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The Future for FEMA: An Interview With R. David Paulison

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     R. David Paulison is currently director of the sometimes maligned, often misunderstood Federal Emergency Management Agency (FEMA). Paulison served as the administrator for the U.S. Fire Administration after being appointed by President Bush and confirmed by the U.S. Senate in December 2001. From 2003–2004, he took on the position of director of the Preparedness Division of the Emergency Preparedness and Response Directorate/FEMA in the newly created Department of Homeland Security. During his tenure, he administered a range of programs designed to strengthen state and community emergency preparedness in order to reduce loss of life and property due to disaster; oversaw first responder grant programs totaling more than $1 billion; and managed more than 350 employees. He was also responsible for training emergency managers and first responders, and for conducting a nationwide program of exercises.

     Before joining FEMA, Paulison was chief of the Miami-Dade Fire Rescue Department-a department with 1,900 personnel, a $200 million operating budget and a $70 million capital budget.

     I recently had the privilege of working with Paulison-who is the opening keynote speaker at this year's EMS EXPO-on this month's column and discussing issues relevant to the EMS community.

     Previously, FEMA has been utilized primarily as a mitigation and recovery organization. This past year's events presented a true response role for the organization-perhaps the first in its history. Do you see a retooling to get FEMA's personnel more comfortable in a "response" mode?

     FEMA continues to lead the federal government's role in the recovery and mitigation phases of a presidential-declared disaster, as evidenced by the more than $25 billion poured into the Gulf Coast for temporary housing, debris removal and insurance claims, among other recovery efforts. The Stafford Act tasks FEMA with coordinating the Disaster Relief Fund, so we will continue to support state and local governments with recovery efforts and the National Flood Insurance Program, which is headed by the director of our mitigation division.

     That said, while FEMA has been looked at as a recovery and mitigation organization in years past, I believe Hurricane Katrina showed more of what you can expect from FEMA and the federal government in responding to a major disaster. In a five-year span, America has seen two of the most unprecedented, catastrophic disasters in our history-9/11 and Hurricane Katrina-and the federal government, overall, is stepping up to support state and local responders. While these responders must continue taking the lead in ensuring the safety, evacuation and rescuing of their residents, the federal government-FEMA included-is strengthening partnerships across the board with the Department of Defense, the Department of Homeland Security and other federal agencies to make sure we have the people and resources in place when needed.

     The Urban Search and Rescue (US&R) teams are one of FEMA's most successful endeavors regarding disaster response (as opposed to mitigation and recovery); however, recent mobilizations of these teams are significantly different from what their original intent was. How do you see this asset changing with FEMA? Do you anticipate increased integration with the newest FEMA component, the National Disaster Medical System (NDMS) and its teams?

     We are proud of the US&R program. The task forces have proven their ability to address effective search and rescue operations for victim rescue from collapsed structures for natural events such as tornadoes and hurricanes, and man-made events such as the Oklahoma City bombing and the 9/11 terrorist attacks. After Hurricane Katrina, where more than 6,500 victims were rescued by the task forces, the White House Report directed the US&R teams be broadened from Urban Search & Rescue to an expanded Search & Rescue focus. As such, the US&R Program Office has been working with the U.S. Coast Guard (USCG) and the Department of Interior (DOI) on expanding the scope of operations. FEMA US&R and the DOI will support the USCG in coordinating search and rescue operations in and around water and areas of inundation. USCG and DOI will support FEMA US&R for structural collapse operations, and FEMA US&R and USCG will support DOI in wilderness SAR operations (such as the Space Shuttle Columbia explosion search and recovery). FEMA US&R already works closely with NDMS in coordinating combined victim rescue, hand-off and patient treatment operations, such as was done in Katrina.

     During Hurricane Katrina we saw a mobilization of various EMS assets in an ad hoc, patchwork format. Do you foresee this somewhat effective, but much debated, move being repeated? Is there a better way to mobilize EMS assets during disasters?

     There will certainly be EMS assets that respond to large disasters, especially early in an incident. For example, a city or town will undoubtedly request mutual aid from nearby jurisdictions if their assets are available and not affected by the incident. In addition, hospitals and nursing homes that need to move some or all of their patients might have contracts in place with commercial EMS providers who will respond to those facilities outside of the 9-1-1 dispatch system.

     Since last year, under FEMA's leadership, the federal agencies that have roles in securing additional EMS resources to assist cities and towns during disasters have worked together with the State of Louisiana to develop joint plans for obtaining and mobilizing them. These efforts include not only the operational plans for early and seamless federal and state medical responses, but identifying available ground and air ambulances that can deploy when needed. Under FEMA's overall lead, the Department of Health and Human Services (HHS) is collaborating with its partners to coordinate access to ambulance and other medical transport capabilities before and during disasters.

     As a former paramedic and current FEMA head, please tell EMS providers and EMS agencies what they can expect from FEMA, as well as your thoughts on the various discussions around a lead federal EMS agency.

     FEMA has a prominent role in the recently enacted legislation that establishes the Federal Interagency Committee on EMS. FEMA has always had a historic tie with the EMS community, and in many ways, the organizations are connected at the base level. The critical expertise that EMS brings to FEMA is invaluable, specifically with perspective on preparedness, public safety and emergency planning. What is most important to understand now is that the different federal agencies are working more closely together than at any time in the past to jointly share resources and expertise with the EMS community.

     In recent years, there has been an ongoing debate between the fire suppression side and the EMS side of the fire-based EMS model. Given your background with a dual-service fire department with firefighter/paramedics, what are your thoughts on this issue?

     As the chief of Metro-Dade (now Miami-Dade) FD, as well as the president of the IAFC, I was a big advocate for the dual-trained firefighter/EMS provider. There are many advantages to this model, including flexibility to provide what is needed at any given time by the community, the ability of the department to support and care for its own in the dangerous field of fire suppression, reduced burnout of personnel by rotating them through different assignments, and, in many cases, officers with broader competence as a result of their combined fire service and medical backgrounds. Integration of new functions into traditional services is not easy. It requires close supervision, conveying equal pride in all of the services provided by a department, and sometimes tight discipline. I believe the rewards of a well-operated fire/rescue/EMS service are more than worthwhile for communities and residents.

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