A guide for an emergency alert system
A project developed by:
ADVANCED PRACTICECENTER FOR EMERGENCY PREPAREDNESS
/
Acknowledgements
Project Team
Charles Ishikawa
Andrew Ellingson
Mary Clark
Susan Kilroy-Ames
Courtney Weimert
LENS Development Team – Cambridge APC
Mary Clark
John Grieb
Bryan Hall
Charles Ishikawa
Basil Kim
Alison Minkoff
Courtney Weimert
Lynn Schoeff
Garrett Simonsen
LENS Development Team – Communicable Disease Control, Massachusetts Department of Public Health
Patricia Kludt
Daniel Church
This project was supported by Cooperative Agreement Number U50/CCU302718 from CDC to NACCHO. The contents are solely the responsibility of the Cambridge Public Health Department Advanced Practice Center for Emergency Preparedness and do not necessarily represent the official views of CDC or NACCHO.
Table of Contents
Glossary
Overview
The Parts
Personnel
Activation Protocol
The LENS Database
Communication Equipment
LENS Activation
Textbook Perfect
Failsafe Measures
The LENS Database
Emergency Contact Information
Scheduling
Activation Data Management
Monitoring Performance
The Activation Report
The System Performance Report
Figures
Appendix 1: LENS Activation Protocols
Appendix 2: Forms
Appendix 3: LENS Database
Appendix 4: LENS Drills
Glossary
Activation: The actions that State, LENS on-call, and Local Public Health agency staff take when person-to-person communication must be established between State and Local Public Health.
Alert: A warning message that triggers LENS Activation.
Cloned text pagers: A-series pagers, capable of receiving text messages, programmed to a single phone number.
Event: A planned activity such as a drill or full-scale exercise.
Incident: An occurrence, natural or human-caused, that requires an emergency response to protect life or property. Incidents can, for example, include major disasters, emergencies, terrorist attacks, terrorist threats, woodland and urban fires, floods, hazardous materials spills, nuclear accidents, aircraft accidents, earthquakes, hurricanes, tornadoes, tropical storms, war-related disasters, public health and medical emergencies, and other occurrences requiring an emergency response.
Region: A group of geographically defined Local Public Health jurisdictions within a LENS network.
LENS Network: A collection of Local Public Health agencies covered by LENS on-call.
Local Public Health Agency (LPHA): A government or government contracted organization that performs a broad range of functions,from preparing for an act ofbioterrorism to assisting vulnerablepopulations to enforcing healthregulations.
Mutual Aid: In an emergency situation, the act of providing, upon request, personnel, equipment, and/or expertise in a specified manner between agencies and/or jurisdictions.
Smart phone: A mobile telecommunication device, such as a BlackBerry, Tero, or iPhone, with email and contact management functions.
Sub-region: A portion of a group of geographically defined local public health jurisdictions within the LENS network.
Task flow diagram: A graphic representation of the order in which specific tasks are conducted to result in a particular end.
Glossary (continued)
Transaction: An exchange of information or goods between two parties. During Activation, information-based transactions take place. The initial conversation between state and LENS on-call about the nature of the emergency and which LPHA(s) in the LENS network are involved is an example.
Validity: Refers to the state of results on an Activation or Summary Report. Valid results are accurate calculations based on accurate data. It also means that all the necessary steps of Activation occurred. This does not mean that there were not any inefficiencies or missteps during the Activation. Rather, only that the summary information automatically generated by the LENS Database can reliably be used to identify the presence or absence of inefficiencies or missteps.
Warnings: Messages found on Activation Reports based on an automated review of call log data to determine whether or not calls occurred in the temporal order outlined in the protocol.
Overview
The Local Emergency Notification System, LENS, is a means for establishing person-to-person communication between state and local health agents regardless of the time of day or day of the week. LENS organizes this coverage through protocol, accurate emergency contact information, standardized tracking forms, and regular reviews of system performance.It unites multiple Local Public Health Agencies (LPHA) and the State by maintaining these assets.
Within LENS, a designated group of individuals assumes responsibility for ensuring person-to-person communication between State and local health agents in emergency situations. These individuals, or LENS Staff, also have the duty of administrating LENS. They ensure that State and Local Public Health Agency (LPHA) personnel are trained to protocol, and they maintain accurate and up-to-date contact information.
In an emergency situation, a member of the LENS staff, the LENS point of contact (LENS on-call staff), serves as the initial point of contact for the State to any LPHA in the LENS network. The LENS on-call staff then quickly contacts the requested LPHA(s) and places them in contact with State health officials knowledgeable about the emergency. In this way, the LENS on-call staff essentially serves as the 24/7 on-call coverage for the LPHA’s, reducing the workload for LPHA’s within the local emergency notification system and serving as an access point to cross-jurisdictional support or mutual aid.
The PartsPersonnel
State, LENS, and LPHA personnel are necessary for the local emergency notification system. State personnel initiate Activations and provide the necessary subject matter expertise on an emergency situation. LENS staff is responsible for maintaining the system and being the central point of contact during Activation, a duty that is rotated on a weekly basis. Finally, LPHA’s designate primary, secondary, and tertiary staff contacts to ensure that someone from the local jurisdiction can be reached during Activation.
Activation Protocol
A 4-step LENS Activation process effectively coordinates the flow of communication from the State through a designated central point of contact to the local health department(s). Three separate protocols, one for each party (i.e., State staff, LENS staff, and LPHA staff), coordinate the LENS Activation process in an emergency situation.
The LENS Database
A Microsoft Access application developed by the Cambridge APC assists LENS staff in maintaining emergency contact information for LENS LPHA’s, managing the real-time information captured on Activation Tracking Forms, and producing reports useful in reviews of the system’s performance.
Communication Equipment
LENS is designed to link with the State’s Health Alert Network to send alerts and establish necessary communications between the State and Local Public Health Agencies. Each LENS staff person carries a cloned text pager (i.e., multiple pagers programmed to a single phone number) and a Smart Phone in order to receive alerts and to communicate with local public health department contacts.
LENS ActivationLENS Activations establish timely person-to-person communication between local and state health departments. Although developed for use in an emergency, Activations can be initiated in any situation that requires a coordinated public health response. Assessing LENS Activation performance requires detailed information on the actions made by state and LENS staff. This data should be recorded in real-time on standardized tracking forms such as those found in Appendix 2.
Textbook Perfect
A perfect Activation places all requested health departments in communication with the State health department at or under the goal time of 30 minutes. Activations begin with an alert that State Public Health issues to the LENS on-call staff, the central contact for all LENS network LPHA’s. Once alerted, the LENS on-call staff responds by calling state public health to determine the nature of the emergency, the LPHA(s) involved, and to obtain direct phone numbers for the state staff person with whom the LPHA(s) must speak. The completion time for this first transaction (i.e., State alert to LENS on-call staff response), is a quantitative measure useful when assessing system performance.
Next, the LENS on-call staff phones the persons pre-identified by the LPHA(s) as emergency contacts for the health department. Using an LPHA’s emergency contact information, the LENS on-call staff sequentially works their way through each of the designated local contacts (i.e., primary, secondary, and then tertiary). Once contact has been established, the LENS on-call staff briefs the LPHA person on the situation, instructs them to call the State staff person immediately, and provides phone numbers for the State staff person and a phone number for the LENS on-call staff. Examining the number of attempts made to reach an LPHA is useful in determining the quality of that LPHA’s emergency contact information.
With a phone number for Sstate health staff and general knowledge about the nature of the emergency, the LPHA then calls State staff to learn about the details of the situation and consult to determine appropriate next steps. The amount of time between the State ending their conversation with the LENS on-call staff and the start of this conversation with the LPHA is another useful quantitative measure of performance.
Once the next steps have been determined, the LPHA then calls the LENS on-call staff to notify them that the final transaction has been completed (i.e., the LPHA has spoken with State staff), and to ask whether the LPHA needs any assistance from the LENS on-call staff. This assistance may range from a return call to check in a couple of hours to a request for mutual aid. Regardless, this confirmation to the LENS on-call staff completes a textbook perfect LENS Activation.
Failsafe Measures
There are occasions when, for any number of reasons, a textbook perfect Activation does not take place. For example, perhaps the LENS on-call staffdoes not respond to the initial alert from the State. Or maybe the LPHA is completely unreachable using the emergency contact information on-hand. Or it may happen that the LPHA simply fails to follow through in contacting the State. At each point where person-to-person communication needs to be established, State, LENS on-call staff and LPHA protocols provide instructions on what to do if communication is difficult to establish. Copies of these protocols, narrative descriptions, and task flow diagrams are in Appendix 1.
The LENS DatabaseAdministrating LENS involves a tremendous amount of information management. Emergency contact information for each LPHA, on-call staff scheduling for LENS staff, and Activation data all need to be organized, stored, and made readily available. LENS administration also entails quality control, which involves monitoring the system’s performance on individual Activations, often over a period of months or years.
The LENS Database has four functions, one to support each of the administration tasks mentioned above. Utilization of this Microsoft Access application requires installation and set-up (see Appendix 3), and an understanding of how a person administrating LENS interacts with the software.
Emergency Contact Information
Accurate emergency contact information is critical to successful activations. A record is maintained for each participating LPHA with phone and/or pager numbers for a minimum of three people who may be contacted in an emergency during non-business hours. In addition, LPHA(s) must designate who should be called first, second, and then third. Confirmation of the accuracy of this information should take place quarterly, and participating State and local health agencies should update information more frequently, as necessary.
The LENS database supports this work. Data from the hardcopy emergency contact information forms (see Appendix 1), can be manually entered into the LENS database and then permanently maintained in this format. With this electronic record, the LENS Database can perform the following operations: Print completed contact information forms, condensed contact sheets, summary contact sheets, and wallet-sized, Avery [template 5371] cards with LENS staff contact information; and tie Activation data to contact data. Emergency contact information records must be maintained in the Database to enable its scheduling function.
Scheduling
The LENS database is able to assist a LENS Administrator in producing a LENS on-call staff schedule and issuing shift change reminders via email. This user friendly feature is entirely optional and can be disabled without eliminating any of the other three major functions. See Appendix 3 for instructions on how to disable this feature.
Activation Data Management
Capturing and maintaining Activation data is necessary for monitoring system performance. During Activations, LENS on-call staff and State personnel should record details about the situation, note significant actions (e.g., a mutual aid request), and log all communications received or sent. This information is critical to assessing the effectiveness of failsafe measures and identifying problems in the system (e.g., outdated contact information or poor cell phone reception). The Activation Tracking Forms in Appendix 2 are useful tools for reminding personnel and organizing the data they ought to record during LENS Activations.
A LENS Administrator can maintain and organize all Activation data within the LENS Database (Figure 2). Once entered, Activation information can be accessed through a search function that locates records based on a number of variables including:
- Activation date
- Purpose of the Activation (i.e., an event or an incident)
- Type of situation (e.g., event or incident)
- Source of the record (i.e., State or LENS staff)
- An identification number assigned by the Database upon entry
Once found, Activation records can be read, edited, or printed. With all data from a particular Activation in the system, the LENS Database will then have the necessary information to enable its reporting function which supports performance monitoring.
Monitoring Performance
The performance of LENS Activations must be monitored on a regular basis in order to ensure that person-to-person communication between local and State health agencies can be established in sufficient time. Many factors impact the timeliness of Activations, including:
- Accuracy of Emergency Contact Information
- Functionality of communication devices
- Staff use of and training on protocol
The LENS Database has a reporting function that produces two types of reports. Each includes quantitative and qualitative data that measure and help in trouble shooting Activation performance: The Activation Report and the System Performance Report.
The Activation Report
Activation Reports present the performance of single Activations. The quantitative section of the Report utilizes call log data to calculate the time to establish or complete key Activation transactions. These include: The time to establish initial State and LENS on-call staff contact; the time for LENS on-call staff to contact a LPHA; and the total amount of time for the state and LPHA to be placed in communication. The qualitative section of the Activation report collapses the notes made by State and LENS staff. Staff involved, nature of the emergency, whether or not mutual aid was requested, and general comments are found in this section of an Activation Report.
Before an Activation Report is used to assess Activation performance, it is necessary to first confirm the validity of the report information (Figure 3). These reports can be completely valid, completely invalid, or valid but containing skewed calculations. Skewed calculations can take place when an unusual activity is found in the electronic record (e.g., a protocol misstep). It is therefore critical that the electronic record is a faithful reproduction of the data recorded in the Activation Tracking Forms. The task of determining the validity of a report is essentially checking the accuracy of the Activation data. Warning messages found in the summary section of the Activation report help in this task.
The System Performance Report
System Performance Reports are quantitative summaries of performance across multiple Activations. Each System Performance Report presents the mean amount of time to establish or complete five key Activation transactions for all Activations within the reporting period. These are: Goal time; total Activation time; LENS on-call staff response time; time to reach LPHA’s; and, if applicable, time to reach LENS back-up. Also presented in the report are the number of times mutual aid requests were made and a table with average time to reach State and number of activations stratified by LPHA.
Unlike an Activation Report, when determining the validity of a System Performance Report, the focus of attention is on the inclusion of proper Activation data (Figure 4). Inclusion of Activation data that resulted in an invalid Activation Report will skew the quantitative information presented in the System Performance Report. Therefore, one must be sure to exclude data from inappropriate Activations.
FiguresThis section contains task flow diagrams depicting work supported by the LENS Database, including: Contact Information Management, On-call Scheduling, LENS Activation Report and LENS System Report Validation.
Figure 1: Managing rapidly changing contact information is simplified and expedited by the LENS Database. New records can be created when a new LPHA staff is designated or existing records can be edited when phone numbers change. Updated sheets are easily printed when changes made.
Figure 2: Scheduling LENS staff for on-call duty is supported by the LENS Database. An entirely optional feature of the application, the scheduling function allows one to maintain a searchable duty record for many years and enables an on-call email reminder function in LENS Database. (Use lower case ‘n’ above in diagram where it now says “ON-Call Scheduling.”
Figure 3: Activation Report validity must be determined prior to interpretation. If the validity is questionable, warning and status messages help direct attention to questionable data. Confirming the accuracy of the electronic record will at times require referencing hard copy forms.