Adding Twitter to your Healthcare Emergency Notification Plan

Originally published by Campus Safety Magazine, January 8, 2014


When it comes to issuing alerts and related messages, a growing number of government agencies, educational institutions and others are adding Twitter to their Emergency Notification strategy.

An emergency notification (or mass notification), according to David Fleming, Marketing Manager at Code Blue, an emergency communication systems vendor, “is a one-way communication sent by first responders or security personnel to a large group of individuals who may be in harm’s way to alert them of a security risk. This could be a weather-related incident (such as a snowstorm or a tornado), natural disaster (wildfire, earthquake, etc.), fire, medical outbreak, active shooter or chemical spill.”

Traditional emergency notification channels have included:

  • press releases sent to the broadcast media (when there’s enough lead time, of course)
  • automated outbound phone calling
  • E-mail, SMS text messages
  • announcements by radio and television broadcast media
  • digital signage, including “ticker” or even screen take-over
  • Web banners
  • sirens and public address systems
  • Wireless Emergency Alerts, which are text messages sent to mobile devices within geographically-targeted cell towers’ service areas
  • some organizations even offer their own mobile apps.

Over the past several years, Twitter and other social media have been added to the list.

(In case you’ve lost track, Twitter is basically a “micro-blogging” site, for “tweets,” which are posts no more than 140 characters, similar to SMS text message length. Tweet content may in turn include URLs (usually “shortened”) and links to attached pictures. With more than half a billion registered users of 2012— although you don’t have to register to be able to see publicly viewable Tweets — Twitter has been nicknamed “the SMS of the Internet.”)

For example, one government agency using Twitter is the Clark Regional Emergency Services Agency CRESA, according to Cheryl Bledsoe, division manager of Emergency Management for the state of Washington’s Clark County. “We serve 435,000 residents, seven cities and the county in general. Information is our only commodity. We receive 911 calls and other contacts, and we communicate information to the public and to emergency response stakeholders like the police, fire, public health and public works departments, as well as to community organizations, non-profits, businesses and volunteer groups.”

CRESA began using social media in 2008, according to Bledsoe. “We wanted a more dynamic way to communicate. Wireless wasn’t as common then, and our Web site was hard to update without involving IT. We began with a blog CRESA911, on BlogSpot, which we still have, then added a Facebook fan page, and then also two Twitter accounts: @CRESA for emergency alerts, and @CRESATalk for everyday information and also for emergency-related information.”

Bledsoe says adding Twitter to their strategy has been successful. “Tweeting has helped responders find missing people in time, fill our training classes quickly and get responses when we have community requests for help,” she says. “Using Twitter is more efficient for us than traditional press releases, email, etc., and by using Twitter, we have been able to enhance our reputation with the local news media and work better with them.”

In addition to alerting about the events, “We communicate with the public on how they can protect themselves, help us, volunteer and other helpful announcements,” says Bledsoe.

Similarly, in 2010 and 2011, Maryland’s Cecil County, located in between the cities of Philadelphia and Baltimore, turned to Twitter (@CecilCountyDES), along with Facebook and other social media platforms, to augment its emergency notification reach for its 418-square miles and 100,000-person population.

“We have four ‘audiences,’ ” says James E. Hamilton, emergency preparedness manager, Cecil County Department of Emergency Services. “There’s the general population, ‘itinerant guests’ like travelers and people at weekend or vacation homes, partner agencies like emergency responders, and elected officials and other key decision makers. Plus there’s the media, which we consider a partner, and a way to help us reach the general public.”

Because of the county’s geographic location, “We do not have a strong broadcast or print media market or presence,” Hamilton notes. “In a typical ‘news cycle,’ coverage for our county would be provided mostly by local print services, we generally only receive attention from the Baltimore or Philadelphia broadcast media during major news events or emergencies. By using Twitter and other social platforms, we can directly reach our core audience in a direct and timely way.

Cecil County uses just a single Twitter feed. “We issue about four to five Tweets a week, on the average,” says Hamilton. “About 75 percent are emergency-oriented. We carefully balance how many non-emergency Tweets we post. Most of our Tweets are about severe weather, others typically are about transportation issues like accidents, and hazmat events,” says Hamilton.

“We find Twitter is extremely valuable to reach not just general population but also to get fast-breaking information to traditional media, compared to the time cycle to write and issue a traditional press release,” adds Hamilton.

The Los Angeles Fire Department (LAFD) has enough to tweet about that they have multiple Twitter accounts, says Brian Humphrey, firefighter/specialist and public service officer for the LAFD’s Emergency Public Information (EPI) Center.

The LAFD currently has 106 fire stations spread across 470 square miles, and serves a population of roughly four million people who speak nearly 150 different languages.

“We try to use the best possible tools for the LAFD Everywhere initiative to connect to people who need timely information they can act on,” says Humphrey. “We look at the four phases of an incident, Preparedness, Mitigation, Response, and Recovery, and we try to find the best tool possible.”

Twitter, according to Humphrey, “is associated mostly with Response. We also use Facebook, YouTube, Vimeo, BlogTalkRadio to do radio call-in shows and even put things on iTunes.”

The LAFD started using Twitter in 2006 in a generic account, and officially began in March 2007, with @LAFD. “We quickly added @LAFDTalk, so we could use @LAFD just for alerts and advisories, using @LAFDTalk as a ‘conversational’ channel for people with inquiries and questions, about fires and about LAFD,” recalls Humphrey. “@LAFDTalk, which we started up in March 2009 has had about 27,000 tweets to date, up through June 2013.”

The LAFD doesn’t just send tweets; they also monitor tweets. For example, in 2007, during a wildfire in Los Angeles’ Griffith Park, tweets from individuals about hot spots and wind direction helped the LAFD firefighters control the blaze.

Currently, according to Humphrey, LAFD’s Twitter accounts have about 30,000 followers, plus the uncountable ones following via Twitters 40404 SMS gateway or simply watching without registering to follow. For comparison, Humphrey reports, “We have about 60,000 users who have signed up for our email alerts.” Plus, of course, there are all the people who get the phone calls from the county-run automatic dial-out system.

In terms of tweet volume, “@LAFD had 2,098 tweets in 2012,” according to Humphrey.

Twitter Pros and Benefits

There are compelling reasons to add Twitter.

Currently, Twitter itself is free both to post to and to follow messages on (although, like any private Internet service, that could change at any time). So, other than the minute-or-less to compose and post each message, there’s no incremental cost to using Twitter, and if your Emergency Notification System includes a Twitter gateway, there’s not even that time bump.

And many people use, even prefer, Twitter as an information-watching tool versus email, text messages, social media sites or classic websites. It’s easily usable from smartphones, and even “dumb phones” can be used, by requesting Tweets be send as text messages.

Don’t Rely Just on Twitter, of Course

But there are, if not quite negatives, limits to Twitter.

All the emergency communication professionals I talked with stressed that no single mechanism, including Twitter, should be relied on solely. Not everybody uses or follows Twitter or text messages or will have a smartphone or computer nearby and on. New York City’s Twitter feed, for example, has about 64,000 registered followers (plus whoever is getting them as SMS messages or without having registered). That’s not a lot, relative to the city’s total population. On the other hand, that may easily include a significant portion of first responders and other people and groups who need to be alerted quickly.

“We look for redundancy, diversification, and amplification,” says Cecil County’s Hamilton. “With social media, for example, people share — ‘amplify’ — information where it’s relevant.”

Also, Twitter itself can be subject to unplanned downtime. For example, on June 21, 2013, service was unavailable or intermittent for roughly six hours (as reported in the Huffington Post). Back on June 26, 2012, service was unavailable for about an hour, and during October 2012, there was an hour-long outage and hundreds of shorter outages, according to CNN.

And, of course, with millions of people, companies, organizations and others Tweeting, often several times a day or even hourly, it’s easy for a Tweet-follower to miss seeing an important emergency Tweet, since Twitter and the various Twitter clients do not, currently, have an “Emergency” prioritizing feature.

Advice and Other Thoughts for Using Twitter

Be sure to archive your Twitter account settings, along with all your tweets. (There are a few services offering this.)

Keep in mind, and publicize, that people can easily arrange to have Tweets texted (sent as SMS messages) to their phone via Twitter’s FastFollow service, which accepts commands via SMS text messaging. “If you don’t have a Twitter account, this lets the information still be pushed to you, so you don’t have to try following by watching a website or a Facebook ‘Wall,’ ” notes Bledsoe.

Within the United States, for example, simply text “Follow Twitterhandle.” For example, “Follow NotifyNYC” to 40404. (Twitter’s FastFollow has other options, like just getting the most recent tweet for a given Twitter feed.)

Unless you only expect to issue a few Tweets per week at most, consider having several emergency-oriented Twitter accounts, e.g. one for alerts, one for information.

Have one or more people prepared to follow Twitter, not just your organization’s own tweets and any follow-ups, but also watching for related tweets (e.g., ones that include your “hashtags,” which are Twitter keywords that are flagged by starting with a # in the tweet).

And, of course, Twitter doesn’t have to be just for emergency-related notifications, points out Esther Schindler, coauthor of The Complete Idiot’s Guide to Twitter Marketing. “When an organization has a Twitter account already in place for events, it’s just a matter of using the existing media during an actual emergency. For example, @BOSTON_POLICE and @FOX6TRAFFIC often have alerts and emergency information,” she says.

Your organization can easily end up with multiple emergency and non-emergency Twitter accounts. LAFD, for example, has additional Twitter feeds including @JoinLAFD, @LAFDFireChief, @LAFDCrew3, @LAFDArson, and monthly check-your-alarm reminders @SmokeAlarm and @COalarm.

Just remember, like you, the people you want to reach have only so much time and attention to give to Twitter-watching, so do your best to make those Tweets worth watching.