This lack of cooperation, collaboration, and communication also led to hospitals being overwhelmed. While some hospitals were overwhelmed from being inundated with a multitude of patients, other nearby hospitals had no patient, or only few patients. There was a haphazard approach in accounting for patient's destination, and the ability of the hospital to treat patients. As an example, St. Luke's Hospital was flooded with 150 patients that were transported by ground ambulance to this hospital in just the first hour and a half. This does not even take into consideration the walk‐ins and the private citizen transports to the hospital. In all, St. Luke's Hospital had 641 patients show up at the emergency room on the day of the incident. It clearly overwhelmed this one hospital.
Communication with all hospitals, and between hospitals, was clearly lacking as well. In one eyewitness account, a television news van rushed several patients to a secondary hospital (not the closest hospital). They arrived an hour after the initial attack, only to find out that the hospital had no idea that an attack had taken place. The treatment of the patients that the news crew transported was delayed. They were initially denied help by a nurse because there was no doctor on duty. The news crew essentially begged for help, and eventually a doctor was brought in to treat those patients (Murakami, 2000, pp. 27–29).
In another eyewitness account, the secretary for the head of the School of Medicine at Shinshu University received a call approximately 30 minutes after the attack. It was a reporter asking if Dr. Nobuo Yanagisawa wanted to make a comment on what might have been used in the attack. Because he was unaware of the attack at this time, he turned on the television to gather more information. Having investigated a similar event of sarin gas that happened almost a year earlier in Matsumoto, Japan (on 27 June 1994), Dr. Yanagisawa was very familiar with the symptoms, and he thought that he knew what the substance, and what antidote should be used.
He immediately called in two doctors to assist him in getting the word out to the hospitals and the EMS providers. They also attempted to communicate with the fire department, so they could spread the word on the suspected type of attack, and the antidote. Unfortunately, contact was never made with the fire department. Initially, the three doctors began faxing the Matsumoto Report to the hospitals nearest to the incident and other nearby hospitals. The report was quite long, so it took a long time to send it by fax. Before the information was sent to all emergency rooms, they began getting requests for the information from hospitals not yet reached. In all, over 100 different hospital accepted patients (Murakami, 2000, pp. 220–223).
Even when this team of doctors led by Dr. Yanagisawa did send the report to the various emergency rooms, the lack of communication within the hospital itself led to delays. A prime example of this was St. Luke's Hospital. Dr. Yanagisawa called the hospital and requested to speak to the doctor in charge of the emergency room. While technically he should have gone through the person in charge of the hospital, he felt that time was of the essence, so he called direct. He had a brief discussion with the person he thought was in charge of the emergency department and told the person he would send the information via fax as soon as possible. He would later find out that several doctors were combing through the library, looking for what the substance might be until 11:00 a.m., and they found out the answer from news coverage of the incident (Murakami, 2000, p. 221).
While most of the other 100 hospitals were available and willing to assist, most received relatively few patients. A lack of communication, collaboration, and coordination, as well as a breakdown of the communication (hardware) system, led to the closest hospital to the incident being overwhelmed. With over 100 hospitals in close proximity, most saw less than 10 patients, while St. Luke's hospital saw over 600 patients.
The lack of preplanning, coordination, cooperation, and a lack of integration of resources led to more human suffering, and it caused the incident to last longer. It also placed emergency personnel at greater risk, and it allowed contamination to be spread citywide. Subsequently, more people (including first responders) needed to be seen as patients. Nurses, doctors, EMS, and many that had contact with any of the initial patients needed treatment, which overwhelmed the medical system for weeks.
Allocation of resources in this incident was disorganized as well. Because agencies had rarely worked together, there was an issue of trust. The culture among these response agencies was been described as isolationist (Pangi, 2002). This led to no information sharing and even more disorganization. Information in this incident only went from pier to pier, rather than going to a higher command, or in all directions so that all personnel were on the same page.
Another key factor that negatively affected the response was governmental bureaucracy. This bureaucracy not only added layers of approvals and direction but also compartmentalized agencies from each other. According to a study by Pangi (2002), this compartmentalization not only caused responding agencies to respond as separate units, it caused them to be in competition with each other. This competition caused information and expertise to not be shared. Rather than helping each other, these agencies made every effort to ensure that their agency knew more than the competing agencies; the same agencies they should have been working with and cooperating with.
As if these issues did not cause enough disorganization, then they added the failure of not using an IMS method to manage the response and recovery. It is easy to see that the Tokyo sarin attack lasted substantially longer than it needed to. Additionally, the chaos, confusion, and uncertainty increased because the responding agencies worked against each other rather than with each other. When one agency would employ a mitigation strategy, another agency might unintentionally do something that made that strategy less effective. Had there been coordination and collaboration, everyone likely would have been on the same page rather than being at odds with each other.
2.4.2 Oklahoma City Bombing
On 19 April 1995, in Oklahoma City, OK, the Alfred P. Murrah Building was bombed by a domestic terrorist. This bombing remained the deadliest terrorist attack on United States soil until the 11 September 2001 attack that was committed by foreign terrorists. The Oklahoma City bombing killed 168 people, including 19 children under the age of six, and physically injured more than 675 other individuals (Shariat, Mallonee, & Stidham 1998).
Beyond the human toll, the explosion destroyed or damaged 325 buildings, including the Murrah Federal Building. The blast was so strong that numerous buildings suffered damage in a 48‐block area and the window glass of 258 nearby buildings was completely shattered. The blast destroyed or burned 86 cars and caused over $650 million in damage (Hewitt, 2003). This was the work of domestic terrorists, later identified as Timothy McVeigh and Terry Nichols (Oklahoma Department of Civil Emergency Management [ODCEM], n.d.). The homemade explosive was contained in seventeen 55‐gallon drums and delivered to the Murrah Federal Building using a rented 24‐ft Ryder delivery truck. The device was designed and positioned to inflict the most damage.
The response to the bombing of the Alfred P. Murrah Federal Building in Oklahoma City involved hundreds of public, nonprofit, and private organizations, as well as untrained spontaneous volunteers. According to the Oklahoma City Memorial Museum, (n.d.), this incident was the first time that the ICS was utilized in a major incident that was not fire‐related. By utilizing the ICS method, there was a fully integrated response of federal, state, local, and tribal governments as well as nongovernmental resources. While there were some issues, overall, the ICS method worked extremely well in organizing and managing all responders.
In looking over the previous actions of Oklahoma City, the city government appeared to be moving in the right direction in preparedness as well. Not only had they created the plans, but they also had been implementing the Cycle of Preparedness. While their preparedness efforts had not considered such a large event, or an event that involved blowing up a federal building, those plans provided a basis and the key elements for any type of disaster response. Because they began undertaking this preparedness process, collaborative networks were already in place, there was already some