Introduction

The disaster cycle involves four phases: preparation, response, recovery, and mitigation.[1] The cycle illustrates the steps that emergency managers take when planning for and responding to a disaster. Preparation is the phase where response plans are constructed. The response is the phase where there is immediate action to limit the hazards created by the disaster. Recovery is the effort to return a community to pre-disaster levels of functioning. Mitigation is the phase where new measures are undertaken to prevent or minimize the effects of future disasters.  Some sources refer to the mitigation phase as “prevention.”

To meaningfully discuss disaster response, it is essential also to discuss disaster and disaster management. Though there exists no consensus definition of disaster, the various definitions published by organizations and agencies at the forefront of disaster management have overlapping concepts.

A disaster is a state in which the usual, normal day-to-day human activities within a determined geographic area cease indefinitely. It is defined by a severe disruption in the basic structure and function of a society. This abnormal state is triggered by some extraordinary circumstance, either occurring naturally or as the result of human activity.

A disaster is the consequence of a sudden event or series of events of grand magnitude, which results in injury, disease, illness, loss of life, destruction of property, and/or damage to critical infrastructure and essential services.[2] The precipitating event may be natural, i.e., natural disasters (e.g., tornado, hurricane, drought, famine, earthquake, landslides, infectious disease outbreaks, etc.) or man-made.[3][4] Man-made events may be unintentional (fires, building collapses, nuclear reactor meltdowns) or intentional (terrorism, sabotage, cyber-attacks, conflict-based). In recent times, both man-made and natural disasters have occurred at an increasing frequency.[5]

Due to its scale and dimension, a disaster exceeds the emergency management capacity of local organizations and agencies, thus necessitating external assistance. That assistance may come from the state, national, and/or international levels. The rapid, immediate, and short-term actions circumjacent to a disaster are known as disaster response.[6]

Disaster response is one of the core activities of disaster management. It involves the execution of a disaster plan in the event of a disaster.

Issues of Concern

A vital concept core within the field of disaster management is that all disasters are local. This concept refers to the idea that the response to a disaster nearly always begins before making an official disaster declaration. Whether the event is a major transportation accident such as the Hong Kong subway fire of 2017, a natural disaster such as Hurricane Katrina, or a planned attack like 9/11, the first to be notified and arrive on the scene are always local first responders.[7][8][9][8][7] Police, firefighters, and EMS personnel within the jurisdiction are called to the scene and begin their work, which could involve any number of rescues, life-saving interventions, hazard reduction, or evacuation efforts.[10]

Throughout the disaster response phase, the local incident management command structure is responsible for directing response efforts and effectively implementing the disaster plan. One of the most important qualities of an advantageous disaster plan is to minimize its complexity.[11] The best plans effectively identify what resources are available to the incident management team and outline procedures to access those resources without applying extensive constraints to their utilization; this allows the plan to be adaptable to the specific needs of the situation. 

The primary objective of disaster response is to provide immediate short-term assistance to meet the myriad needs that arise when a disaster occurs.[12]

If the disaster reaches a significant enough magnitude and presents a drain to local resources, the governor of the affected state or tribal leader of the Native American reservation, makes a formal request for a major disaster declaration to the federal government.[13] Once a disaster is recognized and declared, federal disaster responders and other response resources are activated and moved into position for deployment.

Those individuals and professions potentially involved at this stage are too numerous to name realistically. Local responders will still be involved.  This team of responders could include professional rescuers, police officers, firefighters, paramedics, cities and county emergency managers, public works and other utility workers, local healthcare workers, teams of engineers, members of the media, local volunteers, and many more.

In the United States, federal assets deployed in response to a major disaster declaration bring many more actors to the scene.  The Federal Emergency Management Agency (FEMA) is responsible for coordinating the federal operational and logistical disaster response capability within the National Response Framework.  The available resources break down into bundles, referred to as “Emergency Support Functions (ESFs) [14][15][16]:

• Emergency Support Function (ESF) #1 Transportation
  • Assists with the management of transportation systems and infrastructure
• Emergency Support Function (ESF) #2 Communications
  • Assists in the coordination of stakeholders in response efforts and supports and restores existing communication infrastructure
• Emergency Support Function (ESF) #3 Public Works and Engineering
  • Assists with technical aspects of maintaining necessary public services and engineering expertise
• Emergency Support Function (ESF) #4 Firefighting
  • Assists with suppression of wildland, rural and urban fires
• Emergency Support Function (ESF) #5 Information and Planning
  • Assists with the collection, analysis, processing, and dissemination of information
• Emergency Support Function (ESF) #6 Mass Care, Emergency Assistance, Temporary Housing, and Human Services
  • Assists with providing secure access to finances and housing for those displaced by a disaster
• Emergency Support Function (ESF) #7 Logistics
  • Assists with comprehensive planning of technical assistance, training, educational programs, exercises, and incident response
• Emergency Support Function (ESF) #8 Public Health and Medical Services
  • Assists with public health initiatives, mental health, and medical care response
• Emergency Support Function (ESF) #9 Search and Rescue
  • Assists with life-saving intervention for those trapped by disasters
• Emergency Support Function (ESF) #10 Oil and Hazardous Materials
  • Assists with a response to actual or potential hazmat disasters
• Emergency Support Function (ESF) #11 Agriculture and Natural Resources
  • Assists by providing nutrition assistance, and threats to agricultural infrastructure and the supply chain
• Emergency Support Function (ESF) #12 Energy
  • Assists with technical expertise during threats to the energy sector and stabilizes/restores normal operations at energy facilities.
• Emergency Support Function (ESF) #13 Public Safety and Security
  • Assists with local law enforcement, maintaining order, and protecting citizens.
• Emergency Support Function (ESF) #14 Cross-Sector Business and Infrastructure Annex
  • Assists with the stabilization of key supply chains in disaster areas
• Emergency Support Function (ESF) #15 External Affairs
  • Assists with the communication of accurate, timely and accessible information to affected audiences during a disaster

Which bundle of resources is deployed is dependent on the circumstances of the specific disaster situation and what resources are requested by the governor or tribal leader. Each package brings more actors and professions into the response united in the goal of providing immediate assistance to communities affected by disasters.

The escalation of a disaster situation often brings another player to the scene, the non-governmental organizations (NGOs).  Examples of NGOs include those widely known, such as the Red Cross and the Salvation Army, but also those not as well-known but local, regional, and even international. Though they are not government entities, they can play a crucial role in disaster response and provide relief and services to many victims. These organizations can help even absent a major disaster declaration. Each organization has a particular specific mission and funding sources. They can intervene in circumstances that fulfill their mission.  Some provide medical care. Some, like Team Rubicon, help with housing repairs and clearing debris. Some even are able to provide financial assistance to victims.[17]

In addition to those responders summoned to help with disasters, the recent increase in the occurrence of natural disasters has caused another phenomenon to develop, disaster tourism. This term refers to individuals, or groups of individuals, who “self-dispatch” themselves to a disaster. In some cases, these are people nobly motivated to help. In other cases, some of these people may want to bear first-hand witness to the situation.  Whatever their intentions, disaster responders, regardless of their origin, put stress on the local resources already struggling due to the disaster situation. When those responders are requested and providing necessary help to the community, the benefit outweighs the tax. But for those who are unplanned “responders,” their presence could cause more harm than good. The limited resources for these people could also pose a risk to their health and safety.  For those who respond to disasters, they must be attached to an official organization for both the best interests of the community affected by the disaster and the responders’ personal health and safety.[18]

Regardless of what organization originally dispatched each disaster responder, they are united in their common goal to provide immediate relief to those affected by disasters.

Clinical Significance

Despite advancing preparedness and mitigation strategies, disaster is inevitable and invariably affects human populations.[19] Though the scale of disasters varies, disaster management principles are widely applicable. Disaster management has a goal of reducing the impact of disasters. Disaster response is a crucial phase and involves the immediate actions taken in the aftermath of a disaster to protect against further loss of life and property.[20]

Responders are interdisciplinary and from a wide variety of backgrounds.  For each stakeholder to work together properly, disaster plans need to have minimal complexity and be widely applicable; the correct resources need to be activated; the incident command structure must be respected; and, responders need to be well trained. Once the immediate response phase has passed, efforts can shift towards recovery and return to the normal functioning of the affected community.