How Health Departments and First Response Agencies Can Use Twitter to Monitor Emergencies, Part 2

Yesterday, I talked about how local health departments (LHDs) can use Twitter to communicate about and monitor public health emergencies. I also talked about how to set up your own Twitter account. For nearly a year-and-a-half, I was the Risk Communication Director for the Indiana State Department of Health. I dealt with the media during public health emergencies, and took part in several incidents and training exercises.

A tool like Twitter would have been invaluable, and saved a lot of time and energy in getting valuable information to other first responders, the Incident Command structure, and even the media and public.

Be sure to visit yesterday’s post to see how to set up a Twitter account and what applications will make this extremely useful.

Today, I want to show what a Twitter exchange would look like.

A few more issues to take care of first:

1. GroupTweet is a web-based service that lets you send messages to an entire group, rather than sending something to all of your followers, or typing in their names one at a time. If you need to speak to, say, an entire POD or the entire EOC, set up a group in advance, and assign all the members of that group. Then, when you need to send a message to only those people, follow GroupTweet’s instructions.

2. For training exercises and real emergencies, it’s helpful to set up accounts for the different NIMS roles (e.g. ISDH_INCMD is the Incident Commander for the Indiana State Department of Health). As the shifts change, make sure the new people have the username and password to the Twitter account.

3. If you are using a special term or keyword during the incident, like “ISDH” or “anthrax,” you can use a program like Tweetfeed to monitor Twitter traffic. This will pick up all traffic with that keyword, so you may be inundated with more traffic than just your group.

4. Set up a laptop running TweetDeck or Twhirl (or both), with an LCD projector to show the message windows on the wall. Make sure everyone can see it, but try to squeeze as many tweets on the wall as you can. (Use the display settings in the Control Panel.) Everyone working in the EOC is using the EOC software, as well as their own Twitter account, but they will be able to see the Twitter stream on the wall. They will also be able to respond to the messages from their own station.

5. Have the PIO could have a separate, public Twitter account that he or she can use to contact the media and public directly, rather than waiting for the TV news and newspapers. Updates are immediate and can be made as needed. Information given to a TV station could be obsolete 15 minutes after the news van has left.

Also, use the # hashtag if you’re talking about a more common term AND your timeline is public. This will let other people, like the media and concerned citizens, also monitor what you’re doing. Anyone who is using the #hashtag will show up in the general Twitter timeline through Twitter’s search function at or TweetFeed (they show the same feed. There are not separate feeds for each program). This is an important way for the PIO to monitor Twitter traffic on the incident.

Here’s how Twitter can work during an emergency.

Scenario: During a POD deployment in Clark County, you’ve got too many volunteers in one POD, you’re running out of medication at another, and a TV news crew is on site, but the Clark County PIO is not available.

Normally to handle this, the Operations Officer from Pod#1 would have to call the EOC to find out if they need to redeploy the volunteers. Someone else would call to get more medicine. A third person would frantically be trying to track down the PIO, and running around to find her. I’ve been in the scenarios where all these things are playing out simultaneously, and it’s often hard to get an answer because everyone is searching for their own answer, or working on their own part of the incident, and can’t be found.

While Twitter won’t eliminate this problem, it can help alleviate some of this chaos by making information more readily available. Here’s how:

The volunteer supervisor sends a Tweet, followed by a response from the EOC Incident Commander

Clark_VOLSUP: Clark County POD #1 has 12 too many volunteers? Send home or send elsewhere?

ISDH_INCMD: POD #3, First Haven Church, needs new volunteers. Send 8 there. Rest can go home.

Clark_VOLSUP: They’re on their way.

POD#1_OPS:We’re running low on doxycyclin. Will be out in 2 hours. Does anyone have more?

POD#3_OPS:We have plenty. Will send volunteer with 5 cases.

POD#2_OPS:Sorry, we’ve got just enough. Might run short near end of day.

POD#1_OPS:Channel 4 from Louisville is on site. Can’t find @Clark_PIO. Does anyone know where she is?

ISDH_PIO:@Clark_PIO is caught in traffic. I’m on site, and can handle.

POD#1_OPS:We’ve just sent processed our 10,000th person. How’s everyone else doing?

POD#2_OPS:We’ve had 8,000.

POD#3_OPS:We’ve had 12,000.

ISDH_PIO:Can I share this with the media? Any talking points I should give?

EOC_OPS:@ISDH_INCMD says Yes. 30,000 people through PODs, everything running smooth, enough meds for all. All PODs should finish by 10 pm today.

ISDH_PIO:Understood. Will contact @ISDH_INCMD when interview is done.

This short exchange has accomplished a number of things:

  1. They saved a bunch of phone calls, and chasing down different people to get an answer.
  2. It allowed for flexibility of someone else answering for the Incident Commander. The IC could have been standing nearby, unable to type out an answer, so someone else was able to do it for them. By using the @ reply feature, the IC can also see that someone has done this. It’s not lost in the shuffle.
  3. Using the @ symbol also delivered messages to the intended people, but publicly, so others can answer. The person who received a reply answer (@IDSH_PIO) was able to get the information they needed, but so did everyone else. Now, if someone needs to know where the PIO is, they have that information, instead of racing around again, trying to find out.
  4. It creates a record of what happened, which will help write the After Action Report (AAR), plus it gives a written transcript of the conversation, if needed. Just copy and paste all the Tweets into an index as part of the AAR.
  5. Each POD Ops director was able to share the number of people processed through POD with everyone. Best of all, they did it without sending an email. The information was immediately accessible, visible, and available to everyone. Emails tend to get buried and forgotten.
  6. The ISDH PIO was able to pick up some useful information – the number of people through each POD – just by following the general timeline. He would not have found this out otherwise, because the Operations.
  7. The Incident Commander was able to give the most important talking points to the PIO in a matter of seconds, not minutes on the phone. Or worse, the PIO never being able to reach the Incident Commander on the phone.

There are many more ways health departments and first responders can use Twitter. In fact, there are several social media technologies that health departments can use:

  • Ning social network engine to create a closed social network for all local health departments;
  • create a blog to give the public quick news updates, post press releases, address any rumors, and serve as a news source to the media. (Blogging can also help you keep the public updated without waiting for news channels;
  • and, using a a href=””>wikito create and share information (password-protected, of course) among health departments concerning large scale events, such as pan flu.

I’ll write about these technologies in future posts. In the meantime, if you have any comments, questions, or stories about how you’ve used these technologies, leave a comment.

Resources for Crisis Communication Through Social Media

Originally posted at the blog

I just had an article published in a special report for members of the International Association of Business Communicators to communicate during the swine flu pandemic. (Cue the “Proud Moment” music!). Anyway, this inspired me to find other resources related to using social media for crisis communication. (And yeah, this includes a few of my blog posts.)

Useful Social Networking Apps for Crisis Communication

  • TweetDeck – Browser for Twitter. If you’re new to Twitter, get this!
  • NearbyTweets – Website search app to find Twitter users in your city or state.
  • – URL shortener. Use it on TweetDeck, and then track it with Twitalyzer or’s click tracker.
  • StatCounter – Measures website or blog traffic from minute to minute. Google Analytics is great, but they only update stats around 2:00 am EST. StatCounter may give you the numbers you need for rapid response during a crisis.
  • – Blog software hosted on their servers. Easy to use, especially if you’re not technically savvy. Owned by Google.
  • – Similar to Blogger: hosted on their servers. Not as easy to use as Blogger, but still pretty easy to use.
  • – Regular WordPress software. You download this and load it onto your server. You either need to be technically savvy, or know someone who is.
  • GoDaddy – Inexpensive server space and domain name (URL) registration. Not the best, but for cheap price and ease of use, it’s a pretty a good way to go. This blog is hosted on GoDaddy and uses


Blog posts, PDFs, and PowerPoint slide decks

If you can think of any others, please feel free to add them. If you add enough, I’ll do an addendum to this post.

How Social Media Can Help the Public Avoid the Swine Flu

Originally published on the blog.

I used to be the Risk Communication Director at the Indiana State Department of Health and one of the things we prepared for over and over was “pan flu.” At the time, we thought it was going to be the H5N1 bird flu, and we prepared by practicing drills, simulating events, writing tons of press releases, and creating processes to get information out to the media and public. Quickly.

The problem is the old model of sending out press releases via email was fast enough three years ago, but since the explosion of Twitter and social networking, and the decline of the traditional newspaper, people just aren’t getting their news through traditional methods anymore.

With social media, the public is getting their information as it happens, rather than waiting for a newspaper to publish day-old news, watching network news at certain times of the day, or cable news that only has time for a national focus, but nothing deeply local.

I’ve been using Twitter to get national news from sites like CNN, the BBC, and USA Today.

I’ve been watching the Google Maps case markers, the CDC’s swine flu investigation, and even listened to a couple of the CDC swine flu podcasts.

There are a few ways public health and first responders could use social media to educate the public, and get ahead of the rumor mongering and bad information that many people seem to perpetuate, whether accidentally or otherwise.

Create a Twitter account.

Someone posted a tweet today that the Twittersphere was talking about swine flu the most, so this is the place to start. Use Twitter to quickly answer questions, debunk rumors, and give out good information and news links.
1) Use the name of your agency AND the emergency (for example, IN_SwineFlu.)
2) Download TweetDeck from
3) Set up a search column for “#swineflu and swine flu.”
4) Use Twitter’s Find People function to find media outlets and journalists in your area, and follow them. They’ll follow you back.
5) Use to find other people around your area. Search for the city AND keywords like “#swineflu” and “swine flu” to find local people talking about those topics. Follow them, and they’ll follow you back.

Set up a blog

Don’t screw around with the rigamarole of getting your IT department to set up a blog on your agency’s server. They’ll have to ratify it in their bi-weekly committee meeting, and want to create a mission statement and all that crap. Use blogs to publish press releases, send out quick updates and stats, give information that can’t wait (i.e. locations of hospitals and medication).
1) Go to, and set up a blog for your agency (i.e. You COULD screw around with WordPress, which is actually better, but we’re going for speed here. Plus you can’t do this. . .
2) Set it up so you can send emails and texts to your blog. If you’re one of the lucky people who has a Blackberry, you can send blog updates that way. Ditto with photos.
3) Go to and have your blog automatically update your Twitter account.

Monitor your traffic

It’s important to monitor your traffic so you can know what messages are getting the most attention, what ones are being repeated, and where your biggest traffic sources are from.You need to know how many people are coming to your blog, reading your tweets, and paying attention to what you’re saying to know which areas you need to improve on.
1) Set up your TweetDeck URL shortener to use, not Tiny.url or any of the others.
2) Go to, and enter your Twitter ID. Scroll to the bottom of the page, and click on Return on Influence. You’ll be able to measure how many people have read your Tweets.
3) Install StatCounter into your blog. I usually like Google Analytics, but they only update around 3 am EST. StatCounter updates minute to minute.

Those are the basics of using social media to communicate with the public. If you have any questions or suggestions for best practices, post them here in the comments. I’ll put up new blog posts to answer big questions

In the meantime, please take a few minutes and watch this video to learn how to avoid spreading colds and flu, not just swine flu.

9 Things Government Agencies Can Do To Improve Emergency Communication

I was sitting in a local restaurant a couple weeks ago when I saw the news that a swine flu outbreak had been confirmed in Mexico and California. It was the news I had been afraid of for the last three years, after spending more than a year as the Risk Communication Director at the Indiana State Department of Health (ISDH), training for a flu pandemic, and learning how to communicate to the public during a major crisis.

So I waited for an official response from the ISDH, since we had worked on this for so long. And I waited. And waited.

I didn’t hear anything until Sunday, and after that, I didn’t hear as much as I had hoped for. I got most of my news from the national news outlets, and occasionally the Indianapolis news stations and Indianapolis Star. I saw barely a blip on social media, and a Google search for local information showed that more information was coming from the county health departments, rather than the state one.

It’s easy to Monday morning quarterback, but as a professional communicator and someone who helped develop the ISDH’s crisis communication plan, I can see where there is room for improvement. So, these are nine tips any state agency, or even large corporation, can use to communicate during an emergency or crisis.

1) Jump out in front of the communication wave. When the first news of the swine flu — excuse me, H1N1 — hit on that Friday, there was no news from the state until Sunday afternoon, 48 hours later. After that, they seemed to spend the rest of their time playing catchup, rarely pushing news out to the media, and letting the local health departments get their news out first. As the state’s voice for public health, the ISDH should have been the primary source for the news, not the locals.

The core principles of CERC (Crisis and Emergency Risk Communication) are Be First. Be Right. Be Credible. They’re the guiding principles anyone trained in crisis communication understands and practices. By missing out on the first one, the ISDH never had the chance to be the other two. (You can download a PDF of the CDC’s CERC – First 48 Hours Checklist here.)

2) Create a series of communication and press release templates. Or at least a formula. Most of the initial communication in any crisis is pretty standard. You can guess what the situation is going to be (“swine flu has been found in the state; this is what we know; this is what you can do to prevent getting it”), create a basic press release with some fill-in-the-blank answers, and fill them in when the crisis finally hits. This will save time in trying to write one in the heat of the moment. If you just have a formula, you will at least know what information should go into the press release, and can write it with a minimal effort.

3) Call the emergency what other people are calling it. People and the media started referring to this outbreak as “swine flu,” and it was only financial concerns from the pork industry that made the news people change their designation to “H1N1.” Calling it the “North American Human Influenza” strain will not improve your search engine rankings, and will only confuse the public. At the very least, stick with “H1N1,” so people in the news media recognize what you’re talking about. Use the language people use, not the scientific jargon the scientists are using.

4) Set up a Twitter account for only one agency. The ISDH and the Department of Homeland Security (IDHS) split up an account, which made it unclear to the public who was actually controlling the message, and who was the best resource for information. As a result, nothing was posted very frequently, and the ISDH missed out on a valuable communication outlet. Twitter would have been a valuable tool in the communication toolbox, but it was used improperly and too infrequently, and thus, they missed a huge opportunity to counter public misperceptions and misinformation.

5) Follow the public on Twitter. The ISDH_IDHS Twitter account only follows 21 people, while it has 500 followers. The 21 Twitterers they were following? News sources — some local, some national, including the Associated Press, New York Times, and a health reporter. Problem is, the AP has had no updates that I could see, the health reporter rarely uses Twitter, and the New York Times is, well, in New York. What this tells me is that the ISDH is getting their news from the news sources, not the other way around. Meanwhile, I created a group on TweetDeck for people talking about swine flu in Indiana. I answered questions, referred people to resources, and countered bad information. Something the ISDH should have been doing from the outset.

6) Use social media to communicate directly with the public. It’s important to use traditional media, because they’re still an important way to reach people. But newspapers are failing, there are too many radio stations, and TV news is not always on at a convenient time, while people use social media all the time. They use their computers throughout the day, when they can’t watch TV or listen to the radio, and newspapers are only published the following day.

7) Create a website specifically for the event. An issue-specific website will contain updates and much-needed answers, and it becomes the information clearinghouse for everything related to the issue. The Indiana State Health Department (ISDH) created a website at, but it doesn’t have very much information, and usually points people away from the site to sites like the CDC. In essence, it says “we’re not the experts, everyone else is.” So much for “being credible.”

8) Get an issue-specific domain name. If possible, purchase a domain name with the issue and your state or city:,, etc., and send everyone there. An issue-specific domain name helps with name recognition and search results.

9) Use a blog. Seventy-seven percent of all Internet users read at least one blog, so these things are here to stay. They’re a great way to create short, quick updates that don’t require five levels of editing and committee approval. Post press releases, figures and statistics, and answers to frequently asked questions. Tie that domain name into the blog, and you’re all done. Blogging can be done in 200-word posts that can be done quickly and easily, by anyone who has a modicum of writing skill. In the crisis communication model, a single writer can work with a subject matter to write a post and be done with it. Or in some cases, write one paragraph updating the number of confirmed cases and tagging on the boiler plate language of prevention and flu hotlines, and you’re done. Takes 10 minutes tops, and the public and the media now has a source for news they can rely on.

Another CERC principle is to create the communication plans and procedures NOW. Don’t wait until the emergency is on you to start these things up. The relative weakness of the swine flu was a shot across the public health bow. And for the most part, public health responded admirably. While the number of cases are growing, we’re not facing a raging outbreak, because of the extensive planning and response by the CDC, the Public Health and Emergency Response, and the local health departments and hospitals. We’re not out of the woods yet, and there’s still a lot to do, but it’s not too late to respond to this threat, and there’s plenty of time to get ready for the next one.

What Can Swine Flu Teach Us About Crisis Communication Through Social Media?

Social media has been playing an important part in the swine flu epidemic, which public health experts worry will turn into a pandemic (an epidemic that crosses many countries).social_media_communities_main-1

When I was the Risk Communication Director for the Indiana State Department of Health, half of my time was spent talking about the influenza pandemic — pan flu — and what we could do to communicate during a pandemic. I had a staff of public information officers, and we came up with all sorts of ways to communicate with the media.

We had email, cell phones, and Blackberries, and all of our strategies relied on us being able to have access to those email servers and being able to get news out to the state media outlets, who would then take our news and push it to the top of the news cycle, thus insuring our message would be prominent. Which is great if we were living in 1995.

But they were all the tools in the toolbox for communicating about the impending bird flu.

“People need to quit calling it bird flu,” said more than a few docs and epidemiologists one day. I had made the mistake of calling it bird flu in a meeting one day. (The H5N1 bird flu in Asia was the big fear in 2006.)

“But that’s what people are calling it already,” I countered.

“So?” they all said, in that way educated smart people can. “We just need to educate people to call it pan flu, because by the time it becomes a pandemic, it won’t be from birds, it will be transmitted through people.”

“We’ll spend all our time educating people on not calling it bird flu that we’ll waste our energy we could be using to educate the people.”

But my pleas fell on deaf ears, and so we called it pan flu. “Pan flu” this, “pan flu” that.

Except nobody’s calling it “pan flu” now. We’re calling it swine flu. And that’s the name that stuck, unless you’re from Israel (they’re calling it the Mexico Flu).

So the health department is calling it swine flu, and after three days of no news, they finally put up a press release on their website, and a joint Twitter account with the Indiana Department of Homeland Security.

Social media has taught us all a few lessons when it comes to crisis communication and rapid response, whether you’re in a government agency or the corporate setting.

  • Use the terms the people are using, not your experts. The people are calling this epidemic swine flu. I’m glad to see the health department also calling it swine flu. But avoid the urge to call it “pan flu” if/when that happens. Avoid calling it “influenza.” We all know it as swine flu, so continue to use that term.


  • Go to where the people are. The people are not reading newspapers. That information, if we’re lucky, is only 12 hours old, which means it’s outdated as soon as the printer fires up. The people are online, on Twitter, and reading blogs. Meet them there, don’t make them come to you, because they won’t.


  • Some information is better than no information. Rather than wait for three days to release one press release, give out bits of information as you have it. Talk about precautions. Talk about plans. Talk about the number of cases in the state (at the time, none; now there is one case.


  • Use a blog to communicate with the public and the media. People aren’t reading local newspapers or watching local TV. They’re getting news online that’s been referred to each other through Twitter and other blogs.


  • Use the name of the topic on Twitter. While using ISDH in the title is good, and word will eventually spread that ISDH_IDHS is the Health Department and Homeland Security, it’s not very obvious, like IN_SwineFlu.


  • Follow area people on Twitter. Right now @ISDH_IDHS is only following the news sources, but not the people of Indiana. One of our goals at ISDH was to correct misinformation, and people are putting out all kinds of bad information on Twitter. They should follow as many people as possible in Indiana, and then address any and all questions, bad information, etc. Refer people back to the blog, or at least the CDC’s website. Set up TweetDeck with a group that searches just for “swine flu” and “Indiana.”


A few links to articles I’ve written on using social media for crisis communication.