1. Communication and Team Coordination in Crisis Management Larry Gibbs, CIH - Associate Vice Provost Ellyn Segal, Biosafety Manager Stanford University

2. Overview Case study review of bioterrorism event at Stanford Planning Approaches to Emergency Preparedness Communication challenges as critical part of crisis and recovery management

3. The four confirmed anthrax letters:

4. Events at Stanford Oct. 22: 9:00 am, Risk Management employee received sealed letter marked confidential and proceeded to opened at desk. White powder came out onto employee and surrounding area. Employee calls for assistance (additional office employee exposed), police and fire notified. Stanford EH&S responds. (Time 0) Stanford Police go into office of victim, assess incident (two police officers exposed). Victim remains at desk. (10 min)

5. Letter within envelope deemed a credible threat by Stanford Police: (death threat, ethnic slur, indication of lethality of powder.) FBI notified, agree with credible threat; agents arrive on scene. Building evacuated ( 150 people) Stanford Police, FBI, PAFD, Stanford EH&S on- site (20 minutes) Decision made to decontaminate personnel (2 staff, 2 police officers) (45 minutes)

6. Palo Alto Fire Dept. and Stanford EH&S HazMat set up to remove victims from office. (75 min) Decontamination of personnel proceeds within building, all clothing removed and bagged. (2 hr) Victims seen by SUH Emergency Dept. (4 hr) Building remained closed until evaluation of sample for anthrax finalized (48 hours) and decon. of immediate area completed. (52 hr) Building cleared for occupancy (54 hr) Re-occupied (72 hr)

8. PROBLEMS Multiple additional personnel contaminated –Victim + three additional people contaminated Length of time to determine how to decon victims –Victim remained seated at desk for two hours before being taken for decon inside building –Multiple questions as to procedure(s) for decon –Lack of privacy for decon –Lack of supplies for victims (clothing to supply to victims post decon)

9. Communication within Stanford University Hospital Emergency Dept. ineffective –Victims initially refused entry into ED by staff –Almost 6 hours until medical treatment obtained Authority to test powder from envelope unclear; local county Public Health Laboratory requires sample to be delivered and tested under their auspices, but were not accepting environmental samples at that time. FBI takes sample to State Lab for testing. (EH&S retains split sample of material, after anthrax results known, start battery of analysis)

10. Other Issues Main administrative building, including HR, controller, payroll functions People left building without car keys, pocketbooks, airplane tickets, briefcases, etc. How to maintain administrative functions during building vacancy – alternate location for employees to work on campus? Many issues to re-occupancy

11. Post-event State lab determined sample not anthrax (48 hrs after sample received), nature of sample unknown Building re-opened three days after incident –Office where letter opened cleaned by EH&S HazMat team –Ventilation system cleaned by HVAC personnel, air filters changed –Re-occupancy issues for personnel Debrief of response teams and interactions –Crucial for learning to take place

12. Stanford Incident #2 Oct. 30: same employee manager received and opened letter addressed from labor law firm containing white powder and another written threat intimating this powder was the real anthrax. Employee and immediate environment contaminated. Building evacuated Police, Fire, EH&S respond, building evacuated (all within 15 min) One police officer exposed, remained with victim

13. Letter deemed credible threat FBI notified and responded STAT members assembled on site – coordinated and directed response activities Victims removed from scene, decontaminated (under 1 hr), evaluated at SUH ED (immediately seen by physician) EH&S HazMat staff collected evidence from scene, decontaminated equipment and area. Building re-opened within 36 hrs of incident.

14. Analysis of Powder Contents of envelope aliquoted for evaluation –FBI: State lab for analysis –Stanford University: EH&S Haz Cat Biological culture (Biosafety) Chemical analysis –Stanford Chemistry Department

15. Results Sample negative for B. anthraces, no culture growth on plates at 48 hrs (in house) FBI: neg. for Anthrax, no biological material Chemical analysis: (Chemistry department) –Not corrosive (pH) –Not volatile (Gas Chromatograph-Mass Spec) –Not a protein (Ion-Spray Mass Spec) –Low Molecular weight polymer (High Pressure Liquid Chromatography-Mass Spec) –Small amounts of agricultural chemicals (I.R.) low-grade pesticide identified

16. Follow up Stanford University Police, together with EH&S HazMat and Biosafety, worked together to create Hazardous Material Flow Chart SUMC Bioterrorism Plan EH&S In-house analysis capability Refinement of Emergency Response at Stanford

18. SUMC created Bioterriorism and Emergency Preparedness Task Force – has representation from all relevant departments in SUMC, University EH&S and the School of Medicine – tasked with coordinating SUMC disaster planning with Federal, State, County and Local directives – Web site www.stanfordhospital.com/forPhysiciansOthers/bioterrorism/bioterrorism. html www.stanfordhospital.com/forPhysiciansOthers/bioterrorism/bioterrorism. html – published Bioterriorism and Emergency Preparedness Plan for clinical aspects of bioterrorism Two pronged: clinical pathways (individual patients) and total hospital response

19. Increased ability for in house testing for biological agents Laboratory set up within EH&S with capability of working with samples –Culturing, Gram stains –Rapid tests for: Bacillus antracis (anthrax) (Tetracore) Yersinia pestis (plague) Staphylococcus aureaus (endotoxin B) Botulinum (toxin) Ricin Tularemia

20. Make sure you know what and other duties as assigned means in your job description… SU Biosafety Manager

21. Communications –the other emergency Among emergency responders Upward within organization To affected individuals –Direct victims –Indirect victims To the rest of campus and community

23. Three Emergency Levels 3Disaster (involves entire campus and community) –University EOC, all 26 SOCs, all Departments –Coordination with local, county, state, federal agencies 2Major Emergency (Impacts sizable area, life safety or critical functions) –EOC Operational Directors –Mini EOC=Situation Triage and Assessment Team (STAT) –Affected SOCs and Departments –Possible involvement of local or county agencies 1Minor Incident (resolved with internal resources, no program disruption, service unit daily activity)

24. Level 2 Emergencies Incident with potential for significant impact to portion of the campus or community Has multi-department response needs (public safety, EH&S, Facilities Operations; fire department, etc.) Has internal and external communication needs Does not require activation of EOC Examples: –Major hazardous materials incident (toxic gas release with fire department involvement) –Electrical outage affecting portions of campus –Major Fire in building(s) –Public Safety threats Bio-terrorism threat Bomb threat

25. Communications: Among Emergency Responders Responders Police FBI fire department EH&S Haz Mat Biosafety Sr. Administrators Issues Whos in charge? –Possible crime scene Who leads response effort? –Life safety/haz mat Who provides support?

26. Situation Triage and Assessment Team (STAT) Role is to evaluate, manage and resolve mid-level emergencies Members are heads of: –Public Safety –EH&S –Lands and Buildings –Facilities Operations –Capital Planning and Mgt. –Communications –News Service –Additional contacts as needed from campus

27. EH&S VP, L&B Facilities Operations CP&M Communication Services News Service Public Safety Situation Triage and Assessment Team (STAT) Incident Commander Incident Commander may be any one of the heads of the STAT units, depending upon the nature of the incident. Addtl. Specialist

28. Situation Triage and Assessment Team (STAT) Incident commander of team is dependent upon the nature of the incident (e.g., with a crime scene, Chief of Police is incident commander; haz mat incident – EH&S lead person, etc.)

29. STAT Process Initial Incident OSU 322-8721 Assessment Conf call or on-site STAT Assessment Situation Deactivation Management

30. Methods of Initiating Communication OSU to STAT –Cell phone/pager alpha message with info and direction to team for contact STAT link-up –Conference call at pre-determined time –Meet at site

31. Communications –the other emergency Among emergency responders Upward within organization To affected individuals –Direct victims –Indirect victims To the rest of campus and community

32. Communication to Senior Administrators Need to designate who (one individual) will communicate upward in organization on emergency status- (Incident Commander/designee) Need clear messages on status reports Determine whether any institutional policy decisions are needed from the top. (e.g., close campus) Provide regular updates on critical matters.

33. Communications –the other emergency Among emergency responders Upward within organization To affected individuals –Direct victims –Indirect victims To the rest of campus and community

34. To affected individuals Direct victims –During incident, rescue and decontamination –After immediate emergency Indirect victims (others in affected building) –During the incident (whats going on?) –After the incident (maybe I was exposed too?) –Building re-occupancy (is it safe?) –Psychological impact (fear; blame the victims)

35. Communications –the other emergency Among emergency responders Upward within organization To affected individuals –Direct victims –Indirect victims To the rest of campus and community

36. THE MEDIA !!! (have a plan) Faculty and Staff Students Nearby community Parents of students Governmental and regulatory jurisdictions

37. To the rest of campus and community Use single, central, credible source (Public Information Officer) Ensure accurate information is available, do not speculate All messages go through one source Mechanisms for information dissemination –hot line phone with recorded message –Campus news website –E-mail distribution lists

38. Crisis Communication vrs. Risk Communication Crisis Communication Warning people is priority Communication logistics likely to be difficult Audience often bigger Outrage management matters less Risk Communication Reassuring people Can plan logistics of communication Smaller number of stakeholders, usually Outrage recognition and management critical Often follows a crisis event, during recovery

39. Conclusions Bioterrorism threat has created new issues for emergency planning and response– STAT process works well for this type of emergency Demonstrated need for increased self-reliance by institution Refocused hospital ED on haz mat-related issues CBR Terrorism needs to be part of all emergency planning Ensure good communication procedures are in place Significant public relations/communications issues with aspects of dread and fear caused by terrorism threat Understand the difference between crisis communication and risk communication and factors involved in each