The Evolution of Devolution

One of the most important factors that might change during a major emergency is the availability of “command” – which means not only the continued presence of an officially designated leader but also that person’s ability to communicate with resources in the field. Devolution – the term used when a government official or other leader passes his/her “granting” authority to an official at a lower level of government – facilitates the continuity of operations when there is a disruption of communications and/or a disruption of the designated leader’s ability to communicate. Three common-sense prerequisites must be included in a well-crafted devolution plan: the decision process; a communications capability; and the specific details about both. A process for deciding when it is appropriate to implement the devolution decision must be included in the devolution plan not only because of the understandable reluctance of individuals in higher echelons to yield control but also because of the desire, in many if not all situations, of the designated lower-level leaders to assume the command and decision-making authority. An appropriate balance is achieved by clearly stating: (a) the conditions under which the decision to devolve is made; (b) the name(s) of the person(s) who can make that decision; (c) the process that must be followed in making the decision; and (d) the documentation needed for all the preceding. 

An Urgent Need for Two-Way Communications 

When the decision to devolve is made by the appropriate command authority, that decision must be communicated to the resources in the field. This communication can be issued immediately – i.e., at the time the decision is made – or in advance of the time selected to make the decision. Advance communications about such decisions may take the form of protocols or directives that explain the enhanced authority and either grant that authority in the protocol or explain when it may be used. When a resource assumes expanded authority, that person must attempt to communicate his/her assumption of authority back to command. One of the major risks in any devolution plan, of course, is that some individuals might assume Three common-sense prerequisites must be included in a well-crafted devolution plan: the decision process; a communications capability; and the specific details the authority prematurely and put not only themselves but also those around them at considerable risk. In many respects, it is the details that are the most important aspect of the plan. Such specific details as to who has expanded authority under the devolution plan, under what conditions that person is permitted to use the authority granted, and, of the greatest importance, the limits of the expanded authority should be spelled out as fully and as specifically as possible. An almost everyday medical situation provides an easily understood example of how devolution works: Paramedics provide medicine and other treatments under the direction of a physician; many of those medications, of course, are given under written orders provided in advance, but some require a direct conversation with a physician (usually carried out by phone or radio). In the Philadelphia Fire Department’s EMS (Emergency Medical Services) system, however, when communications fails paramedics are empowered to provide additional treatments under their own authority. This is a very simple example of devolution. In a rural or otherwise less accessible system, though, when a major increase in the volume of calls overwhelms the system’s ability to respond to calls, provisions might be included in the devolution plan to allow the paramedics affected to refuse transportation for, and/or to triage out, patients who do not require an emergency room and to direct them to a private physician. Like so many protocols in the EMS field, though, this option probably would require a specific grant of authority from the state – and, possibly, an act of the state legislature. In New York State, an EMT (emergency medical technician) may refuse transportation only after consultation with a physician – but under disaster conditions, of course, a physician is unlikely to be available, in which case the EMT would be faced with an extremely difficult dilemma. In short, devolution plans are a necessary way of ensuring that the critical functions of government continue to serve the population. However, because most if not quite all disasters generate a major increase in the volume of calls for EMS assistance, appropriate systems and rules must be in place if the local resources are to be able to operate independently – but still within the rule of law.


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Joseph Cahill
Joseph Cahill

Joseph Cahill is the director of medicolegal investigations for the Massachusetts Office of the Chief Medical Examiner. He previously served as exercise and training coordinator for the Massachusetts Department of Public Health and as emergency planner in the Westchester County (N.Y.) Office of Emergency Management. He also served for five years as citywide advanced life support (ALS) coordinator for the FDNY – Bureau of EMS. Before that, he was the department’s Division 6 ALS coordinator, covering the South Bronx and Harlem. He also served on the faculty of the Westchester County Community College’s paramedic program and has been a frequent guest lecturer for the U.S. Secret Service, the FDNY EMS Academy, and Montefiore Hospital.



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