Monday, May 12, 2014
The deep knowledge of networks of science and medical researchers is invaluable when pandemics and health emergencies occur. But how do you marshal diffuse networks of expertise in a crisis?

Almost 40 years ago, the Forest Service developed a command-and-control approach to battling forest fires that was successful in coordinating efforts across multiple jurisdictions and fire departments.  Its approach was adopted by other agencies to address their own forms of emergencies. For example, USDA uses it to battle infestations of crop-killing insects.

The Department of Homeland Security later refined and included the approach – called the Incident Command System (ICS) -- as part of the National Incident Management System and recommends its use by all agencies.

The CDC further refined the system when it confronted the 2009 H1N1 influenza pandemic.  In a series of rapid, incremental steps, it adapted ICS with a number of changes to meet the needs of a network of scientists and doctors.  A new report for the IBM Center by Drs. Chris Ansell and Ann Keller, from the University of California-Berkley, describes the changes and how they could be useful lessons for other agencies facing similar challenges.

 

The Original ICS Model.  The Incident Command System is a governance model that “was initially developed by firefighters in California in the late 1970s after a summer of severe fires that overwhelmed the resources of any single firefighting company,” write Ansell and Keller.  The model resolves coordination problems among multiple agencies by creating a flexible and scalable command and communication structure that minimizes organizations working at cross-purposes in emergency situations.

According to the authors, “The most fundamental element of the ICS model is the rapid establishment of a single chain of command.”  The model is organized around four standard components:  operations, planning, logistics, and finance/administration.  These components report to the “incident commander” and these four sections are further sub-divided into branches and units that follow a common structure.  Regular training and exercises allow participants to be familiar with roles and responsibilities in advance of a crisis.

 

Why Did CDC Make Changes?  The CDC is not a first responder in the traditional sense.  The authors note that its central mission is best described as the “rapid mobilization of authoritative knowledge” in a crisis situation.  The ICS model was developed with “a set of assumptions about what constitute critical agency mission functions during a crisis,” say the authors.  And leveraging knowledge is different than directing a firefight. 

In reviewing the 2009 pandemic, the authors observed that three features of CDC’s pandemic response challenged the logic and assumptions of the traditional ICS model:

  • CDC needed to focus on producing authoritative knowledge rather than carry out an operational mission;
  • CDC needed to draw on specialized and often isolated knowledge from a dispersed network of actors
  • CDC needed to create a robust approach for managing external communications about what was going on, in order to anticipate and respond to confusion and rumors.

 

What Did CDC Do Differently?  Basically, CDC flipped the traditional ICS structure.  The “technical specialty units” that are nested in the planning section in the traditional model were renamed as “task forces” and they became the core of CDC’s revised ICS approach.  These task forces were staffed by subject matter experts from epidemiology labs, vaccination experts, and medical care experts.  They became the most prominent units in the daily meetings of the senior incident leadership team.  One reason, observed the authors, was “leadership wanted experts reporting directly to experts.”

The traditional “line” role of the traditional ICS components – such as a planning and operations – were relegated to “staff” roles.  In addition, CDC elevated the roles of the joint information center – which ensured CDC was speaking with one voice -- and “team B” – which mobilized external experts to check on internal decision-making.

Prior to its use of the ICS model, CDC had used an ad hoc set of task forces. In the end, CDC had produced a hybrid model that combined features of this approach with the more structured logic of the ICS approach.

 

Can Others Use CDC’s Approach?  According to the authors, they can see other knowledge-intensive agencies adapting CDC’s approach to rapidly mobilize authoritative knowledge in other kinds of crises.  For example:

  • The National Weather Service (NWS) is charged with providing timely information that helps the nation respond effectively to weather-related emergencies. This role is clearly critical for effective emergency response, but the NWS’s mission—like the CDC’s—is primarily about man­aging knowledge.
  • Other science-based agencies—like the Environmental Protection Agency—are often called upon to assess emergency situations and to provide expert guidance to decision-makers. Many institu­tions, in fact, have some capacity to deploy experts rapidly in the case of emergencies or crises.
  • Agencies involved in economic regulation—like the Securities and Exchange Commission or the Federal Reserve—are periodically called upon to rapidly provide authoritative informa­tion in support of policy decisions.

If a knowledge-intensive agency envisions that it might become the coordinating center of an emergency or crisis, the authors recommend that they plan in advance as to how they would respond. The ICS model may be a good starting point – which is recommended by the Department of Homeland Security -- but they should assess whether the lessons of how CDC adapted the ICS model might be better suited to their environment.

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