Lessons from Hurricane Andrew
Dr. Joseph Costa, D.H.Sc., PA-C
Health Policy and Management
MPH 525
Mark Thompson
June 2013
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Table of Contents
Chapter
Page
1. Introduction .................................................................................................................................3
Background ..........................................................................................................................3
The Federal Response Plan ..................................................................................................4
The Public Health Service During Hurricane Andrew .........................................................5
Additional Agencies Involved ..............................................................................................6
2. Coordination ...............................................................................................................................8
Successes..............................................................................................................................8
Volunteers ....................................................................................................................8
U.S. Public Health Service...........................................................................................8
Room for Improvement........................................................................................................9
Florida’s Preparedness .................................................................................................9
Implementing the Federal Response Plan ..................................................................10
3. Current Disaster Policy .............................................................................................................12
Federal, State, and Local Policy ........................................................................................12
Summary and Recommendations ......................................................................................13
Conclusion .....................................................................................................................................14
References ......................................................................................................................................15
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Chapter 1
Introduction
Background
On Monday, August 24, 1992, Hurricane Andrew, the most destructive natural disaster to
ever affect the United States to that point struck southern Florida causing $20 billion in damages
and leaving nearly 200,000 residents without homes (Williams, n.d.). Dade County was one of
the most devastated areas among the 1,100 square miles that experienced prolonged periods of
normal activity, emergency response, and state government disruption (Williams, n.d.). The
storm battered these localities with wind gusts up to 175 miles per hour and a record storm surge
of almost 17 feet; in the end 41 people had lost their lives (Williams, n.d.). At that time, it was
the most costly hurricane in the country’s history (American Red Cross, 2012), and required
coordination of federal, state, and local agencies on all levels. Many agencies, both governmental
and non-governmental, had begun preparing days in advance by putting agency heads and
military commanders on alert in anticipation of the humanitarian needs that were sure to arise in
the storm’s aftermath. Volunteers and advanced teams made their way to northern Florida to
begin staging for mobilization upon the hurricane’s passing, and public health services had to
begin working with state government and law enforcement to develop a plan of action. The law
enforcement response in Florida was huge, to say the least, involving hundreds of officers
working with a multitude of agencies over an extended period of time. These roles were crucial
as the public looked to Florida law enforcement and its coordination efforts with public health
agencies for leadership and security during this very tumultuous event (Williams, n.d.).
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The Federal Response Plan
Because disaster emergencies can completely overwhelm state and local governments’
abilities to maintain order and operate effectively in high-risk, high-population areas, the Federal
Response Plan, resulting from the Robert T. Stafford Disaster Relief and Emergency Assistance
Act (Public Law 93-288, as amended) of 1988 (Federal Emergency Management Agency, 2013),
establishes federal assistance parameters for states and their localities following disaster events
(Ginzburg, Jevec, & Reutershan, 1993). Hurricane Andrew saw the first implementation of the
plan which has since been changed and updated. Under the 1988 plan, states are defined as any
state or territory of the United States and Washington D.C., and disaster emergencies are defined
as either natural or man-made (Ginzburg, Jevec, & Reutershan, 1993). The 1988 Response Plan
does not specifically outline recovery assistance under the Federal Emergency Management
Agency, but it does describe the structure and rolls that different federal agencies will play
during recovery and augmentation of state and local responses (Ginzburg, Jevec, & Reutershan,
1993).
Under the Federal Response Plan, which is activated by a presidential declaration of
federal disaster, one or more of the plan’s Emergency Support Functions (ESF) begin staging for
recovery efforts. Each of the 12 ESF’s is headed by a primary agency chosen for its capabilities
and resources to respond to emergency events, and some are supported by other agencies
depending upon availability and resources (Ginzburg, Jevec, & Reutershan, 1993). The 12 ESF’s
are listed in Table 1.1 below. Emergency Support Function 8 designates the Department of
Health and Human Services and the Public Health Service as the agencies responsible for
medical and health assistance to state and local governments. The DHHS Assistant Secretary for
Health, who heads the Public Health Service, is the executive agent for ESF 8 and the action
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agent is the Director of the Office of Emergency Preparedness (OEP)/National Disaster Medical
System (NDMS) (Ginzburg, Jevec, & Reutershan, 1993). The operating agent is the Regional
Public Health Director, and federal assistance is awarded to the states when local resources are
depleted or assistance is requested (Ginzburg, Jevec, & Reutershan, 1993). The agencies then
activate, assisting localities with health and medical needs.
Table 1.1 The 12 ESF’s and the Lead Agency for Each
1. Transportation
Department of Transportation
2. Communications
National Communications System
3. Construction management
Department of Defense
4. Fire fighting
Department of Agriculture
5. Damage information
Federal Emergency Management Administration
6. Mass care
American Red Cross
7. Resources support
General Services Administration
8. Health and medical services
Department of Health and Human Services, Public Health Service
9. Urban search and rescue
Department of Defense
10. Hazardous materials
Environmental Protection Agency
11. Food
Department of Agriculture
12. Energy
Department of Energy
(Ginzburg, Jevec, & Reutershan, 1993).
The Public Health Service During Hurricane Andrew
Several days before the storm hit Florida, the forecasts showed a tropical storm
increasing in intensity that would eventually reach hurricane strength before making landfall. On
Saturday, August 22, 1992, the Public Health Service Office of Emergency Preparedness (EOP)
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established a hurricane watch. The following day, the Acting Assistant Secretary for Health was
briefed on the escalating situation, the National Disaster Medical System (NDMS) was alerted,
and the Advance Element of the Emergency Response Team was sent to northern Florida to
work with the state government and law enforcement in staging for the impending event
(Ginzburg, Jevec, & Reutershan, 1993). At this time, 8 Disaster Medical Assistance Teams
(DMATs) were moved to standby status in preparation to deploy within 24 hours if needed, and
an advance element of the ESF 8 Medical Support Unit was sent to Miami just a few hours
before Hurricane Andrew made landfall (Ginzburg, Jevec, & Reutershan, 1993). On Monday,
August 24, FEMA authorized the Medical Support Unit and two DMAT teams to move to south
Florida, and the following day with airlift support from the Department of Defense, several more
DMATs were activated (Ginzburg, Jevec, & Reutershan, 1993). The following Thursday and
Friday saw several more DMATs activated, as well as a preventive medicine team and a special
mental health team, and a base camp with water and kitchen facilities was established (Ginzburg,
Jevec, & Reutershan, 1993).
Additional Agencies Involved
In addition to the Public Health Service’s response to Hurricane Andrew, several other
agencies were active in public health efforts during the disaster recovery process. Several days
following the hurricane the Department of defense deployed the 18th Airborne Corps, the 44th
Medical Brigade, the 82nd Airborne Division, and the 10th Mountain Division to establish
sectors and security while the public health efforts continued (Ginzburg, Jevec, & Reutershan,
1993). These efforts and coordination with law enforcement undoubtedly assisted the American
Red Cross in its response to the disaster. Over the course of the disaster recovery, the Red Cross
provided over 12,000 trained workers, maintained 225 shelters, served over 5 million meals,
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distributed 42,000 comfort and clean up kits from 88 emergency response vehicles, and offered
family support services and mental health counseling for those in need (American Red Cross,
2012). Additionally, the Centers for Disease Control and Prevention (CDC) and the
Environmental Protection Agency (EPA) played significant roles during cleanup to prevent the
spread of disease and to oversee environmental pollution remediation (Ginzburg, Jevec, &
Reutershan, 1993).
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Chapter 2
Coordination
Successes
Volunteers
Ultimately, the volunteer networks that supported the relief efforts after Hurricane
Andrew were a success. Thousands flooded in to southern Florida to assist the Red Cross in its
humanitarian efforts to provide food, shelter, potable water, medical treatment, and mental health
counseling to the affected communities. During the recovery phase, many different groups of
volunteers also assisted in rebuilding housing and worked with the Army Corps of Engineers in
repairing schools and distributing water (U.S. Army Corps of Engineers, 2002). One of the most
important roles volunteers played after the storm was coordinating search and rescue efforts with
public agencies. Volunteers from the Red Cross worked with the state Department of the Elderly
to attempt locate the many elderly residents who had been forced from their houses and nursing
homes (Nordheimer, 1992). Thousands flooded into shelters before and after the storm, and
many could not verbalize or remember what facility they may have come from or where it was
located. The volunteers assisted by canvassing neighborhoods to find those who may have ridden
out the storm in their homes, and by staffing the shelters in which many of the elderly were
housed.
U.S. Public Health Service
As mentioned previously, the Public Health Service anticipated the impact of Hurricane
Andrew, prepared teams to mobilize, and were ready to move into place to implement public
health services in a timely manner. Advanced teams were sent to southern Florida before the
event, and shortly thereafter, FEMA approved the deployment of Disaster Medical Assistance
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Teams to the affected region (Ginzburg, Jevec, & Reutershan, 1993). In the end, this agency was
responsible for deploying 16 DMATs consisting of 460 personnel who were responsible for
treating over 17,000 patients (Ginzburg, Jevec, & Reutershan, 1993). During the entire recovery
period, FEMA and the Public Health Service maintained emergency operations centers to ensure
that those in the field were able to obtain the required supplies to complete their mission.
Ginzburg, Jevec, and Reutershan (1993) write that, although there are always challenges and
technical errors in these situations, lessons learned from Hurricane Hugo helped minimize
confusion and inefficiencies in this, the first implementation of the Federal Response Plan.
Room for Improvement
Florida’s Preparedness
Williams (n.d.), the Deputy Director of the Division of Criminal Investigation with the
Florida Department of Law Enforcement, wrote that Florida was not necessarily prepared for an
event like Hurricane Andrew. The Governor’s Disaster Planning and Response Review
Committee found problems with hurricane response plans. There was no contingency for
declaring the severity of disasters and adjusting accordingly. Since the needs of the public will
vary depending upon the intensities of these disasters, emergency plans should outline different
processes implemented at different levels of emergencies. Williams (n.d.) also cited a then
emerging trend of residents choosing to remain in their homes instead of evacuating - which may
be wholly impossible for some residents living on barrier islands given the short amount of
notice provided in advance of a major hurricane. The government and law enforcement could
have done a better job in planning for and responding to the unprecedented number of requests
for assistance resulting from the storm.
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Implementing the Federal Response Plan
Though the efforts of the first implementation of the Federal Response Plan were
successful in some aspects, the United States General Accounting Office in a 1993 report to the
House of Representatives Chairman of the Subcommittee on Readiness outlined some of the
inefficiencies found in the process. This report stated that coordination problems delayed
response efforts. Some of these coordination problems were unclear communication from FEMA
regarding tasking assignments that delayed ESF teams, lack of communication regarding the
arrival of food for the Red Cross – they did not know it had arrived and were not prepared to
distribute it, and unexpected aircraft arrivals resulting in unloading and distribution delays
(United States General Accounting Office, 1993). It also outlined the need for a damage
assessment team in order to create timely reports, as well as other suggestions regarding
disbursement of funds, military preparedness, and communication (United States General
Accounting Office, 1993). One of the most unfortunate findings in the report was a lack of
training, and a lack of concern for training seen in some agencies relating to their specific
Emergency Response Functions (United States General Accounting Office, 1993).
There also seems to have been a breakdown in communication among the President, the
Pentagon, and civilian leaders in ordering aid to be sent to the area affected by the hurricane.
Pear (1992) reported that officials at the pentagon were prepared to deliver large amounts of aid
on the day the hurricane struck, but did not receive orders to do so from either the President or
civilian officials. Though President Bush claimed efforts were running smoothly, disaster aid did
not reach Florida until Thursday, most likely due communication problems among top agency
officials and bureaucratic red tape (Pear, 1992). The situation then morphed into a finger
pointing game as the Governor of Florida claimed he asked for aid Monday or Tuesday while the
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Defense department claimed it didn’t receive notice until Thursday (Pear, 1992). Many victims
were rightfully angered by the miscommunications under the federal government’s jurisdiction
because of the resulting delays.
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Chapter 3
Current Disaster Policy
According to FEMA (2012), the disaster process begins on local levels. When local
governments, surrounding communities, and volunteer organizations become overwhelmed, they
then look to the states for help. State agencies, often with the help of the National Guard, assess
damage, declare a major disaster, and request federal assistance. FEMA then evaluates the
request, suggests action to the White House, and awaits the President’s decision to supply aid to
the affected region (FEMA, 2012).
Federal, State, and Local Policy
The National Response Framework (NRF) and the National Incident Management System
(NIMS) are the two current companion documents that outline national response, roles and
responsibilities of responding organizations, and planning in the event of a national incident
(Department of Homeland Security, 2008). The NIMS also provides a framework for command
structures in case of an incident. The CDC has developed the Public Health Emergency
Response Guide for State, Local, and Tribal Public Health Directors - Version 2.0 which is
consistent with the organization, terminology, and processes outlined in the NRF and the NIMS
(CDC, 2013). The lessons learned from Hurricane Andrew and again from Hurricane Katrina
showed that, though many thought they were prepared for such significant natural events,
ultimately breakdowns in the system demanded a more thorough, well designed policy to address
organization and structure not only during natural disasters, but during national disasters of all
kinds.
The State of Florida Resource and Financial Management Policies and Procedures for
Emergency Management is similar to the National Response Framework in its goals of outlining
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responsibilities during an incident. Like the NRF, Florida’s policy includes ESFs (as discussed
earlier) but also includes information on requesting federal aid. While more information on the
state and local public health policies has proven difficult to locate, it is certain that the years of
hurricane experience gained by Florida and other Gulf Coast communities has led them to
develop emergency, evacuation, and public health policies that are continually evolving as new
needs are identified.
Summary and Recommendations
It is apparent that during Hurricane Andrew, the first implementation of the Federal
Response Plan could have functioned better. However, given the circumstances, the public health
response can be considered a success. From staging of medical teams to activation, the public
health response may have been the most efficient federal agency involved in the post- Hurricane
Andrew disaster response. There were certainly communication breakdowns among some
organizations under the response plan that left many citizens angered. Many assumed that after
the Hurricane Andrew disaster, the government would have streamlined the process. When
Hurricane Katrina hit in 2005, it was apparent that it had not. Under FEMA today, the National
Response Framework (NRF) and the National Incident Management System address many of the
organizational and command issues that plagued the response efforts in past disasters.
Communication among agencies is the single most important element during these processes, so
agencies must develop ways to improve. Prompt action can be the difference between life and
death for citizens affected by disasters. The author of this paper recommends implementing
practice drills and scenarios to audit system effectiveness and to identify potential indicators that
require improvements. Also, localities and states must be held responsible for ensuring they have
well-written, thorough, and well-designed emergency policies – especially in high-risk areas.
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These policies can never be sufficient to meet community needs; rather they must be continually
evolving to address new challenges and identify shortcomings. State and local governments, like
the federal government, would undoubtedly benefit from emergency exercises and audits to their
emergency response systems.
Conclusion
The poor communication among government agencies which hindered some of the
response to Hurricane Andrew’s recovery efforts is not terribly surprising. The author of this
paper sees the federal government and its ever-expanding reach as a relatively inefficient
conglomeration of independent and self-reliant agencies. This is unfortunate because, as seen in
cases like this disaster, citizens look to government to help solve dilemmas and help restore order
in affected communities; many times only to become frustrated and demoralized in its inability
to act quickly. This is not to say that all agencies involved with the recovery process are to
blame. Many conducted their missions effectively despite communication setbacks, and public
health efforts seem to have been implemented successfully. Certainly, however, improvements in
all areas of the Federal Response Plan were needed after Hurricane Andrew. Hopefully, as the
2013 hurricane season is upon us, the lessons learned from past disaster responses and our
current emergency response policies will lead to effective, well-coordinated responses, should
the need arise.
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REFERENCES
American Red Cross. (2012). Hurricane Andrew 20th anniversary. Retrieved from
http://www.redcross.org/news/article/Hurricane-Andrew-20th-Anniversary-.
Centers for Disease Control and Prevention. (2013). Public health emergency response guide for
state, local, and tribal public health directors - version 2.0. Retrieved from
http://www.bt.cdc.gov/planning/responseguide.asp.
Department of Homeland Security. (2008). National response framework. Retrieved from
http://www.fema.gov/pdf/emergency/nrf/nrf-core.pdf.
Federal Emergency Management Agency. (2012). The disaster process & disaster aid programs.
Retrieved from http://www.fema.gov/disaster-process-disaster-aid-programs.
Federal Emergency Management Agency. (2013). Robert T. Stafford Disaster Relief and
Emergency Assistance Act (Public Law 93-288) as amended. Retrieved from
http://www.fema.gov/robert-t-stafford-disaster-relief-and-emergency-assistance-act-public-law93-288-amended.
Florida Division of Emergency Management. (2006). State Of Florida resource and financial
management policies and procedures for emergency management. Retrieved from
http://floridadisaster.org/documents/RFMP.pdf.
Ginzburg H. M., Jevec R. J., and Reutershan T. (1993). The Public Health Service's response to
Hurricane Andrew. Public Health Reports, 108(2): 241–244. Retrieved from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1403368/pdf/pubhealthrep00068-0099.pdf.
Nordheimer, J. (1992). Hurricane Andrew; Workers try to track down elderly scattered by storm.
New York Times. Retrieved from http://www.nytimes.com/1992/08/29/us/hurricane-andrewworkers-try-to-track-down-elderly-scattered-by-storm.html?src=pm.
Pear, R. (1992). Hurricane Andrew; Breakdown seen in U.S. storm aid. New York Times.
Retrieved from http://www.nytimes.com/1992/08/29/us/hurricane-andrew-breakdown-seen-inus-storm-aid.html.
U.S. Army Corps of Engineers. (2002). Historical vignette 055 - the corps came to the aid of
Florida in the aftermath of Hurricane Andrew. Retrieved from
http://www.usace.army.mil/About/History/HistoricalVignettes/ReliefandRecovery/055Hurricane
Andrew.aspx.
United States General Accounting Office. (1993). Disaster assistance: DOD’s Support for
Hurricanes Andrew and Iniki and Typhoon Omar. Retrieved from
http://www.gao.gov/assets/220/217920.pdf.
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Williams, E.B. (n.d.). Hurricane response planning in Florida. Retrieved from
http://www.fdle.state.fl.us/Content/getdoc/b2191bef-41b4-4894-b76cc449630feed8/Williams.aspx.