By Jody Moore, PSQH
Hurricanes, floods, fires, and other natural and manmade incidents can strike anytime, anywhere. Faced with such disasters, hospitals must not only respond to the emergency but also maintain continuity of patient care under the most trying circumstances imaginable.
What can your hospital do to be better prepared when the next crisis hits? How can you minimize the physical, psychological, and emotional stresses that can overwhelm staff and patients? What strategies, resources, and practices can you deploy when a natural disaster cripples the technological systems needed for essential functions?
Several hospital leaders with firsthand experience in crisis management shared insights on how to address communication issues—a core element of emergency preparedness—in a discussion I moderated at the annual Voalte User Experience conference (VUE18 ). The panelists included:
- Scott McCarty, unified communications manager at Tampa General Hospital, who is a member of its Emergency Preparedness/Disaster Planning committee and helped the hospital prepare for Hurricane Irma in 2017
- Roberta Romeo Shannon, project manager of strategic projects and clinical systems at UConn Health in suburban Hartford, which recently opened a new hospital tower that gave staff the experience of evacuating inpatients similar to what would happen during an emergency
- Keith Turner, manager of clinical enterprise systems at Texas Children’s Hospital in Houston, who was on-site in 2017 when the Category 4 storm Hurricane Harvey made multiple landfalls and caused massive flooding and $125 billion in damage statewide
The following are 10 practical tips from this discussion that can help hospitals be better prepared to communicate during a crisis:
1. Understand and comply with CMS regulations on crisis communication preparation
Hospitals, along with multiple other provider types, must comply with CMS’ Emergency Preparedness rule to participate in the Medicare or Medicaid program. Developing and executing a communication plan is one of the rule’s four core elements, and the plan should include:
- Compliance with federal and state laws
- A comprehensive method to contact staff, including patients’ physicians and other necessary persons
- Well-coordinated communication within the facility, across healthcare providers, and with state and local public health departments and emergency management agencies
2. Establish one available and secure endpoint to simplify emergency communication
When developing an emergency plan, it’s important to consider all the hospital’s systems and endpoints that people use and how those systems are integrated. Also keep in mind that nurses and staff could be working anywhere in the hospital and may not have access to their desk phones.
According to McCarty, “We’re getting away from pagers by using an SMTP setup that gives us a bridge to funnel communications to our Voalte smartphone platform endpoint. This means that one operator can then quickly send an emergency code without logging in to multiple systems.”
3. Prepare to be home alone
Flooding, power outages, and impassable roads can cut off connections to the outside world. When Hurricane Irma was bearing down in 2017 on the island where Tampa General is located, the hospital faced the possibility of being physically isolated from the rest of the city.
Since it couldn’t rely on the internet, Tampa built redundancies into its core on-premise Wi-Fi network, including data recovery servers. It has backup generators on the island and diesel fuel for four days, with more available if needed. Core switches are located on higher floors in case of flooding. These redundancies ensure that Tampa can continue running its Voalte communication platform if it is ever cut off from the mainland.
4. Use mobile technologies to track and connect patients
Federal regulations  require that hospitals’ emergency preparedness programs include systems to track the location of on-duty staff and sheltered patients in the hospital’s care during an emergency. Hospitals must be able to quickly reunite families with their loved ones, which can be especially challenging on sprawling campuses with millions of square feet of space.
One solution is to use apps that enable physicians, nurses, and staff to take pictures using a smartphone linked to a secure communication platform. These pictures can be stored temporarily on hospital servers and prevented from being uploaded or sent to anyone without access to the platform.
5. Be flexible and redundant, and don’t forget low-tech and old-tech alternatives
The urgency and frequency of alarms, messages, and other patient communications don’t abate just because a network shuts down. Hospitals need backup communication solutions to ensure the continuity of patient services.
“If there’s a system outage, we’ll employ different communications, such as a ticker on our intranet page,” said Turner. “We also keep a directory of phone numbers that can be used for ‘phone tree’ communications and can still pull out walkie talkies if needed.”
At Tampa General, McCarty became interested in ham radio as a result of Irma. The hospital now has a ham radio in its command center with an antenna on its roof as well as three iridium satellite phones—two at the hospital and the other at a large outpatient facility that has a freestanding ED and a helipad.
6. Build muscle memory with training drills
When a crisis happens, chaos and confusion supplant the natural order of everyday routines. To ensure that hospital staff are prepared to function in these high-stress situations, CMS requires facilities to demonstrate completion of two emergency exercises per rolling 12-month interval.  Regulations also currently require hospitals to update their training and testing methods at least once a year.
The panelists emphasized that routinely conducting these drills several times a year builds much-needed “muscle memory” that enables the staff to react reflexively in high-stress situations. At Tampa General, each unit has its own downtime plan and downtime boxes that are routinely updated.
Four more tips
- Ensure IT and communication leaders are included on disaster planning committees
- Align communication policies with current technologies, clinician and patient needs, and various disaster scenarios, including active shooter events
- Keep an extra supply of smartphones on hand and strategically place them in certain units for use only in an emergency
- Don’t put all your eggs in one basket; always have a plan B, C, and D
Ultimately, crisis communication is all about meeting the needs of staff, patients, and their caregivers. As Shannon pointed out, “Our priority during any emergency is to support and connect the people who are doing the most important work. We may find ourselves swirling around trying to get everything right, but our focus should always be helping all those who are caring for patients.”
Jody Moore is co-founder and principal partner of Crisis Focus, an emergency management consulting company for healthcare providers.