Communication and team coordination in crisis management
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Communication and Team Coordination in Crisis Management. Larry Gibbs, CIH - Associate Vice Provost Ellyn Segal, Biosafety Manager Stanford University. Overview. Case study review of bioterrorism event at Stanford Planning Approaches to Emergency Preparedness

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Communication and Team Coordination in Crisis Management

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Communication and team coordination in crisis management

Communication and Team Coordination in Crisis Management

Larry Gibbs, CIH - Associate Vice Provost

Ellyn Segal, Biosafety Manager

Stanford University


Overview

Overview

  • Case study review of bioterrorism event at Stanford

  • Planning Approaches to Emergency Preparedness

  • Communication challenges as critical part of crisis and recovery management


Communication and team coordination in crisis management

The four confirmed anthrax letters:


Events at stanford

Events at Stanford

  • Oct. 22: ∼9:00 am, Risk Management employee received sealed letter marked confidential and proceeded to opened at desk. White powder came out onto employee and surrounding area. Employee calls for assistance (additional office employee exposed), police and fire notified. Stanford EH&S responds. (Time 0)

  • Stanford Police go into office of victim, assess incident (two police officers exposed). Victim remains at desk. (10 min)


Communication and team coordination in crisis management

  • Letter within envelope deemed a credible threat by Stanford Police: (death threat, ethnic slur, indication of lethality of powder.) FBI notified, agree with credible threat; agents arrive on scene.

  • Building evacuated (∼150 people)

  • Stanford Police, FBI, PAFD, Stanford EH&S on-site (20 minutes)

  • Decision made to decontaminate personnel (2 staff, 2 police officers) (45 minutes)


Communication and team coordination in crisis management

  • Palo Alto Fire Dept. and Stanford EH&S HazMat set up to remove victims from office. (75 min)

  • Decontamination of personnel proceeds within building, all clothing removed and bagged. (2 hr)

  • Victims seen by SUH Emergency Dept. (4 hr)

  • Building remained closed until evaluation of sample for anthrax finalized (48 hours) and decon. of immediate area completed. (52 hr)

  • Building cleared for occupancy (54 hr)

  • Re-occupied (72 hr)


Problems

PROBLEMS

  • Multiple additional personnel contaminated

    • Victim + three additional people contaminated

  • Length of time to determine how to decon victims

    • Victim remained seated at desk for two hours before being taken for decon inside building

    • Multiple questions as to procedure(s) for decon

    • Lack of privacy for decon

    • Lack of supplies for victims (clothing to supply to victims post decon)


Communication and team coordination in crisis management

  • Communication within Stanford University Hospital Emergency Dept. ineffective

    • Victims initially refused entry into ED by staff

    • Almost 6 hours until medical treatment obtained

  • Authority to test powder from envelope unclear; local county Public Health Laboratory requires sample to be delivered and tested under their auspices, but were not accepting ‘environmental samples’ at that time.

  • FBI takes sample to State Lab for testing. (EH&S retains split sample of material, after anthrax results known, start battery of analysis)


Communication and team coordination in crisis management

Other Issues

  • Main administrative building, including HR, controller, payroll functions

  • People left building without car keys, pocketbooks, airplane tickets, briefcases, etc.

  • How to maintain administrative functions during building vacancy – alternate location for employees to work on campus?

  • Many issues to re-occupancy


Post event

Post-event

  • State lab determined sample not anthrax (48 hrs after sample received), nature of sample unknown

  • Building re-opened three days after incident

    • Office where letter opened cleaned by EH&S HazMat team

    • Ventilation system cleaned by HVAC personnel, air filters changed

    • Re-occupancy issues for personnel

  • Debrief of response teams and interactions

    • Crucial for learning to take place


Stanford incident 2

Stanford Incident #2

  • Oct. 30: same employee manager received and opened letter addressed from labor law firm containing white powder and another written threat intimating this powder was the real anthrax. Employee and immediate environment contaminated.

  • Building evacuated

  • Police, Fire, EH&S respond, building evacuated (all within 15 min)

  • One police officer exposed, remained with victim


Communication and team coordination in crisis management

  • Letter deemed credible threat

  • FBI notified and responded

  • STAT members assembled on site – coordinated and directed response activities

  • Victims removed from scene, decontaminated (under 1 hr), evaluated at SUH ED (immediately seen by physician)

  • EH&S HazMat staff collected evidence from scene, decontaminated equipment and area.

  • Building re-opened within 36 hrs of incident.


Analysis of powder

Analysis of Powder

  • Contents of envelope aliquoted for evaluation

    • FBI: State lab for analysis

    • Stanford University:

      • EH&S Haz Cat

      • Biological culture (Biosafety)

      • Chemical analysis

        • Stanford Chemistry Department


Results

Results

  • Sample negative for B. anthraces, no culture growth on plates at 48 hrs (in house)

  • FBI: neg. for Anthrax, no biological material

  • Chemical analysis: (Chemistry department)

    • Not corrosive (pH)

    • Not volatile (Gas Chromatograph-Mass Spec)

    • Not a protein (Ion-Spray Mass Spec)

    • Low Molecular weight polymer (High Pressure Liquid Chromatography-Mass Spec)

    • Small amounts of agricultural chemicals (I.R.)

      • low-grade pesticide identified


Follow up

Follow up

  • Stanford University Police, together with EH&S HazMat and Biosafety, worked together to create Hazardous Material Flow Chart

  • SUMC Bioterrorism Plan

  • EH&S In-house analysis capability

  • Refinement of Emergency Response at Stanford


Communication and team coordination in crisis management

  • SUMC created Bioterriorism and Emergency Preparedness Task Force

    • has representation from all relevant departments in SUMC, University EH&S and the School of Medicine

    • tasked with coordinating SUMC disaster planning with Federal, State, County and Local directives

    • Web site www.stanfordhospital.com/forPhysiciansOthers/bioterrorism/bioterrorism.html

    • published Bioterriorism and Emergency Preparedness Plan for clinical aspects of bioterrorism

      • Two pronged: clinical pathways (individual patients) and total hospital response


Communication and team coordination in crisis management

  • Increased ability for ‘in house’ testing for biological agents

  • Laboratory set up within EH&S with capability of working with samples

    • Culturing, Gram stains

    • Rapid tests for: Bacillus antracis (anthrax)

      (Tetracore) Yersinia pestis (plague)

      Staphylococcus aureaus (endotoxin B)

      Botulinum (toxin)

      Ricin

      Tularemia


Communication and team coordination in crisis management

SU Biosafety Manager

“Make sure you know what ‘and other duties as assigned’ means in your job description”…


Communications the other emergency

Communications –the “other emergency”

  • Among emergency responders

  • Upward within organization

  • To affected individuals

    • Direct victims

    • Indirect victims

  • To the rest of campus and community


Three emergency levels

Three “Emergency Levels”

  • Disaster (involves entire campus and community)

    • University EOC, all 26 SOCs, all Departments

    • Coordination with local, county, state, federal agencies

  • Major Emergency (Impacts sizable area, life safety or critical functions)

    • EOC Operational Directors

    • “Mini EOC”=Situation Triage and Assessment Team (STAT)

    • Affected SOCs and Departments

    • Possible involvement of local or county agencies

  • Minor Incident (resolved with internal resources, no program disruption, service unit daily activity)


Level 2 emergencies

Level 2 Emergencies

  • Incident with potential for significant impact to portion of the campus or community

  • Has multi-department response needs (public safety, EH&S, Facilities Operations; fire department, etc.)

  • Has internal and external communication needs

  • Does not require activation of EOC

  • Examples:

    • Major hazardous materials incident (toxic gas release with fire department involvement)

    • Electrical outage affecting portions of campus

    • Major Fire in building(s)

    • Public Safety threats

      • Bio-terrorism threat

      • Bomb threat


Communications among emergency responders

Responders

Police

FBI

fire department

EH&S Haz Mat

Biosafety

Sr. Administrators

Issues

Who’s in charge?

Possible crime scene

Who leads response effort?

Life safety/haz mat

Who provides support?

Communications: Among Emergency Responders


Situation triage and assessment team stat

Situation Triage and Assessment Team (STAT)

  • Role is to evaluate, manage and resolve mid-level emergencies

  • Members are heads of:

    • Public Safety

    • EH&S

    • Lands and Buildings

    • Facilities Operations

    • Capital Planning and Mgt.

    • Communications

    • News Service

    • Additional contacts as needed from campus


Communication and team coordination in crisis management

Situation Triage and Assessment Team (STAT)

VP, L&B

Public

Safety

EH&S

Incident

Commander

Facilities

Operations

Communication

Services

CP&M

News

Service

Addtl.

Specialist

Incident Commander may be any one of the heads of the

STAT units, depending upon the nature of the incident.


Situation triage and assessment team stat1

Situation Triage and Assessment Team (STAT)

  • Incident commander of team is dependent upon the nature of the incident (e.g., with a crime scene, Chief of Police is incident commander; haz mat incident – EH&S lead person, etc.)


Stat process

STAT Process

Initial Incident OSU 322-8721

Assessment

Conf call or on-site STAT

Assessment

Situation Deactivation

Management


Methods of initiating communication

Methods of Initiating Communication

  • OSU to STAT

    • Cell phone/pager alpha message with info and direction to team for contact

  • STAT link-up

    • Conference call at pre-determined time

    • Meet at site


Communications the other emergency1

Communications –the “other emergency”

  • Among emergency responders

  • Upward within organization

  • To affected individuals

    • Direct victims

    • Indirect victims

  • To the rest of campus and community


Communication to senior administrators

Communication to Senior Administrators

  • Need to designate who (one individual) will communicate upward in organization on emergency status- (Incident Commander/designee)

  • Need clear messages on status reports

  • Determine whether any institutional “policy” decisions are needed from the top. (e.g., close campus)

  • Provide regular updates on critical matters.


Communications the other emergency2

Communications –the “other emergency”

  • Among emergency responders

  • Upward within organization

  • To affected individuals

    • Direct victims

    • Indirect victims

  • To the rest of campus and community


To affected individuals

To affected individuals

  • Direct victims

    • During incident, rescue and decontamination

    • After immediate emergency

  • Indirect victims (others in affected building)

    • During the incident (what’s going on?)

    • After the incident (maybe I was exposed too?)

    • Building re-occupancy (is it safe?)

    • Psychological impact (fear; blame the victims)


Communications the other emergency3

Communications –the “other emergency”

  • Among emergency responders

  • Upward within organization

  • To affected individuals

    • Direct victims

    • Indirect victims

  • To the rest of campus and community


To the rest of campus and community

To the rest of campus and community

  • “THE MEDIA” !!! (have a plan)

  • Faculty and Staff

  • Students

  • Nearby community

  • Parents of students

  • Governmental and regulatory jurisdictions


To the rest of campus and community1

To the rest of campus and community

  • Use single, central, credible source (Public Information Officer)

  • Ensure accurate information is available, do not speculate

  • All messages go through one source

  • Mechanisms for information dissemination

    • “hot line” phone with recorded message

    • Campus news website

    • E-mail distribution lists


Crisis communication vrs risk communication

Crisis Communication

Warning people is priority

Communication logistics likely to be difficult

Audience often bigger

Outrage management matters less

Risk Communication

Reassuring people

Can plan logistics of communication

Smaller number of stakeholders, usually

Outrage recognition and management critical

Often follows a crisis event, during recovery

Crisis Communication vrs. Risk Communication


Conclusions

Conclusions

  • Bioterrorism threat has created new issues for emergency planning and response– STAT process works well for this type of emergency

  • Demonstrated need for increased self-reliance by institution

  • Refocused hospital ED on haz mat-related issues

  • CBR Terrorism needs to be part of all emergency planning

  • Ensure good communication procedures are in place

  • Significant public relations/communications issues with aspects of “dread” and fear caused by terrorism threat

  • Understand the difference between crisis communication and risk communication and factors involved in each


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