Volume 18 (2024-25)

Each volume of Journal of Business Continuity & Emergency Planning consists of four 100-page issues both in print and online. Articles currently published in the volume are:

Volume 18 Number 4

Editorial
Lyndon Bird, Editor
Practice Papers
Confronting wicked problems and creeping crises: Integrated crisis management
Brendan Monahan, Head, US Crisis Management & Resilience, Global Pharmaceutical Company, USA

The disciplines of crisis management, emergency management, business continuity and resilience are at an inflection point. Is the work of professionals in these fields subject to what some have called at recent industry conferences a failure of imagination? Are the tried-and-true methods and activities serving practitioners as well as they always have, or does today’s world demand something different? The more important question is: In these conditions, how can crisis leaders do the most good? To answer that question, crisis management professionals may consider shifting their emphasis from planning, training and exercising alone and introducing more explicit focus on the delivery of good decision making — in other words, a transition of emphasis from response planning to more strategic programme management. All crises — whether fast burning, slow burning or creeping — require decision making. Ultimately in the aftermath, organisations and their leaders are judged not only on the outcomes of a crisis response, but on the decisions they made. Furthermore, this judgment is made not only on whether the decisions were right or wrong alone, but also whether they were defensible based on the best available information at the time. In confrontation with these realities, there is a unique role for enterprise crisis teams to define a value proposition along a set of guiding principles. From there, operational execution may be bridged through an integrated crisis management framework. This paper proposes a way forward along these lines. This article is also included in The Business & Management Collection which can be accessed at https://hstalks.com/business/.
Keywords: crisis management; crisis leadership; creeping crisis; integrated crisis management; emergency management; Cynefin; resilience; business continuity; wicked problems
Adapting workplace violence strategies to manage company risk and the modern workforce paradigm
Robert Achenbach, Chief Security Officer and Senior Director, Corporate Security and Safety and Debra Andersen, Security Administrator, Physical and Cyber Security and Security Consultant

As the remote workforce evolves, security professionals must align the workplace violence strategy to secure assets, data and employees to manage company risk tolerances. The threat of workplace violence is not only confined to the traditional office space, it is also a relevant threat for employees working from their own homes. Employees working from home do not have access to the same physical security protections or practices in place in the pre-pandemic workplace. This paper examines considerations for identifying and preparing for threats of violence and establishing a proactive approach for securing the new workforce paradigm. This article is also included in The Business & Management Collection which can be accessed at https://hstalks.com/business/.
Keywords: security; safety; business continuity; workplace violence; threats patterns; risk; harassment; duty of care; risk tolerance; employee training; policies and procedures
Integrating cyber resilience: A critical component of comprehensive business resilience
Robert Fernandes, Chief Information Security Officer, The Investment Center

This paper advocates for the integration of threat exposure monitoring (TEM) as a critical tool in cyber security resilience frameworks. As organisations face increasing cyber threats, TEM provides an essential, proactive approach to identifying potential vulnerabilities before they can be exploited. By monitoring various online environments, including the dark web, hacker forums and misconfigured cloud storage, TEM can uncover compromised credentials, exposed data and other risk factors that could lead to operational disruptions. This proactive monitoring strategy enhances an organisation’s preparedness, helping to prevent costly incidents and mitigate risks before they escalate. Using notable case studies, such as the Colonial Pipeline ransomware incident and the Orange Spain outage, the paper illustrates the devastating impact of cyber breaches and underscores how TEM could help avoid similar disruptions. Readers will gain an understanding of how to implement a TEM programme, identify critical digital assets for monitoring and integrate TEM within broader threat intelligence practices. Ultimately, this paper provides resilience professionals with a structured approach to leveraging TEM for robust cyber defence, offering practical insights on reducing exposure risks and strengthening overall business resiliency. This article is also included in The Business & Management Collection which can be accessed at https://hstalks.com/business/.
Keywords: threat exposure monitoring (TEM); open-source intelligence (OSINT); cyber resilience; threat intelligence; proactive threat management; cyber risk mitigation; incident prevention; ransomware defence
Active shooters: The underutilisation of emergency operations centres — the need for a checklist to guide response and recovery
Mikel Alford, MHS Emergency Manager, City of Temecula, Office of Emergency Management and Rachel Hollinger, Disaster Preparedness Coordinator, City of Murrieta, Fire Department

The emergency operations centre (EOC) is a critical emergency response and recovery component that provides information management and resource allocation. EOCs are often used during all hazards; however, after reviewing over 25 after-action reports for active shooter incidents, they are frequently underutilised. Not activating or delaying activation can slow recovery efforts and lead to chaos for the first responders and the public due to a lack of situational awareness. Historical active shooter incidents, such as the San Bernardino attack, Uvalde school shooting and Aurora theatre shooting, highlight both the challenges and successes of EOC activations. Positive examples, including the Los Angeles International Airport (LAX) shooting and Pulse Nightclub attack, demonstrate how timely EOC activation improved resource coordination, victim services and public communications. A specialised active assailant checklist for EOC operations has remained largely absent even though the incidents pose a complex threat. The City of Murrieta and the City of Temecula worked to fill that void. They developed an ‘Active Shooter EOC Checklist’, informed by lessons learned from previous mass shootings and resources such as the ‘United on Guns’ protocol. The checklist guides the agencies through emergency operations, ensuring public communication, victim assistance, volunteer and donation management, recovery and other critical functions are not missed. This paper describes how EOC utilisation can streamline response operations, reduce fatalities and support community recovery efforts. This article is also included in The Business & Management Collection which can be accessed at https://hstalks.com/business/.
Keywords: active shooter; EOCs; check list; underutilisation; training
Case Studies
Bolstering emergency power resilience for hospitals during power outages: How the Los Angeles County Emergency Medical Services Agency initiative offers a blueprint for other jurisdictions
Eric Cote, Principal, Disaster Safety Strategies, Terry Crammer, Chief, Disaster Response and Coordination, and Christopher Sandoval, Disaster Program Manager, Los Angeles County Emergency Medical Services Agency

This paper describes an initiative launched by the Los Angeles County (LAC) Emergency Medical Services (EMS) Agency to bolster emergency power resilience for hospitals operating in LAC. The multiyear initiative, launched in 2019 and concluded in October 2023, culminated in the publication of the ‘Healthcare Facility Emergency Power Resilience Playbook’,1 a heralded resource that introduces innovative protocols to address significant vulnerabilities uncovered during the initiative. These vulnerabilities included seriously outdated generators, facilities with no redundant emergency power and facilities with limited onsite generator fuel storage capacity. New protocols developed to address these gaps include accelerated emergency power threat reporting by hospitals and a first-ever, confidential risk rating of hospital emergency power systems by a government agency. This move is intended to help the LAC EMS Agency maintain closer vigilance of higher-risk facilities during an outage. The new protocols far exceed the federal government’s emergency power requirements for hospitals. This paper also outlines the additional steps jurisdictions could consider to build on the LAC EMS Agency’s groundbreaking work to achieve even higher levels of emergency power resilience. This article is also included in The Business & Management Collection which can be accessed at https://hstalks.com/business/.
Keywords: power outage; power outage planning; hospital generator failure; emergency power resilience; patient safety; emergency evacuation; CMS Emergency Preparedness Rule
The incident command system and recovery: Establishing the recovery section in the ICS to promote sustained recovery operations
John J. Burke, Fire Chief – EMD, Sandwich Fire Department, et al.

This paper explores the importance of adopting a broader perspective and applying lessons learned from response and recovery efforts to establish a more adaptive incident command system (ICS) approach to recovery and resilience. The National Incident Management Systems (NIMS) has been used since its introduction in 2004 to a consistent nationwide framework and approach to enable government at all levels (federal, state, tribal, local), the private sector and non-governmental organisations (NGOs) to work together to prepare for, prevent, respond to, recover from and mitigate the effects of incidents regardless of their cause, size, location or complexity.1 NIMS provides a consistent framework for responders to handle incidents of any size or significance including those that require large command structures to ensure appropriate objectives and resources are applied to the incident within a common framework.2 While NIMS and the National Defense Response Framework (NDRF) provide specific objectives for response, less attention has been given to establishing a recovery section within ICS to enable small, medium and large communities to facilitate recovery in a structured fashion. Much of the incident command system is used for response operations. This paper examines the history of ICS and the emergence of recovery and resiliency and their intersection to offer communities with a practical recovery platform and playbook. This article is also included in The Business & Management Collection which can be accessed at https://hstalks.com/business/.
Keywords: demobilisation; incident command system; emergency management; recovery; Recovery Section Chief
Research Paper
Stress on the line: The role of organisational communication in responder well-being
Ronda Nowak, Senior Associate, Michael Baker International

Emergency management is an inherently stressful field. Repeated exposure to the stress of emergency incidents increases the vulnerability of responders to post-traumatic stress disorder (PTSD) symptoms. Research has suggested, however, that internal organisational communication can also play a significant role in that vulnerability. This paper examines these findings through a case study of internal communication in a fire department and its effect on the stress levels of its members. This article is also included in The Business & Management Collection which can be accessed at https://hstalks.com/business/.
Keywords: organisational communication; workplace stress; emergency response

Volume 18 Number 3

Editorial
Lyndon Bird, Editor
Research Paper
Ice-hotel or Wonderland? Reimagining the United States’ National Incident Management System
Lisa Wier, Doctoral Student and Graduate Assistant and Tony McAleavy, Assistant Professor, Oklahoma State University

Disasters and catastrophes are increasing in frequency, severity and complexity, meaning that effective multi-organisational response has never been more pertinent. The United States’ National Incident Management System (NIMS), which includes the on-scene Incident Command System (ICS) component, is mandated for use at all levels of government and is often framed, somewhat narrowly, as a mechanistic hierarchy or an organic network. The related literature is divergent: academic critiques are lamented for lacking real-world insights whereas practitioner accounts are, unfairly, dismissed as anecdotal, meaning that novel insights that inform future preparedness are needed. Accordingly, this conceptual study reimagines NIMS/ICS using pragmatism, metaphorical analysis — informed by Morgan’s seminal organisational metaphors, Pinto’s ‘Icehotel’, and McCabe’s ‘Wonderland’ metaphors — and symbolic logic. This paper demonstrates that NIMS/ICS is both mechanistic and organic, and much more at the same time. They engender much-needed novel and innovative perspectives which can be embedded within training and education activities to address the increasingly complex nature of disasters and catastrophes.
Keywords: National Incident Management System; Incident Command System; disaster and catastrophe; complexity; organisations; metaphor
Practice Papers
Expanding the paradigm of evaluating community benefits in investments in grid resilience utilising a balanced scorecard approach
Jeff Schlegelmilch, Research Scholar and Director, National Center for Disaster Preparedness at the Columbia Climate School, et al.

The electric grid is increasingly a major component in the impact of and recovery from disasters. Ultimately, investments in grid resilience help to sustain the ability of a community to withstand and recover after a disaster by mitigating the effects of widespread power outages and hardening critical infrastructure to better withstand and recover from disasters. This notion of ‘resilience’, however, has generally been more theoretical and aspirational rather than something that can be quantified and ultimately integrated into systems evaluation and decision-making paradigms. This paper describes how on resilience profile and balanced scorecard approaches, an evidence-informed approach towards quantifying resilience across various domains utilising a modified balanced scorecard methodology is presented.
Keywords: grid resilience; disaster resilience; investment; equity; quantifying resilience
Unscripted resilience: Improv as a training tool for business continuity and emergency management leaders
Jaeson A. Weber, Portfolio Executive and Senior Business Resilience and Continuity Consultant and Abrielle Grasty, Senior Business Resilience and Continuity Consultant, Asfalis Advisors

Effective leadership training is crucial for fostering organisational resilience and ensuring community safety in the dynamic fields of emergency management and business continuity. Traditional training methods often fail to develop the adaptability and quick thinking necessary for crises. This paper explores the innovative use of improvisational (improv) techniques as a potent training tool for developing critical leadership skills. Improv exercises enhance adaptability, quick decision making and clear communication, preparing leaders to handle crises confidently and swiftly. Furthermore, the paper highlights how improv fosters team building by encouraging collaboration, trust and mutual support among team members. By leveraging improv, organisations can better equip their leaders with the skills to manage realworld emergencies, maintain resilient operations and strengthen team cohesion. The paper also connects improv training to established leadership theories, underscoring its critical role in emergency and emergency management.
Keywords: improvisational training; emergency management; business continuity; leadership development; adaptability; decision making; communication skills; team building; organisational resilience
Case Studies
Enhancing healthcare emergency management training through virtual reality simulation
Suzy Fitzgerald, Learning Advisory Board, Lumeto, Virginia Riggall, Quality and Safety Consultant, TPMG Risk Management and Patient Safety and Jennifer Quevedo, Emergency

This paper examines the challenges associated with training healthcare systems to respond effectively to rare, high-risk and complex disaster events. It explores the potential application of virtual reality (VR) simulation in healthcare emergency management training, describes a pilot education programme implemented by a large healthcare organisation for mass casualty incident (MCI) triage training using VR simulation, outlines steps to implement VR simulation into the healthcare emergency management training curriculum, and discusses possible future directions for further development and research in this area.
Keywords: virtual reality (VR); emergency management; disaster management; simulation training; healthcare emergency management training; mass casualty incident (MCI) triage training
Evacuate or shelter-in-place? Applying a risk-informed decision support tool for long-term care facilities threatened by wildfire
Brent Hobbs, Executive Director, Patient Access, Transport, Emergency Response, Interior Health, et al.

The summer of 2023 was Canada’s most destructive wildfire season in recorded history. The southern region of the province of British Columbia (BC) is prone to wildfires and flooding, placing infrastructure, communities and human lives at risk. Residents of long-term care (LTC) facilities are especially vulnerable to these events. Healthcare leaders face the challenge of deciding when and under what circumstances to evacuate an LTC facility. This requires careful evaluation of the dangers posed by the event and the risks associated with the sudden displacement of frail residents. This risk assessment leads to two decision points: is it safer for residents to shelter-in-place or to evacuate to an alternative care facility? Given the increasing frequency and severity of climate-related disasters and their impact on the health and well-being of LTC residents, health emergency incident managers identified the need to develop a standardised approach for evacuation decision making. This paper analyses how the Interior Health (IH) Authority collaborated with Health Emergency Management BC (HEMBC) to develop an Evacuation Risk Decision-Support Tool. This tool informed LTC facility evacuations during the 2023 McDougall Creek wildfire in West Kelowna, BC.
Keywords: evacuation; risk; wildfire; health outcomes; shelter-in-place; healthcare; long-term care

Volume 18 Number 2

Editorial
Lyndon Bird, Editor
Practice Papers
The role of artificial intelligence in disaster recovery
Linda S. Hanwacker, President, CEO and Founder, The LSH Group

In an era marked by the increasing frequency of major natural and manmade disasters, the imperative for effective disaster recovery planning and response has never been more pronounced. As communities grapple with the aftermath of hurricanes, earthquakes, wildfires, pandemics and other crises and emergencies, the integration of innovation technologies has emerged as a beacon of hope for more resilient and efficient recovery efforts. Standing at the forefront of this technological revolution is artificial intelligence (AI) — a transformative force with the potential to revolutionise every facet of disaster recovery. While the benefits are substantial, challenges in AI implementation are evident. These challenges underscore the need for continuous research and development efforts to unlock the full spectrum of AI’s potential benefits. The journey toward harnessing AI in disaster recovery is dynamic, requiring ongoing innovation to overcome existing limitations. Navigating the evolving systems of AI in disaster recovery planning, the amalgamation of benefits, challenges and ongoing evolution underscores the pivotal role that AI plays in shaping the future of resilient disaster response. This paper identifies where AI can play the most significant positive role for disaster recovery.
Keywords: disaster recovery; disaster recovery management; disaster recovery planning; disaster recovery strategies; disaster recovery scenarios; artificial intelligence; technology; online tools; surveillance; AI risk
The barriers to establishing animal disaster response policies in communities and the effects of not having response networks in place
Cheryl Rogers, National Coordinator, Canadian Disaster Animal Response Team and Theresa Laviolette, Writer and Editor

As climate change exacerbates disasters around the world every year, millions more animals are negatively affected. There is increasing awareness of the importance of the human–animal bond to people’s emotional well-being, along with studies on the traumatic effects on those who lose their animals, both companion animals and livestock, because of disasters. Despite this, however, changes in disaster management to include animal disaster response plans are not being reflected in many communities, and barriers to establishing these protocols remain. This paper addresses the ongoing trauma that can result from losing animals during disasters, outlines barriers that prevent widespread adoption of animal disaster response plans, and offers some suggestions and solutions.
Keywords: animals and disasters and emergencies; human–animal bond; disaster stress; barriers to animal disaster planning
Case Studies
A song of water and fire: Key lessons from Hurricane Fiona and Nova Scotia wildfires
Emad Aziz, Manager of Business Continuity, Province of Nova Scotia

The Province of Nova Scotia has a broad range of responsibilities during provincial emergencies. Hurricane Fiona had significant impacts on citizens and government services for a considerable time due to widespread telecommunication and power outages. The spring wildfires caused widespread destruction, presented coordination and logistical problems, and resulted in mental health impacts for affected communities and responders. This paper describes the challenges faced by provincial emergency management and business continuity response teams: 1) mental health matters — the next evolution in business continuity requires building confidence in people executing the plan under stressful and uncertain conditions for extended periods; 2) senior leadership support is vital to balance business continuity priorities with ongoing operational business demands; and 3) the best plans are as effective as the relationships that make them work. The importance and value of individual and team relationships during planning, preparedness and response, therefore, cannot be underestimated.
Keywords: hurricane; wildfires; business continuity; emergency management; telecommunications failure; incident command system; mental health
Rapid disposition, emergency department flow and best practices in hospital mass casualty incident response
Laura Harwood Jackson, Senior Manager, Office of Emergency Management, Stanford Health Care and M. Meredith Masters, Clinical Assistant Professor, Department of Emergency Medicine, Stanford University School of Medicine

This paper examines the challenges associated with training healthcare systems to respond effectively to rare, high-risk and complex disaster events. It explores the potential application of virtual reality (VR) simulation in healthcare emergency management training, describes a pilot education programme implemented by a large healthcare organisation for mass casualty incident (MCI) triage training using VR simulation, outlines steps to implement VR simulation into the healthcare emergency management training curriculum, and discusses possible future directions for further development and research in this
Keywords: mass casualty incident (MCI); rapid disposition; healthcare emergency management; disaster medicine
Manitoba’s provincial diagnostic and surgical recovery task force: Structure, processes and outcomes
David Matear, Formerly Provincial Executive Director, Diagnostic and Surgical Recovery Task Force, Government of Manitoba

This paper describes how the Government of Manitoba employed a task force to support the recovery of diagnostic and surgical services from the impact of COVID-19 from December 2021 to December 2023. The paper describes how the system evolved during this period to optimise the efficiency and effectiveness of recovery efforts. The paper supports a more comprehensive implementation of the incident command system (ICS) to manage recovery effectively, with specific reference to the recovery of diagnostic and surgical services. The implementation of ICS and robust structure and processes led to the elimination of 83 per cent of the pandemic backlog and achievement of wait time targets for 26 per cent of services lines in ‘expanded scope’, with 83 per cent of service lines trending positively towards the target. ICS structured task forces may be an important tool in addressing specific challenges within a healthcare system.
Keywords: emergency preparedness; recovery management; healthcare; hospital; incident command system; healthcare task force
Research Paper
Knowledge production as an enabler to effective organisational resilience
Mike Blyth, Chief Executive Officer, Sigma7 University, et al.

Organisational resilience depends on knowledge-driven standards and practices that enable risk owners to identify, evaluate, manage and react to complex, dynamic and interconnected threats. It is knowledge that determines the level of sophistication and effectiveness of an organisation’s resilience strategy. This knowledge rests with those whose role is focused on security, who support security as an ancillary function, or who lead in specific technical risk areas. The establishment of consistent, credible, accredited and recognised knowledge production allows individuals and their employers to establish a competency framework that shapes the development and exercising of focused and relevant knowledge, and that critically allows the effectiveness of knowledge application to be measured. The process of knowledge production can be opportunistic or structured, enabling either transformative or incremental change. Learning can bring together professionals from markedly different career start-points to enable the process of career convergence where strengths, weaknesses and gaps in capacity are identified and addressed to create an effective and rounded security professional. This paper explores the concept of the security professional, how knowledge is created, the value of training, the importance of credible knowledge resources, how change can be affected, and the need for a formally recognised competency framework to shape professional development pathways within the security community.
Keywords: knowledge; education; resilience; crisis; training; exercising; professional; security; practitioner; competency framework; knowledge; risk

Volume 18 Number 1

Editorial
Lyndon Bird, Editor
Practice Papers
An apolitical risk assessment of the 2024 US elections: The threat of widespread riots and significant business disruption
Mike Blyth, Chief Executive Officer, Sigma7, et al.

Civil disorder has always plagued humanity, with violence being triggered by real or perceived grievances, rumours and speculation, and internal or external agitators. The risk to people, communities, businesses and the rule of law is not isolated to a particular country or society. The propensity for violence and how it is incited is, however, an evolving threat with the advent of the ‘modern riot’. The causes of violence centre on economic and social injustice, sports- and event-related riots, a reaction to police or security forces and political unrest. As the US nears the contentious 2024 elections, the failing trust in the three branches of government combined with external global tensions and conflict, threats from domestic extremist groups, a rising acceptance of violence as a means of settling political disagreements, hostile nation actors and international terror groups that exploit societal instability create fertile conditions for widespread violence. Exacerbating these factors are the risks from artificial intelligence (AI) deepfake, rapid mass communications, the citizen journalist, prominent influencers amplifying grievances and inflammatory media reporting. This convergence of exacerbators and accelerants for political discord offers the potential for serious security risks and significant business disruption.
Keywords: 2024 elections; deepfake; AI; riots; civil disorder; flashpoints; social unrest
Building capability and community through cyber-incident response exercises
Matthew Ricks, Senior Director, IT Facilities Infrastructure & Resilience, Stanford University

While a natural disaster or related threat may impact an organisation at some point, it is more likely (even inevitable) that it will be the victim of a cyber attack. The solution to being better prepared for these imminent attacks is to undertake more lightweight and frequent incident response (IR) exercises to help build capabilities and community through a tighter, recurring cycle of planning, conducting and assessing. To boost the facilitation of IR exercises, organisations must leverage the established relationships between business continuity management (BCM) or resilience staff (both of which are familiar with business continuity and disaster recovery exercises), and their information security office. As BCM will ultimately be involved in response and recovery after a cyber attack, it is intuitively more effective to collaborate with BCM in advance. Indeed, it has been substantiated that BCM engagement improves incident response time and reduces incident response costs. This paper concludes that involving BCM or resilience departments in IR exercises contributes to more effective responses to actual incidents.
Keywords: cyber security; information security; business continuity management; resilience; incident response; exercises
Redefining cyber resilience: Through the risk register lens
Ria Thomas, Senior Vice President and Head of Cyber Organizational Resilience, Truist

Resilience is deeper than maintaining a company’s operations and services in the face of significant disruptions. It is the ability of a business to withstand, pivot and continue to grow in the face of a significant threat. To achieve resilience, companies must have an integrated, end-to-end understanding of how a specific threat magnifies the risks identified on their risk register, and what measures are needed across the enterprise to address the amplification of those risks. This paper details how the need for a holistic approach is especially important for cyber crises, compared with other types of crises, because they tend to have more broad-ranging impacts and complexities, such as: unclear timelines, lack of public empathy, unpredictable human threat actor(s), as well as a broader set of internal and external stakeholders that need to be engaged. Unlike other crises, cyber crises have the potential to magnify most — if not all — of the risks on the risk register. As such, cyber resilience requires ensuring that key stakeholders, whether shareholders, customers, regulators, business partners, employees, etc, stay resolute in their faith in a company and its leadership’s ability to navigate the increasingly complex issues related to cyber risks and how these issues are addressed enterprise-wide, not purely seen through the lens of technical or operational resilience. To achieve cyber resilience, organisations must develop and implement programmes that integrate both the technical and the broader business measures needed to limit fallout, demonstrate leadership through cyber crises, and deepen trust regardless of the potential severity of the impact.
Keywords: enterprise resilience; cyber resilience; risk register; operational resilience; financial risks; incident response; cyber crisis; preparedness
Case Studies
Electronic health record downtime responses: One health system’s process for ongoing readiness
Julie Bulson, Director Business Assurance and Sean Brower, Operational Readiness Specialist, Corewell Health

Since the implementation of the HITECH Act 2009, the integration of the electronic health record (EHR) with other technology platforms has increased the complexity and necessity of technology downtimes, and the continuity of patient care has become increasingly dependent on an intact EHR. To maintain business continuity and safe patient care during planned or unplanned EHR downtime, it is imperative that organisations have solid downtime and disaster recovery plans. Successful downtime planning will include documenting, with annual reviews, the process for patient care during downtime, as well as an exercise programme that touches all aspects of the downtime process. This paper discusses the experience of a healthcare system based in the US Midwest, which has chosen to exercise part of that process on a quarterly basis, prior to scheduled EHR upgrades. Over the past year of exercises, this healthcare system has collected various data elements in order to identify the education needed and the fine-tuning of the exercise design required to ensure staff competency and patient safety during EHR downtime. The paper describes the process, outcome and the steps the organisation is taking to improve the outcomes of future EHR downtimes.
Keywords: healthcare; patient; electronic record; electronic health record; EHR; disaster; downtime; informatics; drill; exercise
Water, water, everywhere and not a drop to drink: Responding to water disruptions in two coastal healthcare facilities
Kelsey Alexander, Health Emergency Management Specialist, Maddy Laberge, Manager and Norman Kotze, Health Emergency Management Specialist, Health Emergency Management British Columbia

Having a consistent and readily available clean water supply is essential, not only for convenience but also to safeguard public health. While disruptions to the supply of clean water can impact communities of all kinds, some infrastructures and healthcare facilities are more vulnerable than others, such as those located in remote areas or within First Nations communities. This paper presents a case study of water disruption events within Sechelt and the First Nations community of Bella Bella, describing also the associated response efforts and lessons learned. Both events shared similar response activities, requiring the curtailing of normal water usage, the establishment of emergency operations centres, the sourcing of resources via supply chain or transportation partners, implementation of infection prevention and public health considerations, and collaboration with internal and external agencies. The learnings highlight a need for greater focus on building resiliency within healthcare facilities, especially those that serve remote or First Nations communities. The study also presents recommendations for water disruption response planning at the site and community level, and the establishment of non-centralised backup water systems.
Keywords: water security; healthcare facilities; emergency preparedness; public health; resource allocation; community collaboration
Research Paper
Continuity of an essential service during the COVID-19 pandemic: A systematic review and meta-analysis of vaccine perceptions and hesitancy in the emergency medical services profession
Randy D. Kearns, Associate Professor of Healthcare Management and Disaster Management, University of New Orleans, Ginny R. Kaplan, Assistant Professor of Health Care Administration and Advanced Paramedicine, Methodist University and Michael W. Hubble, Assistant Professor, Wake Technical Community College

During and subsequent to a natural disaster, there is an expectation that certain elements of society will continue to operate with a degree of normalcy. For example, it is expected that emergency medical services will continue to function and remain reliable for the community served. Expectations such as these are based on the presumed reliability of government and the assumption that those responsible for the relevant infrastructure will have made plans to ensure it remains functional and taken steps to mitigate known weaknesses. The COVID-19 pandemic provides a case in point. Specifically, data captured during the pandemic are now the subject of ongoing review and analysis, and the findings from such studies are being used to inform planning and preparedness for the next public health disaster. This particular study was conducted in response to circumstantial evidence indicating that frontline workers in the healthcare profession may share some of the same ambivalence towards transmission mitigation as seen in the general population when confronted with new and emerging communicable diseases. This is a concern, as when medical personnel are either unable or unwilling to take reasonable steps to protect themselves and their patients, it undermines the readiness of the essential service. To explore this situation in greater depth, the study examines the real-time responses from a sample of frontline personnel interviewed during the pandemic. The results indicate that there are a number of opportunities to improve workforce readiness to assure reliable continuity during the next outbreak, epidemic or pandemic.
Keywords: COVID-19; emergency medical service; mental health; vaccination; vaccine hesitancy; disaster planning; EMS; vaccine; vaccinations; COVID19; SARS-CoV2