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Koja je bila prva agencija za upravljanje hitnim slučajevima na svijetu?

Koja je bila prva agencija za upravljanje hitnim slučajevima na svijetu?


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S obzirom na nadolazeći orkan Sandy, zapitao sam se koja je prva osnovana agencija za upravljanje u hitnim slučajevima srodna Federalnoj agenciji za upravljanje izvanrednim situacijama?


Wikipedijina povijest vatrogastva uključuje sljedeći isječak:

Prvu rimsku vatrogasnu postrojbu od koje imamo značajnu povijest stvorio je Marko Licinije Crassus. Marko Licinije Crassus rođen je u bogatoj rimskoj obitelji oko 115. godine prije Krista, a stekao je ogromno bogatstvo putem (po Plutarhu) "vatre i grabljenja". Jedna od njegovih najunosnijih shema iskoristila je činjenicu da Rim nije imao vatrogasce. Crassus je ispunio ovu prazninu stvarajući vlastitu brigadu od 500 ljudi-koja je na prvi plamen požurila u zapaljene zgrade. Međutim, po dolasku na mjesto događaja vatrogasci nisu učinili ništa, dok se njihov poslodavac pregovarao o cijeni svojih usluga s vlasnikom nevolje u nevolji. Ako Crassus nije mogao pregovarati o zadovoljavajućoj cijeni, njegovi ljudi jednostavno su dopustili da konstrukcija izgori do temelja, nakon čega se ponudio kupiti je za djelić vrijednosti.

IMO, ova je stranica previše ljubazna prema Crassusu (istom onom) jer se čini da sugerira da je pružao javnu uslugu uz naknadu. Njegova vlastita wiki približava se opće prihvaćenoj istini koja se često prepričava u knjigama o ekonomskoj povijesti:

Ostatak Crassusova bogatstva stečen je konvencionalnije, trgovinom robovima, radom rudnika srebra i razumnom kupnjom zemlje i kuća, osobito onih zabranjenih građana. Najzloglasniji je bio njegov stjecanje zapaljenih kuća: kad je Crassus dobio vijest da gori kuća, stigao bi i kupio osuđeno imanje zajedno s okolnim zgradama za skromnu svotu, a zatim uposlio svoju vojsku od 500 klijenata kako bi ugasio požar prije nego što je nanesena velika šteta. Crassusovi klijenti koristili su rimsku metodu gašenja požara-uništavanje zapaljene zgrade kako bi se spriječilo širenje plamena.

U 6. stoljeću, August, vjerojatno nadovezujući se na Crassusovu ideju, organizirao je grupu robova u Vigiles, silu koja je djelovala i kao vatrogasci i kao policajci u Rimu:

Svaka je skupina bila opremljena standardnom vatrogasnom opremom. The sifona ili su vatrogasno vozilo vukli konji i sastojalo se od velike pumpe dvostrukog djelovanja koja je djelomično potopljena u rezervoar vode. Bdjenja označena kao akvarije trebali imati točno znanje o tome gdje se voda nalazi, a također su formirali i brigade s kantama koje su dovodile vodu do vatre. Pokušalo se ugušiti vatru pokrivajući je krpastim jorganima (centone) natopljen vodom. Postoje čak i dokazi da su kemijske metode gašenja požara korištene bacanjem tvari na bazi octa koja se naziva acetum. U mnogim slučajevima najbolji način sprječavanja širenja plamena bio je rušenje zapaljene zgrade kukama i polugama. Za požare u višekatnicama, jastuci i madraci bili su rašireni po tlu na koje su ljudi mogli skočiti s gornjih razina.

Bdijenjima je zapovijedao Praefectus vigilum (Prefekt straže) kojega je imenovao car.

Neki izvori navode da je August bio nadahnut za stvaranje Budnosti na temelju inovativne uporabe vodenih pumpi za suzbijanje požara u Egiptu.

Čini se da do 19. stoljeća nije bilo nikakvih organiziranih civilnih hitnih službi kao što su bolničari. Iako je poplava bila problem u dolini Nila, sumnjam da je to bilo previše redovito da bi bila potrebna hitna pomoć. Iako su japanski potresi i tsunamiji pomno zabilježeni, čini se da opet nije bilo namjenskih hitnih službi za pružanje pomoći tijekom katastrofa.


Svjetska zdravstvena organizacija

Naši urednici će pregledati ono što ste podnijeli i odlučiti trebate li izmijeniti članak.

Svjetska zdravstvena organizacija (WHO), Francuski Organizacija Mondiale de la Santé, specijalizirana agencija Ujedinjenih naroda (UN) osnovana 1948. radi daljnje međunarodne suradnje radi poboljšanja javnozdravstvenih uvjeta. Iako je naslijedio posebne zadatke koji se odnose na kontrolu epidemija, mjere karantene i standardizaciju lijekova od Zdravstvene organizacije Lige naroda (osnovane 1923.) i Međunarodnog ureda za javno zdravstvo u Parizu (osnovanog 1907.), WHO je dobila široki mandat prema svom ustavu za promicanje postizanja “najviše moguće razine zdravlja” od strane svih ljudi. SZO pozitivno definira zdravlje kao “stanje potpune tjelesne, mentalne i socijalne dobrobiti, a ne samo odsutnost bolesti ili nemoći”. Svake godine WHO slavi svoj datum osnivanja, 7. travnja 1948., kao Svjetski dan zdravlja.

S administrativnim sjedištem u Ženevi, upravljanje WHO-om djeluje putem Svjetske zdravstvene skupštine, koja se sastaje svake godine kao opće tijelo za donošenje politika, te putem Izvršnog odbora zdravstvenih stručnjaka koje skupština bira na tri godine. Tajništvo WHO -a, koje provodi rutinske operacije i pomaže u provedbi strategija, sastoji se od stručnjaka, osoblja i terenskih radnika koji imaju zakazane dužnosti u središnjem sjedištu ili u jednom od šest regionalnih ureda WHO -a ili drugih ureda koji se nalaze u zemljama širom svijeta. Agenciju vodi generalni direktor kojeg imenuje Izvršni odbor, a imenuje Svjetska zdravstvena skupština. Glavnog ravnatelja podržavaju zamjenik glavnog ravnatelja i više pomoćnika generalnog direktora, od kojih je svaki specijaliziran za određeno područje unutar okvira SZO -a, kao što su zdravlje, zdravstveni sustavi i inovacije u obitelji, ženama i djeci. Agencija se prvenstveno financira iz godišnjih doprinosa država članica na temelju relativne platežne sposobnosti. Osim toga, nakon 1951. WHO-u su dodijeljena značajna sredstva iz proširenog programa tehničke pomoći UN-a.

Službenici SZO povremeno pregledavaju i ažuriraju prioritete vodstva agencije. U razdoblju 2014. -19. Vodeći prioriteti SZO -a bili su usmjereni na:

1. Pomoć zemljama koje traže napredak prema univerzalnoj zdravstvenoj pokrivenosti

2. Zemlje koje pomažu u uspostavljanju sposobnosti za poštivanje međunarodnih zdravstvenih propisa

3. Povećanje pristupa osnovnim i visokokvalitetnim medicinskim proizvodima

4. Rješavanje uloge društvenih, ekonomskih i okolišnih čimbenika u javnom zdravlju

5. Koordiniranje odgovora na nezarazne bolesti

6. Promicanje javnog zdravlja i dobrobiti u skladu s ciljevima održivog razvoja, koje je postavio UN.

Posao obuhvaćen tim prioritetima raspoređen je na niz zdravstvenih područja. Na primjer, WHO je uspostavio kodificirani skup međunarodnih sanitarnih propisa osmišljenih za standardizaciju karantenskih mjera bez nepotrebnog ometanja trgovine i zračnog prometa preko nacionalnih granica. WHO također informira zemlje članice o najnovijim dostignućima u istraživanju raka, razvoju lijekova, prevenciji bolesti, kontroli ovisnosti o drogama, uporabi cjepiva i opasnostima po zdravlje kemikalija i drugih tvari.

SZO sponzorira mjere za kontrolu epidemije i endemičnih bolesti promicanjem masovnih kampanja koje uključuju programe cijepljenja u cijeloj zemlji, uputama za uporabu antibiotika i insekticida, poboljšanjem laboratorijskih i kliničkih objekata za ranu dijagnozu i prevenciju, pomoći u opskrbi čistom vodom i sanitarni sustavi i zdravstveni odgoj za ljude koji žive u ruralnim zajednicama. Ove su kampanje imale izvjestan uspjeh u borbi protiv AIDS -a, tuberkuloze, malarije i raznih drugih bolesti. U svibnju 1980. boginje su globalno iskorijenjene, što je podvig u velikoj mjeri zahvaljujući naporima WHO -a. U ožujku 2020. WHO je globalnu epidemiju COVID-19, teške respiratorne bolesti uzrokovane novim koronavirusom koji se prvi put pojavio u kineskom Wuhanu, krajem 2019. godine, proglasio pandemijom. Agencija je djelovala kao svjetski centar za informiranje o bolesti, pružajući redovita izvješća o stanju i medijske brifinge o njezinom širenju i stopama smrtnosti, dajući tehničke smjernice i praktične savjete vladama, tijelima za javno zdravstvo, zdravstvenim radnicima i javnosti te objavljujući ažuriranja znanstveno istraživanje. Kako su se infekcije i smrtni slučajevi povezani s pandemijom nastavljali povećavati u Sjedinjenim Državama, Pres. Donald J. Trump optužio je WHO da se urotio s Kinom kako bi prikrio širenje novog koronavirusa u toj zemlji u ranim fazama izbijanja. U srpnju 2020. Trumpova administracija službeno je obavijestila UN da će se Sjedinjene Države povući iz agencije u srpnju 2021. Povlačenje SAD -a zaustavio je Trumpov nasljednik, pres. Joe Biden, potonjeg prvog dana na vlasti u siječnju 2021.

U svojim redovitim aktivnostima WHO potiče jačanje i proširenje uprava za javno zdravstvo zemalja članica, pruža tehničke savjete vladama u pripremi dugoročnih nacionalnih zdravstvenih planova, šalje međunarodne timove stručnjaka za provođenje terenskih istraživanja i demonstracijskih projekata, pomaže uspostaviti lokalne zdravstvene centre i nudi pomoć u razvoju nacionalnih ustanova za osposobljavanje medicinskog i medicinskog osoblja. SZO kroz različite programe potpore obrazovanju može dodijeliti stipendije liječnicima, administratorima javnog zdravstva, medicinskim sestrama, sanitarnim inspektorima, istraživačima i laboratorijskim tehničarima.

Prvi generalni direktor WHO -a bio je kanadski liječnik Brock Chisholm, koji je radio od 1948. do 1953. Kasniji generalni direktori WHO -a bili su liječnik i bivši premijer Norveške Gro Harlem Brundtland (1998. -2003.), Južnokorejski epidemiolog i stručnjak za javno zdravstvo Lee Jong -Wook (2003–06), i kineska državna službenica Margaret Chan (2007–17). Etiopski dužnosnik za javno zdravstvo Tedros Adhanom Ghebreyesus postao je generalni direktor WHO -a 2017.


Povijest AAEM -a

1960 -ih

Područje hitne medicine razvilo se iz potrebe brige o brzo rastućoj populaciji pacijenata koji traže hitnu i neplaniranu medicinsku skrb za hitna stanja. Do 1960. postalo je jasno da broj posjeta hitnoj službi raste diljem Sjedinjenih Država. Liječnici nisu imali potrebne medicinske vještine hitne medicinske pomoći kako bi se pravilno zbrinuli ti pacijenti i bili su frustrirani rastućom potražnjom. Kao odgovor na to, 1961. doneseni su Pontiac i Aleksandrijski planovi. U Općoj bolnici Pontiac (MI) 23 liječnika u zajednici počela su raditi sa skraćenim radnim vremenom kako bi na svom odjelu hitne pomoći radili non-stop. U Aleksandriji (VA), druga skupina liječnika napustila je svoje privatne pacijente kako bi postali liječnici hitne pomoći s punim radnim vremenom.

Iako su liječnici počeli posvećivati ​​različite stupnjeve svoje prakse hitnoj medicini, i dalje je postojala potreba za specijaliziranom obukom. Godine 1967. Američko liječničko udruženje (AMA) osnovalo je odbor za hitnu medicinu, a 1968. John Wiegenstein i sedam kolega osnovali su American College of Emergency Physicians (ACEP). Prva znanstvena skupština ACEP -a održana je 1969. godine.

1970 -ih

Godine 1970., fakultet medicinske škole koji se bavi hitnom medicinom osnovao je Sveučilišnu udrugu za hitnu medicinsku pomoć (UAEMS) u znanstvene i obrazovne svrhe. Prije svog osnivanja, studenti medicine već su birali hitnu medicinu kao put karijere. Prva sveučilišna specijalizacija za hitnu medicinu nastala je na Sveučilištu u Cincinnatiu 1970. godine gdje je Bruce Janiak postao prvi rezident. Drugi stražarski sveučilišni programi uključuju one u Los Angeles County/University of Southern California Medical Center (1971), Medical College of Pennsylvania (1972), University of Chicago (1972) i University of Louisville (1973). R.R. Hannas osnovao je prvu medicinsku ustanovu za hitnu medicinu u bolnici u zajednici 1973. u bolnici Evanston (IL). Udruga stanovnika hitne medicine (EMRA) osnovana je 1974. godine kako bi ujedinila početne stanovnike na našem području.

Put do priznavanja specijalnosti bio je posebno izazovan. Privremeno vijeće Odjela za hitnu medicinu osnovano je u Domu delegata AMA -e 1973. godine, a postalo je stalno 1975. Također 1975. godine, osnovan je Odbor za podršku boravišta za vezu, preteča Odbora za reviziju prebivališta za hitnu medicinu (RRC/EM) . 1976. godine osnovan je Američki odbor za hitnu medicinu (ABEM), a Američki odbor za medicinske specijalnosti (ABMS) konačno je priznao hitnu medicinu 1979. Za razliku od odbora drugih područja, od ABEM -a je u početku trebalo biti povezano s drugim medicinskim specijalnostima .

Pojava osteopata na tom polju dogodila se 1975. godine kada je Američki koledž osteopatskih liječnika hitne pomoći (ACOEP) postao pridruženi fakultet Američkog udruženja osteopata (AOA). Prva specijalizacija iz osteopatske hitne medicine započela je 1979. godine, a Gerald Reynolds postao je početni stažista na Philadelphia College of Osteopathic Emergency Medicine. U srpnju 1978. godine osnovan je Američki osteopatski odbor za hitnu medicinu (AOBEM) kao pridruženi odbor za specijalnost AOA -e. Prva znanstvena skupština ACOEP -a održana je 1978.

1980 -ih

ABEM je 1980. godine obavio prvi pregled odbora za hitnu medicinu, a AOBEM ga je slijedio 1981. 1982. godine Vijeće za akreditaciju visokog medicinskog obrazovanja (ACGME) odobrilo je posebne zahtjeve za programe osposobljavanja za specijalizaciju iz hitne medicine.

Godine 1988., nakon dobro objavljenog 10-godišnjeg počeka, ABEM je uklonio praksu i počeo zahtijevati specijalizaciju iz hitne medicine kako bi se kvalificirao za ispit za certifikaciju ABEM-a. Ubrzo nakon toga odobrena je jednokratna iznimka za oko 100 akademskih liječnika hitne pomoći na internoj medicini. Prakse za stjecanje AOBEM certifikata također su u ovom trenutku učinkovito zatvorene jer su ograničene na one koji su započeli praksu hitne medicine prije 1986. godine.

Organizacija, Odbor za certifikaciju hitne medicine (BCEM), osnovana je 1987. godine kako bi stvorila rupu za one koji se odluče baviti hitnom medicinom bez formalne obuke. Iste godine BCEM je certificirao prvu skupinu liječnika koji ne ispunjavaju uvjete za dobivanje ABEM ili AOBEM certifikata.

1989. hitna medicina postala je primarni odbor ABMS -a. Ovo je priznanje ovisilo, između ostalog, o zatvaranju staze prakse ABEM -a. Također 1989. UAEMS i Društvo učitelja hitne medicine (STEM) spojili su se u Društvo za akademsku hitnu medicinu (SAEM). Vijeće direktora rezidencija (CORD) kasnije je formirano kao zasebna jedinica koja predstavlja direktore rezidencijalnih programa i njihove pomoćnike.

1990 -ih

Devedesete su donijele previranja u hitnu medicinu. Godine 1990. Gregory Daniel, opći kirurg koji se bavi hitnom medicinom u Buffalu u New Yorku, podnio je tužbu protiv ABEM -a i drugih pojedinaca i ustanova u akademskoj hitnoj medicini. On i brojni drugi tužitelji iz neakademske zajednice tvrdili su da je zatvaranje staze za vježbanje ABEM-a rezultat nezakonite zavjere radi poboljšanja ekonomskog položaja liječnika hitne pomoći s certifikatom. 1991. godine osnovano je Udruženje liječnika hitne pomoći (AEP), koje se prije nazivalo Udruženje liječnika hitne pomoći bez prava glasa, s ciljem ponovnog otvaranja certifikata odbora za hitnu medicinu za liječnike koji nisu obučeni za EM. Dr. Daniel bio je član Upravnog odbora AEP -a.

Godine 1992., pod pseudonimom "Phoenix", James Keaney objavio je Silovanje hitne medicine u kojem je detaljno opisana korupcija koja je negativno utjecala na njegu pacijenata. Tvrdio je da je iskorištavanje liječnika hitne pomoći rasprostranjeno. Mnogi su "volonteri" na terenu prikupljali značajnu zaradu nepoštenom poslovnom taktikom i zapošljavali nekvalificirane liječnike hitne pomoći koji su spremni raditi za manje plaće. Ovaj poziv za buđenje bio je znak za formiranje Američke akademije za hitnu medicinu (AAEM).

AAEM je osnovan 1993. godine radi promicanja poštenih i pravednih okruženja neophodnih za omogućavanje liječnicima hitne pomoći da pruže najvišu kvalitetu skrbi za pacijente. Prva znanstvena skupština održana je 1994. AAEM je u početku definirao specijalista hitne medicine kao certificiranog od strane ABEM-a, a ta je definicija kasnije proširena tako da uključuje i one s certifikatom AOBEM, dječju hitnu medicinu (ABEM ili Američki odbor za pedijatriju) i kraljevskom koledžu liječnika i kirurga u Kanadi.

Izvješće Zaklade Macy iz 1994. pod naslovom Uloga hitne medicine u budućnosti američke medicinske njege proizašlo je iz konferencije koju je zatražio SAEM, a kojom je predsjedao predsjednik Nacionalnog odbora medicinskih ispitivača. Prvotno je preporučeno da Zajedničko povjerenstvo za akreditaciju zdravstvenih organizacija (JCAHO) zahtijeva certifikaciju odbora za hitnu medicinu kako bi se izdale sveobuhvatne službe hitne pomoći. Nažalost, izraz "liječnik hitne pomoći s certifikatom quotboard" zamijenjen je izrazom "kvalificirani liječnik hitne pomoći" nakon intenzivnog lobiranja od strane ACEP-a radi sprječavanja podjele njegovog članstva. Neki tumače "kvalificiranog liječnika hitne pomoći" kao liječnika obučenog za bilo koje područje koje se odluči baviti hitnom medicinom.

Nasuprot tome, AAEM zahtijeva certifikaciju odbora za hitnu medicinu svakog člana s punim pravom glasa. Trenutačno je jedini način da se to stekne dovršenje specijalizacije iz specijalizacije ili stipendije za dječju medicinu.

Nakon 2000

Spomenuta tužba protiv Danielsa odbačena je 2005. godine, nakon neuspješne žalbe tužitelja. AAEM nastavlja voditi napore u sprječavanju erozije certifikacije odbora od strane nepriznatih organizacija koje se smatraju ekvivalentima ABEM -a i AOBEM -a. Od trenutnog tiskanja po ovom pitanju radimo u Kaliforniji, Floridi i Kentuckyju.

Od kraja tisućljeća došlo je do stalnog porasta broja velikih grupa za upravljanje ugovorima (CMG) koje su sklapale ugovore s liječnicima hitne pomoći. U ovom trenutku oko jedne trećine svih liječnika hitne pomoći radi za jednog od njih. Ovaj stupanj & quotcorporatization & quot; daleko nadmašuje bilo koju drugu medicinsku specijalnost i stvara slabu situaciju za budućnost budući da su kvalifikacije liječnika hitne pomoći, radni uvjeti i profesionalne naknade vezani za dno ekonomski nestabilne industrije.

AAEM vjeruje da korporativno vlasništvo ugovora o hitnim službama predstavlja kršenje javne zaštite koju pružaju državne zabrane korporativne medicinske prakse. Nadalje, liječnici hitne pomoći mogu nesvjesno riskirati dobivanje licence pomažući i podržavajući nezakonitu korporativnu medicinsku praksu. Upravni odbor AMA -e dao je opsežan pregled o ovom pitanju koje se odnosi na liječnike. AAEM se uključio u pravne izazove u vezi s korporativnom medicinskom praksom s velikim korporacijama, TeamHealth u Kaliforniji i EmCare u državi Minnesota. AAEM je također sudjelovao u uspješnoj akciji u vezi s korporativnom praksom hitne medicine u Kaliforniji koja je uključivala Catholic Healthcare West.

AAEM je izrazio zabrinutost Uredu glavnog inspektora i uredu državnog odvjetnika u različitim državama da takvi aranžmani zapošljavanja mogu uključivati ​​zabranjene aktivnosti dijeljenja pristojbi prema sadašnjim državnim i saveznim zakonima. Članovi AAEM -a upozoravaju se na prihvaćanje zaposlenja u korporativnim grupama, a AAEM predlaže da bolnice s dužnom pažnjom ispitaju takav aranžman.

AAEM vjeruje da liječnici hitne pomoći moraju ostati slobodni od korporacijskog utjecaja zbog svoje teške uloge zagovornika pacijenata s nedostatkom i neosiguranošću. AAEM čvrsto vjeruje da je u najboljem interesu pacijenata da liječnici hitne pomoći budu neopterećeni brigom o dobiti jedne korporacije. AAEM je uvijek spreman pomoći u ovom pitanju kako bi liječnicima hitne pomoći osigurao skupinu u vlasništvu liječnika, što je najbolji model za profesionalno zadovoljstvo i kvalitetu njege.

U 2010. bilo je 157 alopatskih i 37 osteopatskih programa specijalizacije za hitnu medicinu, koji zajedno prihvaćaju oko 2000 novih stanovnika svake godine. Studije su pokazale da je pohađanje nadzora nad liječnicima hitne pomoći izravno povezano s kvalitetnijom i isplativijom praksom, osobito ako postoji specijalizacija iz hitne medicine. Rezidentni dio AAEM -a, koji je formiran 1999., postao je organizacija nezavisna od AAEM -a 2005. pod nazivom AAEM rezidentna i studentska udruga (ili AAEM/RSA). Njegova je svrha pružiti stanovnicima EM -a forum i sredstvo za posebno rješavanje problema i problema stanovnika, razviti vlastite programe i usluge i imati predstavnika koji može utjecati na smjer i misiju AAEM -a.

Još jedan cilj za sljedeće desetljeće je da autonomni akademski odsjeci hitne medicine postanu univerzalni. Trenutno je hitna medicina priznata kao autonomni odjel u 72 medicinska fakulteta, koji čini većinu. Dekani medicinskih fakulteta trebali bi biti svjesni da mnogi od najboljih studenata medicine borave u hitnoj medicini. Istraživačka skupina SAEM -a nedavno je objavila nalaze da su nezavisni odjeli hitne medicine obostrano korisni i za akademske institucije i za našu specijalnost s mjerljivim poboljšanjima u studentskom i poslijediplomskom obrazovanju, akademskoj produktivnosti i financiranju izvanrednih stipendija.


Kratka povijest saveznog upravljanja izvanrednim situacijama

Od osnutka Sjedinjenih Država, odgovornost i mjesto upravljanja hitnim slučajevima i katastrofama prešlo je s jedne agencije na drugu unutar savezne vlade (a isto vrijedi i za mnoge državne i lokalne vlade). Međutim, osim dva zakona, obavljeno je vrlo malo sustavnog rada koji nalikuje suvremenom upravljanju izvanrednim situacijama sve do 1930 -ih. Drabek (1991b, str. 6) izvještava da je prvi nacionalni napor u upravljanju katastrofama bio Zakon o pomoći u slučaju požara iz 1803. koji je stavio na raspolaganje sredstva za pomoć gradu Portsmouthu i državi New Hampshire u oporavku od velikih požara. Sljedeći je zakon uslijedio 125 godina kasnije kada je donesen Zakon o kontroli poplava u Donjem Mississippiju iz 1928. godine kao sredstvo za odgovor na poplave donje rijeke Mississippi 1927. (Platt, 1998., str. 38). Važno je napomenuti da su oba ova rana zakona slijedio katastrofu i imali su za cilj podržati oporavak jer je to obrazac koji se nastavio do danas. Naglasak na obnovi nakon katastrofe obilježio je napore reagiranja u hitnim slučajevima na saveznoj razini čak i u 21. stoljeću.

Federalno upravljanje katastrofama, ako ga okarakteriziramo kao usklađene pokušaje suzbijanja negativnih posljedica prirodnih sila, doista je počelo kada je predsjednik Franklin Roosevelt 1933. osnovao Reconstruction Finance Corporation i ovlastio ga da daje zajmove za popravak javnih zgrada oštećenih potresima (Drabek, 1991b ). Osim toga, mnogi socijalni programi New Deal pružali su usluge i različite vrste financijske pomoći žrtvama prirodnih katastrofa. Osim pojedinačnih programa, Nacionalno vijeće za hitne slučajeve djelovalo je u Bijeloj kući između 1933. i 1939., prvenstveno kako bi se nosilo s velikom depresijom, ali i nadgledalo pomoć u prirodnim katastrofama. Zakon o kontroli poplava iz 1936. uspostavio je Inženjerski korpus vojske kao važnu agenciju za upravljanje američkim plovnim putovima. 1939., kada je najgori dio Velike depresije počeo popuštati, Nacionalno vijeće za hitne slučajeve premješteno je u Izvršni ured predsjednika i preimenovano u Ured za upravljanje u hitnim slučajevima. Pomoć u prirodnim katastrofama nastavila se nalaziti u središtu ove agencije, koja je djelovala kao tim za upravljanje kriznim situacijama različitih vrsta prijetnji na nacionalnoj razini.

Početak Drugoga svjetskog rata zahtijevao je punu pozornost Rooseveltove administracije na isti način na koji je depresija to ranije zahtijevala. Osim odgovornosti za prirodne opasnosti, Ured za upravljanje u hitnim slučajevima postao je predsjednička agencija za razvoj planova civilne obrane i rješavanje hitnih situacija povezanih s ratom na domaćem terenu. Mnogi programi koje je osmislio Ured za upravljanje u hitnim slučajevima bili su smješteni u Ministarstvu rata, pod Uredom za civilnu obranu (režija Fiorello La Guardia). Ovaj je ured ukinut 1945., pa je Ured za hitne slučajeve ponovno postao glavna federalna hitna služba (Yoshpe, 1981., str.72).

Nakon Drugog svjetskog rata, predsjednik Harry Truman u početku se opirao pritiscima da se osnuje druga agencija za civilnu obranu, smatrajući da bi civilna obrana trebala biti odgovornost država (Perry, 1982.). Ured za planiranje civilne obrane osnovan je 1948. pod godine starim Odjelom za obranu, a Ured za upravljanje u hitnim slučajevima ponovno je prepušten da se usredotoči na prirodne katastrofe i druge hitne slučajeve u zemlji. Ovo razdvajanje planiranja civilne obrane od prirodnih i domaćih katastrofa nastavilo se gotovo dvije godine, ali se ponovno pojavilo tijekom desetljeća naknadnom reorganizacijom saveznih napora. Nakon što je Sovjetski Savez testirao svoju prvu atomsku bombu u ljeto 1949., Truman je popustio i stvorio Saveznu upravu civilne zaštite u okviru Izvršnog ureda predsjednika kao nasljednika Ureda za upravljanje u hitnim slučajevima. Odgovornost za saveznu pomoć u slučaju velikih prirodnih katastrofa postala je odgovornost Uprave za stanovanje i financije doma. Zakonodavstvo je brzo uslijedilo donošenjem Saveznog zakona o civilnoj obrani iz 1950. i Zakona o pomoći u katastrofama iz 1950. (Blanchard, 1986., str. 2). Značajno je napomenuti da je ovim zakonodavstvom državama i dalje dodjeljivana odgovornost za civilnu obranu i katastrofe te su se pokušale odrediti posebne savezne obveze. Na kraju administracije predsjednika Trumana & rsquosa 16. siječnja 1953., Izvršnom naredbom 10427 uklonjena je odgovornost za pomoć u slučaju prirodnih katastrofa sa stambenih i kućnih financija i dodana je u FCDA (Yoshpe, 1981., str. 166).

Ovakav raspored funkcija i agencija trajao je kroz obje Eisenhowerove uprave, iako se naziv primarne agencije promijenio prvo u Ured za obranu i civilnu mobilizaciju, a zatim u Ured za mobilizaciju civilne obrane. Ured za mobilizaciju civilne obrane bio je prva organizacija za hitne slučajeve koja je dobila status neovisne agencije (1958.), a ne pod drugim kabinetom ili Bijelom kućom. Sa političke strane, Savezni zakon o civilnoj obrani izmijenjen je 1958. kako bi civilnu obranu učinila zajedničkom odgovornošću savezne vlade i državnih i lokalnih vlada. Ovaj amandman također je predviđao federalno usklađivanje izdataka državne i lokalne uprave za civilnu obranu, koji su se zapravo počeli financirati 1961. godine pod upravom predsjednika Johna F. Kennedyja. Tako je Kennedyjevo doba doživjelo prvo brzo širenje agencija civilne obrane na državnoj i lokalnoj razini. Predsjednik Kennedy ponovno je razdvojio saveznu odgovornost za domaće katastrofe i civilnu obranu 1961. godine kada je osnovao Ured za planiranje izvanrednih situacija (u Bijeloj kući) i Ured civilne obrane (u Ministarstvu obrane). Nasljednik Kennedy & rsquosa, Lyndon B. Johnson, premjestio je OCD u Odjel vojske 1964. godine, signalizirajući smanjenje važnosti (i financiranja) za ovu funkciju. Ovo opće razdvajanje funkcija zadržalo se do 1978., iako je Ured civilne obrane 1972. postao Agencija za civilnu pripravnost obrane. Počevši s stvaranjem Ureda za pripravnost u hitnim slučajevima pri Izvršnom uredu predsjednika 1968., programi koji se bave prirodnim i tehnološke opasnosti počele su se rekonstituirati i dijeliti među raznim saveznim agencijama. Na primjer, Savezna uprava za osiguranje osnovana je 1968. kao dio Odjela za stanogradnju i urbani razvoj. 1973. predsjednik Richard M. Nixon rasformirao je Ured za hitnu pripravnost i dodijelio odgovornost za pomoć i obnovu nakon katastrofe Federalnoj upravi za pomoć u katastrofama u Odjelu za stanovanje i urbani razvoj. Opće upravljanje i nadzor saveznih programa dodijeljeno je Uredu za pripravnost, koji je premješten u Upravu za opće usluge, a 1975. postala je Savezna agencija za pripravnost.

Tijekom 1970-ih, budući da su novi savezni zakoni ili izvršni nalozi nalagali zabrinutost savezne vlade različitim aspektima prirodnih opasnosti i opasnosti koje je izazvao čovjek, u raznim saveznim uredima i agencijama stvoreni su novi programi. Oni su bili uključeni u Nacionalni program pripravnosti zajednice Ministarstva za trgovinu & rsquos (1973.) i Nacionalnu upravu za sprječavanje i kontrolu požara (1974.). Nakon haosa iz 1972. koji je izazvao uragan Agnes, donesen je Zakon o pomoći u katastrofama iz 1974. kojim se žrtvama katastrofe dodjeljuje individualna i obiteljska pomoć (kojom se upravlja putem Savezne uprave za pomoć u katastrofama). Krajem sedamdesetih godina prošlog stoljeća u Izvršnom uredu predsjednika uspostavljena su četiri glavna programa: Koordinacija sigurnosti brana, Program za smanjenje opasnosti od potresa, Sustav upozorenja i emitiranja u hitnim slučajevima te Upravljanje posljedicama u terorizmu. Ostali programi tehnološke opasnosti također su uključivali agencije kao što su Agencija za zaštitu okoliša, Komisija za nuklearnu regulaciju i Odjeli za energetiku i promet.

Ovo difuzno dodjeljivanje odgovornosti za programe upravljanja u hitnim slučajevima raznim saveznim agencijama ustrajalo je do kraja sedamdesetih godina, a kako je vrijeme prolazilo, stvorilo je sve veću zabrinutost u izvršnoj vlasti i Kongresu da su savezni programi za upravljanje katastrofama previše fragmentirani. Slične zabrinutosti državnih i lokalnih vlasti postale su u središtu pozornosti Projekta katastrofe Nacionalnog guvernera & rsquo Association (NGA) krajem 1970 -ih. Osoblje projekta & rsquos pratilo je mnoge državne i lokalne probleme u upravljanju izvanrednim situacijama sve do saveznih administrativnih aranžmana. Tvrdili su da federalna fragmentacija ometa učinkovito planiranje i odgovor na pripravnost, prikriva dvostruke napore i čini nacionalnu pripremljenost vrlo skupim poduzećem. Ravnatelj Savezne agencije za pripravnost, general Leslie W. Bray, priznao je da je, kad je funkcija pripravnosti za hitne slučajeve izvađena iz Izvršnog ureda predsjednika i dodijeljen joj status pod-agencije, mnogi ljudi shvatili da je funkcija smanjena na nižu prioritet, a njegov se posao koordinacije zakomplicirao. Države su tvrdile da je njihov posao reagiranja na katastrofe otežan prisiljavanjem na koordinaciju s toliko saveznih agencija. In 1975, a study of these issues sponsored by the Joint Committee on Defense Production (1976, p. 27) concluded:

The civil preparedness system as it exists today is fraught with problems that seriously hamper its effectiveness even in peacetime disasters. . . It is a system where literally dozens of agencies, often with duplicate, overlapping, and even conflicting responsibilities, interact.

In addition to the administrative and structural difficulties, there was also concern the scope of the functions performed as part of emergency management was too narrow, too many resources were devoted to post-disaster response and recovery, and too few resources devoted to the disaster prevention. When the federal response to the nuclear power plant accident at Three Mile Island was severely criticized, calls for reorganization became very loud (Perry, 1982).

Responding to these concerns in 1978, President Jimmy Carter initiated a process of reorganizing federal agencies charged with emergency planning, response, and recovery. This reorganization resulted in the creation, in 1979, of the Federal Emergency Management Agency (FEMA), whose director reported directly to the President of the United States. Far from being an entirely new organization, FEMA was a consolidation of the major federal disaster agencies and programs. Most of FEMA&rsquos administrative apparatus came from combining the three largest disaster agencies: the Federal Preparedness Agency, Defense Civil Preparedness Agency, and Federal Disaster Assistance Administration. Thirteen separate hazard-relevant programs were moved to FEMA, including most of the programs and offices created in the 1970s (Drabek, 1991b). These moves gave FEMA responsibility for nearly all federal emergency programs of any size, including civil defense, warning dissemination for severe weather threats, hazard insurance, fire prevention and control, dam safety coordination, emergency broadcast and warning system, earthquake hazard reduction, terrorism, and technological hazards planning and response. Where FEMA did not absorb a program in its entirety, interagency agreements were developed giving FEMA coordinating responsibility. These agreements included such agencies as the Environmental Protection Agency (EPA), Department of Transportation (DOT), National Oceanic and Atmospheric Administration (NOAA), and Nuclear Regulatory Commission (NRC).

At least on paper, the Executive Order made FEMA the focal point for all federal efforts in emergency management. Although FEMA remained the designated federal lead agency in most cases, there were 12 other independent agencies with disaster responsibilities. The EPA is the largest of these agencies, but others included the Federal Energy Regulatory Commission (FERC), the National Transportation Safety Board (NTSB), NRC, Small Business Administration (SBA), and the Tennessee Valley Authority (TVA). Because disaster related federal relief programs were so scattered through the government, many small programs remained in their home agencies. For example, the Emergency Hay and Grazing program allows federal officials to authorize the harvesting of hay for emergency feed from land assigned for conservation and environmental uses under the Conservation Reserve Program. This program is operated in the Farm Service Agency of the US Department of Agriculture. Ultimately, some emergency or disaster related programs remained in thirteen cabinet level departments, including Agriculture, Commerce, Defense, Education, Energy, Health and Human Services, Housing and Urban Development, Interior, Justice, Labor, State, Transportation and Treasury. Certainly the creation of FEMA moved federal emergency management to a much more central position than it had ever been given previously, but it was not possible to completely consolidate all federal programs and offices within the new agency.

The FEMA Director is appointed by the President of the United States and, until the establishment of the Department of Homeland Security, was part of the cabinet. The organization has a regional structure composed of ten offices throughout the United States plus two larger area offices. Although by far the most comprehensive effort, the establishment of FEMA represented the third time that all federal disaster efforts and functions were combined the first was the National Emergency Council (1933-1939), followed by the Office of Civil Defense Mobilization (1958-1961). The early history of FEMA was dominated by attempts to define its mission and organize its own bureaucracy. John Macy, the agency&rsquos first director, was faced with organizational consolidation as a most pressing task: converting thirty separate nation-wide offices to 16 and eight Washington, D.C. offices to five (Macy, 1980). Ultimately, creating a single bureaucracy (with a $630 million budget) from thirteen entrenched organizations proved to be a herculean task.

The efforts to obtain an optimal structure for FEMA continued over the next two decades later directors undertook major reorganizations of headquarters and FEMA&rsquos mission, like its structure, continued to evolve. The early years of FEMA saw much significant legislation and activity. In 1979, the NGA Disaster Project published the first statement of Comprehensive Emergency Management (CEM, the notion that authorities should develop a capacity to manage all phases of all types of disasters), and the concept was subsequently adopted by both the NGA and FEMA. In 1980, the Federal Civil Defense Act of 1950 was amended to emphasize crisis relocation of population (evacuation of people from cities to areas less likely to be Soviet nuclear targets), signaling a fundamental change in US civil defense strategy. Also in 1980, the Comprehensive Environmental Response, Compensation, and Liability Act (called the Superfund Law) was passed, precipitated by the 1978 dioxin contamination of Love Canal, New York (Rubin, Renda-Tanali & Cumming, 2006&mdashwww.disaster-timeline.com). In 1983, FEMA adopted the concept of Integrated Emergency Management System (IEMS) as part of the strategy for achieving CEM (Blanchard, 1986 Drabek, 1985). The basic notion was to identify generic emergency functions&mdashapplicable across a variety of hazards&mdashand develop modules to be used where and when appropriate. For example, population evacuation is a useful protective technique in the case of hurricanes, floods, nuclear power plant accidents, or a wartime attack (Perry, 1985). Similar generic utility exists is developing systems for population warning, interagency communication, victim sheltering, and other functions. Thus, in the early 1980s, FEMA was formed, shaped by organizational growing pains, and also shaped through the adoption of new philosophies of emergency management. While FEMA&rsquos basic charge of developing a strategy and capability to manage all phases of all types of environmental hazards remained, the precise definitions of hazards, the basic conception of emergency management, and the organizational arrangements through which its mission should be accomplished continued to evolve through the end of the 20 th Century.

The end of the 1980s saw passage of the Superfund Amendments and Reauthorization Act (SARA Title III) in 1986 (Lindell & Perry, 2001) and President Ronald Reagan&rsquos Presidential Policy Guidance (1987) that became the last gasp of nuclear attack related civil defense programs in the United States (Blanchard, 1986). Passage of the Robert Stafford Disaster Relief and Emergency Assistance Act of 1988 again boosted state and local emergency management efforts. The Stafford Act established federal cost sharing for planning and public assistance (family grants and housing).

The 1990s opened with controversy for FEMA. In 1989, FEMA response to Hurricane Hugo was criticized as inept&mdasha charge repeated in 1992 when Hurricane Andrew struck Florida. In 1993, flooding in the mid-western US caused more than 15 billion dollars in damage and resulted in six states receiving federal disaster declarations. President Clinton appointed James Lee Witt Director of FEMA in 1993, marking the only time a professional emergency manager held the post. Witt (1995) aggressively increased the federal emergency management emphasis on hazard mitigation and began a reorganization effort. Prior to this time, the federal emphasis had been largely upon emergency response and, to a lesser extent, short-term disaster recovery. Witt began the first real change in federal strategy since emergency management efforts had begun. By the close of the 1990s, FEMA&rsquos organization reflected its critical functions. In 1997, there were seven directorates within FEMA: Mitigation, Preparedness, Response and Recovery, the Federal Insurance Administration, the United States Fire Administration, Information Technology Services, and Operations Support (Witt, 1997). As the 21 st Century began, the overall emphasis of FEMA remained mitigation and both comprehensive emergency management and integrated emergency management systems remained concepts in force.

The most recent epoch in American emergency management began on September 11, 2001, when the attacks on the World Trade Center and the Pentagon shocked Americans and challenged government disaster response capabilities. The attack initiated a comprehensive rethinking of &ldquosecurity&rdquo, &ldquoemergencies&rdquo, and the appropriate role of the federal government. During October, 2001, President George W. Bush used Executive Orders to create the Office of Homeland Security (appointing Governor Tom Ridge as Director) and the Office of Combating Terrorism (General Wayne Downing as Director). On October 29 th , President Bush issued Homeland Security Presidential Directive Number 1 (HSPD-1), establishing the Homeland Security Council, chaired by the President. In June of 2002, President Bush submitted his proposal to Congress to establish a cabinet level Department of Homeland Security (DHS), which was passed later that year.

Since the establishment of DHS, the department&rsquos mission has encompassed three goals: preventing terrorist attacks within the United States, reducing vulnerability to terrorism, and minimizing the damage and recovering rapidly from terrorist attacks (Bush, 2002, p. 8). Although not reflected in the mission statement, DHS would also retain the all hazards responsibilities assigned to FEMA. As was the case in the establishment of FEMA over two decades earlier, DHS incorporated a variety of agencies and programs from many cabinet-level departments, including Agriculture, Commerce, Defense, Energy, Health and Human Services, Interior, Justice, and Treasury. The US Secret Service reports directly to the Secretary of Homeland Security, as does the Coast Guard. The line agencies of DHS comprise four Directorates. The Border and Transportation Security Directorate incorporated the Customs Service from the Department of Treasury, Immigration and Naturalization Service from the Department of Justice, Federal Protective Service, the Transportation Security Agency from the Department of Transportation, Federal Law Enforcement Training Center from the Department of Treasury, Animal and Plant Health Inspection Service from the Department of Agriculture, and Office of Domestic Preparedness from the Department of Justice. The Emergency Preparedness and Response Directorate was built around FEMA and also included the Strategic National Stockpile and National Disaster Medical System of the Department of Health and Human Services, Nuclear Incident Response Team from the Department of Energy, the Department of Justice&rsquos Domestic Emergency Support Teams, and the FBI National Domestic Preparedness Office. The Science and Technology Directorate incorporates the Chemical, Biological, Radiological and Nuclear Countermeasures Programs and the Environmental Measurements Laboratory from the Department of Energy, the National BW Defense Analysis Center from the Department of Defense, and the Plum Island Animal Disease Center from the Department of Agriculture. Konačno, Information Analysis and Infrastructure Protection Directorate absorbed the Federal Computer Incident Response Center from the General Services Administration, the National Communications System from the Department of Defense, the National Infrastructure Protection center from the FBI, and the Energy Security and Assurance Program from the Department of Energy.

Since 2001, the President has issued additional HSPDs defining the fundamental policies governing homeland security operations (www.dhs.gov/dhspublic). Thirteen HSPDs were issued through mid-2006. Recent documents have established the National Incident Management System (HSPD-5), the Homeland Security Advisory System (HSPD-3), the Terrorist Threat Integration Center (HSPD-6), and a common identification standard for all federal employees (HSPD-12). Other documents proposed strategies to combat weapons of mass destruction (HSPD-4), protect critical infrastructure (HSPD-7) and the agriculture and food system (HSPD-9), coordinate incident response (HSPD-8), and enhance protection from biohazards (HSPD-10). In addition, these documents have established policies for protecting international borders from illegal immigration (HSPD-2), promoting terrorist-related screening (HSPD-11), and securing maritime activities (HSPD-13).

These developments make it clear that the President and the Congress consider homeland security to be much broader than emergency management. Incorporation of FEMA into DHS&rsquos Emergency Preparedness and Response Directorate seems to imply FEMA is responsible only for preparedness and response (and perhaps disaster recovery if this is viewed as an extension of the emergency response phase). Consistent with this line of reasoning, one can interpret the mission of the Border and Transportation Security Directorate and the Information Analysis and Infrastructure Protection Directorate in terms of incident prevention. This gives these directorates responsibilities analogous to what emergency managers call hazard mitigation. Even so, the DHS organization chart seems to indicate a significant loss in the priority given to mitigation of natural and accidental technological hazards.


Tehnologija

In 1960, GSA created the Federal Telecommunications System, a governmentwide intercity telephone system. Then, in 1984, GSA introduced the Federal Government to the use of charge cards. Today, the GSA SmartPay program has more than 3 million cardholders.

As the agency transformed itself to enter the 21st century, GSA embraced new technologies, launched electronic government initiatives, and helped develop means of doing government business on the internet. GSA assumed responsibility for George W. Bush’s E-Gov Initiatives: E-Authentication, E-Gov Travel, Federal Asset Sales, and the Integrated Award Environment in 2001.

In 2009, a new Office of Citizen Services and Innovative Technologies was created to foster public engagement by using innovative technologies to connect the public to government information and services. As a result, GSA’s social media outreach efforts grew.

In 2010, GSA became the first federal agency to move email to a cloud-based system, which reduced inefficiencies and lowered costs by 50 percent.

In 2013, GSA began managing the Presidential Innovation Fellows (PIF) program, which Obama then made a part of GSA in 2015. The highly-competitive program pairs talented, diverse technologists and innovators with top civil-servants and change-makers working at the highest levels of the Federal Government to tackle some of our nation’s biggest challenges. GSA also announced the creation of 18F, which consisted of a team of 15 designers, engineers, and product specialists focused on improving the Federal Government’s digital services.GSA was established by President Harry Truman on July 1, 1949, to streamline the administrative work of the federal government. GSA consolidated the National Archives Establishment, the Federal Works Agency, and the Public Buildings Administration the Bureau of Federal Supply and the Office of Contract Settlement and the War Assets Administration into one federal agency tasked with administering supplies and providing workplaces for federal employees.

GSA’s original mission was to dispose of war surplus goods, manage and store government records, handle emergency preparedness, and stockpile strategic supplies for wartime. GSA also regulated the sale of various office supplies to federal agencies.

Today, through its two largest offices – the Public Buildings Service and the Federal Acquisition Service – and various staff offices, GSA provides workspace to more than 1 million federal civilian workers, oversees the preservation of more than 480 historic buildings, and facilitates the federal government's purchase of high-quality, low-cost goods and services from quality commercial vendors.


Until the twentieth century, there was no formal government response system for emergency situations. The fear of an attack on U.S. soil, for example was almost nonexistent the last foreign troops in the United States had been the British during the War of 1812. By the twentieth century, attitudes had changed, but it was not until the 1940s that the federal government felt compelled to take action. President Franklin D. Roosevelt created the first Office of Civilian Defense in 1941, in anticipation of possible attacks on U.S. soil by the Axis forces in Germany and Japan. By 1950,when President Harry S. Truman created the Federal Civil Defense Administration, the main focus of emergency management was guarding against a possible invasion from Communist forces.

During the Cold War years following World War II, civil defense administrators worked with citizens to help them prepare against possible enemy attacks. A major fear was nuclear attack. The devastation of the bombings at Hiroshima and Nagasaki in Japan were still fresh in people’s minds. During the 1950s, many families installed bomb shelters underground or in their basements to guard not only against bombs but also against nuclear fallout. Municipal buildings, schools, and large private office buildings and apartment houses often displayed placards with the Civil Defense logo and the words “Fallout Shelter” (many older buildings still sport these placards). Up until the 1960s, students were led through air-raid drills in which they were instructed to “duck and cover” by ducking under their desks and covering their heads with their arms.


TDEM's Leadership

TDEM Chief - W.NIM KIDD, MPA, CEM®

W. Nim Kidd serves as the Chief of the Texas Division of Emergency Management (TDEM). In this capacity, he is responsible for the state’s emergency preparedness, response, recovery, and mitigation activities. Prior to serving with TDEM, Chief Kidd was appointed to the San Antonio Fire Department (SAFD), where he promoted through the ranks from firefighter to District Fire Chief, including Lieutenant in charge of the SAFD Technical Rescue Team and Captain of the SAFD Hazardous Materials Response
Team. From 2004 to 2010, Chief Kidd served as City Emergency Manager for the City of San Antonio, where he managed the city’s response to over a dozen
state and presidential disaster declarations.

In 1997, Chief Kidd was one of the original members appointed to the Texas Task Force 1 Urban Search and Rescue Team. In 2001, He was the Plans
Section Chief that responded to the 9/11 attack on the World Trade Center. Chief Kidd currently serves as chair for the Federal Emergency Management
Agency’s (FEMA) National Advisory Council (NAC).


Emergency Management

The Final Rule (81 FR 63860, Sept. 16, 2016) assists providers and suppliers to adequately prepare to meet the needs of patients, clients, residents, and participants during disasters and emergency situations, striving to provide consistent requirements across provider and supplier-types, with some variations. Healthcare organizations that receive Medicare or Medicaid must follow Emergency Preparedness regulations in order to participate (aka Conditions of Participation, or CoP).

The requirements set forth in the SOM Appendix Z focus on three key essentials necessary for maintaining access to healthcare during disasters or emergencies: safeguarding human resources, maintaining business continuity, and protecting physical resources. The SOM also provides interpretive guidelines and survey procedures to support the adoption of a standard all- hazards emergency preparedness program for all certified providers and suppliers.

When the President declares a major disaster or an emergency under the Stafford Act or an emergency under the National Emergencies Act, and the HHS Secretary declares a public health emergency, the Secretary is authorized to take certain actions in addition to his regular authorities under section 1135 of the Social Security Act. Examples of these 1135 waivers or modifications include:

  • Conditions of participation or other certification requirements
  • Program participation and similar requirements
  • Emergency Medical Treatment and Labor Act (EMTALA) sanctions for redirection of an individual to receive a medical screening examination in an alternative location pursuant to a state emergency preparedness plan

Preparing our hospitals and other healthcare facilities for disasters is a national security priority. Disasters occur nearly every day in the United States, and the frequency is increasing. This includes such diverse events as storms, droughts, wildfires, floods, earthquakes, chemical and industrial accidents, burns, mass shootings and bombings, and epidemics. All sickened or injured people require a well-prepared public health and healthcare system.

Training provides the foundation for understanding Emergency Preparedness and activation of Emergency Operation Plans and role delineation for Incident command structures.

CDC works 24/7 to protect America from health, safety and security threats, both foreign and in the U.S. Whether diseases start at home or abroad, are chronic or acute, curable or preventable, human error or deliberate attack, CDC fights disease and supports communities and citizens to do the same.

When CDC gets the call to assist in a public health emergency, the Emergency Operations Center (EOC) is ready to respond. The CDC Emergency Operations Center &ndash a place where highly trained experts monitor information, prepare for known (and unknown) public health events, and gather in the event of an emergency to exchange information and make decisions quickly.

The mission of the HHS Office of the Assistant Secretary for Preparedness and Response (ASPR) is to save lives and protect Americans from 21st century health security threats.

ASPR leads the nation&rsquos medical and public health preparedness for, response to, and recovery from disasters and public health emergencies. ASPR collaborates with hospitals, healthcare coalitions, biotech firms, community members, state, local, tribal, and territorial governments, and other partners across the country to improve readiness and response capabilities.

The NFPA ® Standards Council established the Disaster Management Committee in January 1991. The committee was given the responsibility for developing documents relating to preparedness for, response to, and recovery from disasters resulting from natural, human, or technological events.

When directed, The Marine led CBIRF forward-deploys and/or responds with minimal warning to a chemical, biological, radiological, nuclear or high-yield explosive (CBRNE) threat or event in order to assist local, state, or federal agencies.

Terrorist organizations throughout the world have used a variety of chemical, biological, and radiological weapons (collectively known as HAZMAT/weapons of mass destruction [WMD]) to further their agendas. The possibility of such incidents requires first responders to prepare for such incidents, which can affect individuals or inflict mass casualties.

Incidents involving HAZMAT/WMD are complicated because victims may become contaminated with the hazardous material. The purpose of decontamination is to make an individual and/or their equipment safe by physically removing toxic substances quickly and easily.


History of USDA's Farm Service Agency

The Farm Service Agency traces its beginnings to 1933, in the depths of the Great Depression. A wave of discontent caused by mounting unemployment and farm failures had helped elect President Franklin Delano Roosevelt, who promised Americans a "New Deal."

One result was the establishment in 1935 of a Department of Agriculture agency with familiar initials: FSA, which stood for Farm Security Administration. Originally called the Resettlement Administration, and renamed in 1937, its original mission was to relocate entire farm communities to areas in which it was hoped farming could be carried out more profitably. But resettlement was controversial and expensive, and its results ambiguous. Other roles soon became more important, including the Standard Rural Rehabilitation Loan Program, which provided credit, farm and home management planning and technical supervision. This was the forerunner of the farm loan programs of the Farmers Home Administration.

Another related program was Debt Adjustment and Tenure Improvement. FSA county supervisors, sometimes with the help of volunteer committees of local farmers, would work with farmers and their debtors to try to arbitrate agreements and head off foreclosure. The idea was to reach a deal by which the bank could recover as much or more than it would through foreclosure by allowing the farmer to remain in business.

FSA also promoted co-ops and even provided medical care to poor rural families. Although the scope of its programs was limited, poor farm families who took part benefited greatly. One study estimates that families who participated in FSA programs saw their incomes rise by 69 percent between 1937 and 1941! Annual per capita meat consumption increased from 85 pounds to 447 pounds in the same period. Milk consumption increased by more than half.

In 1946 the Farmers Home Administration Act consolidated the Farm Security Administration with the Emergency Crop and Feed Loan Division of the Farm Credit Administration - a quasi-governmental agency that still exists today. This Act added authorities to the new Farmers Home Administration that included insuring loans made by other lenders. Later legislation established lending for rural housing, rural business enterprises, and rural water and waste disposal agencies.

Meanwhile, the Agricultural Adjustment Act of 1933 had established the Agricultural Adjustment Administration, or AAA. The "Triple A's" purpose was to stabilize farm prices at a level at which farmers could survive. The law established state and county committees of farmers called "Triple A committees." These committees oversaw the first federal farm program offering price support loans to farmers to bring about crop reduction.

The old Triple A was built on two major program divisions: the Division of Production and the Division of Processing and Marketing. These were responsible for the work of commodity sections including dairy, rice, tobacco, sugar, wheat, cotton, corn and hogs.

With the passage of the Agricultural Adjustment Act of 1938 and a general reorganization of the Department of Agriculture that October came new, complicated changes in conservation, crop support and marketing legislation. Programs such as commodity marketing controls, and the policy of the Congress to assist farmers in obtaining parity prices and parity income, made the federal government the decision-maker for the nation's farmers.

After Pearl Harbor, the War Food Administration (WFA) was organized to meet the increased needs of a country at war. This reorganization grouped production, supply and marketing authorities under a central agency which coordinated the flow of basic commodities.

Following World War II, the authority of the WFA was terminated. In its place came the Production and Marketing Administration, which, aside from other responsibilities, maintained a field services branch to aid in program oversight.

The post-war period of adjustment to peace-time production levels was almost as difficult as gearing up for war. New priorities had to be established, and at the same time, over-production of certain commodities threatened drops in farm income levels. The increased needs of war-ravaged nations helped absorb surplus production, but surpluses remained a nagging problem for farmers and policymakers.

In 1953, a reorganization of USDA again made changes in the powers and duties of its price support and supply management agency. With the changes came a new name - Commodity Stabilization Service - and an increased emphasis on the preservation of farm income. Conserving programs such as the Soil Bank were introduced to bring production in line with demand by taking land out of production for periods of time ranging up to 10 years. Community, county and state committees were formally identified for the first time as Agricultural Stabilization and Conservation committees.

The Commodity Stabilization Service became the Agricultural Stabilization and Conservation Service (ASCS) in 1961, and the new name reflected the agency's stabilization and resource conservation missions. Field activities in connection with farm programs continue to be carried out through an extensive network of state and county field offices.

In 1994, a reorganization of USDA resulted in the Consolidated Farm Service Agency, renamed Farm Service Agency in November 1995. The new FSA encompassed the Agricultural Stabilization and Conservation Service, Federal Crop Insurance Corporation (FCIC) and the farm credit portion of the Farmers Home Administration. In May 1996 FCIC became the Risk Management Agency.

Today, FSA's responsibilities are organized into five areas: Farm Programs, Farm Loans, Commodity Operations, Management and State Operations. The agency continues to provide America's farmers with a strong safety net through the administration of farm commodity programs. FSA also implements ad hoc disaster programs. FSA's long-standing tradition of conserving the nation's natural resources continues through the Conservation Reserve Program. The agency provides credit to agricultural producers who are unable to receive private, commercial credit. FSA places special emphasis on providing loans to beginning, minority and women farmers and ranchers. Its Commodity Operations division purchases and delivers commodities for use in humanitarian programs at home and abroad. FSA programs help feed America's school children and hungry people around the globe. Additionally, the agency supports the nation's disabled citizens by purchasing products made by these persons.


A Brief History of Emergency Medical Services in the United States

Pre-hospital emergency care in the modern age is often described as a “hierarchy” of human and physical resources utilized in the acute setting to provide the best possible patient care until definitive care can be established. Like most hierarchies, the system we have in place today was forged one link at time, dating as far back as the Civil War. With widespread trauma, a systematic and organized method of field care and transport of the injured was born out of necessity. It wasn’t until 1865, however, that the first civilian ambulance was put into service in Cincinnati followed by a civilian Ambulance Surgeon in New York four years later1 . The New York service differed slightly from the modern approach as they arrived equipped with a quart of emergency brandy for each patient.

Once again, military conflicts and necessity provided much of the impetus to develop innovations in the transportation and treatment of injured. In the wake of World War I, the roaring 20s saw the first volunteer rescue squads forming in locations such as Virginia and New Jersey. Control began to shift towards municipal hospitals or fire departments as funeral home hearses were slowly joined by fire departments, rescue squads and private ambulances in the transportation of the ill and injured. Landmark articles in the late 50’s and early 60’s began to detail the science and methods for initial cardiopulmonary resuscitation (CPR), forging yet another vital link in the chain as EMS began its first steps into the treatment of pre-hospital cardiac patients. Departments trained in cardiac resuscitation began to reveal successes in major urban areas such as Columbus, Los Angeles, Seattle and Miami.

The 1960’s provided another challenge to public health as traffic accidents began to lead to considerable trauma and death. This “neglected disease of modern society”2 was detailed in the infamous 1966 white paper titled “Accidental Death and Disability: The Neglected Disease of Modern Society.” The paper, prepared by the National Academy of Sciences and the President's Commission on Highway Safety, detailed the injury epidemic and the lack of appropriate pre-hospital care and lack of an organized system to treat patients suffering from critical traumatic injuries. Reforms were indicated in the education and training, systems design, staffing, and response in the nation’s ambulance services. The white paper and its recommendations for a standardized emergency response gave way to National Highway Safety Act of 1966 that established the Department of Transportation (DOT). The DOT, and it’s daughter organization the National Highway Traffic Safety Administration (NHTSA), were critical in pushing for the development of EMS systems while standardizing education and curriculum standards, encouraging involvement at the state level, and providing oversight into the creation of regional pre-hospital emergency systems and regional trauma center systems, forming the birth of trauma center accreditation by the American College of Surgeons Committee on Trauma. For the first time in US history, a curriculum standard was being set in skills and qualifications required to become an Emergency Medical Technician. Paramedic education arrived shortly afterwards, but still has a ways to go in terms of scope and depth.

The EMS Systems Act of 1973 provided funding for the creation of more than 300 EMS systems across the nation, as well as set aside funding for key future planning and growth. It was during this time that while EMS began to get a stable foothold, emergency medicine began to establish itself as a distinct specialty with the first residency training program in 1972 at the University of Cincinnati3. By 1975, there were 32 EM residencies across the nation preparing physicians that would interface with EMS at all levels from responders and educators all the way to medical directors.

Advances in care standards and education continued well throughout the 1980’s, including changes in the principles of funding for EMS with the Omnibus Budget Reconciliation Act. The act established EMS funding from state preventative health block grants rather than funding from the EMS Systems Act. EMS also began to see its role change towards the front line of healthcare as its practice was no longer just for adult trauma and cardiac emergencies. Chronic diseases, pediatric patients, and the underserved all began to play major roles in defining who EMS is dispatched for. Recognizing the need for a cohesive approach between EMS and the remaining healthcare world, the 1996 EMS Agenda for the Future was drafted to detail how EMS can integrate into the other medical and care fields as well as advance its own practice. The EMS Education Agenda for the Future was published shortly after and described more modern recommendations for core curriculum content, scope of practice, and certification of EMS professionals4.

Within the last 10 years, EMS has become a focus of intense research of pre-hospital interventions into many commonly encountered acute care issues seen in emergency medicine, such as acute respiratory distress, cardiac arrest, chest pain and more. With increasingly integrated technology between pre-hospital care and the emergency department, patient data is beginning to be transmitted real time allowing for earlier determination of patient severity and care management prior to arrival. Quality improvement with integrated electronic charting including patient outcomes is beginning to provide much needed feedback to allow EMS to grow as a dedicated subspecialty of emergency medicine. Within regional stroke centers, cardiac catheterization centers and trauma systems, EMS has become the forefront of emergency medical care and can only serve to advance how emergency medicine is conducted in the future.

EMS has come a long ways from its infancy in the days of horse and buggy. As it grows alongside emergency medicine, there are opportunities for physicians to become involved at every level. While EMTs are not independent practitioners and require operating under a medical director’s scope and license, the situations they face require considerable problem solving, judgment, and clinical decision making skills. Physicians are needed at every step to help develop treatment protocols, provide quality improvement, hold regular training sessions and ensure all personnel have the tools they need to perform high quality pre-hospital care. In addition, physicians may be called upon for situations that require their presence on scene in the field including mass casualty incidents, high acuity and high risk scenarios, tactical situations, or patients that require advanced skills such as surgical airways, pericardiocentesis, chest tubes and others. Large scale operations including concerts, conventions, and city events also benefit form physician input.

EMS will continue to be the front line of emergency medicine as the field expands in the coming future. Physicians involved with pre-hospital care will be paramount to providing the support and knowledge required to help EMS systems grow, as evidenced by the recent recognition of EMS as an official clinical subspecialty.


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