The airline industry is often held up as a model of operational excellence — one that the health care industry would do well to emulate.
This summer, however, I was surprised to find myself in circumstances in which the reverse seemed true. Like thousands of travelers across the nation, I spent several days in July stranded in an airport with multiple canceled flights, lost luggage, and a whole lot of uncertainty about what to do with my hotel reservations. Customer service lines, overwhelmed by the surge of displaced travelers, snaked a quarter-mile down the terminal. Baggage claim was pandemonium — luggage strewn across the floor and carousels, a few employees frantically trying to process new claims. In short, it was a disaster.
Over the past decade, the health care industry has grown adept at responding to disasters. A panoply of events (including but most certainly not limited to a pandemic, wildfires and poor air quality, and recurrent patient surges) have given health care organizations extensive opportunity to refine their approach to disaster preparation and response — lessons the airline industry might find useful. As a frontline physician and director of disaster preparedness for a California health care organization, I offer the following tips to the airline industry.
To begin with, it’s important to recognize a disaster when one occurs. Historically, disasters have tended to be sudden, complex, unpredictable situations that can be caused by natural phenomena (such as hurricanes or wildfires) or manmade ones (including bombings and mass shootings). They require organizations to address unusual or unique situations in a radically altered and at times austere environment with staff that may rarely work together. Disasters often cross state lines and demand collaboration of multiple agencies and specialties. And, of course, they are stressful.
Although they may differ in cause, all disasters share a fundamental characteristic: Demand outstrips supply. My health care organization defines a disaster as any unforeseen event with potentially drastic consequences that cannot be managed by normal operations.
Consequently, effective disaster response requires a unique organizational framework. In 1970, Southern California experienced a catastrophic fire season. Resources became critically overwhelmed and the result was mass confusion and poor outcomes. Out of this experience, the Incident Command System (ICS) was born. Since then, it has become second nature for health care organizations to open a command center and implement ICS when faced with a disaster. ICS delineates a clear chain of command with pre-defined roles and responsibilities and a manageable span of control for every individual in the command center. It provides the framework to ensure that operations, planning, logistics, and finance considerations are addressed. The structure supports effective resource distribution and clarity of communication, elements distinctly lacking in my recent airport experience. ICS is scalable, flexible, and adaptable and well-suited for all-hazards response in any field — including the airline industry.
Having recognized an event as a disaster and opened a command center, it can be effective to break down the response into three elements: space, staff, and stuff. Faced with a surge (of patients, of delayed travelers, of luggage), an organization must be able to expand its space, staff, and stuff. The health care industry has plenty of grim experience in scaling up all three in order to meet increased demand.
For example, during the Covid-19 patient surges, hospitals erected tents outside their facilities, opened conference rooms, and filled hallways with gurneys to provide extra space. Health care organizations redeployed staff across specialties, re-licensed retirees, and level-loaded clinicians from less impacted sites to overwhelmed sites. New gurneys, ventilators, cardiac monitors — all the patient care essentials — were brought in to deliver care.
For an airline, flexing up space, staff, and stuff might mean additional customer service desks, ambassadors to deliver advice and directions to lost travelers, additional luggage scanning equipment. It would definitely mean leveraging all employees, from executives to clerks, since disasters are all-hands-on-deck situations. It’s also important to recognize the response might be prolonged. Disasters tend to have a cascade effect — the initial breakdown in normal operations leads to additional complexities. One can reasonably anticipate that reversing a disaster will take twice as long as it took for that disaster to occur.
Generally, the most challenging aspect of disaster response is communication and situational awareness — concise, accurate information in the fast-paced swirl of an evolving disaster. Poor situational awareness compounds stress, leads to duplication of work, and can promote dangerous errors. To be effective, communication during a disaster requires frequent messaging through redundant channels in the hopes that information will trickle out to those who need it most — including staff.
During my airport purgatory, I saw staff who were as bewildered as travelers (and considerably more exhausted). I watched as some travelers waited hours in the wrong line and luggage was flown to random locations. I received most of my information not from airline updates but from other travelers. In my health care organization, we leverage emails, texts, huddle updates, and broad messaging across various channels to get information to our clinicians, patients, and communities during emergency events.
Finally, the single most important element in responding to disasters is to plan for them. We live in an era of inevitable disasters, and this will worsen as climate change causes more extreme weather. The cost of not planning for disasters is simply too high. The next event might be catastrophic weather, or a severe staffing shortage, or a new pathogen. As a director of disaster preparedness, my work is to imagine every worst-case scenario and for each of these scenarios to have a back-up plan and a back-up to the back-up plan. This planning is iterative, refined through drills that test our assumptions and expose our weaknesses.
The Federal Emergency Management Agency has defined 15 emergency support functions — functions that are critical to our nation’s business continuity and simply too big to fail during a disaster situation. Public Health and Medical Services are the eighth of these critical functions. The first function is Transportation. It’s time for the airline industry, like health care, to invest in a good disaster preparedness program.
Mary C. Meyer, M.D., MPH, is an emergency medicine physician who practices in Northern California, where she is the regional director of emergency management for a large health care organization.