AHRQ free webcast on “Lessons learned…” Nov. 6, 2008

The Agency for Healthcare Research and Quality (AHRQ) is hosting a webcast on “Lessons Learned from the Field of Emergency Preparedness” on November 6.  The webcast is free, taking place from 12-1:30 EST, and registration is required.  Quoting from the announcement (thanks, DIMRC!):

“Presenters will offer diverse perspectives on emergency planning and the use of AHRQ tools in order to enhance surge capacity, medical supply allocation planning and resource inventories reporting systems. Participants will receive key insight on customizing AHRQ tools in order to address the distinct needs of their communities. Emergency preparedness planners as well as federal, state and local community health planners, providers and first-responders are invited to attend.”   Go here to find the registration site.

New “stories told” web page from the Library of Congress

Following is an announcement of a new resource made available by the Library of Congress.  In addition to listening to the stories, check out the links on the left side of the Preservation pages for a wealth of resources for libraries preparing for or responding to disasters.  

 

“For the third anniversary of Hurricane Katrina’s devastating impact to New Orleans and the Gulf Coast, in commemoration and in light of the current hurricane season, the Library of Congress announces a Web site titled “Learning from Katrina,” which provides insights for better responses to record and artifact damage by hurricanes.

On this site, www.loc.gov/preserv/emergprep/katrinarespond.html, visitors can hear seven interviews with professional conservators who helped salvage collections affected in August 2005.In the interviews, responders discuss the lessons learned, their motivations, expectations and preparations, and their experiences. The interviews were conducted in 2006 at the Library of Congress by the Preservation Directorate, in collaboration with the Federal Library and Information Center Committee (FLICC) and the American Folklife Center.”

Reporting forms available

Today we have added a new page to the Toolkit.  It is called “Forms” and you’ll see it in the top menu bar.  So far, the forms included are for reporting emergency incidents and for contributing to the “Library Disaster Stories” page.  As part of the NN/LM Emergency Preparedness & Response plan, the designated regional and/or state coordinators will provide follow-up to any incident within their regions by using the first form on the list, the Incident Reporting Form.  The second form contains questions designed to elicit narratives from network members of experiences during disasters that might help to contribute to our knowledge base of “lessons learned.”  Please let us know if you have any questions or would like to suggest changes to either form based on your experience.

Toolkit Tip #1: Library Disaster Stories

It is good to see (via our statistics page) that visits to this toolkit are increasing weekly, and there are many “clicks” showing on the pages, such as Disaster Plan Templates/Samples and Service Continuity Planning.  Today we are adding a category called “Toolkit Tips,” which we’ll use to highlight new or already existing features of the toolkit.  We hope this will help everyone keep up with the continuing development of the toolkit, as well as uncover some buried treasure!

Tip #1:  Check out the new Google map that links to Library Disaster Stories.  It is located in two places in the toolkit:  in the left column, just past the photos and the Article Archives, and on the Library Disaster Stories page in the top menu bar.  Emily Vardell created the map, linking it to the stories, and worked with Dan to fine-tune its functionality on the toolkit.  Click on the “View Larger Map” link (below the image of the map on this page) to see the entire map, along with a list of the stories and links to them.  The symbols denote what type of disaster or incident is being described; i.e. hurricane, fire, earthquake, terrorism, flooding, tornado, and public health emergency.

We would like to continue adding to our Lessons Learned/Stories Told, so please let us know if you have a story to tell, and especially what you learned from the incident that might help other people prepare.  Contact Dan at danwilson@virginia.edu or Susan at syowell@virginia.edu.

New Jersey Hospital Association

Michelle Brewer, Director of Library and Corporate Information Services for NJHA (New Jersey Hospital Association), talks about the events on September 11, 2001, and her involvement.

Director of Library and Corporate Information Services for NJHA (New Jersey Hospital Association) for more than 28 years

She has been elected president of numerous local, state, regional and national library associations; chaired several Board of Trustees and given over 100 workshops, courses and presentations

Currently she is President of the HALS (Health Association Libraries) of the Medical Library Association (MLA), Chair of the Library Improvement Committee for the Middle Atlantic Region of the National Library of Medicine and Chair and Editor of the Benchmarking and Statistics Survey U.S. Hospital and Health Sciences Libraries for the MLA.

Has written about preparation for terrorist disasters in an Algorithm for Disaster Information Preparedness: Checklist for Medical Librarians, and It wasn’t raining when Noah built the ark: disaster preparedness for hospitals and medical librarians post September 11

Interview date: June 29, 2007

Questions:

(1.) What happened in your community (i.e., what was the disaster/emergency)?

The New Jersey Hospital Association (NJHA) and I have been involved in many disaster response and planning efforts. The events are listed below:

A. September 11th – By far, the majority of my comment relate to this man-made disaster.

B. The anthrax incidents that hit our local post office in Hamilton, New Jersey

C. The Asian Tsunami

D. Hurricane Katrina

E. The one that we just avoided, but that I was poised to assist with was the Pinelands wildfires sweeping the southern part of the state. Thankfully, it rained just as the hospitals were ready to evacuate, and the notice came through the listservs I manage that the evacuation was imminent. A nurse, who was at NJHA the next day, and visited the library, told me that the mulch on the hospital lawn was smoking and we were readying the patients to leave. Then it rained; thank god.

F. Somewhere in there I was a participant in TOPOFF3, a federally mandated emergency exercise (http://www.njha.com/topoff3/). I served as the manager of the listservs and the Web site content. In the disaster scenario, NJ wound up spreading smallpox to several countries and many people died.

(2.) How did the library respond? How did the librarian respond? Were there non-traditional (unusual) roles that the librarian performed?

Some of our roles were traditional, while others were unique. The competencies and skills of the librarian in each instance played key roles.

Non-traditional Roles

A. After 9/11, the NJHA recognized the need for a database to identify the victims. The NJ DOH (Department of Health) was suppose to do it, and in their inability to get it accomplished, our President was able to tell the NJ Commissioner of Health that NJHA could do it for them. I suggested to the executive that we create and post it on the Web site in short order. I wrote up the programming requirements for the database, researched the legal issues, and wrote the disclaimer. The patient victim database was online within a day of getting authorization to do it. We tracked more than a thousand victims through it, and were able to alert family and friends to whether their family member was treated and released or admitted or transferred. I believe the fact that I sat in on all the daily emergency updates, heard the problems, analyzed the needs, and made recommendations to solve the problems was key.

B. I updated the database on a daily basis with the NJ State Epidemiologist, who gave me the excel files. I, in turn, worked with our programmer to get them online each day.

C. I created a new Web area for all of our NJ hospitals as well as the public. It is archived: http://www.njha.com/njresponse/index.aspx

D. For a fund for the victims, I also researched the best way and wording for doing this. An online fund was created and a Web site was set up for donations. The page that is left describes the disposition of the fund: http://www.njha.com/njresponse/ReliefFundDollars.aspx

E. Oddly enough, we in the library found ourselves to be the unofficial hoax busters. In the early days of 9/11 and anthrax, there were so many rumors flying around; people came into the library visibly upset because of the talk or the emails. We researched each rumor and gently corrected or pointed out the hoax to whoever was talking, relating or emailing it.

F. I also found myself in the role of disseminating health or hospital related updates about what was happening with 9/11 to all the libraries in the state via several listservs. I asked the recipients to further distribute the information to their publics. For example, through the listservs, I shared the patient-victim database, the NJHA press releases, the toll free number, the trauma resources, the mental health resources, the blood bank information, the donation fund, etc…

G. We also distributed in the first day or two, when the systems were overloaded, paper copies of the daily updates on the Web to all staff in the building.

H. In the first and second day after 9/11 in particular (and really for the entire two weeks) we answered non-stop phone calls from people looking for family members. We also fielded calls from good Samaritans wanting to help, legislators wanting to help their constituents, etc… None of these interactions were really either reference or research; but, we were there and helped along with the other NJHA staff.

I. I was asked more than once by our PR department to take a reporter’s call to describe the patient victim database for a story they were writing.

J. I also completed several reports for the Governor of New York and the U.S. military about the patient-victim database, which included statistics from the hospitals.

K. For the anthrax issue, I was privy to many confidential communications to emergency personnel via the listservs I manage. Keeping sources confidential, I was able to connect one librarian in my consortia who had told me she had a bizarre patron that concerned her. A physician was sending odd email and using the library computer to check out water reservoirs. Our Emergency Director was able to connect his State Police liaison with her. The library PCs were eventually taken by the police for further investigation.

L. For the Tsunami disaster, I was asked to research charities for our donation of more than 100,000 dollars. Again, I created the Web site and wrote the proper language for it. I got to call and talk to all the potential charities about NJHA and NJ hospitals giving money to them and how it would work and what it would be used for. We eventually gave the large sum of money we collected to Save the Children.

J. I Almost forgot to mention that during Orange Alerts (a terrorist alert level) I would take all the core reference tools into boxes and drive around with them in my car trunk so I would have them handy at home if needed.

K. Also, for Orange Alerts, I would remind and help the Emergency Preparedness and Health Planning departments get back-up files of all their e-mail and listserv contacts and fax numbers etc… so they could work from home if needed.

L. I also participated in preparedness activities by evaluating software and training people to use these technology tools.

M. Countless times, I have had to discuss and cover all the particulars about the Patient Victim database with other state hospital associations and even our internal Emergency Preparedness staff, for their discussion of it with others.

Traditional Roles

A. The research requests were fast, furious and, at times, highly unusual. Some could only be answered via primary research. We were asked to answer questions about such topics as radiation at the World Trade Center site and the possibility of locating people under the rubble by using their cell phones. One hospital called us and asked if any biological agents were used in the attacks. We felt more like investigative reporters at times! Another example from the aftermath of hurricane Katrina was a request to find a hospital for a displaced physician from Louisiana. We started to get a few more questions like this and, eventually, our Association needed to take a broader look at the issue.

B. We were asked to compile all the mental health clinics into a resource handout. We surveyed and quickly got that online for anyone.

C. We kept links for information sources from the government and news sites up to date on the Web site. It became a huge list. See:

http://www.njha.com/ep/exewin.aspx

D. Due to the intense need for information, I worked with the Middle Atlantic Region of the NLM and the state organization, The Health Sciences Library Association of N.J., to put together a seminar. It took place on December 5, 2001 and was very well attended. It was called, Thinking the Unthinkable – Biochemical Terrorism and Disasters: Information Resources for Medical Librarians, and is available online at:

http://www.njha.com/ep/slides.aspx

I also prepared a checklist for medical libraries that I gave permission to be widely reprinted. The checklist is available at:

http://www.njha.com/ep/pdf/bio-NJHAhandout.pdf

E. I wrote an article about disaster preparedness, post 9/11, called, “It Wasn’t Raining When Noah Build the Ark.” It is available at:

http://www.njha.com/ep/content.aspx?cat=el

F. Along with the article, I also developed and published an online Memorandum of Understanding that allows medical librarians to find buddy libraries and easily create cooperative agreements.

H. Along the cooperative lines, in the second week of 9/11, I called the Robert M. Bird Health Sciences Library at the University of Oklahoma. They cooperated greatly by sharing citations for all the books they had purchased for healthcare professionals on psychosocial and trauma issues Likewise, I asked a medical library colleague to do a resource list of books for children from their consumer health collection as well as one on grief for adults. See:

http://www.njha.com/njresponse/mentalHealth.aspx

I. One urgent thing I had to do was buy equipment fast. Within an hour of 9/11 happening I was in Circuit City taking one of the last TVs off the shelf and charging it to my corporate AmEx. Our need for a TV in the building was extreme! We had one on the second floor, but needed one on the first floor.

J. We regularly and extensively assisted the Emergency Preparedness department with the content and organization of their Web sites. See:

http://www.njha.com/ep/

(3.) How has the library (or the services provided) changed as a result of these events?

It is typical that once a disaster recedes into memory, that urgency for preparedness vanishes too. And, especially in light of this, my experiences have made me more committed to promoting preparedness activities. I think as a professional, I am more alert to the possibility and better ready for the challenges. For example, as soon as I heard of the imminent evacuation due to the wild fires, I immediately asked our PR and Emergency Preparedness department what I could do. Should I dust off the Daily Message feature that allows us to post multiple messages? Should I put the evacuation order online? Etc…

I am asked to evaluate software specific to Emergency Preparedness Web sites. This just happened recently. So I worked with our Health Planning Department, CIO and the vendor to do that.

We’ve had to do software training for hospital staff in the computer lab on the statewide disaster system. This was big undertaking and very interesting on many levels. Oye!

Another interesting experience in the aftermath of 9/11 was TOPOFF3, a disaster planning simulation activity. It was a real eye-opener! In the simulation, it became clear that very personal choices had to be made. Sometimes you have to leave your professional role to take care of personal responsibilities. But, in the simulation, the area was locked down and we couldn’t leave. It was a total shock! I’m not sure people will be adequately prepared for the reality of the situation. But, being involved with such simulation planning activities was a good start.

(4.) What, in your opinion, are the roles for libraries (and librarians) in disaster planning, response and recovery efforts?

After 9/11, I saw planning activities evolving. But librarians weren’t always included; this distressed me as we have a lot to offer.

A. Librarians should use their unique expertise to help with decision making, identifying needs, and providing solutions to the many problems that a disaster creates. I think the Patient Victim database was done so efficiently and received such an amazing response from everyone because the librarian was there at a critical moment and used a unique skill set.

B. Librarians have highly honed and competent people skills that come to the fore during stressful events. I observed hospital association staff coming to the library to ‘escape’ from the high demands a disaster places on professional roles. The library and the librarian became a community haven; and we should strive to offer that ‘peace’ to the patron. It is the ‘fuzzy’ and very human side of what we do. In doing this public service though, a librarian and their staff need to ‘turn off’ their stress and find relief outside of the workplace. I still recall coming home the first Friday during the week of 9/11 to a candle light vigil with a large circle of my neighbors in the common area of our condominium complex. I stopped the car, walked over and was immediately added to the circle, singing and prayers, as someone passed me a candle and I just wept my heart out. If felt good to do that there, and I hardly knew I needed it and was glad I did not do it at work. At work, in the library, we were the shoulders others leaned on.

C. Librarians unique research skills and insights into information can offer amazing results to the organizations we serve. I am still astonished at how many requests came in. We suspended shelving, document retrieval, and all other normal library services just to keep up. I think the fact that patrons came to us and relied on us so much speaks to this important reference and research role. I think librarians in some organizations should also be prepared for an extension of this role into primary research and investigative journalism (for lack of a better word). We talked to government officials, scientists and other organizations to find answers and often wrote them up for staff, presenting ‘findings’ and providing analysis.

D. Librarians are trusted sources of information and should remain that way regardless of what unique characteristics of the disaster come to the fore. This is an important role. Libraries and librarians can be relied upon to disseminate timely and accurate information to a wide audience, as well as a source to identify hoaxes and correct inaccurate information.

E. Librarians are uniquely skilled to create Web resources that can be made widely available. We can also work cooperatively to achieve that, when the crush of immediate service needs prevents one library from doing it all. We have so much information power when we work together. In this way the librarians’ great ability to collaborate serves not only us but our patrons and our organizations well. The resource lists and the conference I put together speak to that.

F. We can also act as the “institutional memory.” When the New Jersey Historical Committee was preparing reports, they contacted me. They wanted to know what was done and I was responsible for knowing. In fact, it often becomes to job of the librarian to answer the question, “What did we do last time?”

G. Librarians are also in a position to aid in the development of technology tools for disaster response. For example, I was asked to evaluate a software product, Fast Command by Fast Health Corporation, which aids hospitals in creating disaster websites.

(5.) What are your experiences working with emergency agencies, organizations and groups?

Oh, my. I wouldn’t know where to begin! Basically, there was SO MUCH I did as a librarian or my library did that my answers to questions numbered 1 to 4 barely cover it all. And I fear, like all things, I am forgetting a lot. In addition to the examples mentioned above, here is a list of the emergency agencies, organizations and individuals with whom I worked:

  1. NJ Dept of Health and Senior Services
  2. NJ State Health Epidemiologist
  3. Area Blood Banks (after 9/11, they were overwhelmed with people who wanted to donate blood)
  4. Jersey City Medical Center — they had a call center and we worked with them to make sure they had the information correct on their Web site. They were the first line of information – taking names of missing people. Then the state police.
  5. Worked with the state police for the anthrax incident
  6. Worked with every library group in the region via their listservs (MLA, SLA, NJ state library cooperative,)
  7. Worked with local hospital to compile resource lists.
  8. Worked with the CDC – looked for good anthrax information. Asked them to speak at conference.
  9. ASTROX Corporation – medical research institute for chemical defense (another speaker at the conference). Helped get their stuff online

Tornado Drill Creates Lessons Learned

Tornado Drill, University of Virginia, March 18, 2008

The University of Virginia (UVa) held a tornado drill, which included our library, on March 18 at 9:45 AM (see this site for more information). The drill had been announced two days before it was scheduled to occur. Overall, our library’s plan functioned well, but the drill definitely served its purpose, as it tested the systems and the knowledge of staff, and effectively showed the areas that need to be improved. Our Library Director held a drill de-briefing meeting this morning, so that we could share information/observations about the exercise and what we need to do to improve our planning and training. Lessons learned from the drill:

–in our library, staff followed procedures for sheltering-in-place. Patrons were given the option to participate in the drill or not, and only one person took shelter with our staff.

–we realized that our shelter-in-place plans need to be clarified so that everyone realizes the differences between sheltering-in-place for tornadoes and sheltering from a biochemical/hazmat situation or an active shooter

–a goal of the drill was that it be completed in 3 minutes. We found that this is adequate time if the overhead PA system is working. However, if power is off when a tornado is sighted, staff will have to warn patrons in person. We have a bullhorn with a siren, and have moved it to Circulation for use in making announcements if necessary.

–we had already contacted the Office of Emergency Preparedness at UVa to request help in verifying the best shelter locations in our library, so we look forward to having their guidance

–we are investigating the purchase of signs to designate shelter-in-place spaces in the library, once our sites are verified by UVa’s Office Emergency Preparedness

Points to Ponder: MSU Library’s Flood

Michael Boer posted a second article about the water damage at the Montana State University’s Library (see the Comment below the “Water Damage…” post). Here are some points to ponder that we can glean from the article and hopefully use as “lessons learned” in our own disaster planning.

  • this is the second burst pipe incident in a week, and library staff have already spent a week trying to clean up and salvage the rare materials that were damaged a week ago. Lesson: we all need help sometimes. Two incidents in a row, with the second being worse than the first, is beyond what most of us plan for or are equipped to deal with.
  • Library Dean, Tamara Miller said that they began recovery immediately, and that “getting organized was my first thought.” Lesson: get organized before you start the process–have a plan in place, have supplies on hand, know who to call for help with salvaging and clean up.
  • MSU’s library kept their essential services up and running–their online resources were still available, including class resources for faculty and students, the classes that would have been taught in the library were re-located to other buildings, and they continued to provide Reference services. Lesson: a good example for all of us who are working on service continuity plans!
  • two commercial salvage/recovery companies are already involved; a local company helping with clean-up, and a Texas-based company sending a freezer truck to remove items to be freeze-dried. Lesson: if possible, develop a relationship with a commercial recovery company (see links here on the Toolkit) as part of your planning process.
  • the fire sprinkler system was installed only eight years ago, with safeguards in place for potential pipe leaks, but this is the third incident of a frozen pipe that burst and flooded in the library. Lesson: even relatively new systems can fail, and often the source is inside the building rather than on the roof or flooding only on the ground floor.
  • extreme weather caused the failure of the sprinkler system in areas where the damage was not anticipated, so a combination of unforeseen factors contributed to the failure. Lesson: sometimes our best efforts aren’t enough to prevent a disaster.
  • water came into the library for 20 minutes, at about 120 gallons per minute (2,400 gallons). An alarm had sounded, but even so, it took 20 minutes to get the water turned off. Lesson: water is the most likely cause of damage to library collections and facilities, and it seems to often get in when the library is closed. This 20 minute turnaround was fast, considering that staff were probably not in the library at the time, but 20 minutes is a long time when water is pouring in at 120 gallons per minute.

The quote from Tamara Miller says it all: “It’s really hard to look at. And still, I know it will be fine.” Great job, Renne Library, and best wishes for a speedy recovery!