Boston Hospital’s Focus on Preparedness Paid Off During Marathon Bombing

Post by: Kim Stephens

September is National Preparedness Month, so it seemed worth noting a story that appeared on NPR that discussed organizational preparedness.  The interview was on NPR’s “Here and Now” and  was with Dr. Ron Walls, Chairman of the Department of Emergency Medicine at Brigham and Women’s Hospital in Boston,  and Dr. Richard Zane,  Chairman of the Department of Emergency Medicine at the University of Colorado Hospital in Denver. The topic and title:  Before Marathon Bombings, Aurora Helped Boston Prepare. Several things in this interview stood out: 1. Drills and exercises won’t measure your ability to respond to a worst case scenario unless you test the worst case scenario;  2. It’s OK to question your state of readiness; 3. Twitter and social media matter; and 4.  The lessons we can learn from others in our profession are invaluable.  (CBS News did a similar story and the YouTube video of it is embedded below.)

Are We Ready?

In this interview, Dr. Walls noted that their hospital did 70 drills in the previous six years, and he thought they were prepared. However, Dr. Zane provided information about the Aurora movie theatre shooting that made him question his underlying readiness rational. Dr. Walls stated “In all of our planning…we had never drilled for receiving more than 12 patients per hour.”  In Colorado, however, instead of 12 per hour, the University of Colorado Hospital received 23… in rapid succession. This information left Dr. Walls wondering:  “Oh my goodness, are we really ready for this?”

Dr. Walls pulled together his Disaster preparedness committee and said: “I want to tear this up [their preparedness update to the Board] and start all over.”  His new theme became:  “Are We Ready?” He said in the interview, “I wanted to ensure we could do this, and I didn’t think we were ready.”

Twitter Matters

One thing noted in the NPR piece was the importance social media played in providing information from the scene. When the bombing happened  staffers at some Boston hospitals found out about the event when they saw Tweets alerting them to tragedy from doctors positioned at the finish line.  This had an impact–for instance, at Mass General an anesthesiologist suggested immediately stopping all elective surgeries.  The report, “Twitter as a Sentinel in Emergency Situations: Lessons from the Boston Marathon Explosions, was referenced by the NPR host in which researchers found that Tweets sent from the scene appeared 6 full minutes before hospitals were notified by Public Health Officials. This information has left some hospitals asking: Can we use social media more effectively?

Prepare to Support the Staff

On a final note, Dr. Walls said that when the dust settled  he called Dr. Zane and asked him what he had done wrong in the first 48 hours after the movie theatre shooting. The answer came down to supporting the staffs’ emotion needs. Dr. Zane told him:

“Think of all the intensive emotional support you need to provide to your staff. Think of it in the most generous way… and then triple it.”

One piece of irony: the Brigham and Women’s Hospital received exactly 23 patients.

Listen to the Story Here:

• Before Marathon Bombings, Aurora Helped Boston Prepare (wnyc.org)
• How Colo. shooting massacre aftermath prepared hospitals (cbsnews.com)

More Research on Boston Marathon Official Twitter Activity #SMEM

Post by: Kim Stephens

Project Hazards Emergency Response and Online Informal Communication (HEROIC)* has posted two more reports that describe their research around the use of Twitter by public safety organizations during the aftermath of the Boston Marathon bombing (see the complete citation at the end of this post).  You can read them in their entirety by clicking the hyperlinked titles and then choosing “Research Highlights.”

• Tweeting Boston: The Influence of Micro-structure in Broadcasting Messages through Twitter
• Tweeting What Matters: Information, Advisories, and Alerts Following the Boston Marathon Events

Below, I briefly describe both of these reports and provide the most significant findings.

Emergency services working after the 2013 Boston Marathon Bombings

 Micro-structure in Broadcasting Messages

The Microstructure report reviews  “conversational microstructures.”  They specifically examined whether or not Federal, State or local entities took part in or were the focus of the conversation on Twitter.  For the purposes of the study,  conversational Tweets were identified if they included a hyperlink, a hashtag, an @ message  or were ReTweeted, each of which  “…signify varying dimensions of online engagement…. Aspects of conversational microstructure use are of interest because they provide insights into which Twitter messages are amplified and why.”

Findings

By studying the data in a systematic fashion (which they describe) they found something very interesting regarding the use of hashtags–by now a common item  in public Tweets, especially for advance notice events.  They discovered that even though this crisis lasted a week, there was NOT a consistent use of one particular hashtag by public safety organizations. They state:

While there were a series of events throughout the week, including the detonation of improvised explosive devices at the beginning of the week, the killing of a police officer at MIT, and the lockdowns of Boston and Watertown, there was no indication that a consistent hashtag emerged or trended among official organizations to organize their content into a traceable stream.

That finding, in my opinion, can be turned into a simple take-away lesson:  agencies that are part of the Joint Information System should immediately determine which hashtags will be used throughout an event to ensure the broadest possible message distribution (of note, the public initially used the tag #BostonMarathon, which was rarely used by public safety organizations). Furthermore, this could have easily been something decided upon when planning for the marathon. The researchers note:

Hashtags that were utilized varied by sector, such as #tweetfromthebeat, #WANTED, and #CommunityAlert by law enforcement, and #oneboston from local government, indicating different aspects of the response.  However, a single hashtag, related to the weeklong investigation and subsequent manhunt and capture, did not emerge.

Tweeting What Matters

Increasingly there are a variety of systems or channels in place to notify the public about what protective action measures they should take before, during or immediately following a crisis event. These systems include everything from the Emergency Alert System–which should reach almost everyone, to targeted text messages from local Universities,  to reverse phone calls from local government, to opt-in mobile applications from the State, etc., all of which were used at some point during the manhunt stage of the crisis. The Project HEROIC report, however, specifically examined Tweets that were posted that contained guidance  to  shelter-in-place, therefore “discussing the role of Twitter as a redundant channel for risk communications.”

Findings

Interestingly, they found that during the immediate aftermath of the bombing (on Monday) there were not a lot of official Tweets providing direction to the public. They speculate why: “…few [protective action] guidance-related tweets were posted, possibly signifying the lack of certainty about the event, the speed at which it unfolded, and having little information regarding what people should do in response.  However, at the end of the week, guidance tweets became more prevalent and focused on sheltering in place.”

They found that during the manhunt stage of the event Twitter was “definitely” used as a redundant channel to provide protective action guidance to the public; however, the public did not necessary repeat (ReTweet) these message as much as other content posted by official organizations. Again, this finding required the researchers  to speculate. They conclude that since the information about the protective action measure was provided  in so many different formats, it is quite possible that people did not feel the information required repeating–particularly not during the day once it was widely distributed and repeated on all forms of media.

Mission Hill Capture Celebrations

The take-aways for the researchers:

“With this in mind, it is becoming prudent for organizations to consider the kinds of information that is most desired by an online audience, at different points in time, and for different sectors of the public.

Messages can be crafted for both locally affected community members in need of advisories and guidance, as well as distant observers intent on serving as information conduits.  Future disaster communicators ought to learn from these detailed observations about public retweeting practices in order to determine how to more effectively focus, shape, and share messages that make a difference.”

Let me know what you think. Does their analysis fit with your own experience?

Sources:

Sutton, J., Johnson, B.,  Spiro, E.,  and Butts, C. (2013). “Tweeting What Matters: Information, Advisories, and Alerts Following the Boston Marathon Events.” Online Research Highlight. http://heroicproject.org

Sutton, J., Spiro, E., Johnson, B., Fitzhugh, S., and Butts, C. (2013). “Tweeting Boston: The Influence of Microstructure in Broadcasting Messages through Twitter.” Online Research Highlight. http://heroicproject.org

**Project HEROIC is a collaborative, NSF funded effort by researchers at the University of Colorado at Colorado Springs and the University of California-Irvine to better understand the dynamics of informal online communication in response to extreme events.

Related articles

• Researchers Review Boston Bombing Social Media Activity (idisaster.wordpress.com)
• 3 Observations: Social Media and the Boston PD #BostonMarathon (idisaster.wordpress.com)
• Boston Marathon: Social Key in Response (cnbc.com)
• Research in to use of hashtags on Twitter (protohub.net)

Researchers Review Boston Bombing Social Media Activity

Post by: Kim Stephens

Project HEROIC–which stands for Hazards, Emergency Response, and Online Informal Communications (see footnote)–took a close look at the online activity of official organizations during the recent domestic terrorist event in Boston and the ensuing suspect chase–that seemed like a marathon in itself.  They released a report today (May 10) titled “Following the Bombing” which I have summarize below.

Their Methodology and Findings

In order to understand  what types of information was provided to the public and how broadly it was distributed, the project team reviewed 29 different government agency or related Twitter accounts. The first question might be: why only Twitter? Researchers like Twitter–the data is easy to grab and analyze.

The project team reviewed two main items: 1. Rate of posting by the selected organizations and elected officials;  and 2. The percent change in followers  (spoiler alert: Boston PD had a 500% increase and the Boston PD PIO Cheryl Fiandaca had a 2291% increase).  The rate that these organizations posted was tied to their increase in followers, which is no surprise, however, there was a notable exception–Boston Fire Department.

Boston FD gained a 25% increase in followers without posting once the day of the attack. Their absence  was not lost on the Twittersphere, and the Boston FD even felt it necessary to defend their decision the next day.  They Tweeted that they deliberately did not post any Tweets from the scene because it is their policy not to “…show any injured person or discuss our treatment.” Quite a few people, however, thought their decision was unfortunate; at a minimum they could have simply ReTweeted the Boston PD account. As the researchers pointed out:  “…organizations that have increased their network size must provide information of value and to be aware that the public is watching.” Honestly, its about trust. People who follow official accounts do so because they know they can trust the content. The public followers also have a notion that they will provided information in timely manner-especially during incidents such as this one where everyone was looking for any tidbit  they could find in order to make sense out of the chaos.  It is not a stretch to see why people were upset.

Read the whole report here. I like some of their questions they pose at the end:  What can organizations do to ensure their newfound followers stick around? and What educational preparedness-type information should organizations provide to take advantage of the narrow window of attention they have? Let me know your thoughts.

Footnote: “Project HEROIC is a collaborative, NSF funded effort by researchers at the University of Colorado at Colorado Springs and the University of California-Irvine to better understand the dynamics of informal online communication in response to extreme events. Through a combination of data collection and modeling of conversation dynamics, the project team aims to understand the relationship between hazard events, informal communication and emergency response.” (via: http://heroicproject.org/)

Related articles

• 3 Observations: Social Media and the Boston PD #BostonMarathon (idisaster.wordpress.com)
• How Social Media was used During the Boston Marathon Bombings (abarbuto3.wordpress.com)

Social Media and #NEMO in Massachusetts: Some observations

Post by: Kim Stephens

The blizzard of 2013 is still causing problems from New Jersey to Maine at the time of writing. Although recovery from the storm is far from over, I’d like to look at Massachusetts specifically and make some observations about the role social media and web-based communications played (and continues to play) during this event.

1. Public organizations, as well as elected officials, provided great service announcements to encourage people to help one another. My favorite was a Tweet from the Mayor of Boston asking people to be a snow angel, not just make one.

Don't just make a snow angel on your snow day- be one! Help elderly & disabled neighbors. #BOSnowAngel http://t.co/wMvi1FvJ #bosnow #bps

— Mayor Tom Menino (@mayortommenino) February 11, 2013

They even took it  a step further by asking “How are you being a Snow Angel today? Use#BOSnowAngel to share a photo of your good deed.”

2. Sometimes the message was simple: “I don’t know.”  This post on Facebook was from Mass 2-1-1 who defines themselves as “an easy to remember, toll-free telephone number that connects callers to information about critical health and human services available in their community, 24 hours a day, 7 days a week.”

One thing Mass 2-1-1 might have done is linked to the private utility company’s Facebook page, which brings me to #3.

3. Utility companies definitely bear the brunt of much of the public’s ire in the aftermath of disaster events, and this one is proving to be no exception.  This storm also provides an age-old lesson in how to handle some of that anger: no comment. One look at the Nstar’s page will give you an idea of some of the vitriol that can be spewed when the power is out, even for a day or two.  This simple statement on their page elicited over 200 responses, quite a lot of them angry.

“We expect to have all customers restored by Thursday night and will have community by community restoration times available tomorrow. Our crews will continue to work around the clock until all affected customers are restored. Please stay away from downed power lines and assume all lines are live. Thanks for your patience as we repair the damage from this devastating blizzard“

Although this post seems innocuous, people felt that the restoration rate was way too slow. One person started a fire storm by stating the following:

“I just observed TWENTY SEVEN trucks parked at Dunkin donuts in Falmouth. I have an infant and no power for 48 hours with no end in sight. Some sort of estimate would be extremely appreciated. I am a healthcare worker that’s been working for 30 of the past 48 hours I’m cold, hungry and cranky. My patience is wearing very thin…”

I think they handled it well, however, by letting the public defend them versus jumping into the argument. Often it is a worker’s family member that is the most animated with statements along the lines of “Hey–they are working hard, I haven’t seen my husband in three days!” An example of someone coming to their defense is provided below. This somewhat inelegant statement both defends the company but also points out what everyone would like…more information.

4. If you build it, they will come…and maybe crash your site. The International Business Times reported before the storm that Boston was promoting their snowplow tracking website called SnowOps Viewer that would allow citizens to track snow removal by location by zooming in on the map as well as by inputting an address. This is possible because all city plows are equipped with GPS devices.  Other major cities including New York  (PlowNYC) and Washington DC have similar systems. The problem, however, was that so many people went to the site it crashed under the weight. This is the message even today, Feb. 11: We are experiencing significant traffic and the site is currently unavailable. We are working to resolve these issues. Please check back later. Thank you for your patience. 

Every disaster seems to teach us that sending large amounts of people to your website is not a great idea, unless you have done significant load testing beforehand. I hope they sort out what went wrong soon!

5. Boston has operationalized Twitter. Twitter, unlike their snowplow website, remains up with no problem and Bostonians have been encouraged to send a Tweet to @NotifyBoston to report problems such as unshoveled sidewalks or disabled vehicles. One look at the exchanges taking place there shows that it is obvious the city is taking the citizen-reported information very seriously and wants to hear about problems (see an example below). The @NotifyBoston feed also includes information for citizens as well, including advisories, closures, and storm updates.  (I wonder if or how Mass 2-1-1 and @NotifyBoston are coordinating their efforts and sharing information? That will be a question for future posts.)

Please send us your plow requests, or report here. We'll get there. http://t.co/4Oz4PjDU RT Is your st still unplowed in #Boston @PeterWBZ

— City of Boston (@NotifyBoston) February 11, 2013

What are your observations, let me know.

Related articles

• Nemo, Social Media, and Swimming (thefarmclub.net)
• Winter Storm Nemo: Share Your Blizzard Pictures (newswatch.nationalgeographic.com)
• Tweeting Nemo: The Weather Channel storms social media (metrowestdailynews.com)

HealthMap, an example of information curation

Sophia B. Liu, a crisis informatics researcher from the University of Colorado, gave a talk at the International Conference of Crisis Mappers in Boston describing the concept of curation. She explained how in this day of information overload it is important to find trends or “the signal in the noise”. How do we decide what information is important versus what information is redundant or unreliable? She described how the process of crisis information curation is similar to the work a curator of an art exhibit, or a newspaper editor:  one or more people decide what is important, what stories are told. The curator also provides context by relating the story to time and place.

[picapp align=”left” wrap=”true” link=”term=Health+map&iid=6873483″ src=”http://view4.picapp.com/pictures.photo/image/6873483/special-school-helps-teen/special-school-helps-teen.jpg?size=500&imageId=6873483″ width=”380″ height=”251″ /]Of course this relates to crisis mapping since, as one person in the audience tweeted, “If it’s not on the map, did it happen?” This comment simply points out how responders and governments need information in a digested format in order to make decisions, to see the trends. The Health Map is a wonderful example of information curation but with a specific focus on diesease outbreaks. From their website:

HealthMap brings together disparate data sources to achieve a unified and comprehensive view of the current global state of infectious diseases and their effect on human and animal health. This freely available Web site integrates outbreak data of varying reliability, ranging from news sources (such as Google News) to curated personal accounts (such as ProMED) to validated official alerts (such as World Health Organization). Through an automated text processing system, the data is aggregated by disease and displayed by location for user-friendly access to the original alert. HealthMap provides a jumping-off point for real-time information on emerging infectious diseases and has particular interest for public health officials and international travelers.

Health Map was co-founded by Dr. John Brownstein of Harvard Medical School and Ph.d candidate, Clark Freifeld, a research software developer at the Children’s Hospital Informatics Program.  I had the pleasure of meeting both of them at the ICCM conference. Their team consist of 13 other equally impressive people with backgrounds ranging from biomedical engineering to epidemiology and biostatistics.

To learn more about what information is provided on their system see their HealthMap 3.0 Tutorial. In general, when you view the map you see either pins which represent precisely placed alerts or dots which represent country, state or province-wide alerts.  The dots are color coded based on a mathematical computation that takes into account time-frame, number of alerts and number of sources. You can customize the map to provide specific information that you are interested in, for example, by location or disease.

Users are able to add to information to the map with the “outbreak missing feature”–which can even be done on-the-go with a mobile app. People are encouraged, however, to add links to news articles which helps the team verify the information. And in fact, all reports are reviewed prior to being displayed. This user-generated information has its own category “HM Community News Reports” so that other users can understand the source of the content.

This model of curation is laudable, however, I wonder if it would work for information aggregation of real-time disaster data. The verification system mostly depends on reports from sources such as newspaper articles or Government or UN released reports; but during a fast moving crisis, by the time information is released by a news organization it could already have become overcome by events. There is no doubt, however, that this system is one of the very best for understanding disease outbreaks.