Key Features to Look For in a Mass Notification System for Hospitals
While there is no one-size-fits-all mass notification system for hospitals, there are several key features a system should have in order to comply with state and federal regulations, provide comprehensive information during all types of incident, and facilitate a speedy recovery after emergency events.
A mass notification system for hospitals should be a multi-functional system capable of communicating appropriate information to patients, staff, visitors, emergency services, and the community in general. Furthermore, as well as alerting people to adverse events, the hospital communication system should have two-way capabilities in order to enhance situational awareness during incidents, and be able to support business continuity and disaster recovery after emergency events.
Due to the large number of roles expected of a mass notification system for hospitals, the system is subject to several state and federal regulations. State regulations (PDF) vary according to the location of the hospital, while federal regulations include the Americans with Disabilities Act, NFPA 72 (Performance Requirements for Emergency Communication Systems) and UL 1971 (Standard for Signaling Devices for the Hearing Impaired). Other local government regulations may also apply.
A mass notification system for hospitals participating in the Medicare and Medicaid programs also has to comply with 42 CFR §489.10 – covering the Civil Rights Act 1964 – and the Communications Plan element of CMS´ Emergency Preparedness Rule. The Communications Plan element stipulates a mass notification system for hospitals should be “well-coordinated within the facility, across health care providers, and with state and local public health departments and emergency management services”.
Breaking Down the Federal Requirements for Mass Notification Systems
The majority of state regulations relating to a mass notification system for hospitals align with the Communications Plan element of CMS´ Emergency Preparedness Rule; however, the federal requirements for mass notification systems extend the necessary capabilities. For example, under NFPA 72, the mass notification system must be readily accessible at all times without the need to “climb over or remove obstacles or to resort to portable ladders, and so forth”.
To comply with the Americans with Disabilities Act and UL 1971 a mass notification system for hospitals should be capable of sending both visual and audible alerts (or integrating with other systems that fulfil this criteria); while, in order to qualify for participation in the Medicare program, the system must have multi-lingual capabilities to send emergency notifications to citizens whose first language is not English. HIPAA regulations do not apply to mass notification systems – only how they are used.
There are systems available that can meet the requirements of state and federal regulations. Notwithstanding that activation buttons for fire alarms have to be publicly-accessible, several types of mass notification systems can be operated remotely from Internet-connected devices. Provided they have multi-modal capabilities (i.e. voice broadcast and SMS text) or can integrate with visual and audible alerting systems, they will comply with most state and federal regulations.
Complying with the requirement to have multi-lingual capabilities can be more difficult. However, some systems provide web portals for personnel to select their preferred mode and language of communication. These can also allow members of the public to opt-in to the system (i.e. patients, visitors, contractors, family members, etc.), who can also select their how they would prefer to receive mass notifications and what language.
Communicating through a Mass Notification System for Hospitals
In October 2017, Stephen Paddock opened fire on 22,000 Las Vegas concertgoers from the 32nd floor of the Mandalay Bay Hotel, killing 58 people. A further 869 were injured in the worst mass shooting in U.S. history – many suffering injuries as they tried to escape the scene. Two reports into how Nevada´s hospitals coped with the tragedy (NVA report / ASTHO report) generally commended the healthcare system and emergency personnel, but found fault in how hospitals communicated.
The primary issue (according the Las Vegas Review-Journal) was that an emergency manager at University Medical Center (UMC) – the only Clark County hospital with a Level 1 trauma center – issued an “internal disaster” mass notification. The internal disaster code is usually used by Las Vegas hospitals to signify their emergency rooms are overcrowded and that ambulances with critically injured patients should divert to another hospital. At the time, UMC´s emergency room still had beds available.
The code is also understood to mean “all hands on deck”, and – as news of the tragedy spread – healthcare personnel arrived at UMC without being called in, raising concerns about staffing levels in subsequent shifts. While some healthcare personnel were sent home, others were reassigned to work in environmental services due to a shortage of environmental services staff to clean gurneys, sterilize equipment, and keep corridors free.
This scenario could have been avoided had UMC´s mass notification system for hospitals used templates and supported database segmentation. Ideally templates could have been prepared in both short form (i.e. SMS messages) and long form (i.e. email) to alert emergency services by the fastest means possible and then provide further information. Database segmentation would have enabled UMC to quickly contact just healthcare personnel required at the time, and to call in environmental services staff.
Features to Support Business Continuity and Disaster Recovery
It was noted in both reports into the Mandalay Bay shooting that none of Las Vegas´ hospitals were prepared for the scale of incident. As well as running short on medical supplies, healthcare personnel were also running out of everyday items such as pens and tags, making it difficult to record names and injuries of victims as they arrived. Two features of a mass notification system for hospitals could have helped mitigate this situation – social media integration and geo-polling.
While it is not recommended to use social media channels for emergency alerts, channels such as Facebook and Twitter have widespread appeal and can be helpful in seeking assistance from the community. After the shooting, thousands of local residents were searching for news of the event, and hospitals could have used these channels to appeal for items such as pens and tags. Communicating on social media might also have prevented rumors circulating about a second assailant.
By comparison, geo-polling targets a specific group of the hospital´s database using database segmentation and most often asks a question to which the recipient responds via a selection of possible answers. For example, UMC could have geo-polled neighboring hospitals to ask if they had excess environmental services staff available, geo-polled healthcare personnel to ask who was available for extra shifts, or geo-polled non-medical suppliers to request emergency supplies.
To summarize, South Nevada´s healthcare system was well prepared to deal with the tragic incident, but there are lessons to be learned in terms of communication. Several key features were absent from UMC´s mass notification system for hospitals and, due to human error, a misleading alert was sent under stress. Therefore, hospitals looking to implement a mass notification system for hospitals – or update an existing system – should consider the following:
- Hospital mass notification systems have to be compliant with state and federal regulations. You should also find out about local regulations.
- The systems do not have to be HIPAA compliant, but the way in which they are used does have to be HIPAA compliant.
- Systems with multi-modal communication capabilities not only broaden the reach of emergency alerts but can also help with business continuity.
- Templates that provide the option of short form and long form notifications can help eliminate human error and avoid misunderstandings.
- Database segmentation enables hospital authorities to get the right message to the right people at the right time. Geo-polling makes this feature more effective.