The airliner-size jet crashed just short of a runway. For a few awful minutes the community didn’t know what it was dealing with. The largest hospital braced for mass casualties that often follow. Authorities quickly learned it was a cargo plane with a crew of two (who died) instead of a passenger jet. Large scale horror was avoided.
Coincidentally, the medical center on the spot and I were set to review their crisis training a few days later. A tabletop exercise would show they were prepared for mass casualty incidents like an airliner accident.
But what does it mean for a hospital to be prepared to deal with a disaster? I surveyed a number of other large hospital clients about how they would deal with mass casualties to get a list of best practices. For those of you who work with large institutions that worry about big-league trouble – and not just hospitals – here are the recommendations of a half-dozen medical centers. They’re intuitive and essential:
Before a disaster
1. Designate your crisis team, spokespeople, their backups and how to contact all at all times.
2. Designate an Emergency Room staff “runner”: one per shift. These medical personnel, often nurses, convey the latest medical information about the tragedy to the hospital command center or crisis team depending on how you’re organized.
3. Participate in the Hospital Incident Command System (HICS) formalized federal management system which prescribes most roles for hospital personnel during a mass casualty event as well as the roles for law enforcement and community first responders as well and how to test performance through drills. Go to http://www.fema.gov/incident-command-system for additional insights into mass casualty response organization and materials.
4. Identify your best administration and physician spokespeople, specify their roles, and media train them. Typically, in fast moving situations the first spokesperson is from communications. Physicians follow as soon as possible.
5. In advance, establish a good working relationship between hospital communications and the ER. Communications personnel should “hang out” in the ER.
6. Establish an incident command center and consider these varied approaches:
- Designate a specific site, stock it with essential communication tools, provide vests with mass casualty job titles, and assign people accordingly.
- Designate a “virtual” command center by specifying personnel, contact information, communication facilities, etc.
- Designate an off-campus site that has access to necessary communications equipment and contact information in case the hospital itself is taken out of action by the mass casualty.
- Equip the command center (or virtual command center) so that traditional and social media can be monitored 24/7.
- Designate command center/crisis team members, their backups, and contact information for all.
6. Regularly update employees’ home emails so that you can rapidly communicate directly with them. All-employee updates will help avoid confusion about the extent of staffing is necessary to manage the casualty. They help avoid staffing imbalances, i.e. too many people at the beginning and not enough a few days later.
7. Drill! Drill! Drill! You cannot practice too much. As an aside, did you know that when airline flight crews participate in annual mandatory crash evacuation training, 80% of it is hands-on and NOT in the classroom?
During a disaster
Command (or however crisis leadership is designated):
8. Declares ASAP that a mass casualty is in progress to set into motion the response set forth in the crisis plan. This is to remove doubt that a serious event is unfolding and to take control.
9. Rapidly organizes an impromptu working group comprised of the facility’s best personnel for the unfolding casualty.
10. Mobilizes spokespeople and uses physicians to speak as soon as possible. Doctors are the most trusted. If the usual physicians are treating victims then deploy media-trained physicians from within administration.
11. Approves all messages. Information must to be clear, correct, and uniform across all audiences.
12. Informs employees first for the sake of trust, coordination, and consistent messaging: notifies stakeholders and media next. The notification time between each notification should be mere minutes but the order is important.
13. Uses social media for speed & frequency. You can convey more information more quickly than via traditional media. Traditional media of course remain in the loop.
14. Gets updates every 1, 4, or 8 hours or at shift change.
15. Debriefs. The crisis team and senior management must know what worked and didn’t. (That’s why drills help.) There WILL be another mass casualty.