After experiencing the false missile crisis during a trip to Hawaii, Dianna E. Graves, COMT, BS ED, recommends ditching the old drills when it comes to crisis management. Instead, create a new conversation around agreed-upon plans and appoint trusted employee leaders who can keep others safe and calm.
How do I know? Because I have always thought my staff was ready for just about anything-but now I seriously wonder if I am being delusional.
We’ve trained, talked, and re-trained-and then have been tested out of the blue: the periodic patient “code,” the thankfully infrequent tornado warning, and blessedly rare fire alarms. In the past year or so, we have worked on our workplace violence training, in-office behavior scenarios between staff members, and how to identify the subtle behavior that would alert us that all might not be right in a number of given situations.
I slept well at night knowing in an emergency, we would shine through! Then I experienced something I never thought I would ever have to think about in my life. A text message reading: “BALLISTIC MISSILE THREAT INBOUND TO HAWAII. SEEK IMMEDIATE SHELTER. THIS IS NOT A DRILL.”
We had arrived late in Maui after a long day of travel from the Twin Cities to Hawaii to warm, tropical weather, but because the time change caught up with us, we were up and ready to roll at dawn’s way too early light. Off we headed for our first breakfast in paradise.
Looking out at the whales breaching the ocean and listening to the sounds of myriad island birds, we were starting to relax.
Off in the distance at the restaurant, I heard a phone message alert, and then another, and then our phones went off. Faces dropped and stared with wonderment at the message. The words “THIS IS NOT A DRILL” was burned into my vision forever. Our early-twenty-something waitress began sobbing-so we began to comfort her. She ran from the restaurant to get home to her family.
Now there were tsunami siren warnings throughout the entire resort and the town behind us. How could there be inbound missiles and a tsunami at the same time?!
Panic began to set in among the guests as we scurried trying to “do something” with no guidance. An overhead announcement came on with instructions that we should go to the outside foyer area and wait for further announcements -which never came.
Scrambling for a plan
It became clear too soon that the guests were on their own as staff after staff raced into the parking lots heading to their families.
A large number of us were there for a conference. We soon began to band together and our emergency training kicked in. We started with plans, and contingencies, and what we “knew” about this problem and what we could do-without knowing “where” we could or couldn’t go.
I ran out to the foyer and grabbed a hotel manager and asked her what she was hearing or knew.
She stated she didn’t know what to do because the computers and phones were down due to the amount of people on them. The airport was shutting. I was told to go to my room and wait.
Thirty-eight minutes later we received another text: “There is no missile threat or danger to the State of Hawaii. Repeat. False alarm.”
The following day, people spoke somberly as they asked, “Were you here for the alert?” and everyone was looking for “I survived the missile attack” T-shirts.
On Monday, I ran into another hotel manager. I identified myself as a manager in a medical office. I asked how much training they had had. He said, “We have hurricane training covered well, and fire training okay. We have recently all read an article on tsunamis-but all islanders are trained in this, so the hotel doesn’t do more.”
They also had yearly online training.
It really made me stop and think: What would my staff have done?
A missile crisis is so rare, I think we need to take that hopefully off the table. Let’s say it is a tornado, or a fire in the break room. Or worse: a patient coming through the front door with a gun. What would your staff do?!
Time is now to plan ahead
Here are a few points to consider in developing a plan now:
1. Look critically at the people that you have “leading” the staff in the clinic.
In most cases, we choose “Leads” in the clinic to do the everyday running of the clinic hopefully because of their ability to be strong in stressful situations. (Stress is not defined as dealing with an angry doctor because his brochures weren’t in the right file!) We choose Leads because they can keep others calm when chaos begins, keep further chaos from occurring, and know when to raise the flag to say they need help in getting a situation under control.
If the person you have chosen is short tempered, has poor communication skills, or isn’t respected by staff members, change your Lead. Staff handles an emergency starting from the top and working down.
2. Plan on your staff’s “shock reaction” and discuss this up front.
Looking at your staff in 2018, you may find that they comprise a mix of 50% under 30 years old and the other 50% over 30.
Discuss their roles in the clinic and patient care. How do they feel knowing a tornado is in their area and they have kids out for summer break? Do you have a plan if they feel they need to leave? Do you have a plan, so they can contact their families and get an idea of how they are doing so you can count on them here?
Who stays in the clinic and who goes (or as one of my gals so eloquently stated: “Sure, they expect the old bat to stay and deal with the patients while they head home to their families.”)
These are conversations that should be held up front, so folks are at least thinking about it.
3. Every time there is a tornado warning, flood warning, severe winter weather -or whatever your area potentially has -you should be using these as “drills.”
For example: Severe thunderstorms and potential tornado warnings were forecasted for the afternoon around one of our county offices. That morning, we discussed the bad weather potential. I ran down the “policy” again and discussed where the safe rooms were. We also discussed avoiding windows, ensuring patient safety, keeping a charged cell phone on at all times, and making sure they remembered we couldn’t force patients to stay (only strongly urge them to stay!). And then I discussed what they needed to do as a Lead: cell phone ready, first aid kit available and ready, flashlights, etc.
Do the best you can
You can never plan, or count, on the human element. In a true emergency, people will behave the way the situation dictates. I have learned from these very crises that people will also rise up and shine when they feel informed, empowered, and “practiced” as to what to do in a given emergency.
Your staff needs training and reminding of the fact that they are medical professionals whose job it is to protect not only their patients, but also themselves.
Remind them you are fully aware that they are mothers and fathers, and daughters and sons. When they realize that you know this, and appreciate it, they will often step up in ways that will inspire you. Give them the tools, and the chance to do so, and watch them shine.
Dianna E. Graves, COMT, BS ED
Graves is a clinical services manager at St. Paul Eye Clinic PA, in Woodbury, MN. Graves is a graduate of the School of Ophthalmic Medical Technology, St. Paul, MN, and has been a member of its teaching faculty since 1983.