Women in Emergency Management

At the core of any public health emergency is communication, coordination, and collaboration. These three C’s are the cornerstones of emergency management – a field charged with responding to all-hazards through an organized, leadership driven framework to reduce the threat, save lives and cope with the crisis. We gather information, monitor the situation, analyze all data coming in, bring key personnel to the table and make decisions that may impact the lives of many. 

As women leaders in the field of emergency management, we know all too well the need for speed when it comes to any local health threat, let alone a rampant, global one like the COVID-19 pandemic. As a department, a team, and a group of women on the frontlines of emergency response, here are four approaches we've embodied as we respond to the COVID19 pandemic:  

Empowerment: Working as a Team 

There’s the unsung bond of sisterhood that prevails during the crisis. As women leaders in emergency management our powers come from empowerment. To hold each other up, to support and be a hand to hold or a shoulder to cry on.  

What makes empowerment so valuable during the COVID19 pandemic is the ability to bring people together, have trust and faith, share burdens and opportunities, and lift each other through encouragement, positive vibes and emotional strength.    

This pandemic has tested the resilience of our teams. It has brought long workdays, everlasting site visits, late-night conference calls, computer screens showing nothing but weary faces. Yet the operative word here is that it "tested" us, leaving us bent yet not broken. Due to the multi-faceted, all-hands-on-deck response, we empowered one another through the cloak of trust and team-building which allowed us to approach tasks, strategies, and situations with faith in our ability to divide and conquer.   

Making Decisions under Pressure  

When COVID hit, we were forced to make important, life-saving decisions under pressure like turning entire emergency departments into hotzones, level loading patients from one hospital to another, or opening surge units in cadence based on surge volume and analytic data coming in.  We quickly had to switch into an objective mindset and take emotions out of the process.  We had to detach as much as possible and dealt as objectively with the situation as we could.   

The first steps we took were to gather as much knowledge as possible, as quickly as possible.  Turn to every source of reliable information we can acquire rapidly.  The better you understand the entirety of the circumstances, the more likely you are to make a good decision.  See the situation from 30,000 feet as well as in the weeds and have all perspectives.   

Gather the experts.  Talk to people who are objective.  Gather them in one room or on one call and hash through the issues at hand and come up with solutions in each of their realms.  Let them give you advice on the best course of action.  But take that with a grain of salt.  Can you live with the results of the decision they suggest?  Does it align with your conclusions and thought-out outcomes?  If not, pass over the advice.  Seek other opinions and land on a workable solution.  Consider all possible outcomes.  Make the best predictions of how the various options could result, both in the long term and the short term. And consider how this is going to affect the lives of many.   

Prioritization: The Need to Triage  

In an emergency situation, you’re pulled in multiple directions with countless to-dos. The need to triage becomes a necessity. When deciding what decisions to make first and how to prioritize, we think of the decision that will benefit the needs of the many like which surge units need to open, or deciding on surge staffing and staffing reassignment and redeployment to accommodate growing needs.  

Decide what takes priority and match that to the resources available and move quickly to implementing those decisions first. Do the most good for the most people and prioritize the decisions that will have the most impact for the greater good factoring in capacity and demand. Factor in some decisions like when to move patients, supplies, equipment or staffing and where, are an hourly reassessment at times.  

Pull the trigger.  It is hard to make a decision, even harder to implement the decision and put it into action.  If you follow your process, gather sound advice, listen to the experts, lead with your head and your gut, then the course of action is obvious.  But it does not mean it is easy.  Start executing right away and keep moving forward. Reassess and shift gears as needed with every step.  That is, in its purest form, emergency management.  

Adaptability to an Evolving Crisis   

The only constant variable we knew for certain was change. We could expect that in a novel, high impact situation like the COVID19 pandemic, new information would be learned that would warrant changes to clinical and operational guidance, challenges would arise, and the impact would be significant – just how significant though would be beyond our wildest nightmares.  

We’re used to emergencies, whether it was the 2012 Hurricane Sandy, the 2014 Ebola outbreak, or the 2016 Zika outbreak but nothing could have prepared us for the COVID-19 pandemic. The sheer influx of patients, the significant impact to staffing, supplies, space and to the entire healthcare system, the uncertainty coupled with being a protracted event - something we’ve only seen in Hollywood blockbuster movies when a contagion takes a foothold. But it became reality before our very eyes. 

Our emergency response to COVID19 started January 21, 2020 – six weeks before our health system treated its first laboratory confirmed COVID-19 patient.  We activated our emergency operations center, stood up our incident command structure and began the 3 C’s – communication, coordination and collaboration that somber, January evening in anticipation of a COVID-19 outbreak in NYC. In our preparedness and mitigation phase, we ran drills and exercises, trained frontline staff, and supported other departments in ensuring the anticipated resources like PPE would be available.  

Like a fast-moving hurricane, it’s hard to remember when we transitioned from preparedness to response and into the eye of the hurricane. The pandemic emergency didn’t wait for anyone and if you weren’t on top of the deluge of the changing viral landscape – from public health updates on the virus and associated disease, it’s transmission-based dynamics and infection prevention precautions, treatment and care to return to work guidance for healthcare workers – you would be forever playing catch-up.  

As we walk on the road to recovery now, we’re adapting to the new normal. The COVID-19 emergency response has been the longest activation in all our careers, a full 14 months and counting. While our 7:30am daily data hurdles have been transitioned to once a week now, and our daily team huddles have moved to every other day, we know things can change on a dime. The yo-yo effect of this pandemic has become ground hogs’ day for us.  

But through it all we’ve adopted and conquered as a team. As the old sports axiom goes: The strength of the team is each member. The attributes of each member are the team. As we continue to respond to this pandemic, we acknowledge the vital role women play and continue to play in shaping emergency management. 

Syra Madad is a Fellow at Harvard Kennedy School's Belfer Center and Senior Director, System-wide Special Pathogens Program; Laura Iavicoli is an MD, FACEP, Senior Assistant Vice President for Emergency Management; and Madeline M. Tavarez is Senior Director, Emergency Management Planning and Operations, all with NYC Health + Hospitals/Emergency Management.