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U.S. Department of Health and Human Services

3.3 Initial Notification/Activation

    Once it is determined that an incident exists for the Healthcare Coalition, initial notifications must be made and the appropriate level of activation for the HCRT should be determined. These steps occur almost simultaneously, so initial notification/activation is presented here as a single response “stage.”

    The decision to activate the HCRT may best reside with the Coalition Duty Officer, with the authority having been conferred by the Coalition member organizations. The initial HCRT activation level may range from a single staffed position (HCRT Leader) to the staffing of all positions in the HCRT. Activation of the HCRT Leader position is differentiated from the baseline Duty Officer position by increased liaison activity between the HCRT and Coalition member organizations (Exhibit 3-3), as well as additional responsibilities.

    Exhibit 3-3. Example of incident recognition and activation of the HCRT for an anticipated need

    In late summer 2008, a long-term care facility in Washington, D.C. experienced a failure of its HVAC system on a warm day. It was unclear when repairs could be made and so the long-term care facility notified the Washington, D.C. Emergency Healthcare Coalition Duty Officer. An “alert” message was sent to Coalition member organizations, and the HCRT was activated with only the HCRT Leader and organizational liaison positions staffed. Coalition members were canvassed for possible bed availability in case patient evacuation was initiated at the impacted facility. Bed numbers were aggregated by location and bed-type, formatted, and provided to the affected organization. Multiple situation updates were provided to Coalition members before, fortunately, the HVAC repairs were completed. Evacuation was not necessary, and the HCRT demobilized.

    3.3.1 Definition and Implications of “Activation” for the Healthcare Coalition

    Activation of the Healthcare Coalition requires rapidly staffing the designated HCRT positions. It begins with the Coalition Duty Officer either transitioning to the HCRT Leader position, or assigning another qualified individual for that role. The HCRT Leader designates which HCRT positions should be initially staffed based on the parameters of the incident. Activation messages to the personnel designated for these positions can occur in multiple ways but may best be handled via the Coalition Notification Center.

    Pre-established HCRT activation levels, with the HCRT positions required for each level, may expedite the decision process. Candidate activation levels for the HCRT are:

    • Partial HCRT Activation: This entails minimal staffing of the HCRT at a pre-established level, but is less robust than a “full” activation. It may include activation of only a single position within the HCRT (HCRT Leader, see Exhibit 3-3).
    • Full HCRT Activation: Personnel are assigned to all defined HCRT positions. Because the Coalition’s response is scalable, the HCRT may initially activate only a single position and rapidly scale to full activation as specific response needs are identified. Conversely, an initial full activation of the HCRT may be scaled back if the situation is less complex than first indicated.
    • HCRT Alert: This level requires no specific response actions by notified personnel. The requested activity could be as simple as monitoring an incident for further developments and ensuring availability for immediate activation, if indicated. In this way, a more rapid activation can be accomplished. In addition, some limited contingency planning could be conducted by the Duty Officer in case the situation evolves.

    3.3.2 Notification Messages and Recipients

    Notification messages provide information about the situation, describe current Coalition actions, such as HCRT activation, and include recommended or requested actions on the part of the notified entity.

    Notification is best conducted when using pre-established urgency categories and message templates. The message should convey the relative importance of the situation and specify the need for any relevant response actions on the part of the recipient. Exhibit 3-4 presents sample categories for notification messages to Coalition member organizations. This specific categorization is also used by Federal and other response agencies. It is most important, however, that the Coalition consider using categories that are consistent with its local jurisdictional authorities (Tier 3) and its member organizations (Tier 1).

    Exhibit 3-4. Sample notification categories for information provided to Coalition member organizations.

    • Advisory: Provides urgent information about an unusual occurrence or threat of an occurrence, but no action by the message recipient is expected. An advisory may include actionable information for individual personnel at Coalition member organizations even though the organizations may not need to take emergency action (e.g., a weather advisory that includes travel precautions for individuals).
    • Alert: Provides urgent information and indicates that some response action on the part of the message recipient may be necessary. An alert may also be used to notify Coalition member organizations that the HCRT has been activated. This category may also be used for ongoing notification during an emergency to convey urgent information and recommended actions from the HCRT or incident command authorities.
    • Update: Provides non-urgent incident information and suggests no urgent actions. This category is used in both emergency and non-emergency times (e.g., notification of a preparedness meeting may be sent as a Coalition update message.)

    Adapted from Barbera JA, Macintyre AG, Shaw G, et al, Emergency Management Principles and Practices for Healthcare Systems. Department of Veterans Affairs, Veterans Health Administration (2006); Available at:

    The recipients of initial and follow-on notifications can be easily pre-identified and categorized into call groups. During any HCRT activation, the following should receive an initial notification message:

    • Personnel expected to staff the HCRT or who are placed on standby status.
    • Coalition members (Tier 1) should be notified of any HCRT activation through an Alert message, even if there is no request for information from them. The Alert message should request that each member organization designate a liaison to be a point of contact for the HCRT (i.e., the Organizational Liaison). The liaison monitors HCRT messages and responds to any information requests. Healthcare organizations are responsible for disseminating these notifications within their own institution.
    • Jurisdictional authorities (Tier 3) should also be notified when the HCRT is activated. This helps integrate the Coalition’s response with the larger community response and may provide Tier 3 entities with critical information they don’t already possess. Methods for notifying Jurisdictional Agencies (Tier 3) should be established during preparedness and accomplished through a single point of contact (e.g., jurisdictional EOC, Dispatch Center, or Department of Health Operations Center). Because not all communities have well integrated communications between public sector entities, individual notification to specific entities may be required.
    • Other regional Healthcare Coalitions should be notified if the HCRT is activated to enhance regional situational awareness.

    Notification messages should be concise and provide the appropriate urgency category. Methods can be established to convey more detailed information as it becomes available, such as posting this information to a password protected web page. Important elements in the notification message include the following:

    • Brief description of the threat or hazard impact
    • Brief description of the implications of the incident for Coalition member organizations, including any projected response actions (e.g., “healthcare facilities should anticipate significant numbers of casualties”)
    • Specific recommended actions for individual Coalition member organizations and/or HCRT staff (e.g., requests for initial information about the hazard impact on member organizations)
    • Request for confirmation that the message was received by the intended recipient
    • Indication of when the next message will be provided, if known
    • Time and date stamp indicating when a message was sent.

    Exhibit 3-5 provides an example template and notification message that a Healthcare Coalition might send to its member organizations.

    Exhibit 3-5. Example Healthcare Coalition Alert for a train derailment

    “This is an Any City Healthcare Coalition Alert (3/29/09 1630 hours). Train derailment with release of hazardous materials, including chlorine gas, near intersection of Route XX and Highway YY at 1610 hours. Area residences are being evacuated. No casualties have been reported at this time. The evacuation order may extend to Happy Times Chronic Care Facility. All Coalition member organizations are asked to provide bed count in case this facility is evacuated. Situation update message anticipated at 1700. Confirm message receipt at [web site address] and provide operational status.”

    3.3.3 Notification Methodologies and Requirements

    Appropriate technology that is fast and reliable is required to send emergency notifications. It is important that the notification message is not easily overlooked by the intended recipient or buried in similar appearing but less urgent messages. This can be a common issue when fax is used for notifications, since fax machines are rarely monitored closely during normal operations. When using text or voice messaging, the Coalition’s name and the urgency level of the notification should be given at the beginning of the message to distinguish it from other messages. Another issue to consider is the truncation of messages by pager systems, since Coalition participants may have different pager vendors with varying message capability.

    Available technologies for emergency notification include:

    • Radio systems in which receivers are always on and near permanently staffed areas
    • Mass text messaging systems (e.g., Health Alert Network (HAN) systems)
    • Reverse 911 and other mass telephone dialing with recorded voice messaging technology
    • Web-based messaging services that target computers that are always staffed
    • Mobile web receiving devices and other emerging technology.

    Because initial notifications are so important, ideal solutions may combine several technologies that offer redundant capabilities. For example, an initial Alert message may be transmitted using the HAN or other messaging system that transmits messages through multiple modalities (text, email, and telephone voice message). The message may refer the recipient to a password protected web site for further information and prompt the recipient to confirm receipt of message and convey a current operational status. Any targeted individuals and organizations not confirming message receipt in a specified time period may then be contacted through alternate methods.

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    • This page last reviewed: February 14, 2012