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[ccm-l] Management People, Principles, Policies, Issues(Formerly Disaster)

Howard C. Berkowitz hcb at gettcomm.com
Wed Oct 12 22:36:33 BST 2005

At 3:02 PM -0400 10/12/05, docrickfry at aol.com wrote:
>These are good questions and important issue to investigate for any 
>local community in assessing their disaster response planning--the 
>textbooks are both much more up to date and address some of the 
>methods of communications to set up in disasters.  A number of 
>different types have been set up--in Connecticut a web-based system 
>of real time communications has been set up statewide that functions 
>well as determined in the recent TOPOFF 3 exercise--power outages 
>can affect this tho (paper is in Dec 2003 J Trauma)..

I'm more familiar with TOPOFF 2. Assuming TOPOFF 3 also used DMIS 
software, which continues to be extended, that software introduces 
alternative ways of working that may be useful.  For example, an 
early version let an incident command staff send out requests for 
resources -- air tanks for fire operations, tents, fluoroquinolones, 
etc.  There's a newer version that is vaguely similar to eBay, in 
that it presents the requester with messages from the agencies 
offering help.  This is much less labor-intensive than phoning each 
potential source.

There are nuances to maintaining power. Of course, in Katrina, we saw 
cases where generators were on lower floors of structures and were 
flooded. Building codes can get complex with emergency power, as 
there are some restrictions on large battery banks on upper floors, 
due to the danger of caustic electrolyte leaks in fires--there are 

If your generators are outside and it's other than a very crime-free 
area, it's very wise to keep an extra battery inside, on a trickle 
charger. While a generator is too big to steal, starting batteries 
are not. I've known of several critical communications systems go 
down because they couldn't start the generator because the battery 
had been pilfered.

New York financial district communications providers made lots of 
emergency preparations, such as having a week's worth of diesel fuel 
onsite and preplanned deliveries, coordinated with the city, of 
additional fuel. On 9/11, however, many generators quit after 24-48 
hours, with plenty of available fuel. The unforeseen problem was 
dust: it clogged the air filters and no one had spare filters. Given 
the low cost of air filters, having spares on site is a good idea, 
considering there are potential sources of large amounts of dust 
besides major building collapse: large forest fires, volcanic 
eruptions, and possibly industrial accidents.

>Satellite phones have been touted but are limited in many ways, 
>sometimes by the need for the receiving person to also have such a 
>phone and who needs to be called cannot always be predicted in 
>advance.  A simple dedicated land line not normally used and without 
>a widely disseminated number (as these will be useless within a few 
>minutes of an event), as long as phone lines are not destroyed. 
>Cell phones are limited if the local towers also go down as happened 
>in Manhattan in 9/11.  Assigning a special radio frequency for 
>prehospital units to be used only in disasters is useful and 
>successful in Israel.   HAM radio networks are among the most widely 
>accepted forms to plan for in advance.

Chuck Krin has special expertise here.

>Any other ideas could certainly be useful to list members if you 
>have more to offer with your background

Anyone (in the US) with assigned emergency management 
responsibilities should browse through the services at 
http://www.ncs.gov, the National Communications System.  There are an 
assortment of programs that variously make sure that predesignated 
landline, and more and more cellular, phones get priority and will 
get through when everyone else is getting fast busy. Some of these 
systems also offer secure communications.  While it would be a 
detailed engineering question, some priority cellular phones may be 
able to talk to more distant towers.

If you are not in the US, there may be equivalent national programs.

In planning emergency operations centers, do consider if you will 
ever get calls from outside your country. Many Internet Service 
Providers made the mistake of publishing only a national toll-free 
number, which cannot be dialed from outside the country.  This is a 
worldwide problem.

Military and communications operations centers have learned that it 
is extremely wise to have one or more television sets with local 
antennas, for receiving news and weather information.

I'm blanking on the specific, but there was a post, IIRC to this 
list, by a London nurse manager about improvising wall displays -- 
just markers on paper or plastic -- with shift changeover 
information, personal care resources for staff, etc.

Local cable TV companies may have rugged interconnects separate from 
the general residential case. Here in Northern Virginia, we have the 
same company running several city/county franchises, with the 
practical, as opposed to contractual, possibility of rerouting one 
jurisdiction through another. A formal interconnection between 
Alexandria City and Arlington County physical networks was just 
announced, and one of the applications being considered is mutual 
backup of the 911 dispatch centers.

Arlington, as part of the cable contract, also had a fiber optic 
network dedicated for the county installed.  When municipalities are 
allowing bids, this is a good resource to have included.

>-----Original Message-----
>From: Howard C. Berkowitz <hcb at gettcomm.com>
>To: Trauma & Critical Care mailing list <trauma-list at trauma.org>
>Sent: Wed, 12 Oct 2005 12:28:13 -0400
>Subject: Re: [ccm-l] Management People, Principles, Policies, 
>Issues(Formerly Disaster)
>At 11:06 AM -0400 10/12/05, docrickfry at aol.com wrote:
>>Yes--precisely--you should first read the citations and get 
>>the >books, then ask your questions! In fact you will find that 
>>thru the >years and hundreds upon hundreds of disaster responses 
>>described in >the literature, communications has always been at the 
>>top of the >list in after action accounts of the major 
>>problems--what that tells >us of course is that we just do not 
>Looking at your other message, I note that some of the references 
>were from 1956, and the latest 1991. Communications has advanced a 
>bit since then, and it's not at all obvious that some of the latest 
>initiatives, such as nonblocking special access to wired and 
>cellular phones, or backup alternatives using mobile Internet 
>services, would be covered. Indeed, speaking as a commuications 
>engineer as well as a medical informaticist, some of these have come 
>out literally in the last few months. Also, some emergency 
>communications measures are not necessarily publicized.
>The references certainly have valid content, but my question is 
>whether they have a structure that fits current emergency 
>management, policy, and technology structures. I've written 
>textbooks, but I don't expect every networking project will neatly 
>follow their structure.
>>-----Original Message-----
>>From: Howard C. Berkowitz <hcb at gettcomm.com>
>>To: Trauma & Critical Care mailing list <trauma-list at trauma.org>
>>Sent: Wed, 12 Oct 2005 10:57:36 -0400
>>Subject: Re: [ccm-l] Management People, Principles, 
>>Policies, >Issues(Formerly Disaster)
>>At 10:49 AM -0400 10/12/05, docrickfry at aol.com wrote:
>>>You make this too complicated, altho your basic 
>>>premise >>is >sound--the data needs to be learned, but it is all 
>>>out there >>and has >been for years. Try some excellent recent 
>>>textbooks on >>Disasters:
>>>Disaster Medicine, Hogan, Burnstein eds
>>>Disaster Principles, Eric Auf der Heide, ed
>  >>A classic paper and more on major barriers and aids 
>to >>effective >disaster response:
>>>Klein J, Weigelt J: Disaster management: lessons learned. 
>>>Surg >>Clin >North Am 1991;71:257-266.
>>>Berry FB: The medical management of mass casualties 
>>>(the >>only >Scudder Oration on Trauma to deal with 
>>>disaster >>management--what >does that tell us?!). Bull Am Coll 
>>>Surg >>1956;41:60-66.
>>>Ammons MA et al: The role of a regional trauma system 
>>>in >>the >management of a mass disaster. J Trauma 
>  >>ERF
>>These appear all to be references to the mass casualty 
>>effort >itself. Yes, there is much out there in this area.
>>But is equivalent information available for defining both 
>>the >requirements and implementation of communications, of recent 
>>lessons >learned in providing for possibly stranded hospital staff 
>>as well as >communications among shifts/teams, about defining both 
>>medical and >logistic information flow?
>>>-----Original Message-----
>>>From: Howard C. Berkowitz <hcb at gettcomm.com>
>>>To: trauma-list at trauma.org; ccm-l at ccm-l.org
>>>Sent: Wed, 12 Oct 2005 09:34:07 -0400
>>>Subject: Re: [ccm-l] Management People, 
>>>Principles, >>Policies, >Issues(Formerly Disaster)
>>>At 8:21 AM -0400 10/12/05, ken wrote:
>>>>I have been aware of what has been available on 
>>>>the >>>net. >>I >recently had the need to review what is in texts 
>>>>and on >>>the net. >>I >am aware of differing perceptions of 
>>>>local and >>>federal >>governments >perceived roles during 
>>>>disasters. I am very >>>aware of >>the many >medical and health 
>>>>needs and responses during >>>any >>disaster. One >big problem is 
>>>>the disconnect between what >>>is >>written, what is >perceived, 
>>>>and what really happens and what >>>works >>and what does 
>>>>not. >We have four huge disasters this last >>>8 months >>to 
>>>>analyze and more >than 30 in the last 4 years to >>>analyze. I 
>>>>am >>amazed at the >disconnects, the misinformation, >>>and the 
>>>>wastes of >>personnel, money, >supplies, and energies >>>because 
>>>>of turf, >>politics, and lack of >communication. >
>>>>We all can do much better.
>>  >>
>>>I've been thinking of the mechanics of capturing the 
>>>information >>on >what works and doesn't work, and simultaneously 
>>>evolving our >>tools. >Have you had any ideas on how best to 
>>>structure the data >>acquisition?
>>>As a strawman, let me suggest beginning with some 
>>>existing, >>written >doctrine on Incident Command System at levels 
>>>from local >>to National >Response. At this level, one can look at 
>>>various >>experiences >Management People Principles Policies 
>>>Issues (Formerly >>Disaster), or >MP3IFD to be acronym rich, and 
>>>record them under >>various ICS >policies. In the process of the 
>>>exercise, it will be >>likely that >certain real-world activities 
>>>don't neatly fit under >>ICS doctrine, >which means that the 
>>>doctrine needs to be updated.
>>  >
>>>Again as a strawman at the next level of detail, 
>>>could >>the >experience be mapped to information management, as 
>>>with >>DM-Services? >Information management, at this level, 
>>>absolutely >>must include >near-real-time message flow (message, 
>>>voice, video, >>etc.), real-time >telemetry, and both reference 
>>>and statistical >>databases. It's again >likely that the existing 
>>>software, even as a >>conceptual model, >doesn't cover the 
>>>experience, and this should >>translate into new >software 
>>>Below this level are tools and standard operating 
>>>procedures. >>An >example of the former are communications 
>>>systems, mostly >>electronic, >with their applicability and their 
>>>need for >>supporting >infrastructure. I could easily start SOPs 
>>>with some of >>your memos to >BTGH, as well as what you learned in 
>>>practice -- >>such as the overuse >of family refuge intended 
>>>primarily for single >>parents.
>>>I am not wedded to any of the architectures, software, 
>>>or >>procedures >mentioned above, but I see them as a starting 
>>>point. >>Other starting >points are welcome.
>>>>-----Original Message-----
>>>>From: "Eric Dobkin" <Edobkin at harthosp.org>
>>>>Date: Wed, 12 Oct 2005 07:45:34
>>>>To:<KMATTOX at aol.com>, >><dchalfin at applied-decision.com>, ><arthurmorgan2 at gmail.com>
>  >>>Cc:trauma-list at trauma.org, ccm-l at ccm-l.org
>>>>Subject: Re: [ccm-l] Management People, Principles, Policies, Issues
>>>>  (Formerly Disaster)
>>>>Bravo, Don
>>>>Eric Dobkin MD, FACS
>>>>Director, SICU
>>>>Hartford Hospital
>>>>Hartford, CT
>>>>>>>  "Donald B. Chalfin, 
>>>>>>>MD, >>>>>>MS, >>>>>FCCM" >>>><dchalfin at applied-decision.com> 
>>>>>>>10/11/2005 >>>>>>10:29:52 >>>>>PM >>>
>>>>At 12:36 PM -0400 10/11/05, KMATTOX at aol.com wrote:
>>>>>In a message dated 10/11/2005 10:57:51 AM
>  >>>>Central Standard Time, arthurmorgan2 at gmail.com
>>>>>All this is on the Net. Study what is available instead of re-inventing
>>>>>the wheel.
>>>>>Disaster management has been around for many years, as has been pointed
>>>>>out before.
>>>>>Arthur Morgan
>>>>>Anaesthesiologist, Johannesburg, South Africa
>>>>>I have read what is on the net and what is in
>>>>>the texts, and the material in the manuals. I
>>>>>can tell you that much of what is there is top
>>>>>down management and a lot of outside people
>>>>>telling the local people just how to run their
>>>>>business and it often has no similiarity to
>>>>>reality. Local Integrated Collaborative
>>>>>Networks is NOT on the net and in the textbooks
>>>>>and that is what I am trying to communicate.
>>>>  >
>>>>One of the shortcomings of medicine at times is
>>>>its inability to look beyond the medical and
>>>>"scientific" realms and disciplines. Critical
>>>>care, trauma, emergency medicine, and related
>>>>fields are unique in the sense that these fields
>>>>are not limited to a single organ system or set
>>>>of diseases and also are defined by a large
>>>>administrative and organizational component.
>>>>In this vein, and in this thread devoted in part
>>>>to management, organization, and systems issues,
>>>>perhaps we should consider going to the
>>>>textbooks, tomes, writings, and teachings outside
>>>>of medicine, and look at what the industrial
>>>>engineers, the management gurus in business
>>>>schools and industry, and the organizational
>>>>theorists are saying and writing. From a
>>>>personal standpoint, going back to graduate
>>>>school for my master's degree (health management,
>>  >>thesis in decision theory) during my fellowship
>>>>illustrated this to me. All one has to do is
>>>>look at issues related to Errors and Safety in
>>>>medicine and how much has been learned by careful
>>>>and close study of the avaition industry.
>>>>Donald B. Chalfin, MD, MS, FCCP, FCCM
>>>>Associate Professor of Medicine
>>>>Associate Professor of Epidemiology and Population Medicine
>>>>Albert Einstein College of Medicine, Bronx, New York
>>>>Director, Critical Care Outcomes Research
>>>>Director, Critical Care Consults
>>>>Montefiore Medical Center
>>>>Bronx, New York
>>>>Chief Scientific Officer
>>>>Analytica International
>>  >>450 Park Avenue South
>>>>New York, NY, USA 10016
>>>>tel: +1-212-686-4100 ext 8201
>>>>mobile: +1-516-448-0047 (preferred)
>>>>emails: dchalfin at analyticaintl.com
>>>>  dchalfin at applied-decision.com
>>>>European Office:
>>>>Untere Herrenstraße 25
>>>>D-79539 Lorrach
>>>>tel: +49-7621-9339-0
>>>>fax: +49-7621-9339-1039
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