BY: THOMAS C. LAWRY
Mr. Lawry is president, Verus, Bellevue,
WA.
On September 11, 2001, St. Vincent's Manhattan,
the trauma center closest to the World Trade Center (WTC), implemented
its disaster plan within minutes of the first plane's crash
into the first tower. In the initial three hours alone, the
hospital received and began treating more than 800 patients.
Along with meeting the medical, social, and spiritual
needs of patients and families, the staff of St. Vincent's Manhattan
and St. Vincent's Catholic Medical Center (SVCMC), of which
St. Vincent's Manhattan is a member, also faced one of the greatest
crisis communication challenges in the history of American health
care. Cell phones became useless shortly after the attack because
the number of calls attempted exceeded the capacity of the infrastructure.
Regular telecommunications in and out of hospitals became unreliable
as thousands of people tried to locate friends and loved ones.
In a disaster of any kind, most traditional types
of communication systems fail to work, or are at least severely
compromised, both during and immediately after the event. However,
the Internet has proven reliable through earthquakes, floods,
tornadoes, and terrorist attacks, even when other communications
systems have failed.
In September people from New York City, and from
around the world, turned to the Internet for information and
help. "Utilization of our website doubled in the 16 days following
the terrorist attack," says Kenneth Ong, MD, MPH, director of
Medical Informatics at SVCMC. "People turned to it for information
and help. It was also a place people turned to in an attempt
to offer assistance."
In the aftermath of September 11, hospitals have
been reexamining and upgrading their disaster plans. An important
goal is to ensure effective and timely communications with victims'
families, the media, staff, and the community at large.
When disaster strikes, the Internet and other
web-based tools, such as intranets and e-mail, can provide a
fast, stable, and efficient means of communicating. Every hospital
should incorporate these tools in a disaster readiness plan.
Here are some of the lessons and ideas gleaned from the experiences
of those who were on the front line during the September 11
disaster.
Creating a Disaster Information "Center"
Any hospital dealing with a disaster — whether major
(such as the WTC attack) or relatively minor (such as a chemical
spill at a manufacturing plant) — should be prepared to provide
the public with timely and useful information about it. A quick
response allays public fears and instills a sense of confidence
in the actions being taken by the hospital and other community
organizations. Experts say a hospital should be able to initiate
outbound communications within one hour from the moment disaster
strikes.
During the WTC disaster, SVCMC used its website
to provide such basic information as locations for donating
blood or money. However, given the experience of last September,
SVCMC's leaders now realize that they must prepare their website
to do more than that. "We are currently developing an online
content management system for disaster communications," says
Ong. "It will include processes and tools that allow nontechnical
staff members to immediately begin using the website to manage
disaster communications."
SVCMC is, for example, developing an online disaster
communication "center" that can be quickly activated on its
website in the event of a disaster. Such a center can be as
simple as a set of predeveloped web pages that can be quickly
linked to the site's home page. The center should be equipped
with easy-to-use content editing tools, so that nontechnical
staff members can use it to quickly post and manage information
on the hospital's website.
A website disaster communication center should
include:
- Periodic updates and status reports on the facility's response
to the event
- General information concerning the number of people and
the types of injuries being treated at the hospital
- Instructions to family members of disaster casualties (concerning,
e.g., how to begin a search for missing persons, how to contact
the hospital)
- Background information on key services and disaster personnel
(e.g., members of the trauma team and key clinicians).
The plan for activating the center should be
documented and tested as part of the organization's disaster
plan. The hospital's public affairs staff should make sure the
local media are aware of the plan so that they can help direct
people to the hospital's website in the event of a disaster.
SVCMC, in addition to creating a disaster communication
center, is exploring the use of "IP telephony" as a backup for
traditional telephone services. IP telephony is a term for technologies
that use the Internet to exchange voice mail, faxes, and other
forms of information normally carried over the dedicated circuit-switched
connections of the public telephone network.
Disseminating Patient Information
In the days following the WTC attack, tens of
thousands of people were desperately trying to locate friends
and loved ones. Hospitals were forced to find a method of communicating
that balanced the public's need for information, on one hand,
with patients' privacy rights and legal liabilities connected
to the Health Insurance Portability and Accountability Act (HIPAA),
on the other.
"We initially looked at using our website as
a means of providing patient information," says Ong. "We were
reluctant to do this because of HIPAA regulations and other
legal considerations. We also realized a coordinated effort
was needed, so that people wouldn't have to go from hospital
to hospital in search of information."
The problem was solved when the Greater New York
Hospital Association led an effort to create an online search
tool that would contain data from all hospitals. A user of this
tool could, simply by typing in a name, discover whether a person
was a patient in any of the participating hospitals. SVCMC became
one of those participating institutions. (Once casualties were
located and identified, this service was discontinued.)
Hospitals involved in regional or statewide disaster
planning should, taking a cue from New York's September 11 experience,
work collaboratively to develop similar online patient inquiry
systems. Of course, such systems must be developed and managed
in keeping with the laws and regulations concerning the release
of patient information. An excellent resource concerning the
release of patient information during a crisis is the recently
revised American Hospital Association publication, Guidelines
for Releasing Information on the Condition of Patients, available
online.
Community Preparedness
A hospital website is an ideal place to put information
that can help area residents learn about potential disasters
and how to prepare for them. Shortly after anthrax was found
to be a public health risk last fall, many health care organizations,
including SVCMC, developed and placed anthrax-related information
on their websites. When people called hospitals asking about
anthrax, they were directed to go online. This practice gave
New Yorkers fast access to important information while reducing
the amount of time hospitals had to spend responding to inquiries
or disseminating information.
Bringing Closure to Disaster Efforts
Once a disaster is past, a hospital can use its
website to help bring closure to all who were affected. It is
an ideal medium for educating the public about the hospital's
response to the crisis, expressing appreciation for all the
people and organizations that responded, and promoting "story
telling" about the various efforts and the results produced.
After the worst of the WTC crisis, SVCMC published
a wonderful tribute
to the heroic efforts of staff, physicians, volunteers, and
others who provided care to victims.
Disasters, which come in many forms, have the
potential to cause significant disruptions to a hospital's operations.
In such a situation, a hospital is sure to become the focus
of extensive news coverage and public scrutiny. The Internet
was originally developed by the federal government and the military
as a fail-safe means of communicating and continuing operations
in the event of a nuclear attack. With proper planning, the
same qualities can be employed in disaster communications at
your hospital.
Online Resources for Disaster Planning
Health care leaders concerned
about disaster-response planning may find the following resources
useful.
- The American Hospital Association (AHA)
has published an article called "A
Crisis Communication Primer for Hospital CEOs," which
succinctly describes key communication planning activities
and the role of hospital leadership.
- The Joint Commission on Accreditation
of Health Care Organizations (JCAHO) has published a special
24-page issue of JCAHO
Perspectives that offers guidance to health care organizations preparing
for possible terrorist attacks involving nuclear, biological,
or chemical weapons.
- In March 2000 the AHA, with support
from the U.S. Office of Emergency Preparedness, sponsored
an Invitational Forum on Hospital Preparedness for Mass Casualties
in Chicago. The forum's final report, "Hospital
Preparedness for Mass Casualties," includes recommendations
concerning community-wide preparedness, staffing, staff training,
staff support, internal and external communications, and public
policy.
- The Association for Professionals in
Infection Control and Epidemiology has published a "Mass
Casualty Disaster Plan Checklist: A Template for Healthcare
Facilities," intended to stimulate discussion by health
care and community leaders of the steps they have taken to
plan for possible disasters.
- Paul V. Richter, risk management coordinator
for support services, South Carolina Hospital Association,
is the author of an article, "Hospital
Disaster Preparedness: Meeting a Requirement or Preparing
for the Worst," that addresses hospital preparedness issues
that go beyond meeting accreditation requirements. The article
includes a disaster-planning checklist.