The real first responders: citizens?

As planning for terrorism becomes a part of daily life in the Western World, a growing number of disaster experts are calling for a dramatic reassessment in the way the nation plans for emergencies.

The problem, they argue, is that the current top-down approach views the public as a problem to be managed rather than an asset to be utilized. Officials don't take into account people's natural willingness to help or address their most basic needs - like concern about the safety of their spouses and kids.

This upstart group of sociologists, physicians, and terrorism experts contends that the use of ordinary citizens during a large-scale emergency could save hundreds if not thousands of lives. And they are determined to ensure the public is properly prepared before the next catastrophic event.

"It's critical that we readjust our thinking. If you look at the 9/11 commission report they talked about first responders versus what they called 'civilians,' as if all of the civilians did was just stand at the sidelines," says Kathleen Tierney, the director of the Natural Hazards Center at the University of Colorado in Boulder. "That is so radically at variance with what actually happened that day."

For instance, right after the first plane crashed into the World Trade Center, Diane Lapson, who lives nearby, ran to the local police precinct for help and was told by the lone officer manning it: "We can't help you, do what you have to do."

"That was a stunning experience, that moment was frozen for me," she says. "I thought, 'These are the people who are supposed to help us. So what do we do now?' We had to figure it out."

She spent the rest of the day helping evacuate the schools and move people uptown. For the next 10 days, she and others worked nonstop to ensure her 3,000 neighbors had food, water, and medicine, none of which was prepared for by emergency authorities in advance.

Again in London last week, citizens played the critical first roles because it took rescue workers as long as half an hour to reach victims like Paul Mitchell, whose leg was badly damaged. In the interim, he told the BBC, the passenger sitting across from him made a makeshift tourniquet and probably saved his life.

A year ago in Madrid, the first official help arrived 10 to 20 minutes after the explosions. In the meantime, as reported by Spanish-language newspapers, other passengers worked to get people out of the wrecked rail cars, tended their wounds, and urged calm in the chaos. Such incidents have prompted a growing number of disaster experts to call for a new disaster paradigm, one based on a grass-roots, public-first approach.

While police, fire, and rescue workers need equipment and training, this groupof experts contends that it would be equally, if not more, important to organize local communities, schools, and businesses. They believe the public should be trained in what to do in an emergency response but, more important, that emergency managers base those plans on what people say they will need, and how they will react in the case of, say, a dirty bomb, or a smallpox attack.

"Extreme events, like an act of terrorism that creates mass casualties, requires communitywide readiness, not just a set of elite health and safety professionals," says Monica Schoch-Spana, a senior fellow at the University of Pittsburgh Center for Biosecurity in Baltimore. "Plans that local and state governments have put in place ... have been crafted strictly by professionals and members of government. It hasn't been an open process, so the practical feasibility of these plans hasn't been put to the test of public critique."

A major study done by the Center for the Advancement of Collaborative Strategies in Health at the New York Academy of Medicine found what many experts call an alarming disconnect between those official plans and the needs of the public. Researchers did an extensive review of the current plans to deal with a dirtybomb explosion and a smallpox attack at an airport. Then they did in-depth interviews with citizens at 14 different locations around the country, and a national telephone survey to find out how people would actually react.

In the case of a smallpox outbreak, they found the official plans expect everyone to go to a vaccination site. But the study found that only 40 percent of the public would actually go. The reasons are twofold: 40 percent of the people surveyed said they basically didn't trust their government in such a case, and 60 percent were concerned about impact of the vaccine. That's twice as many as were worried about catching the virus.

The official plans have another vulnerability. Currently, medical experts estimate that 50 million people are at risk of developing life-threatening complications if they get the smallpox vaccine. In the case of an outbreak, the official plans expect even those people to go to public vaccination sites which could unnecessarily put them at risk.

And in the case of a dirty bomb, the study found only 60 percent would "shelter in place" for as long as officials tell them to, primarily because they'd be worried about their families. On the upside, the study found that if people knew that their workplaces were organized and safe, and their children's schools were safe and prepared, and that they could communicate with family members, they'd be much more likely to follow official instructions.

"Because we haven't looked at these issues from the perspective of the public, we're missing some very important information in developing strategies that would work best for them and also would be much more effective in terms of protecting people," says Roz Lasker, the study's principal researcher. "There's been no planning that starts with asking, 'What would make you feel safe?' "

That's why researchers contend it's crucial to involve whole communities in disaster planning from the start.

"If we really truly want to prepare for a disaster, we need to do it on a local level, where local means down to the level of the workplace and the level of schools," says Lee Clarke, a disaster planning expert at Rutgers University In New Jersey. "Too many of the usual ways of looking at disaster planning looks at command and control, as if we're all children and we need the generals to organize us otherwise the world will fall apart."