A colleague is concerned that sufficient planning has not taken place to secure hospitals and blood centers from natural or man-made disasters. As such, he suggests that colleagues familiarize themselves with the information on planning for a natural or man-made disaster at the following links at the Federal Emergency Management Agency (FEMA) website 'Are You Ready? A Guide to Citizen Preparedness' and the American Red Cross website (under Family Disaster planning - PDF).

In addition to the above information, the following may be useful in preventing a direct threat to your hospital or blood center.

A. Be aware of and report the following to the appropriate authority within your organization:

• People in buildings or areas who do not appear to be conducting legitimate business
• People monitoring areas, buildings or entrances
• Unauthorized people in restricted, sensitive or private areas
• People requesting information with no apparent need for that information
• People wearing clothing not consistent with the weather conditions or events (bulky coat in warm weather etc.)
• Abandoned parcels or other items in unusual locations or high traffic areas
• Individual attempting to access utility locations (water, electrical, petroleum, telecommunications, information systems)

B. Be Alert to:

• Abandoned Vehicles
• Vehicles Parked Near Buildings or Public and Common Areas
• Unexpected/Unfamiliar Delivery Trucks
• Unfamiliar Vehicles Parked For Long Periods
• Vehicles Containing Unusual/Suspicious Parcels or Material
• Vehicles Arriving and Being Left Behind at Odd Hours
• Substances Leaking or Spilling from Vehicles

C. Building/Office Security:

• Don't prop open building/residence hall entrance doors/windows. Rectify these situations when you observe them
• Don't leave keys unattended or give them to unauthorized persons
• Secure all sensitive material/information when not able to attend to it
• Secure sensitive deliveries in a timely manner
• Secure all areas when not attended
• Be aware of unfamiliar persons in or visitors to your office/lab etc.
• Protect access codes and combinations, change codes regularly. Report compromised codes immediately
• Be Prepared - Take time out to familiarize yourself with building evacuation plans/routes
• Report suspicious tampering with physical security (doors, locks etc.)
• Talk with co-workers; know what is out-of-place (unclaimed items etc.)

The following responses were received.

1. A Hematologist/Blood Banker in Melbourne, Australia reports that in addition to being prepared for possible acts of terrorism that might affect hospitals and blood supplies, we also need to have disaster plans for "Internal Hospital and Blood Service Events" such as failures of local power and computers, etc. which can impede our ability to support OR, ER and Trauma Services, even when such failures are not directly caused by an incident which disables the Blood Bank. The Australian wants to know if other institutions have made plans that link their blood bank laboratory to the broader hospital disaster plan, in the event their Blood Bank service cannot operate and OR, ER and Trauma Services are potentially compromised? For example, do staff in the Emergency Department immediately divert patients to other institutions etc? The Australian would be very interested to hear through CBBS how others address this scenario.

ADDENDA Feb. 24, 2003

2. A transfusion medicine physician reports that when he was a blood bank medical director at a hospital in Minnesota they received a threatening telephone call that prompted the evacuation of all staff and patients except for a patient with a GI bleed and a patient undergoing a coronary bypass. A transfusion request came after everyone had evacuated the blood bank, except for the medical director. A security officer with a two-way radio helped locate blood bank staff outside, two of whom volunteered to come back into the building. Now, the laboratory staff have designated places to assemble outside after evacuation.

Since the above scenario, the responding colleague has changed jobs and where he now works they recently conducted an annual fire evacuation exercise. All employees have designated assembly areas for evacuation, and evacuation coordinators communicate with Family Radio Service (FRS) walkie-talkies. The institution hosts a CBBS Amateur Radio Network (CBBS-ARN) station, and one of their licensed amateur radio (ham) volunteers co-directs a monthly communications exercise on shortwave and VHF frequencies.

The responding colleague reports that on September 11, 2001 amateur radio provided coast-to-coast communications that expedited the movement of blood and other relief supplies. Closer to his new home (CA), amateurs have proven their worth in natural disasters such as the Northridge earthquake. Our colleague concludes that "now is a good time to encourage people already involved in blood banking to become licensed in the Amateur Radio Service. The emergency communications capabilities in the Amateur Radio Service far exceed those of the Family Radio Service, the Citizens Radio Service (CB), or the General Mobile Radio Service (GMRS, or "business band"). In the United States, amateur operators are licensed by the Federal Communications Commission. The "price of admission" is passing an examination, which, for blood bankers accustomed to constant training and assessment, shouldn't represent too much of a challenge. A good place to learn more is at the ARRL, the national organization of radio amateurs in the United States, and a leading member of the International Amateur Radio Union (IARU)."

ADDENDA April 21, 2007

3. John Damgaard, Vice President & General Manager of Blood Management at Mediware Information Systems (attribution used with permission) reports that 'Disaster Preparedness' is a hot issue that has been highlighted by the recent events in NYC and the Gulf Coast. According to Mr. Damgaard, in the event of an emergency-being anything from a multi-car accident to a catastrophic national disaster, the blood industry must have plans to handle a capacity far greater than current levels. This includes an increased need for blood, loss of communications or technology, or damage to a blood bank or blood center. He adds that participants in Mediware's Blood Transfusion and Cellular Therapy executive summit discussed this topic at length, including experiences with recent disasters and hypothetical tools that could help cope with the disasters of the future.

This report on disaster preparedness covers the following topics and can be accessed from www.mediware.com/bb/disasterpreparedness

• Quick Decisions and Post-Disaster Dilemmas
• The 'O' Protocol: Single Typing in an Emergency
• Lost Connections: Data Recovery and Computer Operations in Crisis
• The Three C's of Disaster Preparedness

ADDENDA April 27, 2007

4. A Quality Assurance Specialist/Safety officer at a hospital affiliated blood center in Northern California reports that in addition to the ideas already expressed in the discussion above, the following items might also be worth considering:

1. The Joint Commission encourages 'disaster directors' to attend Incident Command System (ICS) training.
2. The responding colleague's center has a mutual aid agreement with other blood centers to share resources in the event of an emergency.
3. It was reported during Katrina that although calls could not be made, text messaging still worked for cell phones.
4. Be sure to include consideration of time reporting during disaster and paychecks if main systems were to go down.
5. Employee and family counseling may be needed depending on the disaster.

Please submit comments to the e-Network Forum.

Ira A. Shulman, MD
CBBS e-Network Forum Editor & Moderator

W. Tait Stevens, MD
CBBS e-Network Forum Assistant Editor & Moderator