Disaster planning: What we can learn from recent events
As this article is going to print, a disaster of unbelievable proportions is unfolding in Japan.
On Friday, March 11, a magnitude 8.9 earthquake occurred near the east coast of Honshu, Japan. The initial earthquake was followed shortly by its self-generated tsunami. The unforgiving wall of water, estimated at nearly 10 meters (33 feet), obliterated tens of thousands of buildings and caused an as-yetunknown number of deaths that could reach to the tens of thousands.
The devastation and its impact are just now coming to light, and the uncertainty of the stability of several nuclear reactors has yet to be resolved. This horrible disaster could turn into an even greater catastrophe should a meltdown occur at one or more nuclear plants in northern Japan. And we are witnesses to it all-we watch, fixated to our televisions and computers, as events unfold.
Earthquakes are not uncommon in Japan. As recently as 1995, the 6.9-magnitude Great Hanshin earthquake, commonly referred to as the Kobe earthquake, resulted in 5,500 deaths and more than 26,000 injured. The economic loss has been estimated at about $200 billion U.S. dollars. This is a nation that has earthquakes imbedded in its national psyche.
As a result of its history, Japan is perhaps the most prepared nation in the world when it comes to dealing with earthquakes and their common companion, tsunamis. Yet we watch as this nation-which has invested heavily in infrastructure protection, drilled and educated its population continuously, developed redundant strategies to protect its most fragile assets, and understands and appreciates the reality of its geography-struggles and nearly collapses under the impact of this disaster. The country is experiencing an escalating and expanding series of events; it believed it was prepared, but in fact it was overwhelmed by the unexpected and unforeseen.
We can only pray that this situation will be brought to resolution without additional insult to the Japanese people-or for that matter, to the rest of the world in the event of a nuclear catastrophe.
What this means for hospitals
The question, however, that begs to be asked is: How would we withstand and recover from such an event? Have we made the same investments in earthquake protection as Japan? Are building codes adequate? Have realistic exercises been conducted? Are the populations at risk really aware of their situation and prepared to self-sustain if needed?
This question brings into relevance the New Madrid fault earthquake zone. This seismic zone is six times bigger than the San Andreas fault zone in California and encompasses portions of the states of Illinois, Indiana, Missouri, Arkansas, Kentucky, Tennessee, and Mississippi.
In 1895, a magnitude 6.8 earthquake, the largest in U.S. history, struck in this zone. Earlier, in 1811 and 1812, there were four earthquakes reported, and it was estimated that all four reached a magnitude of 7.0. Based on recent observations, there are many who believe that the New Madrid fault is "waking up."
Whether there is validity in that statement will be left to the scientists and our unfolding history. The message, however, is that the Japan earthquake should be a wake-up call. Could a similar cascade of events impact us as it has one of the most prepared and resilient nations on the planet? Are we prepared? Do we have the mind-set necessary to anticipate what is possible or likely to occur? Do we have the ability to assimilate the events unfolding in Japan into our psyche?
The normalcy bias
People who face disasters often enter into a state referred to as "normalcy bias." In essence, it causes people to have a difficult time dealing with something they never have experienced and didn't believe could ever happen. It causes people to refuse to see evidence of a looming or developing disaster even when it is right in front of them.
As Barton Briggs reports in his book Wealth, War, and Wisdom, by the end of 1935, 100,000 Jews had left Germany, but 450,000 remained. They had been in Germany so long and were so well established, they simply couldn't believe there was going to be a crisis that would endanger them. They believed the Nazis' anti-Semitism was an episodic event and that Hitler's bark was worse than his bite. They reacted sluggishly to the rise of Hitler for completely understandable but tragically erroneous reasons. Events moved much faster than they could have imagined.
This is one of the most tragic examples of the devastating effects of normalcy bias the world has ever seen. Yet this state refers not only to people, but to organizations, institutions, and governments. Often the assumption is made that since a disaster has never occurred, it never will occur.
Hurricane Katrina is a perfect example. Inadequate government preparation and widespread denial that the levees could fail, despite evidence to the contrary, is an example of normalcy bias at the governmental level. The failure to heed the warning to evacuate and the refusal to accept the reality of the situation is the normalcy bias at work at the individual level. People refused to evacuate even in the face of rapidly rising floodwaters.
The Internet is rife with articles describing the normalcy bias, applying it to decipher historical events, predict our economic future, and explain the reactions of people in stress-related events. Sometimes called the "ostrich syndrome" or "analysis paralysis," normalcy bias may account for why organizations invest so little in preparedness and resiliency activities.
Leaders have a fundamental and erroneous belief that if it hasn't happened before, it probably won't happen on their watch. The normalcy bias causes governments to plan and invest limited funds based on what has already occurred, not what is possible or likely to occur. The normalcy bias leads to inadequate planning and preparation and may lead to significant unnecessary deaths in disaster situations. Despite adequate warnings, we always seem to be caught off guard when some significant event occurs.
If this nation should ever face a disaster like the one unfolding in Japan, will we have the instincts to overcome normalcy bias? In his 1972 book Watership Down, author Richard Adams tells the tale of a group of rabbits in search of a home. Through the adventures of these rabbits, he provides us a mirror to the human condition. Two themes that he weaves throughout the story focus on leadership and adaptation. The rabbits are repeatedly forced to adapt to situations that they could never have anticipated.
To their credit, they adapt quite well, but mostly because there are members of the group who are always prepared to look at things in a different way and to figure out how they will survive. Hazel, the protagonist of the story, is also the leader of the rabbits. Not the biggest or the strongest, Hazel has the confidence of the warren because he has the ability to do things differently. He is unafraid to let others come up with ideas when he is puzzled and he acts swiftly and confidently, keeping the entire group in mind when he makes decisions. He knows how to involve each member of the group, utilizing their special gifts for the benefit of the entire warren.
As with every good leader, Hazel knows that the whole is greater than the sum of its parts and he lets nothing interfere with the goals of the warren.
This allegorical tale is a perfect example of how inspired leadership and rapid adaptation can overcome the normalcy bias. In Adams' story, one of the conditions rabbits can fall into is a state known as "going tharn." It's a condition in which the rabbits are so overwhelmed by danger or chaos that they just freeze.
They go into a situational trance state, right where they are, paralyzed in mind and body with their only hope being that the threat will pass without impacting them or even noticing them. As a nation, as members of healthcare organizations, as professionals, we must guard against the normalcy bias and never be so overwhelmed that we all "go tharn." Hope is not a plan. Faith is not a strategy.
The Japanese people knew that the potential for this disaster was always on the horizon. Watching their reactions on television, listening to their stories, watching them queue up for supplies in such an orderly and respectful manner, one wonders how we would react. Their strength comes from their culture of honor, respect, and deep-felt obligation to society. Their survival comes from their institutional and personal level of preparedness.
Let us keep the Japanese people in our thoughts and prayers and collectively breathe out a sigh of relief that this time it wasn't us.