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

Terrorism Information Center, Memorial Institute for the Prevention of Terrorism, Oklahoma

Brad Robison, Director of the Terrorism Information Center at the Memorial Institute for the Prevention of Terrorism, discusses his experience during the bombing in Oklahoma City in April 1995 and the disaster information services the library currently provides.

Interview date: July 18th, 2007

Questions:

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

It was a beautiful spring morning on April 19, 1995. No one could have known that before the end of this particular day thousands of lives would change forever. As the director of a small private university library in Oklahoma City, I arrived at the library early that morning and began to settle in for the expected rush of students who had put off completing term papers until the last moment. It was about 9:00 a.m. and I was having a conversation with one of the reference librarians when suddenly the building shook and the windows rattled violently. Having taken numerous study groups to Japan and having experienced several minor earthquakes I immediately thought EARTHQUAKE. My second thought was, no this is Oklahoma, not a typical site for a violent earthquake. Geneva, the reference librarian, thought the weight of shelving and journals on the third floor of our building had finally taken its toll and the floor collapsed. I headed for the stairwell fully expecting people to be running down as I was running up but no one was in sight. When I arrived on the third floor I quickly surmised nothing had fallen but saw smoke rising from the downtown Oklahoma City skyline. Of course not knowing to put the smoke with the sudden shaking of the building, I determined that what Geneva and I had felt and heard was nothing more than a sonic boom from Tinker Air Force Base, just east of Oklahoma City.

Several minutes passed before my phone started ringing and friends in New York were calling to ask me what was going on in Oklahoma City. Not having turned on the TV I was unaware of what they were referring to. I rolled one of our TV’s into the lobby of the library, turned it on and saw for the first time the carnage of what ended up being a terrorist attack on the Alfred P. Murrah Federal Building. At first, the reports were “there has been some sort of explosion downtown.” Perhaps it was a gas explosion. The thought of a terrorist bomb was not mentioned for nearly half an hour. The library, being at the physical center of the campus was a hub for the students to gather and watch the story unfold. Our staff brought in extra chairs as more and more students came by to see what was going on. The immediate thought on everyone’s mind was what we can do to help.

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

The lobby of the library quickly became the focal point on campus where students and faculty could easily learn the needs of the emergency response community. People gathered around the TV to know where to go to donate blood, where to take food and where donations were being collected. The lobby of the library also became a place for the sharing of tears as we learned that the explosion was probably caused by a fellow human full of hatred. We were learning too that children may have been included in the list of those that were obviously not going to survive the explosion and collapse of the building. By afternoon, the beautiful spring morning had given way to thunderstorms and a city full of shock and grief as the victims were removed from the bombed out building, one body at a time.

When the dust and debris cleared 168 people, including 19 children were killed and hundreds more seriously injured. Out of the rubble a plan for a multi-component memorial was established. The memorial was to consist of a remembrance component an educational component and a research component. It was the dream of the family members and survivors that the research component have a library and information center as the “living memorial” to their loved ones. Thus the Memorial Institute for the Prevention of Terrorism was founded. An act of Congress was passed and appropriation made to begin development of the “premier source of terrorism information sharing among federal, state and local agencies.”

As the steering committee for the development of the Institute and Library began their work, it became clear the emergency response community would need to be actively involved in creating this new resource of information. As a volunteer for the Memorial Archive, I was invited to be on the steering committee for the development of the Institute’s information center and library. Though not apparent at the time, the need for information professionals, both librarians and archivists was a necessity. Thousands of cards, letters and artifacts were mailed to the bomb site along with thousands more being left at the scene on a daily basis. Archiving and preserving this information was the foundation of what later became the Memorial Museum. Many of the documents collected early on became the basis of the future Lessons Learned Information Sharing, (LLIS) the official lessons learned site for the Department of Homeland Security. Final reports, after action reports, studies, etc. from numerous agencies were collected with the hope of assisting other communities in preparation dealing with a similar mass casualty event. Reports and studies following a variety of terrorist incidents and natural disasters make up the LLIS database.

Fire and law enforcement professionals were brought to the table to assist in the establishment of key databases that would help these groups prepare and perhaps prevent future acts of terrorism. The Responder Knowledge Base (RKB) was created to assist the emergency response community know what protective clothing and equipment is available and whether or not it meets standards and who certified the equipment against the standards. The RKB also informs the emergency response community if grant money is available in order for them to make application.

The MIPT Terrorism Information Center and Library (TIC) is a wealth of information not only for the emergency response community but for academics, policy makers, and the public at large. Thousands of documents have been added to the TIC along with nearly 3,000 book titles easily available for checkout. Information on the topic of terrorism seems to be endless and the need to collect, organize and disseminate that information is essential for eliminating this scourge from the world. The services that libraries and librarians have traditionally provided remain very important.

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

The MIPT and its Terrorism Information Center work closely with emergency agencies on a regular basis. The TIC has held forums to bring members of the law enforcement community together to inform them of the information resources available. We have also brought together fire prevention and preparedness professionals in an effort to inform them of the valuable resources the TIC have to offer. We are currently working with Hospital Security Officials to make sure they are planning and preparing for whatever terrorists bring to the table with another event.

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

I suppose to sum everything up, I would say that librarians need to work closely with their respective communities and serve as neutral forums in bringing to the table people needed to plan and organize community preparedness programs. Whoever their constituency consists of need to be part of the planning. In a city, the mayor, city manager, fire chief, police chief, public health officials and personnel from utilities companies need to meet and develop emergency response plans. Librarians can lead the way in bringing these groups together by providing them with necessary information to develop their own disaster response and recovery plans.

Additional Question:

(5.) Were you involved in the response to any other disaster/emergency situations?

After the anthrax attacks our library staff, which consists of two, assisted the Oklahoma State Office of Civil Emergency Management by answering phone calls from a 24-hour call-in center. A phone number was posted via radio and TV for those having specific questions related to small pox and anthrax. It’s just another service librarians can provide.

Toronto Public Health, Ontario, Canada

Bruce Gardham, Senior Librarian for Toronto Public Health in Ontario, Canada, discusses his personal experiences with the SARS epidemic in 2003 and the special library.

Interview date: June 22nd, 2007

Questions:

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

The SARS (Severe Acute Respiratory Syndrome) public health emergency in Toronto began on February 23, 2003. A woman returned to Toronto after visiting Hong Kong. She had stayed on the same floor of a hotel with an infected person. She got sick and went to her doctor who diagnosed the flu. She went home and died. Then her son got sick and ended up in hospital before dying as well. The person who shared his hospital room got sick. And then that person’s spouse got sick too. The outbreak infected 257 persons in Toronto’s hospitals, occurring in two separate waves. The emergency lasted until the end of June, 2003.

The hospital realized that they had a highly infectious case on their hands and Toronto Public Health started mobilizing. Initially there was a lot of tension and fear. But, not as much as you would expect. A great media system helped. Dr. Sheela Basrur, the Medical Officer of Health for the City of Toronto, was also an extremely capable leader. She worked very hard to keep the population calm.

Everything happened so fast and information constantly needed to be updated. Patients being transferred between hospitals aided the transmission of the disease. Also, it was very common for nurses to work in multiple hospitals and they were traveling back and forth through the infected zone. In the end, more than 23, 000 people had to be quarantined to control the spread of the disease.

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

The Toronto Public Health Library wasn’t very involved in the response to the first wave. I supplied some information that was coming out from The New England Journal of Medicine and The Lancet. Toronto has a pretty tight community when it comes to the medical library field and I knew that hospital librarians were not working in their traditional roles. They were deployed to the front entrances of the hospitals to screen people, take temperatures. During a Code Yellow, all hospital personnel are deployed and whole sections of the hospitals are closed off. All personnel, including the librarians, were deployed to screen.

During the first wave, we monitored journals that were starting to publish electronically. Our library liaison in the government was corresponding with officials. But, in the Public Health Library we didn’t even get asked for anything before people started thinking the whole event was over. And then the second wave hit.

Toronto Public Health had set up an information hotline during the first wave. It wasn’t until the second wave that the managers of the hotline realized they had a problem organizing the information. I was called in to help.

The hotline workers (45 public health nurses) all used these big binders to help them answer the wide variety of questions that were coming in from the public. The binders used in the first phase of the outbreak were not updated before being pressed into service for the second wave. The binders each had three sections with many chapters. The information had been gathered as the staff members went along and attempted to answer the questions that came up. But, there were literally thousands of questions.

When I was assigned to the hotline area. No one knew what information they had or what was right. Information was changing hourly and daily. Public briefings were happening all the time. There were lists of deaths, outbreaks, quarantines, etc… Instructions were issued by the Public Health Department and the hotline number was distributed by the media. Any piece of information released by the media would cause a flood of phone calls. As soon as an outbreak was reported, people wanted to know if they had been exposed. We had to know exactly where each outbreak was located and where the person had been. The entire situation demanded current, accurate data to be distributed to the hotline workers. There were so many calls that — at one point — Public Health was preparing to requisition major call centers if the numbers increased any more.

The first problem was updating the binders. I worked with a public health nurse who had been manning the phones since the beginning. We worked to take out all of the old information. The process I adopted for updating these binders was based on loose-leaf processes used mainly for law library materials Each binder included a master index and ten sections. They were:

  1. Phone Log-in Instructions
  2. What is SARS?
  3. Process for Dealing with SARS Calls
  4. Contact Follow-up and Documentation Forms
  5. Mask Information / Sanitizing with Bleach
  6. Information Regarding Discharged Patients
  7. New / Communication Updates / Travel Advisories
  8. Medical Information for Hospitals
  9. Travel Advisories
  10. Helpful Telephone / Addresses / Websites

I maintained the master binder and there were regular checks to make sure the other 35 binders were the same as the master copy. It took a couple of days to organize the binders.

Then, we began the system of adding updates. Hotline managers attended meetings at about the same time every day. After the meeting, daily updates would be added to the binders. Urgent updates were added as soon as the information was received. The phones were manned every day from 8:30 am until 11:00 pm. There were day and night shifts, but more people worked in the day than during the evening. It would become a problem if someone missed an update. Discrepancies between information resources were also a problem; and there was a lot of information confusion during the emergency. And sometimes small format changes (the date for example) would result in serious problems. All of these discrepancies had to be accounted for before any updates could be distributed to the hotline.

Larger problems in disseminating information were due to Toronto being such a multicultural city. After the fact, I heard from some Chinese friends. They all watch Hong Kong television and were completely in the dark when it came to local public health notices. 110 languages were being spoken in Toronto, but the hotline and the Toronto Public Health website was only translating into six. Even then, it was difficult to have staffing to ensure that all six languages were covered in any given shift.

My role wasn’t conducting typical library work. Public Health had their own information sources so they weren’t coming to the library. Organizing the binders for the hotline was more about my general skills. I was filling a practical role keeping information organized, maintaining an information network and dealing with people. Toronto Public Health was significantly affected as an organization. Many workers were quarantined or had relatives in the hospitals. Areas were closed and it was difficult to get information. As a librarian, I had experience working with people and it helped tremendously.

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

After the fact, I worked to evaluate the effectiveness of the binders and wrote a report with recommendations. Some of my recommendations include the following:

  1. A communication binder or manual be produced which would act as a template for future hotline operations. This should include an orientation manual for staff.
  2. An evaluation be carried out on the types of questions coming into the hotline to determine the information needed.
  3. Keep a log of the types of questions fielded by managers and team leaders to ascertain the problem area which may be addressed by having that information in the binders or an electronic system.
  4. All communications produced exclusively for the binder or database has section numbers for the headers, date and time of issue. Time is important since during a single day materials could be issued three times and time is the only way to ascertain the latest version of a document.
  5. Subject indexing be adopted for binder materials using reference manager software. Controlled language subject indexing would have helped to locate materials faster. Subject indexing should be incorporated for any electronic database constructed to handle future hotline communication materials.
  6. Keyword searching is not the best answer to subject access as keywords are produced from titles of documents or the full text of a document. Such keywords may not always reflect the genre of the document or be too confusing to an individual trying to locate information quickly. Subject descriptors would have to be assigned by an information officer or health professional using an authority file.

I also examined the information discrepancies and created a SARS Information Discrepancy Table. My main recommendation was for the creation of an Information Liaison Control Officer to manage the flow of information.

The SARS outbreak in Toronto was the first major outbreak of an illness in our area to happen since the 1950s and 1960s. It really shook people up and a lot of plans were made after the fact. But, disaster planning has really fallen off the radar since. And there is still a lot more we could do.

For example, I really feel that better contact should be established with the non-English speaking communities in Toronto. If another disease outbreak occurred in the area, we could have real problems communicating with these groups. I also think that we need to have a better handle on the social services and agencies in town and how they work. In another disease outbreak situation, this information needs to be at our fingertips.

And there was definitely a need for better access to detailed, military maps. People were calling who had been in a certain section of the building. We needed to see where exactly the outbreak happened and how close they were to it. That kind of building information wasn’t always accessible at the time it was needed.

The library started getting reference questions about SARS after the emergency died down. Suddenly, all of these people were writing reports. I started to assemble what is now that most comprehensive collection on SARS; we probably have every single book ever published on the disease.

The experience made me think about information access in a disaster. I started asking: How would we have access to the electronic information if everything falls apart? What are the core areas? What do we need to have in print? It made me realize that certain things should always be collected in paper. For example, I still buy the new print editions of the CPS (Compendium of Pharmaceutical and Specialties) even though there is an electronic edition available.

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

For the library, we developed a specialized collection on SARS. It is one of our roles now to help other institutions, communities, hospitals, libraries, etc… with their information needs on the subject.

But, most of the roles are for the librarian as an individual. In my recommendations, I outlined the needs for an Information Control Officer. I see the librarian’s role as aiding information flow and working between the administrative levels. I can even see an information officer needed on every floor. We need to help our organizations understand how information should be presented, to stress the importance of continuity (in date formats, for example). It was a corporate standard in the city of Toronto not to put a date on websites. This standard had to be changed. Little things make a big difference in an emergency situation because little details have to be confirmed.

Another role for the library is being involved in the community. Sharing vital information with the public will be very difficult in an outbreak situation, especially in the large, multi-cultural city centers. Librarians have to be aware of the whole community and have contacts that they can call on in an emergency.

The following documents were submitted by Bruce Gardham:

Binder Inventory and Audit Control Sheet: binder-inventory-and-control-sheet

Hotline Information Liaison & Co-ordination Officer Report : information-liason-and-co

Toronto Public Health Library Bibliography on SARS: sars-bibliography