DMR

Testing Hospital Disaster CommunicationPlan has Immense Value

Dear Editor:Recent United States disasters have identified

a need to ensure that disaster responses and resourcesare timely and effective. Concerns regarding disasterresponse include unclear roles and responsibilities,poor planning, inadequate training, and poor commu-nication.1-4 Emergency physicians play a critical role inhospital disaster response; thus, it is essential thatemergency medicine residents receive appropriateemergency preparedness education and have an op-portunity to participate in disaster exercises. Ensuringan efficient method for mobilizing emergency medi-cine residents and ED directors at the start of a disasterappears to be crucial in providing a well-organized re-sponse. Therefore, testing the hospital disaster com-munication plan has immense value in determiningthe efficiency of the plans and identifying major weak-nesses in the system.

To identify whether a phone tree communicationplan was effective in mobilizing and rapidly dispens-ing crucial information to a large group of staff (68 res-idents and 4 residency directors), a communicationdrill was conducted among the emergency medicineresidents at Kings County Hospital Center in Brooklyn,New York. The phone tree is activated by the resi-dency director, who notifies the assistant residency di-rectors and the four chief residents. The tree thendivides out into 8 different branches, with 8 residentsin each branch. Residents call the people directly be-low their name and continue making calls until theyspeak to another resident; they then re-call the resi-dents who originally were unavailable. The final resi-dent in each branch calls one of the residencydirectors, acting as a secondary check point. The res-idency directors, located in final positions on thetree, then call the drill moderator (or incident com-mander in a real disaster situation) to mark completionof their branch.

The phone tree containing each participant’s pagerand cell phone number was distributed to all residentsand residency directors prior to the exercise. At thestart of the drill, all the residency directors were noti-fied and the chief residents were paged, initiating thephone tree. The directors were instructed to call the

Disaster Manage Response 2007;5:27.

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Copyright � 2007 by the The Emergency Nurses Association.

April-June 2007

Letter to the Editor

drill moderator upon receiving their final calls. Fourof the 8 branches reached the directors within 1hour. Three more completed by 1 hour and 35 min-utes (78 minutes, 83 minutes, and 105 minutes, respec-tively). The last branch finished after 3 hours and 45minutes. The delay for this branch was due to inade-quate attempts by one resident to reach the otherone (a message was left on the cell phone but nofollow-up calls were made). Our findings indicatethat 30 residents could have been mobilized within1 hour. Reasons for delay included not carrying theirpagers, not receiving the page, or sleeping throughthe page (several were post-call).

Overall, a disaster phone tree appears to be an ef-fective method of rapidly distributing important infor-mation to a large number of people. Residents whodid not understand their roles in the phone treewere counseled. The importance of carrying pagersas a form of communication in the event of disasterwas re-emphasized to the residency as a whole. Thesedrills will be repeated to achieve a higher level ofcompliance.

Matthew Goldman, MDTodd Anderson, MDShahriar Zehtabchi, MDBonnie Arquilla, DODepartment of Emergency MedicineKings County Hospital Center451 Clarkson AveBrooklyn, NY 11215E-mail: Mattgoldman5@yahoo.com

References

1. Kaji AH, Waeckerle JF. Disaster medicine and the emer-gency medicine resident. Ann Emerg Med 2003;41:865-70.

2. Alexander AJ, Bandiera GW, Mazurik L. A multiphase di-saster training exercise for emergency medicine residents:opportunity knocks. Acad Emerg Med 2005;12:404-9.

3. Auf der Heide E. Disaster planning, part II. Disaster prob-lems, issues, and challenges identified in the researchliterature. Emerg Med Clin North Am 1996;14:453-80.

4. Klein JS, Weigelt JA. Disaster management. Lessonslearned. Surg Clin North Am 1991;71:257-66.

doi: 10.1016/j.dmr.2007.04.001

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