical personnel, and hospitals have a similar role.

A key role of response agencies in disasters is to ensure the continuity of services.  Tobia (2013) describes the problems first responders faced in a disaster:  “You’re the station captain: look around your office. If everything was gone in an instant—training records, computers, phones, payroll systems, LOSAP records, personnel files—how would you reconstitute your station? Walk out to the apparatus bay and imagine all of the apparatus destroyed. Again, how would you provide essential services? If the members of your company failed to post for duty because their homes and families were severely affected by an event, who would respond to the calls for help?”

Tobia (2013) makes the following recommendations, which I’ve adapted to apply to all emergency services:

  • Leaders in the emergency services must be closely tied to their communities. They should never misinform the public about their capacity to respond during extreme weather and other natural disasters.
  • Emergency service leaders must lead by example by being prepared and having a plan to keep their own family members safe. This includes planning and practicing a home escape plan, which also designates a meeting location away from a disaster in the event families become separated. Families also need to have copies of all essential documents, and cash, secured in a location away from their homes. Tobia (2013) says first responders “should not jeopardize our public by being unprepared ourselves.”
  • Emergency service leaders must develop and maintain Continuity of Operations Plans (COOPs) that deal with how to reconstitute their organizations after a disaster. This means identifying and securing critical hardware, software and supporting documentation before an event occurs. “COOPs provide a roadmap to recovery while maintaining the ability to respond to calls for service,” says Tobia (2013).
  • Should a massive storm approach, emergency service leaders may have to evacuate their apparatus, hardware, software, equipment and your people, so that when the storm is over they can come back and assist the community to respond and recover. 
Tobia (2013) says: “Since Katrina, FEMA has dramatically altered its language when speaking to the public. In 2008, when Gustav was approaching Galveston, Texas, the message was loud and clear: “If you choose not to evacuate, you will face certain death.” That is the first time I can recall hearing such blunt and honest language from a federal agency whose mission is to save lives. And that is exactly what they were doing—by educating the public so that they could make the right decisions about their safety. As firefighters, we have a similar obligation to not only echo those words but heed them.”

References:

Dwyer, Jim, Kevin Flynn and Ford Fessenden. (2002, July 7). FATAL CONFUSION: A Troubled Emergency Response; 9/11 Exposed Deadly Flaws In Rescue Plan. New York Times. Retrieved from http://www.nytimes.com/2002/07/07/nyregion/fatal-confusion-troubled-emergency-response-9-11-exposed-deadly-flaws-rescue.html?pagewanted=all
FEMA. (2015, October 3). The National Incident Management System (NIMS). Retrieved from https://www.fema.gov/national-incident-management-system
FEMA. (2008, May). ICS Review Material. Retrieved from https://training.fema.gov/emiweb/is/icsresource/assets/reviewmaterials.pdf
Heritage Foundation. (2002, May 14). Feds Must Train "First Responders" in More Organized Manner, Analysts Say. Retrieved from http://www.heritage.org/research/reports/2002/05/feds-must-train-first-responders-in-more-organized-manner-analysts-say
Hylton, Roberto. (2013, August 12). Law Enforcement’s Role in Responding to Disasters. Retrieved from http://www.fema.gov/blog/2013-08-12/law-enforcements-role-responding-disasters
Jorgustin, Ken. (2012, February 20). Disaster and Emergency, What’s The Difference? Modern Survival Blog. Retrieved from http://modernsurvivalblog.com/modern-survival-ideology/disaster-and-emergency-whats-the-difference/
List25. (2014, February 17). 25 Worst Acts of Terrorism Ever Committed. Retrieved from http://list25.com/25-worst-acts-terrorism-committed/
Occupational Safety and Health Administration. (1997). Hospitals and Community Emergency Response - What You Need to Know (OSHA 3152). U.S. Department of Labor. Retrieved from https://www.osha.gov/Publications/OSHA3152/osha3152.html
Rodak, Sabrina. (2012, December 10). 9 Essentials for Hospital Disaster Readiness and Response. Becker's Hospital Review.  Retrieved from http://www.beckershospitalreview.com/capacity-management/9-essentials-for-hospital-disaster-readiness-and-response.html
Sauer LM, McCarthy ML, Knebel A, & Brewster P. (2009). Major influences on hospital emergency management and disaster preparedness. Disaster Medicine and Public Health Preparedness, 3(2): S68-73. doi: 10.1097/DMP.0b013e31819ef060.
Timmons, Ronald. (2007, February). Interoperability: Stop Blaming the Radio. Homeland Security Affairs 3, Article 5. Retrieved from https://www.hsaj.org/articles/153
Tobia, Matthew. (2013, January).  Fire Departments Must Prepare for Natural Disasters: We have an obligation to prepare ourselves, our familiars and our stations. Fire Rescue. Retrieved from http://www.firefighternation.com/article/special-operations/fire-departments-must-prepare-natural-disasters
US Legal. (2010-2014). Homeland Security. Retrieved from http://homelandsecurity.uslegal.com/
WHO/EHA. (2002, March). DEFINITIONS: Training Package. retrieved from http://apps.who.int/disasters/repo/7656.pdf

Cite this article:
Fisher, John. (2015). The Role of First Responders. Community Emergency Preparedness. Retrieved from http://www.communityemergencypreparedness.com/2015/11/the-role-of-first-responders.html