Product Description

This important book by one of our leading experts on disaster preparedness offers a compelling narrative about our nation’s inability to properly plan for large-scale disasters and proposes changes that can still be made to assure the safety of its citizens.

Five years after 9/11 and one year after Hurricane Katrina, it is painfully clear that the government’s emergency response capacity is plagued by incompetence and a paralyzing bureaucracy. Irwin Redlener, who founded and directs the National Center for Disaster Preparedness, brings his years of experience with disasters and health care crises, national and international, to an incisive analysis of why our health care system, our infrastructure, and our overall approach to disaster readiness have left the nation vulnerable, virtually unable to respond effectively to catastrophic events. He has had frank, and sometimes shocking, conversations about the failure of systems during and after disasters with a broad spectrum of people—from hospital workers and FEMA officials to Washington policy makers and military leaders. And he also analyzes the role of nongovernmental organizations, such as the American Red Cross in the aftermath of Katrina.

Redlener points out how a government with a track record of over-the-top cronyism and a stunning disregard for accountability has spent billions on “random acts of preparedness,” with very little to show for it—other than an ever-growing bureaucracy. As a doctor, Redlener is especially concerned about America’s increasingly dysfunctional and expensive health care system, incapable of handling a large-scale public health emergency, such as pandemic flu or widespread bioterrorism. And he also looks at the serious problem of a disengaged, uninformed citizenry—one of the most important obstacles to assuring optimal readiness for any major crisis.

Redlener describes five natural and man-made disaster scenarios as a way to imagine what we might face, what our current systems would and would not prepare us for, and what would constitute optimal planning—for government and the public—in each situation. To see what could be learned from others, he points up some of the more effective ways countries in Europe, Asia, and the Middle East have dealt with various disasters. And he concludes with a real prescription: a nine-point proposal for how America can be better prepared as well as an addendum of what citizens themselves can do.

An essential book for our time, Americans at Risk is a devastating and realistic account of where we stand today.

Product Details

• Amazon Sales Rank: #385449 in Books
• Published on: 2006-08-22
• Released on: 2006-08-22
• Number of items: 1
• Binding: Hardcover
• 304 pages

Review
“Preparing for major disasters is one of the most difficult challenges we face. This fresh look at what’s at stake is a must-read for opinion leaders, elected officials, and, especially, for American citizens who want to know what each of us can–and should–do now.”
–Dr. Robert Kadlec, Staff Director, U.S. Senate Subcommittee on Bioterrorism and Public Health Preparedness

“In his compelling book, Dr. Redlener makes a stirring argument about what’s wrong with our approach to preventing and responding to megadisasters. The descriptions of what actually happens in a large-scale catastrophe are eye-opening. The good news is that the book also tells us what can be done–by governments and individuals–to reduce the devastation of future disasters.”
–President William J. Clinton

“If you are skeptical of White House claims, FEMA’s stated plans, Homeland Security’s policy or DOD’s assessments, do what I have done for more than thirty years, find out what Dr. Irwin Redlener thinks. He has been an unbiased, golden source to reporters who want real answers in our troubled times.”
–Fred Francis, Senior Correspondent, NBC News

About the Author
Dr. Irwin Redlener is the director of the National Center for Disaster Preparedness at Columbia University’s Mailman School of Public Health and president of the Children's Health Fund, which he cofounded with singer Paul Simon. He has three children and lives with his wife in New York City.

Excerpt. © Reprinted by permission. All rights reserved.
1

Help on Hold, Lives at Stake

Almost a month to the day following the devastating landfall of Hurricane Katrina, I made my third of many trips to the Gulf region of Mississippi. I was there to meet with members of the Operation Assist medical relief team who had been working nonstop to treat the unending flow of displaced and disoriented people who needed medical care. Operation Assist is the collaboration singer-songwriter Paul Simon and I organized between the Children's Health Fund and Columbia University's Mailman School of Public Health to bring emergency relief to people who had survived the storm. On the way from the Biloxi-Gulfport airport, I asked to be driven by some areas that had been particularly hard-hit. I had been to these neighborhoods before but was anxious to see what progress had been made.

We drove down I-90, heading into D'Iberville, a community of some 7,500 citizens, with a Wal-Mart, a Winn-Dixie supermarket, and a couple of dollar stores. The weather was balmy and slightly overcast. It felt like a normal day in a typical small southern town—until we looked out the window. In some neighborhoods, whole blocks had been flattened. Storefronts had been ripped off the buildings and overhead signs were left dangling from one corner of the store or had been blown away entirely. There were about 1,830 homes in D'Iberville before Katrina came crashing through town. In Katrina's wake some 1,250 homes had sustained wind or water damage. Nearly 400 had been destroyed.

In 2000, the median income for residents of D'Iberville was about $34,000 a year, about 20 percent under the national average of about $42,000. People were more or less middle class and mostly white, with fewer than one in five residents African American or Vietnamese. Many families were living at or below the poverty level; few had substantial investments or savings—in other words, little or no financial safety net was readily available. The storm damage, the disruption of the social networks, and vastly diminished public services were taking a toll on the community.

On my first visit, just days after the storm, I was overwhelmed by the extent of the damage, and perplexed and infuriated by so little evidence of any organized governmental response—or even presence. Now, just four weeks later, it seemed that nothing much had changed.

I saw high in the still standing trees of a destroyed middle-class community what seemed to be some toys and children's shredded clothes. Sifting through the wreckage of what had been a home, a family was looking for something to salvage. A few crews of Central American workers were beginning to reconstruct a roof or a house here and there, but in general, time seemed to have stopped altogether.

In a low-income housing project, children surrounded us and clamored for the bottled water and granola bars we had brought. I asked a mother if FEMA (the Federal Emergency Management Agency) or the Red Cross had been there. She said, "Not here. We have to send somebody out every day to find the closest Red Cross center, where we can get water for the community. It's usually a ten- or fifteen-minute drive from here. And we still don't have electricity or fresh water." When I asked if the children were going to school, she said, "Some days."

This visit and every subsequent one to the Gulf reinforced what we have now learned: the emergency response to the hurricane's damage in the Gulf was woefully, painfully insufficient. And as bad as things were in Mississippi, the situation was even worse in neighboring Louisiana, where, even six months after the storm, the news remained disheartening, an endless stream of unanticipated consequences and unresolved problems. Well beyond the acute emergency phase of the initial response, the services and relief efforts seem to be struggling as much as ever in New Orleans and throughout Louisiana. Information is faulty and incomplete. Issues that should have been thought about long before the disaster struck have become intractable barriers to meeting the needs of people who have been through a hellish combination of natural violence and bureaucratic blunders.

Gregory Kutz, the Government Accountability Office auditor who led an investigation into use of federal funds for relief, testified on February 14, 2006, before the Senate Committee on Homeland Security and Governmental Affairs that funds wasted in the Katrina aftermath will certainly amount to millions of dollars, and "it could be tens or hundreds of millions of dollars." And an audit by the Department of Homeland Security (DHS), led by Inspector General Richard L. Skinner and released on April 14, 2006, reaffirmed the chaotic squandering of taxpayer funds. No example better typifies this waste than the FEMA-administered debit card program that gave evacuees cards with $2,000 balances intended to purchase emergency provisions. The debit cards came with no oversight and no guidelines. As a result, the cards were used to purchase frivolous items unrelated to evacuation needs including adult entertainment, gambling, a $450 tattoo, and a diamond engagement ring for $1,100. Moreover, qualification for the cards required very little verification. Consequently, 900,000 of the 2.5 million cards distributed went to people with fake addresses and duplicate or fake Social Security numbers. A total of $24 million worth of cards were given out, with little hope that the total will ever be accounted for.

The basic challenge was finding housing for the estimated 300,000 families whose homes Katrina wrecked. As I write, the hard-hit neighborhoods of New Orleans remain virtually unchanged since the day after the floodwaters retreated. The 300,000 homes destroyed or made uninhabitable represent at least $67 billion in losses. This devastation surpasses the combined damage from the four largest hurricanes in 2004 (Charley, Francis, Ivan, and Jeanne), which ruined 85,000 homes. There are still blocks and blocks of irreversibly damaged houses, their interior walls covered with black mold, and thousands of metric tons of debris and garbage still filling the streets. So much of the mess remains frozen in time that a thriving new business has emerged: entrepreneurs, like the Gray Line bus tour that charges $35 a head, have been taking gawking tourists to see what Mother Nature has wrought and human beings cannot seem to fix.

At the very time when the federal government has begun to cut off funds supporting displaced families being sheltered in hotels throughout—and beyond—Louisiana, thousands of FEMA-purchased mobile homes languish in fields and empty lots in Florida and Arkansas, undelivered and unused. This fact came out in a CNN interview with a FEMA official in Arkansas. The backdrop was the surreal image of a sea of 11,000 empty, brand new white mobile homes.

The reporter asked, "Why aren't these trailers being used to house evacuees in Louisiana? Why are they still here?" The FEMA official replied, "It's hard to find places to put them in Louisiana where the right hookups—like electricity and water—are available." Later in the interview, the FEMA official, referring to New Orleans, offered, "Mobile homes can't be put in floodplains."

The need for temporary housing is still greatest in the neighborhoods that have been evacuated. Workers are needed to clean up and rebuild New Orleans. And employees are needed to restart the businesses struggling to regain their footing. But for workers to return, their families have to have somewhere to live and to go back to school.

Only 2,700 of the 25,000 perfectly adequate trailers used for temporary housing and purchased for more than $850 million had been installed by mid-February, 2006; nearly half of them were sitting in mud in Hope, Arkansas, waiting to be shipped and put to use. Tax dollars are paying for this travesty of a recovery program in a part of the country that Congress is trying hard to forget. There was at least one major military base in Louisiana that might have been a good medium-term housing solution; ironically, it was closed in 1992 through the Base Realignment and Closure (BRAC) process. England Air Force Base in Alexandria, Louisiana, a few hours north of New Orleans, was temporarily used to house about two hundred evacuees. Although a mixed-use property, surely it could have been considered as a location for trailers or other temporary housing. Yet, through February 2006, the government spent $249 million commissioning four cruise ships to provide more than 8,000 cabins for this purpose. The cost of some $5,100 per month per cabin was six times the going rate to rent a two-bedroom apartment. I am still wondering how this makes sense.

The truth is, we weren't prepared to prevent the flooding of New Orleans because we didn't make sure that the levees at the 17th Street Canal and Industrial Canal and along canals extending south from Lake Pontchartrain would stand up to a greater than category 3 hurricane. While the Bush administration's proposed FY 2004 budget included $297 million for civil works projects in the U.S. Army Corps of Engineers' New Orleans district, Congress approved only $40 million, of which $3 million was slated for New Orleans's East Bank Hurricane Levee Project. But the U.S. Army Corps of Engineers project manager, Al Naomi, reported that $11 million was needed. Congress ultimately approved $5.5 million, but because of the project's reduced budget, work on the levee system was halted for the first time in thirty-seven years. To correct this deficit, we should have mounted an organized emergency response but stunning governmental incompetence and lack of coordination got in the way on many levels. And we are unprepared to recove...

Customer Reviews

Excellent: The Emperor and the Assassin
I can understand why this movie may have been too violent for mainstream American movie theaters. However, those were violent times and this movie is both complex and dazzling. It is certainly not one that you will ever forget. There are similarities to "Curse of the Golden Flower." Both are visually stunning and full of political intrigue.

Good but compromised (3.5*)
Certainly the author is an expert in the field but I thought that the book had three shortcomings. The author, as he admits in the preface, rushed the book out the door, relying on others to do much of the work. Political diatribe displaced accurate facts and sound reasoning in several parts. Finally, the author stumbled at the end, which was perhaps the most important part. Despite these flaws it is an important book which should be read, but with some reservations.

It's a fast read for a variety of reasons. I purchased it just prior to a 2-hour flight and was finished before they collected the coffee cups.

What the author does contribute is a variety of scenarios and the consequences.

Redlener's political orientation is left of Hillary and friends and it shows. My guess is that some of his Columbia associates also sprinkled their venom into the text. Some of the many examples where his bias influences the analysis include flu vaccines and New Orleans.

The author concludes that some profit driven scheme is resulted in the flight of vaccine producers from the US to foreign shores and the concentration of the world's production of flu vaccines into two plants. If there is a scheme it is simply one of survival. Flu vaccine production is a low margin product, rushed to production each year just ahead of the flu season to serve an uncertain demand. If the demand is there (and the author is correct that the public does not take responsibility for basic stuff) they make a little money. However, if there is an allegation of a problem, years after the vaccine was produced, the maker is going to get sued. US courts are the preferred venue where the rules of evidence are lax, joint and several liability is common and the juries are generous. Therefore, only high margin drugs whose primary market is to Americans are manufactured in the US. Attempts at tort reform have of course been blocked by Redlener's friends in government, thanks to the abundant cash contributions of the trial attorneys.

Redlener concludes that New Orleans wrote a disaster plan and then forgot about it. He then goes on to place most of the blame at FEMAs doorstep. What he does not share with the reader is that FEMA paid for and sponsored a full-scale exercise involving local government the year before the hurricane hit and which exercise contemplated exactly the scenario that happened.

The author covers the importance of media cooperation in the efforts to prepare and then a few chapters later dismisses the Bush administration's recommendations that people obtain the materials to shelter in place. He says that the flaw in the process was not with the concept of sheltering in place but rather the fact that it was subject to jokes on late night TV. Guess why? His political friends attacked the concept not because it was ineffective, but because they wanted to attack the administration and the press jumped in on the effort. This was the perfect opportunity for one or more of his political pals to have put the country first and reminded the press of the research done by RAND, which concluded that sheltering in place was both effective and important in a number of scenarios. The author does in other sections refer to some of the other work done by RAND on this area and recommends reading it.

The author's scenario of a terrorist attack using children is excellent. However, it misses the propensity of the most threatening terrorist groups to incresase the scope and sophistication of attacks. Redlener does understand that unlike most conventional wars the purpose of the attacks are not to cause strategic damage but rather to create terror and to show the inability of the government to stop them. It is far easier to create terror than to stop terrorists, but the public sees it as a "fair fight" so if terror continues the terrorists must be stronger.

Redlener complains that people refuse to prepare but makes no mention that his friends need to stop conveying the message that the government can do everything.

His analysis of the consequences of a nuclear attack is abbreviated and while valuable does not include some of the more important risks. The chapter leaves the victims long before the full extent of the effects are discussed. Again this is probably the consequence of a rush to publish prior to the elections.

Redlener spends pages describing a Seattle earthquake using the techniques of a newscast where the impacts are personalized. While this focus provides drama it misses the enormous importance of critical factors like the time of the earthquake. Both the San Francisco and Los Angeles earthquakes of the early 90s occurred outside of normal business hours. While the San Francisco earthquake affected commuters it did not occur while people were working in high-rise buildings, factories, warehouses, schools and retail stores.

Also missing from the book is a serious look at the impotence of government in the face of a widespread disaster. In military terms there are simply not enough boots on the ground. Consider Los Angles where 3.8 million people (plus vast numbers of uncounted illegal aliens) are protected by a thin blue line of less than 10,000 police officers, 90% of whom live outside the city. In the event of a flu pandemic many will be off duty and if the pandemic is national there will not be other community resources to augment the depleted ranks. Citizens are going to need to be responsible for their own protection.

Perhaps the greatest shortfall is the failure to spend a few more days on the last chapter detailing the development of a family disaster plan, preparing and the need to act. Far too much emphasis is given to what government must do and not enough to what people need to do, especially with respect to taking action early. An example of this was the night prior to the Mayors' order to evacuate New Orleans. The bloggers had access to the information that the city employees were fleeing, that it was critical to begin evacuations prior to the Mayor's announcement and that immediate action was required.

To his credit Redlener recognizes that the military is far better prepared to deal with disasters than most government officials. Some of the greatest advantages of the military are that they are mission oriented rather than PR oriented and their culture rewards leadership.

Not a criticism but rather a suggestion for what hopefully will be a revised version is that our entire disaster relief system appears to ignore the fundamental changes which have occured in our capabilities to communicate and react. If there is one element of New Orleans that displays the failure of imagination it is the failure to instantly create an accessable information system/database for affected persons and families. Craigslist, church groups and local papers filled the gap but in a fragmented approach. Here is an example where the government could have asked one group to create and maintain the system overnight.

The author dwells on the problems of refugees without medical records but does not consider the simplicity of a solution - give emergency physicians access to the programs that were paying for the resident's prescriptions and to the major drug store databases. The information is there, instantly accessable but hidden for a lack of imagination.

The failure to use our resources goes far beyond the simple but highly effective database of the missing, lost, family members and folks offering help. The bureaucratic Red Cross wanted to dominate managment of the relief efforts but focused on New Orleans, a tiny fraction of the affected area. In other areas church groups became the focus of relief efforts in many areas. Unlike the Red Cross they operated a peer to peer national organization and were able to identify needed supplies and workers. Operating at no cost to the taxpayer, happy to recieve most any support they were the stars of the recovery.

I was saddened to see the author comment that his daughter probably did not have room in her tiny apartment for the basic emergency kit. Perhaps he would ask himself what would she do if presented with 6 pairs of highly desirable shoes, find a place for them or refuse the gift.

Had Redlener cleansed the manuscript of excess political diatribe, taken the time to more carefully examine the scenarios he developed and finally and most importantly spent a little more time on development and implementation of personal plans and acting on the plans in time of crisis the book would have been a 7 star homerun.

Redlener might pause to measure his attitude and efforts against the Boy Scout philosophy - be prepared, be honorable and do good deeds.

An Urgent Need for Government Preparedness Spelled Out in Foreboding, Realistic Terms
The coming Armageddon is quite realistically covered by author Irwin Redlener, the Director of the National Center for Disaster Preparedness at Columbia University, in a variety of forms in his foreboding tome. In meticulous, sometimes bitingly dramatic detail, he paints five fatalistic scenarios - an avian flu outbreak in New York City; a major earthquake in Seattle; a nuclear attack; a train wreck that causes the release of toxic chemicals; and a terrorist attack that targets elementary schools in Arizona. Within each scenario, we see a chaotic morass of bureaucracy, and Redlener points out real-life examples of such deficient actions that make the aftermath he describes of such disasters feel palpable.

For instance, in mentioning an actual attack on a school in Beslan, Russia, the author brings to light the possibility that terrorists could go after soft targets, specially women and children, since such sacrifices are more typical in Muslim. He also discusses the threat of nuclear detonations. Just as North Korea proved today, terrorists could use newer technology to assemble small nuclear weapons covertly. Moreover, there are liquid explosives and other such low-tech threats that can be used in even more clandestine ways. The variety found in the possible onslaughts is daunting, especially to the reader, and sadly, no one, from Redlener's informed perspective, seems prepared to handle these disasters optimally. Starting with FEMA's lethargic response to Katrina, there is a wellspring of stories about how Homeland Security has mishandled both money and expertise.

In the most prescriptive section of the book, the author describes a nine-point strategy which amounts to validating good common sense and a more disciplined approach to organization by the government. The author is particularly critical of the random nature of American preparations as opposed to the more pivotally positioned and prepared European nations. Redlener begins his recommendations with having the 9/11 Commission reconvene to address preparedness efforts, and including the expansion of the military role in planning for and responding to major disasters. He also discusses the key role played by volunteer organizations in recovering from mega-disasters with little organized support from the government.

Most tangibly, Redlener discusses citizen preparedness and our sometimes surprising history of lapses in this area, even when such efforts were highly publicized during WWII. Despite common belief, little was actually accomplished in this area at the time. The current threat of WMDs is quite different from the A-bombs of yore since they are so focused in devastation, but the need for personal preparedness is still quite evident. While it may come across as prosaic to tell citizens to stay healthy and fit, Redlener knows full well that it comes down to the individual to ensure larger plans can be mobilized. This is a hard read at times but most worthwhile.