"Preparedness simply isn't about having plans," said lead study author Christopher Nelson, a researcher at RAND Health's Center for Domestic and International Health Security.

"It's not a destination or a fixed point in space, it's a process."

Most communities have plans to deal with large-scale emergencies like flu outbreaks or bioterrorist attacks, but many of those plans are missing key ingredients and nobody knows how prepared the country is, Nelson told United Press International.

Every community plan should outline clear roles, a command structure and mechanisms for monitoring and communicating the status of the emergency for all of the players, Nelson said. "Public health preparation isn't simply about governments, it's also about communities, businesses and non-governmental organizations."

Once the strategy is in place, a well-trained workforce should be at the ready to execute it when disaster strikes.

The next step is an ongoing process of evaluating, testing and updating plans to make sure they are effective and timely.

Without that final step, no one knows how prepared the United States really is for the next Hurricane Katrina or other disaster, Nelson said. "There has been a flood of performance indicators and standards and they don't really line up.

"It's like looking for a needle in a haystack when you don't really know what the needle looks like."

Community plans are not finished until they have also been evaluated for fairness to marginalized groups, as evidenced by post-hurricane New Orleans, he added.

Planners should not let "big-picture preparations obscure the picture of whether certain groups in society get more protection than others."

Communities need to be ready to respond to an array of different health emergencies, not just avian flu or another threat du jour, Jeff Levy, executive director of the Trust for America's Health, told UPI.

"The goal here is to be prepared for all types of emergency," Levy said. "There is a commonality to how we need to address them and we need to be prepared for all kinds."

Communities cannot do the job alone, he said, and recent proposed federal cuts could hurt efforts to prepare.

"These are potential national crises and the federal government needs to be prepared to step in and help localities."

Comprehensive plans also have to take into account problems that most would not even think of. After Hurricane Katrina, almost 85,000 emergency Social Security payments had to be issued because checks could not be mailed to addresses that no longer existed.

In response, the U.S. Treasury and Federal Reserve Banks have launched a campaign urging beneficiaries to enroll in a direct deposit program.

The best way to find out what those difficult-to-foresee problems might be is to test plans through drills and exercises, William Stinson, senior risk control consultant at Travelers Public Sector Services, told UPI.

"A plan that looks pretty on paper will not necessarily meet the needs of the disaster event if it has never been exercised through a realistic and comprehensive drill," Stinson said.

As a New York City firefighter on Sept. 11, 2001, Charles Wells ended up in the emergency department of St. Vincent Hospital Manhattan, the hospital closest to the World Trade Center.

Good planning allowed him to receive swift treatment, despite the surge of patients, Wells said, and now as the hospital's administrative director of emergency medicine, he participates in the hospital's efforts to coordinate planning for new threats with other hospitals and city officials.

"Outside of a terrorist attack with obvious explosions or fire, with bioterrorism, it's very subtle," he told UPI. "The sentries are medical facilities.

"It's a team effort, all the hospitals have to play."

While such planning had been under way for several years before 2001, the pace dramatically increased after the terrorist attacks, and now the hospital is implementing changes based on the experience, he said. "The lessons learned from that day spawned revised procedures, new procedures and dovetailing between departments.

"I don't know if there's ever going to be enough money, because there's always something you can improve upon."

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