Historical perspective

In the past, the U.S. government’s response to disasters involved dozens of federal agencies handling various individual components. Communications planning was rarely addressed explicitly. Instead, often the assumption was that the existing communications infrastructure would be sufficient.

In 1979 President Jimmy Carter created the Federal Emergency Management Agency (FEMA) to coordinate domestic disaster response. Although FEMA represented a consolidation of response efforts, communications planning initially was not directly addressed. Furthermore, disaster management remained largely focused on natural catastrophes, such as hurricanes and earthquakes, or unintentional human-made events, including oil spills and radiation leaks. Following the explosion that leveled the Alfred P. Murrah Federal Building in Oklahoma City on April 19, 1995, it became evident that reliance on call-forwarding of emergency medical service (EMS) dispatches from a police- or fire-based 911 phone system would fail when local phone lines were overwhelmed by numbers of calls that exceeded capacity. The importance of disaster planning and response with local commercial providers of landline and cellular communications services was exemplified by the Oklahoma City response.

With the terrorist attacks of September 11, 2001, the United States experienced unprecedented challenges in domestic disaster management, including a substantial strain on its communications systems. Within minutes of the first plane hitting the World Trade Center, the New York City Police Department established command central in a conference room at Bellevue Hospital’s emergency department and began coordinating with EMS. As the media and public picked up on events, telephone lines became jammed and connections were unreliable. Additionally, the Emergency Operations Center that had been designed to handle large-scale disasters affecting New York City was evacuated and most of its structures were destroyed; it had been located at 7 World Trade Center. Communications within the emergency department grew difficult as misinformation regarding the attacks circulated. Police and administrators were able to correspond through direct conversation, radios, and pagers; however, cell phones and landlines remained unreliable. Amateur radio played a large role in facilitating communications among affected emergency departments and New York City administrative departments. Even days into the response, National Disaster Medical System (NDMS) teams experienced frequent bomb scares and evacuation notices in response to terrorist threats. The issues surrounding false information with regard to the policies on the use of personal protective equipment (PPE) also exemplify a failure in communications.

In the wake of 9/11, many changes have taken place in U.S. disaster management. The Department of Homeland Security was established, bringing FEMA under its auspices. With this reorganization, the conception of disasters has been expanded to focus on intentional terrorist acts, and greater attention has been paid to establishing and protecting emergency communications infrastructure.

At the level of operational communications responses, case studies of other specific historical events have played a major role in learning lessons from actual events. After Hurricane Katrina struck New Orleans in 2005, leading to levee breaks and flooding of the city, emergency communications systems were completely destroyed, including power stations, Internet servers, cell phone towers, and 911 services, leading to loss of command and control of the entire disaster response. Additional problems resulted when military assets were not interoperational with civilian communications assets because of security issues.

The 2007 Virginia Tech Massacre, when a student killed two fellow students in a campus dorm at 7 am , then proceeded to murder 30 others 2 hours later, revealed the need for higher education institutions to communicate information about potential threats quickly and efficiently to everyone who needs to know, as soon as possible. Such communication is mandated by the Clery Act of 1990, as amended on numerous occasions, and includes informing the campus community about a “significant emergency or dangerous situation involving an immediate threat to the health or safety of students or employees occurring on the campus.” ^,

Current practice

The National Incident Management System (NIMS) was approved in 2004 as a means to coordinate first responder disaster management between federal, state, and local levels using a military model of command and control. The amended Homeland Security Act of 2006 mandated the creation of an overarching strategy to address emergency communications shortfalls. The Department of Homeland Security’s Office of Emergency Communications (OEC) developed the National Emergency Communications Plan (NECP) in 2008 to provide a disaster communication framework for the United States. The NECP outlines a strategy to identify agencies’ communication processes, capabilities, and potential obstacles to the deployment of interoperable systems. The plan offers short- and long-term solutions for ensuring interoperability and continuity of communications infrastructure coordination among federal, state, local, and tribal governments. Provision of goals, timeframes, and benchmarks for current and future emergency communications systems is made through the NECP to achieve a baseline level of national standards for interoperable communications.

A declaration of disaster will activate Emergency Support Functions (ESF) where federal agencies provide or support an impacted region. ESF #2 pertains to communications, and the lead and supporting agencies are listed in Table 42-1 . Federal agencies are tasked during a disaster to assist with coordination with telecommunications and information technology industries; protect, restore, and repair communications and informational technology infrastructure; and provide oversight of communications within the federal incident management and response structures.

Best practices in disaster settings involve the NIMS Incident Command System (ICS) structure where communication chains are well defined. ICS encourages the use of common communications plans, interoperable equipment, processes, standards, and system designs. The ICS informational flow framework consists of processes, procedures, and systems to communicate timely, accurate, and accessible information promoting situational awareness for all involved stakeholders. Provision of public information must be coordinated and integrated across jurisdictions and organizations to include affected government agencies, the private sector, and others. ICS meets this objective through the Public Information Officer (PIO), the Joint Information System (JIS) and the Joint Information Center (JIC). The JIC integrates critical incident information and provides crisis communications along with public affairs functions through the JIS to ensure timely, accurate, accessible, and consistent communication.

FEMA has multiple communication components involving early warning and notification to support destroyed communications infrastructure. The Integrated Public Alert and Warning System (IPAWS) provides public safety officials with a widespread method to alert and warn the nation’s community about crises using the Emergency Alert System (EAS), Wireless Emergency Alerts (WEA), the National Oceanic and Atmospheric Administration (NOAA) Weather Radio, and other public alerting systems from a single interface. FEMA has established Mobile Emergency Response Support (MERS) systems to provide support in disaster-affected regions throughout the United States. In this system, the country is divided into 10 regions. Mobile units are located in each region and can provide assistance in the form of telecommunications with satellite, line of sight microwave, and radio (high frequency [HF], ultrahigh frequency [UHF], and very high frequency [VHF]) communications as well as generators in the event of power failure. HF radio is used to communicate with federal, state, and local emergency centers via the FEMA National Radio Network and FEMA Regional Radio Network. VHF and UHF can be used for local radio communications.

The Government Emergency Telecommunications Service (GETS) supports national leadership; federal, state, local, tribal and territorial governments; and other authorized national security and emergency preparedness users. It is intended for use when entire networks of phone lines are so congested as to be near useless, reducing the chances of successful calls being connected. The system is designed in conjunction with the leading providers of public telephone service to label calls being made through the system as higher priority than routine calls, increasing the chances that such calls can be completed.

There are many resources available to reinforce health systems communications. The Centers for Disease Control and Prevention (CDC) has established the Health Alert Networks, which aim to ensure high-speed Internet access for local health officials, increase capacity for secure communications, improve early warning broadcast alert systems, and optimize general organizational capacity of local systems.

In addition to these established systems, Radio Amateur Civil Emergency Services (RACES) provides certified volunteer personnel to perform many tasks related to augmentation of disaster communications. This public service is intended to assist government agencies and health care facilities in times of extraordinary need by providing or supplementing communications during emergencies where public communication infrastructure has sustained damage.

Accessing and reporting emergencies in North America for disaster and nondisaster events involve a complex system with multiple formats for dispatching local emergency response agencies. In most situations, a 911 telephone call is routed through a dispatch center, also known as a public safety answering point (PSAP), before being referred to the responding agency or agencies including fire, police, and EMS. These systems may be able to localize calls from landline or wireless sources and provide a physical address if enhanced 911 services are available. Resources are dispatched to the scene following local protocols as the situation dictates. Computer-aided dispatch (CAD) provides the priority dispatcher with in-service responder status updates to handle calls-for-service as efficiently as feasible via geolocation of nearby units. Field units may be notified of call details over two-way radios on designated emergency frequencies and may receive text messages with dispatch details through pagers or wireless text services like Short Message Service (SMS).

Dispatch centers may also relay emergency information to the surrounding populace via reverse 911 messages. A recorded message or SMS can be sent out simultaneously to all phones in a preprogrammed area. Notifications including evacuation announcements and routes, shelter information, and potential hazards warnings may be pushed to impacted communities. Reverse 911 warnings have been shown to outperform other evacuation warning sources, as indicated by the high influence and successful hit rate. Individuals who received reverse 911 warnings also were significantly more likely to evacuate, as did those who received warnings from more than one source.

Ambulances en route from the scene may contact base stations or hospitals to notify them of potential inbound patients. In most areas, this point-to-point radio communication is based on VHF band (30 to 300 MHz) and UHF band (300 to 3000 MHz) transmissions that are broadcast via radio towers located at specific sites throughout a service region. UHF and VHF systems both vary widely in functionality, capability, and range. Transmission is affected by intentional and unintentional interference, which can lead to loss of relayed information. Catastrophes such as earthquakes and tsunamis can destroy relay towers or repeaters, the mainstay of VHF/UHF communications to increase range of signal. Obstructions, severe weather, natural disasters, power outages, and military attacks can also render them ineffectual. To allow for the efficient transmission of airwaves, radio towers require a degree of unobstructed space; this lack of obstruction makes them difficult to protect. Even though this type of infrastructure presents a vulnerability, strategic duplication of radio towers may serve as a buffer in the event of distress. Not all radio devices possess encryption functions for transmitted messages.

Local and nearby prehospital and hospital assets would be placed in an emergency operating status upon activation of community mass casualty incident (MCI) or disaster protocols. Medical facility plans are initiated from the moment of disaster notification, based on the potential patients that may present. Response plans are based on the Hospital Incident Command System (HICS) with a recall of employees to support a potential surge of victims. Predetermined rosters with demographic information for hospital staff may be utilized to manually phone, or more efficiently, utilize automated SMS paging of required employees during emergency operations. In addition to establishing a hierarchy, HICS is also essential to clarify the means by which information will be relayed. An emergency operations center (EOC) is activated to coordinate hospital command functions and provide communication links within a facility and to outside agencies and institutions. ^,

The Incident Commander (IC) will assign roles to senior staff present. Areas to be addressed should include the following:

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  Media communications

  
  
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  Interfacility communications

  
  
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  Intrafacility and interdepartmental communications

  
  
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  Emergency department medical care

  
  
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  Transfer of stabilized patients out of the emergency department

  
  
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  Communications between the emergency department and the hospital command center

One person is often assigned to supervise and coordinate each of these tasks. In many cases, hospitals already have public relations staff members who handle media communications so that the main focus of practitioners can remain on patient care. Additionally, the local IC must be able to maintain two-way communication with the disaster site. Information that should be prioritized in such communications includes emergency department capacity, hospital capacity, and potential hazards. A robust intrahospital communications system is beneficial to normal hospital operations in the absence of disaster. These systems may be used to facilitate movement of patients in the hospital and assist in coordinating tasks that could increase overall efficiency of operations.

Accurate communications regarding the status of events can serve to minimize confusion. Even though effective communication should be a goal in any workplace, it is crucial in disaster management. All pathways of communication should be designed to function both up and down the chain of command. Nurses, residents, and physicians should be able to discuss trends or concerns regarding patients with their supervisors, who can then relay these details to superiors to avoid loss of valuable information. Within a hospital, there are several means to alert personnel of potential disasters, plan activation, and status updates. Overhead announcements are often possible, but text paging is a simpler and arguably better means of communicating this information. A list of key personnel is distributed to page operators, and in the event of a disaster, a single SMS message can be sent to all parties via a group page. This is an approach that requires advance discussion and preparation but one that can save considerable time and minimize confusion. Text paging may also be an effective means of communication within individual departments.

Interfacility communications may provide relief when a disaster overwhelms a medical facility. E-mail, telephone, and radio communications are excellent means by which hospitals can maintain contact and ensure that patient care is optimally coordinated. For example, if two hospitals are fairly close in location, specific patients may be directed to the site that is best equipped to manage their presenting concerns. In another scenario, if evidence of potential hazards to caretakers becomes apparent at one facility, it is essential that other facilities at risk be notified.

Communication of resource needs, shortfalls, and availabilities can be facilitated among the hospitals in a community through use of web-based communications tools. Representation of medical needs of communities can occur through the use of a county-based Medical Operations Center, which can report medical needs and situations directly to a county EOC.

A novel disaster communications system was created in the wake of the Station nightclub fire incident in Rhode Island, with grant support from the federal government. A mobile self-contained communications box was created with generator power and satellite communications capabilities that could be interfaced into a hospital’s communications system to provide temporary telephone, data, and radio communications. These units were dispersed to all acute care hospitals in the state and tested regularly. However, these units are expensive and require ongoing funding to maintain. These and other systems which are not routinely used and devoted to disaster operations are subject to failure when the sinusoidal disaster funding cycles hit a nadir.

Finally, testing the plan and communication systems with local and interagency exercises at regular intervals ensures competency among users. It is even desirable to incorporate as much of disaster communications systems as possible into routine daily operations.