Crisis Management and Emergency Preparedness
ACHA’s Emergency Planning Guidelines for Campus Health Services: An All-Hazards Approach serves as the exemplar of how campus health and wellness centers should prepare and/or respond to emergencies.
Our campuses, including our health and wellness centers, must prepare in order to enhance resiliency and minimize risk, injury, mortality, or business disruption that inevitably follows emergencies. This article will focus on emergency management via an all-hazards approach, communication, management of disease outbreak, campus violence, natural disasters, and mass casualty incidents, and postvention.
An all-hazards approach can be tailored to manage any type of emergency regardless of the hazard that caused it. It uses a national framework that can be customized to meet campus as well as health/wellness center needs. This framework, the National Response Framework (NRF), defines strategies for prevention, protection, mitigation, response, and recovery.
These five elements can be met by developing an emergency operations plan (EOP). There is usually a campus EOP plan as well as departmental emergency operations plan (DEOP). An example of a DEOP template can be found here under Campus Emergency Plans. The DEOPs should align with the campus’ overall plan. Recovery strategies should also be a part of the EOP. Information about disaster recovery can be found here. Key elements of disaster recovery include After Action Reports and revision of EOPs to incorporate lessons learned during the emergency. EOPs should be living documents and reviewed on a regular cycle, minimally every two years or following an emergency/disaster.
Under the NRF, training is an important component for preparedness and response. This initial staff training educates staff on basic principles and understanding of the terminology, and on-going training gives staff practical experience.
Initial training of staff should include the following free, online courses:
- IS-100c. Introduction to the Incident Command System (ICS)
- IS-200.c Basic Incident Command System for Initial Response (for staff taking on supervisory roles during an emergency)
- IS-363: Introduction to Emergency Management for Higher Education
- IS-700.b: An Introduction to the National Incident Management System
- IS-800c: National Response Framework, an Introduction
- IS-830: Introduction to NRF Incident Annexes
- IS-2900.a: National Disaster Recovery Framework (NDRF) Overview
On-going training should occur at regular intervals and should include seminars, tabletops, drills, and full-scale exercises as applicable. Not only are these tools for practical learning, they can also be instrumental in the revision of EOPs.
Not enough can be said about the importance of communication during a crisis or emergency. This topic is extensively covered in the ACHA guidelines, the NRF, and NDRF, and on the web. The Chronicle of Higher Education has an article entitled “A Crash Course in Crisis Communication”. The organization HigherEd Live has a podcast entitled “Campus Crisis Management and Communication”. The U.S. Centers for Disease Control and Prevention (CDC) dedicates part of its Emergency and Preparedness website to Crisis and Emergency Risk Communication (CERC). CERC program provides training, presentations, as well as a manual and tools for communication during a crisis and emergency.
Types of Communication
Routine—when telecommunications is operational:
- Internal communication is for constituents on campus and can be conducted via campus and health center websites and social media accounts and the phone (cell and/or landline).
- External communication is for those outside the campus community including parents/relatives of students and employees, and the surrounding area. If the incident is of large enough magnitude, it could become of national prominence. If the health center is the focus-point of the emergency, administrators need to adhere to campus policy regarding the provision of emergency-related information to the public and/or media.
When telecommunications are non-operational:
In an emergency situation, the health/wellness center must still be able to communicate with its staff despite any absence of telecommunication systems. This may be achieved in a number of ways including
- Hand-held radios on which the frequency (channel) can be predetermined.
- An app such as Zello, which allows cell phones to work like a walkie-talkie.
- Face-to-face interaction where designated staff are tasked with delivering messages in person to other staff.
Disease outbreaks can affect students’ health as well as the interrupt their education and disrupt the normal operations of the university. It can also disrupt the normal operations of the health center, especially if large in scope and/or staff becomes ill. Many communicable diseases are vaccine-preventable; therefore, outbreaks can be prevented with adequate immunization and herd immunity. Other diseases, such as norovirus, could possibly be prevented through education, proper hygiene, and self-isolation.
Some disease outbreaks that could occur on campus include:
- Hand, foot, and mouth disease
The health center may be the first to recognize the outbreak of a contagious disease. Local community providers who routinely see students from campus may also recognize an outbreak.
Once an outbreak has been verified, the health center should take the lead in notifying the campus community to ensure appropriate preventative measures are in place to reduce further spread of the contagion.
Notifying students, faculty and staff: if the university, has an emergency alert, warnings, and notifications (AWN) system in place, it should be used in addition to the health center’s website and social media accounts.
Notifying administration: depending on specific campus protocol, meetings may need to be held with the campus emergency management team and/or campus administration to strategize how to best respond.
Notifying local health department: if the disease is reportable, the local health department must be notified and possibly brought on board.
Containment strategies may need to be implemented whether or not a major outbreak is declared. Decreasing exposure to contagions may involve isolation and quarantine and/or social distancing. Social distancing may involve the personal use of N-95 disposable masks, increasing physical space when individuals converse, and the cancellation of classes and campus events.
Sadly, violence such as a shooting can and probably will happen on your campus. Unfortunately, there is no way to know when such an incident will occur. Despite the safety measures instituted since the Virginia Tech incident, campus shootings and other acts of violence continue. According to Campus Safety Magazine, there were 190 campus shootings between the academic years 2001-2002 through 2016-2016. Campuses and their health services need to know how to respond to an incident. Campuses may also experience civil unrest due to differing politics, social issues, discrimination, or even following victory or defeat for an athletic team.
There are multiple ways to prepare staff for potential violence within and outside of the health center.
To prepare for a shooter within the health center, consider the installation of panic buttons in key areas to notify staff and campus police. Consider the use of code words/phrases announcing a shooter in the building. For example, if you have a paging system in the health center, a “Code Silver” could be announced to alert staff. It should be a word or phrase which has been distributed to all staff and easily recognized by staff. A code word or phrase to designate “all clear” will signal the staff when it is safe to return.
Training that targets general workplace security can be found here.
Follow campus procedures when there is an active shooter elsewhere on campus. This will probably include sheltering in place and securing of the health center’s building to prevent the shooter from gaining access.
Civil unrest: although rare, there could be civil unrest at the health center if students are not content with the type and/or quality of care available and decide to protest. Unfortunately, the protest could escalate. Staff should be prepared to shelter in place or evacuate depending on the magnitude of unrest.
Natural Disaster or Emergency
Natural disasters/emergencies are those events caused by weather or environmental conditions and can cause destruction of property and loss of life. An emergency is usually smaller in scale and can be handled locally. A disaster is typically widespread and requires response outside of the local area. The most prevalent natural hazards in the United States include:
An event that causes an unusually large number of patients to present to the health center at one time would quickly overwhelm the resources of the center. This would be deemed a mass casualty incident which may be the result of a traffic accident, bombing, active shooter, or explosion involving an extraordinary number of people. First responders from the local community may or may not be able to respond; therefore, the health center and the campus must be prepared to respond to such incidents. FEMA offers an independent-study course on preparing for mass casualty events; it can be found here.
The health center should be prepared to deliver triage and treatment services to the best of its abilities. The center may be called upon to assist local first responders.
- Triage will involve making decisions about who to treat or not treat. One way in which this can be done objectively is with the START protocol.
- Treatment will be determined by the capabilities of the staff and the center’s other resources including equipment, supplies, and physical space.
- Document these capabilities in the EOP for campus and the DEOP for the health center. The campus should have Memorandum of Understanding (MOU) in place with local first responders as allowed by campus policy.
Postvention is a coordinated crisis response normally associated with suicide prevention, but it can also be implemented following any student death or traumatic event. The following points should be considered following the death of a student on campus.
- Family notification should be per university protocol. Protocol could dictate that the health center’s administrator or another campus administrator (e.g., vice president or assistant vice president) personally notify the family of the deceased student.
- Ascertain if the student was a health center patient. If so, the administrator, or designee, should review the bill and handle appropriately. It may or may not involve not billing and/or refunding for specific services.
- Mental health and counseling services should reach out to students who may have had a class, shared living quarters, or been friends with the deceased student. Faculty and staff who may have taught or interacted with the deceased should also be contacted by the appropriate department (i.e., a Faculty and Staff Assistance Program).
- Though mental health professionals typically lead the response, a network of campus and community resources including academic support, trained peers, religious community and law enforcement could augment the response.