Complicating a numbers game: SAR, emergency preparedness, and how we should spend our resources – Logistics for global health and aid: A Humourless Lot - A Humourless Lot

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Complicating a numbers game: SAR, emergency preparedness, and how we should spend our resources

by Michael Keizer on January 20, 2010

Over at his blog Wanderlust, Tris Clements questions whether sending in SAR teams is the wisest way to spend our resources:

If, as is generally shown, SAR teams can only hit the ground after 48 hours, and are only saving a few dozen lives in any given reponse [sic], is this a worthwhile use of funding? Should the media continue to carry such high-profile stories and continue to justify this as the best way forward in an emergency? Had an additional 1,200 medical staff and equipment been flown in to Port-au-Prince instead, how many people could they have treated, how many life-threatening wound infections treated, how many shock-managing IV drips inserted, in the last three or four days? Thousands? Tens of thousands?

These are important and relevant questions. However, I think Tris leaves out an important part of the equation: why do we actually send out these SAR teams?

Part of it can be found in an intriguing comment in response to my blog post on the logistics of emergency response: commenter rob_s suggests to send local people involved in emergency preparedness in developing countries to disasters like Haiti earthquake, so they can learn from and experience firsthand the lessons learned.

This is exactly how many of the developed countries who have sent SAR teams think. It is not only altruism, or even a PR exercise, but also a valuable opportunity for these teams to train and learn, so they are better able to respond when something similar happens in their own countries. In that sense, one should add the lives saved by better preparedness in future disasters to the lives saved now; but it will be obvious that any estimate of how many lives we are talking about is no more than a guess, educated or otherwise.

Tris’ questions are still very relevant, and the answer is still likely to be that the resources spent on foreign SAR teams could be spent better elsewhere; but the arithmetic is a bit more complicated than he makes it out to be.

[Image: Fairfax County Urban Search and Rescue at Montana Hotel in Port-au-Prince, by Chuck Simmins. Some rights reserved.]

{ 21 comments… read them below or add one }

cynan_sez January 21, 2010 at 12:14 am

And when the dust settles, why not also consider within this arithmetic the number of

bums on seats
flight landings at PAP
m3 of equipment airlifted
4WD vehicles commandeered in DR

in the first 72 hours by the global media wagon, rather than by SAR teams and other aid agency technical first responders?

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John Jacobs January 21, 2010 at 1:27 am

If it is your Mother or Sister who is pulled from the rubble on day 5 then the debate is one bordering on the absurd, just as it is if it is your Son who dies in a under equipped clinic days after having been rescued.

Certainly WE can see the advantage in “banking” the lessons and skills taken away from Haiti or Ache. But what of the yet unnamed place in the inevitable event of the next disaster? What will be done to develop the local human resources and infrastructure that is capable of learning these lessons so that THEY can put them to use in these places? When a devastating cyclone slams into Bangladesh and thousands die “stupid” deaths, will WE be proud of these lessons learned if WE are destined to be apply the lessons three days late and a dollar short?

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Valerie Booth January 21, 2010 at 4:58 am

The right answer, the humane answer is YES, SAR, even after 48 hours, is worth the funding. Just ask some of the folks pulled from the rubble in Haiti. Or ask their families and friends.

We support, fund or do SAR because we know saving a life is really the ONLY reason to be there. Just need to get there sooner…

Try this: To the world you may be one person but to one person you may be the world.

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Michael Keizer January 21, 2010 at 8:44 am

@cynan_sez
That is a good point. The press has an important role, but one should question whether the call for aid coordination should not extend to press coordination too. Is it really necessary that each and every channel, station, news paper, has their people on the ground?

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Michael Keizer January 21, 2010 at 8:54 am

@John Jacobs
I could not agree more with you. See also what I write about emergency preparedness in my previous post.

I think we agree that it all is about how we can save as many lives and avoid and relief as much suffering as possible. My point here is that we should look at this in the long term, taking into account lives saved in a next Hurricane Katrina or 1953 North Sea Flood, not only the ones saved now. I agree, though, that this will probably still mean that SAR efforts cost more lives than they save due to the resources they divert from other aid efforts.

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Michael Keizer January 21, 2010 at 9:02 am

@Valerie Booth
I think we all agree that, as you say, “saving a life is really the ONLY reason to be there”; but the corollary is that resources potentially saving thousands of lives, but diverted to an effort saving 90 lives, are resources wasted. The only way “to get there sooner” is by ensuring that vulnerable countries have SAR capacity themselves — or in other words, it comes back again to emergency preparedness. Please note that Tris’ writes specifically about international SAR teams, who will never be there “sooner”; local SAR teams are a whole other kettle of fish, obviously.

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Michael Keizer January 21, 2010 at 4:54 pm

@cynan_sez
More on the issue of press and resources: http://www.slate.com/id/2241947/

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cynan_sez January 21, 2010 at 10:07 pm

Thanks for the link Michael. 75 staff in Haiti for CNN alone? Amazing. I’m plucking numbers here, but even conservatively that might put the US media contingent alone at 250+. Maybe the global media another 150 for a total around 400? Times food and fuel for the lot of them. Sigh.

In practice tho, how are you going to coord the media in these situations? Ultimately only the Haitian government can approve/deny visas for entry, and news orgs would squeal long and loud about any implicit censorship in such an act. Getting news orgs to voluntarily coordinate and share pooled resources, when in a situation like this they’re actually competing fiercely with each other, might put fiesty cluster meetings in a rather different light

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Michael Keizer January 21, 2010 at 10:15 pm

@cynan_sez
Wouldn’t you just love to see them try it and then tell humanitarian responders to coordinate, though? ;)

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rob_s January 21, 2010 at 11:47 pm

A good point made by one agency medical coordinator is that it is more or less the current doctrine these days that external medical assistance is designed to complement the initial local primary response. That is rational for most risk areas, where substantial hospital resources can be expected to survive. Haiti is somewhat different though. There was rather little to start with, so we have what is essentially an improvised, very delayed, external primary response. That raises major questions about contingency planning, which presumably any evaluations will address. More generally, it clearly also raises strategic questions about long-term future responses in big cities in thoroughly broken states (though the number of cities of this type at real risk may in fact be small). There are also important questions to be asked again now about the risk of delayed secondary responses in more isolated cities, for example in mountain areas, where weather and landslides cut primary routes.

One broader issue this whole operation also illustrates, I think, is the compartmentalization of aid responses. Activities in these kinds of large, sudden emergencies proceed in their own compartments regardless of much logic, and with remarkably little potential for any rational transfer of resources between them. Even at the margin it seems exceptionally difficult to vire/switch resources for general preparedness, for operational research, or for better contingency planning. I realise that it is completely unrealistic to think in these terms, but can one imagine any of the military contingents dropping (say) twenty from their total of perhaps sixteen thousand troops in exchange for the field training costs of a Bhutanese epidemiologist or a Bolivian national identity system manager? Nor presumably would ABC stop the deployment of one of their producers in exchange for two or three casualty response simulation analysts. One might hope for more from NGOs, but even when flush with funds, they tend to focus on their new local development and welfare projects. My sense is that early relief responses will only improve when we take much more seriously both the emergency planning role of national governments (or in the case of the more broken states, the bits of them that still work, which is most likely epi/health) and megacity adminstrations, and the operational analysis needed to build a proper evidence base. Yet few donors are willing to confront the challenges this entails for resource reallocation and the very real practical problems of making it work sustainably over long periods on the ground.

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cynan_sez January 23, 2010 at 12:28 am

@michael
ha! ok you sold me.

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Ursula L January 23, 2010 at 4:52 am

I posted a longer bit about this at Wanderlust, but I’ll summarize here.

There is also the need to relieve local S&R teams. Those teams will be suffering as victims of the disaster, as well as being rescuers. Some or much of their equipment will be damaged or destroyed by the disaster. More will be used up by the rescue efforts thus far. And by the time that foreign S&R can start to arrive (48 hours out), they will be physically, mentally and emotionally exhausted. Exhaustion leads to poor judgment, risk-taking, and less efficient work. The need for foreign S&R is not merely to “do the rescuing”, which implies that rescue was not already being done, but to care for the rescuers by giving them a chance to rest and grieve.

There is also the emotional need to continue S&R for as long as there is a chance of finding people alive. Those who are doing other types of relief work need to know that it is happening, to avoid the stress of feeling that they are ignoring trapped people in order to do their work, and to avoid being diverted to S&R.

Foreign S&R is a gap-filler, between the point where local S&R is exhausted and further S&R is futile, and support that allows other types of aide workers to focus on their tasks.

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Michael Keizer January 23, 2010 at 8:32 am

@Ursula L
Thanks, Ursula! I did see your response at Wanderlust, and like Tris I think your point about the emotional need is a very good one. If we would be rational beings, we would of course concentrate on where we could save most lives and relief most suffering; but you rightly point out that we are not rational beings, and that we will need to adapt our strategies accordingly.

Back in the 1980s/1990s, I was a volunteer with the Netherlands Red Cross. One of the things that was hammered into us in our training was that triage in diasaster circumstances followed different rules: you would need to concentrate on those you were likely to save — and would often have to decide to let people die who might be able to survive if you would spend enough time and resources on them, in the process depriving many others from a chance to live. Although I agreed in principle, I was always a bit sceptical about how this would work out in practice: would we really be able to be as callous to stop working on somebody, not because they were impossible to save, but because saving them would just take too much time? I thought it was telling that we were never presented with such a scenario during our exercises (and one of the reasons why I left the Red Cross was disillusionment with how badly we were trained and how many lives would be lost due to inadequate training). Clearly, those who designed the exercises were not as confident either that the right choices would be made.

All this just to say that I agree with you that the situation is much more complex than Tris or I presented it initially, and that it might even be too complex for arithmetic.

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Michael Keizer January 28, 2010 at 9:15 am
Michael Keizer February 3, 2010 at 9:52 pm

@cynan_sez
Actually, it looks like the issue is getting some traction: http://alertnet.org/db/blogs/60725/2010/00/25-164739-1.htm

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Eric K. Noji, M.D. February 19, 2010 at 3:20 am

The questions and comments above have been raised ad nauseum after every major event since the Mexico City earthquake in 1985 (first major international deployment of teams specialized in building collapse SAR). A voluminous amount of research has been conducted on the issue of survivability in building collapse and cost-benefit of deployment of HUSAR. Published in both scientific journals as well as training manuals. Hundreds of major conferences, forums, symposia on these issues since the mid-1980s. Gauging by the less than knowledgeable comments in this forum, what is discouraging to me is how few of the lessons of past major SAR operations have been institutionalized. The challenge is how to translate the results of research to policy makers, funding agencies and to well-meaning medical volunteers.

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Michael Keizer February 19, 2010 at 9:03 am

@Eric K. Noji, M.D.
“Gauging by the less than knowledgeable comments in this forum, what is discouraging to me is how few of the lessons of past major SAR operations have been institutionalized. The challenge is how to translate the results of research to policy makers, funding agencies and to well-meaning medical volunteers.”

One way to start would be by pointing us to relevant literature; and perhaps even by giving a summary of these findings. You would be very welcome to do so in a featured post instead of the comments section if you would prefer so.

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Seanagh O'Meara July 15, 2010 at 4:23 am

Is there relevant literature? I have spent two days trying to find such documentation and have enjoyed limited success thus far. I would love to see some detailed statistics on the costs of deploying and maintaining USAR teams in a variety of situations; lessons learned from past deployments; and findings and recommendations for various stake-holders.

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Michael Keizer July 17, 2010 at 5:28 pm

I asked a similar question, but sadly never received an answer. I have also tried to find some literature myself, but what I have been able to find was all very technology-oriented with not much about the more institutional side.

Is CIDA working on this? If so, I (and many others) would love to hear what you will come up with.

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Tim Ogden March 9, 2010 at 12:43 am

The comment about the usefulness of sending SAR teams for “training” purposes makes me feel even worse about sending SAR teams. That logic, boiled down, is: “The lives of current Haitians (who are not receiving medical attention because of resources devoted to SAR) are less valuable than the lives of potential future first world victims of urban disasters.”

In all aid, but especially in emergencies, it comes down to limited resources: money, time, runway space, fuel, etc.

Let’s hope that we are getting better at the trade-offs between uses of those resources over time, and not just better at either papering over or ineffectually complaining about those trade-offs.

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Michael Keizer March 9, 2010 at 9:27 am

@Tim Ogden
Ì think you misunderstand my argument. If you don’t mind me altering your own words a bit, this would be the correct way of describing it: “The lives of of potential future victims of urban disasters (who would not be rescued by well-trained SAR services because of resources devoted to health efforts in Haiti), not only in the ‘first world’ but just as much in developing countries who could send SAR teams for this sort of real-life experience, are as valuable as the lives of potential current Haitian patients.” I am not saying that this, by itself, would have the scales dip in favour of doing this, just that ignoring this part of the ‘equation’ is short-sighted.

In any case, I think @Ursula L’s argument, about the emotional side-effects, is even more cogent. I still think it does not automatically lead to the conclusion that we should continue with SAR as we do now, but I do think that the case against it, as it is presented now, is often overly simplistic.

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