Table Of ContentIntegrating Emergency Management
and Disaster Behavioral Health
Integrating Emergency
Management and
Disaster Behavioral
Health
One Picture through Two Lenses
Edited by
Brian W. Flynn
Ronald Sherman
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This book is dedicated to those who have
experienced unthinkable loss in disasters.
And to those who help them recover
from the unthinkable.
List of Contributors
AlbertAshwood,B.A.
OklahomaDepartmentofEmergencyManagement,OklahomaCity,OK,
UnitedStates
JohnJ.Brown,Jr.,M.S.,B.S.
OfficeofEmergencyManagement,Virginia,VA,UnitedStates
ValerieL.Cole,Ph.D.
AmericanRedCross,Washington,DC,UnitedStates
DanielDodgen,Ph.D.
USDeptofHealth&HumanServices,Washington,DC,UnitedStates
NancyDragani,B.A.,M.A.
FederalEmergencyManagementAgency,Denver,CO,UnitedStates
SusanFlanigan,CBCP
MissouriDepartmentofMentalHealth,JeffersonCity,MO,UnitedStates
BrianW.Flynn,Ed.D.
UniformedServicesUniversityoftheHealthSciences,Bethesda,MD,UnitedStates
ChanceA.Freeman,B.S.
TexasDepartmentofStateHealthServices,Austin,TX,UnitedStates
MarianneC.Jackson,B.A.,M.A.
FederalEmergencyManagementAgency(Retired),NewYork,NY,UnitedStates;
NYCEmergencyManagement,NewYorkCity,NY,UnitedStates
GerardA.Jacobs,Ph.D.
UniversityofSouthDakota,Vermillion,SD,UnitedStates
BerlD.Jones,Jr.,M.P.H.,CEM
FederalEmergencyManagementAgency,Washington,DC,UnitedStates
RachelE.Kaul,LCSW,CTS
U.S.DepartmentofHealthandHumanServices,Washington,DC,UnitedStates
DanielW.McGowan,B.A.,M.A.
McGowanEnterprises,Inc.,Helena,MT,UnitedStates
StevenMoskowitz,M.S.W.
NewYorkStateOfficeofMentalHealth,Albany,NY,UnitedStates
AprilJ.Naturale,Ph.D.,M.S.W
ICFInternational,Fairfax,VA,UnitedStates
xvii
xviii ListofContributors
DianaNordboe,M.Ed.
EmergencyManager,IndependentConsultant,CarterLake,IA,UnitedStates
JohnP.Philbin,Ph.D.
Crisis1,LLC,Reston,VA,UnitedStates
LesliA.Rucker
CenibarkInternational,Inc.,Richland,WA,UnitedStates
RonaldSherman,B.A.,M.A.
IndependentConsultant,FEMAFederalCoordinatingOfficer(Retired),UnitedStates
JamesM.Shultz,M.S.,Ph.D.
UniversityofMiamiMillerSchoolofMedicine,Miami,FL,UnitedStates
JamesSiemianowski,M.S.W.
CTDeptMentalHealthandAddictionSvcs.,Hartford,CT,UnitedStates
AnthonyH.Speier,Ph.D.
LouisianaStateUniversityHealthSciencesCenter,NewOrleans,LA,UnitedStates
LaurenceW.Zensinger,B.A.,M.S.
Director of the Recovery Division for the Federal Emergency Management Agency
(Retired),UnitedStates
Acknowledgments
We are both humbled and gratified by the many people who have given so
generously or their time, effort, and expertise to make this book possible. It
is only through your good work that these important topics can be shared so
widely andcomprehensively.
We would like to first thank the many contributors to the book. You
were carefully selected for this unique project by virtue of your real-life
experiences and your demonstrated ability to conceptualize what you do and
to effectively communicate your knowledge and wisdom. Each of you have
walked the walk as well as talked the talk. This is a powerful combination
that is seldom found.
We would like to thank our guardian angels at Elsevier who have sup-
ported and guided us through this project from start to finish. Sara Scott was
the first to approach us with the idea for such a book. Somehow she knew
that neither of us could resist such an opportunity. She cast the line and set
the hook. Hilary Carr worked with us throughout the project and was ready
at a moment’s notice to guide us, support us, and help us stay organized. She
was both ourcoach andcheerleader.
Michelle Herman served as research and editorial assistant on the book.
Her contributions contributed immeasurably to making the content clear and
accurate.
We both would like to thank our wives, Donna Flynn and Carol
Sherman, for their support, encouragement, and tolerance throughout more
than the past year as we poured ourselves into this effort. We realize it dis-
tracted both of us from our time with, and attention to, you. We also realize
that both of you had every reason to expect that once we gave up direct
disaster response leadership roles, we would be more physically and psycho-
logically available. Neither of us can say no to an opportunity to support the
work of those who help survivors who have suffered so much. We cannot
tell youenough how much yourlove and supportcontinuesto mean tous.
xix
Introduction
Preparing for and responding to disasters and large-scale emergencies make
for strange bedfellows. These tragic events require that individuals, groups,
and governments work in harmony if victims and survivors are to be opti-
mally served. As disaster response has become more standardized and for-
malized over the past several decades, the complexities, challenges, and
promises of integrating critical partners has become clearer. One of the most
challenging and promising integrative opportunities is between emergency
management (EM) professionals and behavioral health (DBH) professions
involved in disaster preparation and response. As the chapters of this book
willreveal,thereareimmeasurableadvantagestobegainedfromtheintegra-
tion of these two professional domains. At the same time, this is not an easy
match. These are two rapidly evolving areas of theoretical, legislative, and
practical formalization grounded in conceptual structure, research, and real-
life experience.
Both the structure and content of this book are designed to guide the
reader through key areas of important integration, articulate the challenges
and opportunities involved, and provide practical guidance for implementa-
tion and application. The structure is designed to model an integrated
approach to the topics presented. Chapters will provide perspectives on the
topic from both professions as well as case examples or suggestions for
accomplishing integration.
The editing of this volume is also intended to model integration. Each of
us comes from a different profession and has designed the book based on not
only our own experiences. We have fully incorporated the suggestions from
both EM and disaster behavioral health communities to identify the most
relevanttopical areas and contributing authors.
Fundamental to the foundation in designing and editing this book, both
us have walked the walk. Combined, the two of us have more decades of
hands-on involvement in disaster preparedness and response that we like to
contemplate. Our experience spans significant governmental, legislative and
policy developmentandimplementation,consultationtonationalandinterna-
tional leaders, knowledge development and dissemination. Perhaps most
important, is our real-time experience in disaster preparation and response in
some of the most complex and difficult situations the United States has
faced,such asin the aftermath of both natural and human-caused disasters.
xxi
xxii Introduction
I, Brian Flynn, have lived primarily in the DBH and science world.
During my 31 years in the U.S. Public Health Service (USPHS), in addi-
tion to other responsibilities, I worked in, managed, and supervised the
federal government’s domestic disaster mental health program. In that role,
I served on-site with EM professionals at many, if not most, of the nation’s
largest disasters. Since I retired from the USPHS in 2002 at the rank of
Rear Admiral/Assistant Surgeon General, I have directed nearly all of my
professional efforts toward advancing the field of preparing for and
responding to large-scale trauma. I have provided training and consultation
to both public and private entities throughout the United States and interna-
tionally. I currently serve as Adjunct Professor and Associate Director
of the Center for the Studies of Traumatic Stress, in the Department of
Psychiatry at the Uniformed Service University of the Health Sciences in
Bethesda, Maryland.
I, Ron Sherman, spent almost 29 years as an EM specialist with the
Federal Emergency Management Agency (FEMA). I worked on over 200
federal disaster operations, including some of this nation’s most devastating
events. Many times I was in the role of Federal Coordinating Officer (FCO),
the on-site official in charge of all federal response and recovery efforts.
After Hurricane Katrina, I served as the FCO in Alabama before becoming
the Senior Housing Official responsible for disaster housing operations for
the entire Gulf Coast. After retiring in 2007, I continued EM involvement by
starting a Citizen Corps Council in my hometown and am now the leader of
a Community Emergency Response Team. I provide EM consulting services
to communities and emergency response training for volunteer groups. I suc-
cessfully integrated the operations of a Community Emergency Response
Team with a new Medical Reserve Corps team and made Psychiatric First
Aid a requisite part of the training curriculum.
We have both “been there and done that.” We have lived first-hand the
enormous opportunities that emerge where EM and DBH professions under-
stand each other and integrate our experience and expertise. We have also
witnessed situations where this was not the case. Failure to understand,
respect, and value the perspectives and responsibilities of the other field
have compromised preparedness and response. The stakes are high. In the
end, our ability to work together and integrate our professions makes a dif-
ference inthe lives of countlessdisastervictims and survivors.We owe them
no less than ourbest.
Contrary to what the prior few paragraphs may have implied, this book is
notallaboutus.We andoursupportersatElsevierareprovidingthegateway
for the almost incalculable knowledge and experience represented by the
contributors to this volume. An introduction to this book would be incom-
plete without a discussion of who they are and what they have so generously
broughtto thisbook.
Introduction xxiii
First, all contributors were selected because of not only their status and
credibility in their professional domains. A defining criterion for selection
was not only a conceptual grounding on specific topics, but their real-life
experiences in operationalizing their expertise. Every contributor has been in
a position to prepare for and/or respond to real disasters. This is not just the-
ory for them. They too have walked the walk. Think about the magnitude of
what this means. It means that you, the reader, hold in your hands almost
400personyearsofcollectiveexperience,wisdom,andadvice.Weareproud
to have had their willing andeager participation incrafting this uniquebook.
Yet, for us, that is only part of the picture. Both of us know these contri-
butors well. Certainly as important as the knowledge they bring are the
values they represent. The writers of this book have spent much, if not most,
of their careers in service to protecting their national and global neighbors,
giving their all in helping others rebuild their lives and communities in the
darkest hours, and have brought comfort to the vulnerable, frightened, and
displaced. They have healed the broken. For their service, many, if not most,
along with their families and colleagues, have paid a price. One does not do
this type of work, no matter how noble, without testing the limits of health
and relationships. Yet, we know they would tell you, the reader, as they tell
us—they would not want to do anything else. In these pages, they serve once
again by sharing with you the lessons they have learned trusting that you
will continue to build on both their work and their values. We all hope that
you will use what you take from these pages to“pay itforward.”
TOPIC SELECTION
Together, pooling our collective decades of experience, we identified topics
that we felt were the most central to facilitating meaningful and practical
integration of EM and DBH. To assure that the content reflects the needs
and priorities of both fields, we distributed a draft of the book’s content
and structure to individuals and groups with credibility in both professional
domains, asking for their input both on topic and potential contributors.
The topics and contributors identified through that process are contained on
these pages.
STRUCTURE
The format of this book is a bit different than one might be used to. From the
start, we were determined to avoid a structure that would keep the two pro-
fessions talking only to the reader and not to each other. We have attempted
to model integration as not only a goal but as the foundation for this book.
We also were driven by a commitment to assure that content was not only
theoretical,conceptual,orpractical—butrather,allofthese,combined.
