In Times of Crisis

In 1992, when a gunman took several employees hostage in Duke Hospital, the best way for university officials to notify and update key people around campus was to send out faxes.

"We were standing by the fax machine, sending updates to the deans and others every 10 minutes or so. That was the technology we had at the time," said John F. Burness, senior vice president for public affairs and government relations of the situation that ended when a Durham police sniper shot and killed the gunman. No members of the Duke community were injured in the incident.

Since then technology and emergency response procedures have changed. Now, in the aftermath of last week's Virginia Tech shootings, Duke and other institutions are reviewing emergency response and notification procedures.

In the Hospital

Duke Hospital has an Emergency Management Plan to protect staff, patients, and visitors and to continue hospital operations in the event of an emergency or disaster. The plan activates HEICS, the Hospital Emergency Incident Command System, a model incident command system of managing emergencies

The system has designated emergency codes, which are standardized color codes depicting the type of emergency. The codes are:

• Code Blue (Medical Emergency) -- Call for help (115). Administer aid (CPR) within your level of training.
• Code Gray (Security Alert) -- Call 911 to report all security issues. Stay clear of areas identified in the Code Gray.
• Code Pink (Infant Abduction) -- Call 911 to report a missing infant. Be alert to suspicious behaviors and infant-sized packages. Do not confront abductors.
• "This is a drill" (Code Red)(Fire Alarm) -- Sound the alarm using the pull station in the area and call for help (911). Follow your site specific fire plan. Use RACE and PASS. Know how to respond if the alarm is not in your area.
• Code Orange (Hazardous Materials Incident) -- Call 911 to report hazardous materials (hazmat) events. If the situation warrants, a Code Orange will be declared for significant events. Follow the directions of the incident commander and spill team.
• Code purple (Critical Saturation) -- Inpatient units should assess their census and be prepared to take an additional patient or patients.
• Code triage (Mass Casualty/Emergency Response Plan Activation) -- Do not call the operations administrator unless you have an emergency. Follow your unit subplan's mobilization procedures. Await further instructions from the Emergency Operations Center.
• Code Black (Utility Failures) -- More information will be forthcoming.
• Weather warnings (tornadoes, hurricanes, severe thunderstorms, and winters storms) -- More information will be forthcoming.

(This article originally appeared in INSIDE. For more on the hospital's emergency plan, click here.

Last week, many Duke faculty, staff and students were asking Duke officials what the university would do in a situation similar to Virginia Tech and how they would notify the community. Executive Vice President Tallman Trask asked Kemel Dawkins, vice president of campus services, and Aaron Graves, associate vice president for campus safety and security, to review Duke's emergency preparedness. (For Trask's comments to the Academic Council Thursday, click here.)

One Duke employee who wrote the police said he understood it was difficult getting good information out very quickly. But he said he wanted to know how police would make use of the latest technology to notify Duke employees.

"Obviously, we want to hear as soon as possible when there is a potential problem," said Lawrence "Doc" Muhlbaier of medical center biostatistics and bioinformatics. "I know the police are often working with partial information, so the notice may well be less complete than I, or they, would like."

Duke Police conducts regular emergency response training based on a recently developed plan, said Graves, who came to Duke in January 2006 from the University of Southern California, where he had years of experience of emergency preparedness in earthquake-prone Los Angeles.

"We are trained and equipped to respond to these kinds of situations," Graves said. "Our training is for initial response and communicating about the situation to the public. Our job is to contain, but part of containment is notifying people in the area."

If an emergency occurred, Duke Police would use a combination of methods to notify the campus, using both high and low technology.

• Telephone notification. Police have phone trees for every building, starting with a building or facility manager. This would be an initial step, with the manager contacting others in the office. If the manager is not immediately available, police have back-up numbers to call, Graves said.
• E-mail blast. Although e-mails can be sent to all members of the Duke community, this could be a lengthy process and not necessarily conducive to all emergency situations, Graves said. Instead, Duke is evaluating a notification system it piloted earlier this year that can target messages to specific groups by phone, pager, text message and e-mail.
• Public address systems. Many buildings include PA systems that can get messages to specific buildings quickly.
• Text messaging. Currently, Duke has an operational text messaging system in place and is exploring options for an enhanced text messaging system that could broadcast emergency messages.
• Websites. Initial notices will be posted on the Duke university homepage with updates also on Duke Today.
• Direct contact. Police runners can be sent to specific buildings to alert people.

"There is no one method that is foolproof," Graves said, "so we use a combination of methods in our attempt to contact members of the Duke community as quickly as possible.

"As part of our review, we're looking at the issues that showed up in the Virginia Tech shootings and in other incidents," he said. "Part of that process is looking at how we communicate information and whether people know what to do in an emergency. That is going to be an important part of this review, and that process will be ongoing. We will never stop reviewing our emergency preparations because situations and technologies change."

Graves also has several tips for Duke community members in an emergency:

• Report suspicious behavior. "People should err on the side of safety," he said. "Please let us know anything that causes you to be uncomfortable."
• Follow alerts seriously. "If you receive a notification to leave or remain in your building, please don't take it lightly. Too often we have a fire drill and find that people remain in the building. In these situations, we need people to follow instructions without question.
• Share information. "Because we can't contact everyone, people who do have the official information need to share it with others," Graves said.

Graves said that Duke officials are not just trying to respond to the latest crisis but rather are trying to anticipate the most likely future threats.

"Most of the key things that we worry about in our environment are fire and severe weather, events that are the most likely to occur," he said. "Since 9/11, we also have kept in back of our mind and in the forefront of our plans that universities can be terrorist targets."

In fact, he notes that emergency preparedness has improved following more than a year of discussion with Duke Hospital on responses in case of flu pandemics.

"What we learn from preparing for one kind of emergency is helping us prepare for other kinds," Graves said.