Homeland Security Watch

News and analysis of critical issues in homeland security

April 9, 2014

House Foreign Affairs Committee hearing on “Is al-Qaeda Winning? Grading the Administration’s Counterterrorism Policy”

Filed under: Congress and HLS,Risk Assessment,Terrorist Threats & Attacks — by Arnold Bogis on April 9, 2014

Yesterday, the House Foreign Affairs Subcommittee on Subcommittee on Terrorism, Nonproliferation, and Trade held a hearing on “Is al-Qaeda Winning?”

I’m going to say no.  No, they are not.

It seemed more an opportunity to critique the Administration on the concept of a “pivot toward Asia” and keeping us (too?) engaged in the Middle East rather than a honest attempt at assessing this difficult question.

However, the participants are well qualified to address this issue:

Panel I

The Honorable Joseph Lieberman
(Former United States Senator)
[full text of statement]
[truth in testimony form]

The Honorable Jane Harman
Director, President, and Chief Executive Officer
The Woodrow Wilson International Center for Scholars
(Former Member of Congress)
[full text of statement]
[truth in testimony form]

Panel II

Seth Jones, Ph.D.
Associate Director
International Security and Defense Policy Center
RAND Corporation
[full text of statement]
[truth in testimony form]

Frederick W. Kagan, Ph.D.
Christopher DeMuth Chair and Director
Critical Threats Project
American Enterprise Institute for Public Policy Research
[full text of statement]
[truth in testimony form]

Mr. Benjamin Wittes
Senior Fellow
Governance Studies
The Brookings Institution
[full text of statement]
[truth in testimony form]

One would think this would be a well attended hearing, but notice the empty seats around the 2:00 minute mark in this video (unfortunately I couldn’t find a video of the entire hearing that I could post):

For the full hearing, go here.

 

April 8, 2014

How the quest for short-term efficiency creates vulnerabilities in public health and medical service; and what to do about it.

Filed under: Public Health & Medical Care — by Christopher Bellavita on April 8, 2014

Today’s post was written by Jeff Kaliner.  Kaliner works in health security and preparedness at a state health department. He holds a Master of Arts degree in Security Studies from the Naval Postgraduate School as well as a Master of Science degree in Education from Northern Illinois University.

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The other day I checked the American Society of Health-System Pharmacists (ASHP) website for current drug shortages. The ASHP uses the following criteria to determine if a drug qualifies under the “new shortage” heading:

“A drug product shortage is defined as a supply issue that affects how the pharmacy prepares or dispenses a drug product or influences patient care when prescribers must use an alternative agent.”

The ASHP also states that:

“Shortages can adversely affect drug therapy, compromise or delay medical procedures, and result in medication errors.”

I must admit I was a little surprised to find approximately 250 Current Drug Shortage Bulletins listed on the site.  Is this an average day’s shortage?  I don’t know, and to be fair, some drugs are listed more than once because different predetermined measurements of the same drug may have their own bulletin. For example, Sodium Chloride 0.45% and Sodium Chloride 0.9% are both listed. It’s actually my interest in Sodium Chloride (normal saline solution) that brought me to the ASHP website in the first place.

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A few months back some of our healthcare partners started to inform us that they were at low levels for 0.45 1000cc bags of saline. These types of shortages are not necessarily unusual and can normally be resolved through internal sharing protocols within larger healthcare systems. We had heard that the shortage was nationwide and was due to increased demand on the three major manufacturers (Baxter, Braun and Hospira). This reason is also the one indicated on the ASHP website.

However, this instance was anything but normal; the situation was becoming critical. For instance, a few of our health care partners stated that patient diversion due to lack of the needed supplies was possible. Another facility activated alternative treatment guidelines, consolidated saline supply and verified necessity prior to patient distribution.

After a little probing, we began hearing that some of the larger saline vendors had contracts with hospitals that prohibited them from purchasing product from a different vendor. In other words, the hospitals were restricted from purchasing saline outside of their initial vendor agreements. Even if the hospitals could contract with other vendors, we were also hearing that the vendors themselves were running low. And, it turns out that there are vendor restrictions on adding new clients when products are under allocation.

We also learned that larger systems will sometimes purchase directly from the manufacturer. Of course buying in volume reduces the amount paid but these types of contracts may also prohibit the larger facility from selling product to partner systems to discourage possible profit making.

Regardless, the option for some systems to purchase product at different points in supply chain influences overall supply availability and may leave smaller hospitals and systems at a disadvantage.

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Another problem with these overly efficient supply chain models is that the practice of just-in-time ordering does not allow for a large enough buffer if there is a legitimate emergency. In an effort to decrease costs by reducing the number of storage points in the network, just in time ordering leaves a facility vulnerable in case of a catastrophic hit to the regular supply chain.

For example, in the case of an earthquake that takes out road access to a healthcare facility, a just in time policy may exacerbate an already challenging situation. A policy that relies on receiving product when it is needed instead of keeping large quantities readily available is at greater risk in an event where the supply chain is compromised.

Additionally, hospitals are often times unable to store these types of products in-house due to limited space.  Actual “storage wars” between hospital departments are not uncommon. Even if a hospital does have available storage areas, product rotation can also become an issue. Depending on when saline is manufactured, it will probably need to be rotated every six months to a year to keep  the supply fresh. Thus, the critical dependency on vendors to keep the supply change moving.

Regardless, the usual protocol for a health care facility when they are unable to receive product from their vendor or their own internal systems is to reach out to other nearby facilities and initiate formal or informal mutual aid agreements. However, due to the nationwide shortage, requests to other facilities for product were being denied. If a facility only carries three days worth of saline, sharing one day’s worth of product with another facility during a shortage would only leave the lending facility more vulnerable. In this type of situation, it’s not worth the risk to a lender to assist a partner agency in need.

Ultimately, after about a week of intense consternation and consideration, our emergency saline situation subsided (at least for the short-term). The few hospitals that were critical were finally able to get the product they needed from their vendors…just in time. In the end, the system work perfectly.

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It was also about this time that it finally hit me.  While state and local public health emergency preparedness programs focus on building public and private capabilities to handle the added systemic stress of an emergency, such as a patient surge during the aforementioned earthquake scenario, many health and medical partners in the private sector are undermining the effort by creating just in time systems that could possibly leave healthcare facilities and their patients more vulnerable during their greatest time of need.

Using the saline example, if a surge in patients created a need to use excess product during an emergency, the just in time system of product delivery would not allow for the most effective patient care. As the situation narrated above outlined, many hospitals are already operating on slim product stockpiles (usually a maximum of three days). If they were unable to receive product for longer periods of time because of an event, patient care would be compromised.

As it occurs to me, the manufacturers, vendors and healthcare facilities share responsibility in this scenario. I have to believe that building in added risk during a crisis is not intentional on the part of our private partners.  However, creating such efficient systems is working at odds with the greater public health. Hospitals that are unwilling to add robustness to their systems by adding extra storage space are basically averse to stockpile necessary product.  Manufacturers and vendors operating on just in time delivery schedules are also seemingly more concerned with the bottom line than the needs of the patient. In all cases, profits win out over patients.

Ted Lewis describes this phenomenon as self-organized criticality (SOC). In his book Bak’s Sandpile (2011), Lewis write:

“I propose a unifying theory that explains how accidents, disasters, and catastrophes are intensified by the way modern society has evolved into a collection of highly connected, optimized, and cost-efficient systems. Everything has been optimized—principally by eliminating surge capacity that allows a given system to deal with any overload it experiences. Add to this optimization of capacity the fact that modern just-in-time systems have squeezed out any tolerance for error, and you have the ingredients of what the Danish physicist Per Bak called self organized criticality. This has brought modern society to the brink, and it is our own fault. Modern systems weren’t designed to be resilient, self-correcting, and secure, but rather to be low-cost, efficient, and optimized for profitability. As a consequence, the critical infrastructures supporting modern civilization have evolved over the centuries into fragile, error-prone systems. We have reaped the benefits of short-term efficiency, but now we are suffering from it. Efficient, optimal, and cost-effective systems are why $#^! happens.” (Pgs. 8-9)

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Although there has been much talk about private/public partnerships within the ESF 8 landscape, I have never heard (at least at the state or local levels) any of these conversations put within the context of self-organized criticality.  Using the SOC lens to view the problem makes it clear to me that when Public Health encourages partners to come together and discuss increasing surge capacity within our health and medical systems, we must include product manufactures and vendors.

Leaving these partners on the sideline of the health and medical system during preparedness and response conversations focused on surge planning will only lead to the creation of more unnecessary fantasy documents. If collaboration is the key, all players in the supply chain must be at the table and all the accompanying issues, including SOC, must be honestly and directly addressed.

However, when one player in a system is trying to maximize economic gain, while the others have more altruistic goals in mind, the possibility for overall systemic collapse would seem to be amplified as public and private agencies work at their opposing missions.  Thus, these types of conversations would ideally need to take place at the highest policy levels. In other words, tackling problems that impact free market behaviors need to be addressed at the federal level so that any resulting policy or regulations can be implemented on a national basis. In this way, entire national health and medical supply chain systems are addressed in any proposed solution.

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What has also become clear is that the Public Health Emergency Preparedness enterprise needs to reevaluate how it trains and educates its practitioners. Encouraging professionals to take the latest Incident Command class will not help problem-solvers at all levels to identify and apply concepts such as SOC to supply chain and other systems related problems. Understanding and using these types of theory based concepts in relation to increasingly wicked problems needs to be at the foundation of the 21st century homeland security practitioner’s tool kit. Otherwise, professionals in the field will not have a fertile soil to ground their practice.

Yet entering into conversations without 21st century knowledge tools is exactly what I see happen on an almost daily basis. Most everyday I witness emergency management and homeland security professionals discuss problems and propose solutions that have no grounding in any type of researched or scientific theory. In this context, meetings dominated by assumption, personal preference and group think can easily become the status quo.

An inability by professionals in the field to understand systems, network and other related theories is no longer acceptable in an enterprise that has now been in existence for over ten years.  Although Public Health Emergency Preparedness may not have its own specific and unique set of concepts to apply to the field, borrowing these types of ideas from other disciplines (including Public Health!) must be encouraged and supported.

To be clear, I am not suggesting that an understanding of concepts like SOC is all it will take to solve difficult issues like the saline supply chain situation. A complex problem like this will need any number of solutions (at all levels) interacting together to achieve the desired outcome for both the short and long term.

However, redesigning a 21st century Public Health Emergency Preparedness training and education curriculum that provides practitioners at all levels these types of cognitive tools is crucial so that players at all points in the system can view problems though a common lens. If we do not make these fundamental changes in how we develop these professionals, the millions of dollars we have endowed into the human resources of this nascent field will certainly provide a more than disappointing return on investment. In a knowledge based economy, critical and independent thinking, intellectual courage and beliefs based on facts and evidence are our stock-in-trade.

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Good intentions, an understanding of the Incident Command system and an ability to mimic “grant jargon” is no longer enough to confront our ever changing and increasingly complex world. It’s now time that Public Health Emergency Preparedness programs provide up to date evidence based and research supported professional development opportunities to its practitioners.

If we don’t move in that direction, the next time you need some basic saline solution, it just might not be there.

 

 

April 7, 2014

Nostalgia – a key component of resilience?

Filed under: General Homeland Security — by Dan OConnor on April 7, 2014

My oldest daughter and I were having a conversation which led to talk about my grandfather.  We were discussing the toughness and ruggedness of him and his era.  Born at the turn of the 20th century “Gramps” was everything I thought a man should be.  He was a boxer, slept in jails during the depression, worked in the Brooklyn Navy yard during World War II and did whatever he needed to do in order to provide.  I have yet to meet the man who I respected as much as my grandfather. He embodied what I thought all men of his age and Americans were: strong, smart, capable, dutiful, and unafraid.

I reminisced about one day sitting on a school bus with a bunch of cub scouts going to a New York Mets game for a father and son night.  My grandfather, then in his mid-70s, and another “grandpa” began to talk.  I listened agape as he described how he played against Babe Ruth and Lou Gehrig during barnstorming games.

In the conversation I realized that this reminiscence, this idea of nostalgia has a powerful effect on expectations, performance and point of view.  In my maturation I recognize what I saw in him was probably not completely accurate, but was my interpretation of him. His characteristics, in my nostalgic point of view, are tantamount to what I need to return to when things and life are not ideal.  His actions in my nostalgic recollections are tantamount to resilience.

Resilience — as has often been mentioned in this blog — has many formulas and definitions.  It’s an overused aphorism in many instances and somewhat nebulous in others.  Resilience is part of a broader definition of panarchy and biodiversity.  Resilience is many things to many people and I think very easy and at the same time very difficult for some to define.

From the metaphorical point of view, I see resilience as the owed narrative of our nostalgic past.  We often speak about the Greatest Generation, the Depression, the Right Stuff, the American way.  All those phrases are versed in nostalgic virtue and have a theme of returning to something.  The return is part of the resilience definition.

In many of my postings over the years I notice I have an “I owe” theme.  I believe in my heritage and to a large extent the nationalist themes of exceptionalism and my time in the Marine Corps.  That said, it’s a bit abstract to shape ones actions on a subjective past.  Marines don’t want to let down marines of the past, those that came before them. It is certainly a bit weird, but then again not.

Our history, our expectations, and our belief system are shaped by a narrative of nostalgia.   To channel Phil Palin for a moment, the word nostalgia is a formation of a Greek compound, consisting of nóstos, meaning “homecoming”, a Homeric word, and álgos, meaning “pain, ache”; the word was coined by a 17th-century medical student.    Nostalgia can also be seen in that aching for home and the past as a purported ideal. That idea, the longing for a return, has a resilience theme in it.   Nostalgia may reflect an ambivalence of sorts, but it is a positive emotion.

Nostalgia, whether captured in history books or propagated in Frank Capra pictures, is part of the American experience. Maybe America has always been nostalgic, whether from our multiple immigrant pasts or simply the fringe of the empire creating a culture that embraced such reminiscence.  We often read and hear today that our online, nearly virtual lives and cultural shifts have eroded the sense of community and togetherness that we once experienced. Maybe more nostalgia at work!

In some psychological circles it is believed that nostalgia is necessary for people to be resilient.  Nostalgia may have a restorative function amongst resilient people and also bolster mental health.  Several studies indicate that it is a key attribute in returning to some type of mental symbiosis.   If the key to resilience in social-ecological systems is diversity, as some researchers present, than perhaps our national resilience and personal resilience would benefit from a diverse and rich nostalgic discovery .

The homeland security aspect of resilience is spoken of regularly and often in this blog.  Perhaps that’s an ingredient that we have overlooked: the narrative, with its distorted warts and all is a decidedly important aspect of building a resilient nation.

I was never unsafe, unprotected, or fearful in the presence or company of my grandfather.  He was easily the toughest, bravest, and most fearless man I have ever met.  He’s been gone now a good while, but his legacy and my remembrance of him lives on by what he would expect of me and how he lived his life.  If that is not nostalgia, than I do not know what it is.

Nostalgia is an important and often overlooked aspect of a personal and national resilience. It is based not in myth but in narrative shaped by two perspectives kluged together.  Maybe it’s time to reinforce who we are and where we come from as a key component of resilience.

April 4, 2014

Friday Free Forum

Filed under: General Homeland Security — by Philip J. Palin on April 4, 2014

From April 3 to April 4, 1974, there were 148 tornadoes confirmed in 13 U.S. states, including thirty F4/F5 tornadoes.

On April 5, 2010 there was an explosion at the Upper Big Branch Mine in Raleigh County, West Virginia. Twenty-nine miners were killed.

On this date in 1968 Martin Luther King was assassinated by James Earl Ray.

What’s on your mind related to homeland security?

April 3, 2014

“Simply a manifestation of the criticality of the system” and the implications if true

Filed under: Catastrophes,Preparedness and Response,Resilience,Strategy — by Philip J. Palin on April 3, 2014

OSO_Photo by Marcus Yam_The Seattle TimesPhoto by Marcus Yam, The Seattle Times

John Schwartz and the New York Times gave us an unusually thoughtful piece of journalism last Saturday: No Easy Way To Restrict Construction In Risky Areas.  Several cases are examined: Oso Landslide, Sandy, Katrina and more.

This is largely an issue of the transfer, avoidance, reduction, or acceptance of risk.  Very closely related are attitudes toward contingency.

The Oso landslide is a specific case where “complexity originates from the tendency of large dynamical systems to organize themselves into a critical state, with avalanches or punctuations of all sizes.” Other dynamical systems include seismic networks, volcanoes, ocean currents and I would include the electrical grid and significant concentrations (populations) of almost anything.

In a seminal 1995 paper Per Bak and Maya Paczuski outline two very different explanations of the same “punctuation” event:

A Historian Describes a Sandslide.

On December 16, 1994, a grain of sand landed at the site with coordinates [14, 17] on the pile. Adding to the grains of sand already accumulated at this site, this addition caused a toppling of that site, spilling over to the neighboring sites. Unfortunately, one of these sites [14, 18] happened to be near an instability so that the toppling caused this site to topple also. This toppling destabilized sites [14, 19] and [15, 18] and eventually led to the collapse of a large part of the pile. “Clearly, the event was contingent on several factors. First, had the initial grain of sand fallen elsewhere, nothing dramatic would have happened. Also, if the configuration at position [14, 19] had been slightly different, the sandslide would have stopped sooner, without devastating consequences. While we can give an accurate and complete account of what actually happened, we are at a loss to explain how these many accidental features could possibly have conspired to produce an event of such magnitude. The event was contingent upon many separate, freak occurrences and could clearly have been prevented. Furthermore, we are baffled by the fact that even though sand had been added to the system for a longtime, only minor events had occurred before the devastating collapse, and we had every right to expect the system to be stable. Clearly, the event was a freak one caused by very unusual and unfortunate circumstances in an otherwise stable system that appeared to be in balance. Precautions should and could be taken to prevent such events in the future.

A Physicist Describes a Sandslide

During a long transient period, the pile evolved to a critical state with avalanches of all sizes. We were able to make a rough identification of the toppling rule and to construct a computer model of the phenomenon. Actually, the particular rule that we use is not very important. In any case, we do not have sufficient information about the details of the system to be able to make long-term predictions. “Nevertheless, our model exhibits some general features of the sandpile. We monitored how many avalanches of each size occurred, after the addition of a single grain to the pile. We made a histogram (Fig. 2), and found that the distribution of events where a total of s sites topple obeys a power law, P(s)- s-T. Thus, if one waits long enough, one is bound to see events that are as large as one has the patience to wait for. We ran our simulations (the tape of evolution) several times. Eliminating the particular grain of sand that caused a particular avalanche only made the system produce large avalanches somewhere else at different times. Changing the rules slightly — for instance, by planting snow screens here and there — does not have any effect on the general pattern.

Avalanches are an unavoidable and intrinsic part of the sandpile dynamics. “Actually, I’m not interested in the specific details of the event which Prof. Historian is so excited about and gives such a vivid account of. What the professor sees as a string of freak events appearing accidentally and mysteriously by an apparent act of God and leading to a catastrophe is simply a manifestation of the criticality of the system. History has prepared the sandpile in a state that is far from equilibrium, and the matrix through which the avalanche propagates is predisposed to accommodate events of large sizes. The complex dynamics which is observed in the ‘historical science,’ where the outcome appears contingent on many different, specific events, represents the dynamics of self-organized critical systems.

Historical narrative is inclined toward an understanding of reality where human intention, rationality and will can assert control.  Bak and Paczuski point toward the possibility of domains beyond our power, though certainly deserving our attention and respect.

April 1, 2014

Sustainable agriculture as a homeland security issue: sometimes the old ideas are the best

Filed under: General Homeland Security — by Christopher Bellavita on April 1, 2014

Resource sustainability insistently encroaches onto the homeland security agenda.

Regardless of the causes — climate change, increasing global demand for a middle class life, depletion of available land and water, ethical norms — the throw-away culture is itself being tossed into the recycling bin.

Not long ago, Pope Francis told reporters

“We’ve become a little accustomed to a throw-away culture, … we do it far too much. With all these young people out of work, the throw-away culture is reaching them too. We must get rid of this throw-away mentality.”

The sustainable agriculture movement is one manifestation of this cultural shift.

Sustainable agriculture weaves these ethical traditions together. It requires rigorous science and reverence for nature. It treats plants, animals, and human beings with care and respect. Sustainable agriculture arises out of concern for the health and wellbeing of individual farmers, farming communities, and the public at large. It replaces the prevailing economic and technological models of “more, bigger, faster, and more efficient” with utmost concern for quality. Above all, it replaces the norms of extraction and exploitation with the norm of sustainability.

 While the language may sound like a neo-new age hash, sustainable agricultural practices are not a new idea.

…if sustainable agriculture is defined as the ability to maintain productivity, one can find hints of attempts at “sustaining” agriculture since its inception some 10,000 to 12,000 years ago. In fact one could contend, as some do, that since we have ably maintained productivity, agriculture as we know it is sustainable. The real question is whether current agricultural practices can be sustained much longer.

Some people look to technology and innovative institutional practices as the keys to achieving a sustainable future.  See, for example, the discussion of The Farmery, on the always informative Resilient Communities website:

The Farmery is designed to be an innovative grocery store where produce is grown and sold under one roof.  The modular design of the structure is created from shipping containers.  These are cheap and easily accessible building materials making nationwide construction a very real possibility.

But we also have a great deal to learn from our grandparents, the people who lived sustainably before it was culturally correct.

The two minute, and now declassified, British video below shows one technique the Swiss practiced, presumably during the food shortages of the 1930s and 1940s.

Among other things, the video illustrates that sometimes the old, simple ideas remain the best.  One wonders how many other antediluvian solutions to 21st century threats are also filed away — like this video — in dusty, all but forgotten storage rooms, patiently waiting to be rediscovered.

 

 

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