'Plain talk' is best when dealing with disasters
'Plain talk' is best when dealing with disasters
Communication breakdown can overturn response plan
This past summer, when strong storms knocked out power in the St. Louis area, the incident command group at BJC Healthcare called the local emergency management agency (EMA) to tell them they had lost power at several of their 13 hospitals and were operating on emergency generators. The EMA representative, not having a medical background, thought everything was fine, and it wasn't until a later follow-up call that it became clear help was needed.
"When we called them, they had no idea we meant that if we did not get the power on soon we probably would have to evacuate our ICUs because we lost suction and chillers," explains Debbie Mays, MS, the director of emergency preparedness.
This episode underscores just how far we still have to go in the area of disaster communications. As ED managers may be aware, as of fiscal year 2006, the National Incident Management System (NIMS) has required the use of plain language, rather than 10-codes, for disasters and exercises that involve several agencies, jurisdictions, or disciplines. However, say the experts, this plain language will not be enough to ensure clear communications during a disaster. While everyone now will be using plain language, that doesn't mean they will be using the same language.
Even though you think you are using plain language, communication between EDs and local EMAs can be problematic if you are talking to a non-medical person, notes J. William Jermyn, DO, FACEP, EMS medical director of the Missouri Department of Health and Senior Services in Jefferson City. Jermyn says he has seen problems arise in communication between EDs and local agencies on more than one occasion. "Once, when the local EOC [Emergency Operations Center] had been activated, several ED personnel who were requesting both manpower and equipment did not understand that they were being asked what their current needs were, rather than what they anticipated their needs to be over the next 72 hours," he says. "They were giving projections, vs. what they needed to get through the next six to 12 hours."
Thus, he continues, using plain language is not enough. "You need to clarify the time frame and respond exactly to what it is you are being asked," he advises. "Most of all, when you are making requests during a disaster, don't ask for what you think you may need in a day or two, but what you need right now."
Make requests specific
The manner in which you ask is just as important as what you are asking for, adds Bruce Clements, MPH, director of the Missouri Center for Emergency Response and Terrorism (CERT), also in Jefferson City. "During our recent ice storms, one hospital said they would like a DMAT [Disaster Medical Assistance Team], but when we asked a few additional questions, it turns out what they really needed was additional nursing support."
Your requests must be specific, he continues. "If you say you need doctors, I might send you some podiatrists, when what you really need are emergency physicians or trauma specialists," Clements notes.
A prime consideration for the ED manager talking with a local agency is to know who is on the other end of the line, says Jermyn.
"It very well may not be another health care professional; therefore, using a health care language perspective, as many ED managers may do, may not serve you well," he says. For example, an ASAP request to someone in the ED might mean five minutes or less, "whereas in public health, it might mean anywhere from one to three days," Jermyn says.
If you're talking with a nonmedical person within the EMA, "you may need to repeat yourself and ask them to read back to you what they heard," he says.
Mays agrees. "Once you get to the appropriate EOC, don't speak in clinical terms; use very plain layman's language," she says. "You may be talking to a firefighter, a public health official, or someone else who may have no experience in the hospital," Mays says. So, for example, if you are having a staffing issue, be very plain and specific, she emphasizes. "Say something like, 'We have a 40% no-show, and we can't provide adequate care,'" she advises.
Is there a way to prepare in advance for such potentially difficult communications? It would be very helpful to meet with them ahead of time, suggests Jermyn. "Having met and sat across the table, even if it is just done in a couple of tabletop exercises, could be very helpful in your efforts to improve communications," he says.
Communication during a disaster is especially challenging, Jermyn concedes, because you may be dealing with individuals from a number of different areas. "If I had to condense it all into one point, it would be to sit down and participate in those EM [emergency management] exercises," Jermyn emphasizes. Through those exercises, you develop respect and perspective for what your counterparts need, and vice versa, he says. "You begin to have that dialogue and get to know those people," Jermyn says.This past summer, when strong storms knocked out power in the St. Louis area, the incident command group at BJC Healthcare called the local emergency management agency (EMA) to tell them they had lost power at several of their 13 hospitals and were operating on emergency generators.
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