A. September 11^th - By far, the majority of my comment relate to this man-made disaster.

B. The anthrax incidents that hit our local post office in Hamilton, New Jersey

C. The Asian Tsunami

D. Hurricane Katrina

E. The one that we just avoided, but that I was poised to assist with was the Pinelands wildfires sweeping the southern part of the state. Thankfully, it rained just as the hospitals were ready to evacuate, and the notice came through the listservs I manage that the evacuation was imminent. A nurse, who was at NJHA the next day, and visited the library, told me that the mulch on the hospital lawn was smoking and we were readying the patients to leave. Then it rained; thank god.

F. Somewhere in there I was a participant in TOPOFF3, a federally mandated emergency exercise (http://www.njha.com/topoff3/). I served as the manager of the listservs and the Web site content. In the disaster scenario, NJ wound up spreading smallpox to several countries and many people died.

Non-traditional Roles

A. After 9/11, the NJHA recognized the need for a database to identify the victims. The NJ DOH (Department of Health) was suppose to do it, and in their inability to get it accomplished, our President was able to tell the NJ Commissioner of Health that NJHA could do it for them. I suggested to the executive that we create and post it on the Web site in short order. I wrote up the programming requirements for the database, researched the legal issues, and wrote the disclaimer. The patient victim database was online within a day of getting authorization to do it. We tracked more than a thousand victims through it, and were able to alert family and friends to whether their family member was treated and released or admitted or transferred. I believe the fact that I sat in on all the daily emergency updates, heard the problems, analyzed the needs, and made recommendations to solve the problems was key.

B. I updated the database on a daily basis with the NJ State Epidemiologist, who gave me the excel files. I, in turn, worked with our programmer to get them online each day.

C. I created a new Web area for all of our NJ hospitals as well as the public. It is archived: http://www.njha.com/njresponse/index.aspx

D. For a fund for the victims, I also researched the best way and wording for doing this. An online fund was created and a Web site was set up for donations. The page that is left describes the disposition of the fund: http://www.njha.com/njresponse/ReliefFundDollars.aspx

E. Oddly enough, we in the library found ourselves to be the unofficial hoax busters. In the early days of 9/11 and anthrax, there were so many rumors flying around; people came into the library visibly upset because of the talk or the emails. We researched each rumor and gently corrected or pointed out the hoax to whoever was talking, relating or emailing it.

F. I also found myself in the role of disseminating health or hospital related updates about what was happening with 9/11 to all the libraries in the state via several listservs. I asked the recipients to further distribute the information to their publics. For example, through the listservs, I shared the patient-victim database, the NJHA press releases, the toll free number, the trauma resources, the mental health resources, the blood bank information, the donation fund, etc…

G. We also distributed in the first day or two, when the systems were overloaded, paper copies of the daily updates on the Web to all staff in the building.

H. In the first and second day after 9/11 in particular (and really for the entire two weeks) we answered non-stop phone calls from people looking for family members. We also fielded calls from good Samaritans wanting to help, legislators wanting to help their constituents, etc… None of these interactions were really either reference or research; but, we were there and helped along with the other NJHA staff.

I. I was asked more than once by our PR department to take a reporter’s call to describe the patient victim database for a story they were writing.

J. I also completed several reports for the Governor of New York and the U.S. military about the patient-victim database, which included statistics from the hospitals.

K. For the anthrax issue, I was privy to many confidential communications to emergency personnel via the listservs I manage. Keeping sources confidential, I was able to connect one librarian in my consortia who had told me she had a bizarre patron that concerned her. A physician was sending odd email and using the library computer to check out water reservoirs. Our Emergency Director was able to connect his State Police liaison with her. The library PCs were eventually taken by the police for further investigation.

L. For the Tsunami disaster, I was asked to research charities for our donation of more than 100,000 dollars. Again, I created the Web site and wrote the proper language for it. I got to call and talk to all the potential charities about NJHA and NJ hospitals giving money to them and how it would work and what it would be used for. We eventually gave the large sum of money we collected to Save the Children.

J. I Almost forgot to mention that during Orange Alerts (a terrorist alert level) I would take all the core reference tools into boxes and drive around with them in my car trunk so I would have them handy at home if needed.

K. Also, for Orange Alerts, I would remind and help the Emergency Preparedness and Health Planning departments get back-up files of all their e-mail and listserv contacts and fax numbers etc… so they could work from home if needed.

L. I also participated in preparedness activities by evaluating software and training people to use these technology tools.

M. Countless times, I have had to discuss and cover all the particulars about the Patient Victim database with other state hospital associations and even our internal Emergency Preparedness staff, for their discussion of it with others.

Traditional Roles

A. The research requests were fast, furious and, at times, highly unusual. Some could only be answered via primary research. We were asked to answer questions about such topics as radiation at the World Trade Center site and the possibility of locating people under the rubble by using their cell phones. One hospital called us and asked if any biological agents were used in the attacks. We felt more like investigative reporters at times! Another example from the aftermath of hurricane Katrina was a request to find a hospital for a displaced physician from Louisiana. We started to get a few more questions like this and, eventually, our Association needed to take a broader look at the issue.

B. We were asked to compile all the mental health clinics into a resource handout. We surveyed and quickly got that online for anyone.

C. We kept links for information sources from the government and news sites up to date on the Web site. It became a huge list. See:

http://www.njha.com/ep/exewin.aspx

D. Due to the intense need for information, I worked with the Middle Atlantic Region of the NLM and the state organization, The Health Sciences Library Association of N.J., to put together a seminar. It took place on December 5, 2001 and was very well attended. It was called, Thinking the Unthinkable - Biochemical Terrorism and Disasters: Information Resources for Medical Librarians, and is available online at:

http://www.njha.com/ep/slides.aspx

I also prepared a checklist for medical libraries that I gave permission to be widely reprinted. The checklist is available at:

http://www.njha.com/ep/pdf/bio-NJHAhandout.pdf

E. I wrote an article about disaster preparedness, post 9/11, called, “It Wasn’t Raining When Noah Build the Ark.” It is available at:

http://www.njha.com/ep/content.aspx?cat=el

F. Along with the article, I also developed and published an online Memorandum of Understanding that allows medical librarians to find buddy libraries and easily create cooperative agreements.

H. Along the cooperative lines, in the second week of 9/11, I called the Robert M. Bird Health Sciences Library at the University of Oklahoma. They cooperated greatly by sharing citations for all the books they had purchased for healthcare professionals on psychosocial and trauma issues Likewise, I asked a medical library colleague to do a resource list of books for children from their consumer health collection as well as one on grief for adults. See:

http://www.njha.com/njresponse/mentalHealth.aspx

I. One urgent thing I had to do was buy equipment fast. Within an hour of 9/11 happening I was in Circuit City taking one of the last TVs off the shelf and charging it to my corporate AmEx. Our need for a TV in the building was extreme! We had one on the second floor, but needed one on the first floor.

J. We regularly and extensively assisted the Emergency Preparedness department with the content and organization of their Web sites. See:

http://www.njha.com/ep/

I am asked to evaluate software specific to Emergency Preparedness Web sites. This just happened recently. So I worked with our Health Planning Department, CIO and the vendor to do that.

We’ve had to do software training for hospital staff in the computer lab on the statewide disaster system. This was big undertaking and very interesting on many levels. Oye!

Another interesting experience in the aftermath of 9/11 was TOPOFF3, a disaster planning simulation activity. It was a real eye-opener! In the simulation, it became clear that very personal choices had to be made. Sometimes you have to leave your professional role to take care of personal responsibilities. But, in the simulation, the area was locked down and we couldn’t leave. It was a total shock! I’m not sure people will be adequately prepared for the reality of the situation. But, being involved with such simulation planning activities was a good start.

A. Librarians should use their unique expertise to help with decision making, identifying needs, and providing solutions to the many problems that a disaster creates. I think the Patient Victim database was done so efficiently and received such an amazing response from everyone because the librarian was there at a critical moment and used a unique skill set.

B. Librarians have highly honed and competent people skills that come to the fore during stressful events. I observed hospital association staff coming to the library to ‘escape’ from the high demands a disaster places on professional roles. The library and the librarian became a community haven; and we should strive to offer that ‘peace’ to the patron. It is the ‘fuzzy’ and very human side of what we do. In doing this public service though, a librarian and their staff need to ‘turn off’ their stress and find relief outside of the workplace. I still recall coming home the first Friday during the week of 9/11 to a candle light vigil with a large circle of my neighbors in the common area of our condominium complex. I stopped the car, walked over and was immediately added to the circle, singing and prayers, as someone passed me a candle and I just wept my heart out. If felt good to do that there, and I hardly knew I needed it and was glad I did not do it at work. At work, in the library, we were the shoulders others leaned on.

C. Librarians unique research skills and insights into information can offer amazing results to the organizations we serve. I am still astonished at how many requests came in. We suspended shelving, document retrieval, and all other normal library services just to keep up. I think the fact that patrons came to us and relied on us so much speaks to this important reference and research role. I think librarians in some organizations should also be prepared for an extension of this role into primary research and investigative journalism (for lack of a better word). We talked to government officials, scientists and other organizations to find answers and often wrote them up for staff, presenting ‘findings’ and providing analysis.

D. Librarians are trusted sources of information and should remain that way regardless of what unique characteristics of the disaster come to the fore. This is an important role. Libraries and librarians can be relied upon to disseminate timely and accurate information to a wide audience, as well as a source to identify hoaxes and correct inaccurate information.

E. Librarians are uniquely skilled to create Web resources that can be made widely available. We can also work cooperatively to achieve that, when the crush of immediate service needs prevents one library from doing it all. We have so much information power when we work together. In this way the librarians’ great ability to collaborate serves not only us but our patrons and our organizations well. The resource lists and the conference I put together speak to that.

F. We can also act as the “institutional memory.” When the New Jersey Historical Committee was preparing reports, they contacted me. They wanted to know what was done and I was responsible for knowing. In fact, it often becomes to job of the librarian to answer the question, “What did we do last time?”

G. Librarians are also in a position to aid in the development of technology tools for disaster response. For example, I was asked to evaluate a software product, Fast Command by Fast Health Corporation, which aids hospitals in creating disaster websites.

1. NJ Dept of Health and Senior Services
2. NJ State Health Epidemiologist
3. Area Blood Banks (after 9/11, they were overwhelmed with people who wanted to donate blood)
4. Jersey City Medical Center — they had a call center and we worked with them to make sure they had the information correct on their Web site. They were the first line of information - taking names of missing people. Then the state police.
5. Worked with the state police for the anthrax incident
6. Worked with every library group in the region via their listservs (MLA, SLA, NJ state library cooperative,)
7. Worked with local hospital to compile resource lists.
8. Worked with the CDC - looked for good anthrax information. Asked them to speak at conference.
9. ASTROX Corporation - medical research institute for chemical defense (another speaker at the conference). Helped get their stuff online

Several minutes passed before my phone started ringing and friends in New York were calling to ask me what was going on in Oklahoma City. Not having turned on the TV I was unaware of what they were referring to. I rolled one of our TV’s into the lobby of the library, turned it on and saw for the first time the carnage of what ended up being a terrorist attack on the Alfred P. Murrah Federal Building. At first, the reports were “there has been some sort of explosion downtown.” Perhaps it was a gas explosion. The thought of a terrorist bomb was not mentioned for nearly half an hour. The library, being at the physical center of the campus was a hub for the students to gather and watch the story unfold. Our staff brought in extra chairs as more and more students came by to see what was going on. The immediate thought on everyone’s mind was what we can do to help.

When the dust and debris cleared 168 people, including 19 children were killed and hundreds more seriously injured. Out of the rubble a plan for a multi-component memorial was established. The memorial was to consist of a remembrance component an educational component and a research component. It was the dream of the family members and survivors that the research component have a library and information center as the “living memorial” to their loved ones. Thus the Memorial Institute for the Prevention of Terrorism was founded. An act of Congress was passed and appropriation made to begin development of the “premier source of terrorism information sharing among federal, state and local agencies.”

As the steering committee for the development of the Institute and Library began their work, it became clear the emergency response community would need to be actively involved in creating this new resource of information. As a volunteer for the Memorial Archive, I was invited to be on the steering committee for the development of the Institute’s information center and library. Though not apparent at the time, the need for information professionals, both librarians and archivists was a necessity. Thousands of cards, letters and artifacts were mailed to the bomb site along with thousands more being left at the scene on a daily basis. Archiving and preserving this information was the foundation of what later became the Memorial Museum. Many of the documents collected early on became the basis of the future Lessons Learned Information Sharing, (LLIS) the official lessons learned site for the Department of Homeland Security. Final reports, after action reports, studies, etc. from numerous agencies were collected with the hope of assisting other communities in preparation dealing with a similar mass casualty event. Reports and studies following a variety of terrorist incidents and natural disasters make up the LLIS database.

Fire and law enforcement professionals were brought to the table to assist in the establishment of key databases that would help these groups prepare and perhaps prevent future acts of terrorism. The Responder Knowledge Base (RKB) was created to assist the emergency response community know what protective clothing and equipment is available and whether or not it meets standards and who certified the equipment against the standards. The RKB also informs the emergency response community if grant money is available in order for them to make application.

The MIPT Terrorism Information Center and Library (TIC) is a wealth of information not only for the emergency response community but for academics, policy makers, and the public at large. Thousands of documents have been added to the TIC along with nearly 3,000 book titles easily available for checkout. Information on the topic of terrorism seems to be endless and the need to collect, organize and disseminate that information is essential for eliminating this scourge from the world. The services that libraries and librarians have traditionally provided remain very important.

Personally, my first priority was helping our staff members cope with the grief. Every staff member had a different situation as a result of the disaster. I had to treat them all as individuals and handle each of them appropriately. Only when the library staff members were able to move forward did we re-focus on the health professional community. We were very lucky as no one on our staff was directly involved. But we all knew families that were. Some staff found it very difficult to pull certain library materials (psychiatry and pathology). I believe that it was harder on the paraprofessionals than on the professional staff. The professional staff members were wonderful; they did everything possible to serve our community. Our reference staff acted very professionally and they were able to deal with any question. For the most part, the paraprofessional staff was shielded from medical cases.

But, everyone needed to find a way to deal with the constant reminders of this terrible event. The State Medical Examiner’s office is only one block from the library. Of course, all of the bodies went there. The building was roped off for a long time and our staff had to see it every time they came to work. I didn’t think beforehand about how this would affect them, but it was terribly upsetting. I had to suggest to some people that they take another route to work. It wasn’t obvious to some people that they had to change their regular routine in order to deal with the stress and the emotional impact.

Support came from everywhere. We received many calls from other libraries. They asked if we needed help with ILL (interlibrary loan). Vendors called to offer support. From just a few comments, they started to send us pathology and psychiatry resources. They suggested databases that might be turned on for a period of time. Everyone wanted to help; and I swiftly came to realize just how small and tightly knit the library community was. The headquarters for the Metropolitan Library System was only four blocks south of the explosion. Technically speaking, they were “inside the yellow tape,” for several days. The force of the explosion blew out all of their windows. As much as possible, we tried to support them and to solicit help on their behalf.

We had a strong desire to do more, but the reality was different. People will tell you to find your niche and fill in. But, it is a hard prospect. We tried to help everyday. But when disasters are happening; it is all about first responders. What we discovered was that our primary role was in the aftermath. The pathology department at the university became involved and we supported them through reference, literature searches, etc… The psychiatry department also was very active dealing with the aftermath of the disaster. The work that was done after the attack turned into numerous research projects. The university departments became first-hand experts with valuable knowledge for communities that had suffered due to terrorist attacks. Our people have been around the world helping others and the library has always been involved with supporting these efforts.

From a grant offered by the CDC, the Southwest Center for Preparedness was opened and is now located on the university campus. We have done a lot of direct training for the center.

The attack changed research directions for the entire campus. And, as a result, the library now collects more in the areas of emergency medicine, disaster planning, response, recovery, grief counseling, etc… In the weeks and months after the attack, we saw victims’ families coming into the library looking for information. This was just another indication of how dramatically our user group had changed.

The changes to our collections and services inspired an awareness that the library didn’t have before. Tornadoes are a regular occurrence in Oklahoma and now we are ready for them. We have learned to prepare for natural disasters that are likely to happen in our area; and we’re doing what we can to avoid being caught off-guard and to help other institutions do the same. But, as much as we can predict and plan, real preparedness is more about attitude than anything else.

One of my favorite stories about libraries helping was from Lee Brawner who was the director of the Metropolitan Library System (he has since passed away). We called him the “Consummate Library Director.” After the attacks, a church just north of the library headquarters was being used as a morgue. First responders were facing horrible and grisly work pulling bodies out of the rubble and bringing them to the church. Lee asked the responders what he could do to help. They told him that they needed a place to wash their dogs. Lee took care of it right away; he offered the staff lounge and the shower room at the library. It became the refuge for those responders. It was a place to relax, away from the mayhem. They could just wash their dogs and sit in peace.

Lee’s story isn’t about being at the site, acting the hero. It was about doing what you could, about being on the periphery and finding a way to offer effective help, even in the most non-traditional ways.

In our classes, we present situations and ask the students what to do. If you were to ask me, I would tell you that my first priority is to take care of the staff. Then work on reestablishing the library. This is a lesson I learned from Lee: the library is an important constant for the community. Let them know that you are OK; and it will give them the confidence to move forward.

One of our scenarios involves an infectious outbreak in the community. The first reaction is always to go home. But, we have to think about opening again and establishing normalcy. Library is the touchstone and we set the tone for the campus.

Librarians have to know who to call; know who is in charge; know what to do. They have to be able to answer questions like: where are the freezers for the books?

A lot of the people that you need to know in a disaster won’t be part of your everyday lives (police, fire people, maintenance, etc…). However, they become immediately important in a disaster. It is very important to change your normal routine and get to know these people.

After the bombing, there was a heightened sense of awareness. People were really excited about teaching disaster planning. But then there was a drought for many years. People forget when everything returns to normal. It would seem that we all need some event to wake us up. However, now is the time for revival and retraining.