Perspective
Integrating Social Media into Emergency-Preparedness Efforts
N Engl J Med 2011; 365:289-291July 28, 2011DOI: 10.1056/NEJMp1103591
- Article
Despite blocked Internet service, new social media such as “speak-to-tweet” (which allows brief Twitter messages to be sent through a voice connection) were being used to improve communication about health and safety within the first few days of the 2011 Egyptian uprising, which had itself been organized by means of social media. After Haiti's 2010 earthquake, Ushahidi, an open-source Web platform that uses “crowd-sourced” information to support crisis management, linked health care providers requiring supplies to those who had them, and victims trapped under the rubble used Facebook to reach out for help.1 During the 2009 influenza pandemic, within minutes after the Alexandria, Virginia, health department tweeted and texted about where vaccine against H1N1 influenza was available, people flocked to vaccination sites. Community residents responding to the 2010 Deepwater Horizon oil spill in the Gulf of Mexico texted photographs of oiled birds to the Louisiana Bucket Brigade, whose maps helped volunteers to identify areas most in need of clean-up efforts.
Clearly, social media are changing the way people communicate not only in their day-to-day lives, but also during disasters that threaten public health. Engaging with and using emerging social media may well place the emergency-management community, including medical and public health professionals, in a better position to respond to disasters. The effectiveness of our public health emergency system relies on routine attention to preparedness, agility in responding to daily stresses and catastrophes, and the resilience that promotes rapid recovery. Social media can enhance each of these component efforts.
Since these new media are so pervasive in communication (more than 40 million Americans, for instance, use social media Web sites multiple times a day),2 it makes sense to explicitly consider the best way of leveraging these communication channels before, during, and after disasters. Networking sites such as Facebook can help individuals, communities, and agencies share emergency plans and establish emergency networks. Web-based “buddy” systems, for example, might have allowed more at-risk people to receive medical attention and social services during the 1995 Chicago heat wave, when hundreds of people died of heat-related illness within a short period.3 Integrating these networks into a community's preparedness activities for public health emergencies could help to build social capital and community resilience, making it easier for both professional responders and ordinary citizens to use familiar social media networks and tools in a crisis.
These tools can also be used to improve preparedness by linking the public with day-to-day, real-time information about how their community's health care system is functioning. For example, emergency room and clinic waiting times are already available in some areas of the country through mobile-phone applications, billboard Really Simple Syndication (RSS) feeds, or hospital tweets. Routine collection and rapid dissemination of these measures of strain on a health care system can inform decision making by patients and health care providers and administrators. Monitoring this important information through the same social channels during an actual disaster may help responders verify whether certain facilities are overloaded and determine which ones can offer needed medical care.
Location-based service applications (such as Foursquare and Loopt) offer another type of opportunity for improving preparedness, by enhancing people's awareness of crisis situations in their geographic area. Using global positioning system (GPS) software for mobile phones, these applications allow people to “check in” to a specific location and share information about their immediate surroundings. With an additional click, perhaps off-duty nurses or paramedics who check in at a venue could also broadcast their professional background and willingness to help in the event of a nearby emergency.
In many instances, by sharing images, texting, and tweeting, the public is already becoming part of a large response network,2 rather than remaining mere bystanders or casualties. During the first hour and a half of the 2007 massacre at Virginia Tech, students posted on-scene updates on Facebook.4 Online message boards generated by the American Red Cross have also been used during recent emergencies as a forum for sharing and receiving information about suspected disaster victims. During the 2009 H1N1 influenza pandemic, the Department of Health and Human Services used a “Mommycast” — viewed on YouTube or downloaded as an iTunes video podcast — to tell 1 million viewers what was happening, what to expect, and how to prevent the spread of influenza. At the same time, the number of people following the Centers for Disease Control and Prevention's “emergency profile” on Twitter increased from 65,000 to 1.2 million within a year, and the agency created online applications, or widgets, that provided credible health information and could be displayed on other Web sites. Thus, social media provide opportunities for engaging citizens in public health efforts both by “pushing” information to the public and by “pulling” information from bystanders. Both approaches may improve management of future emergencies.
Social media are also becoming vital to recovery efforts after crises, when infrastructure must be rebuilt and stress management is critical. The extensive reach of social networks allows people who are recovering from disasters to rapidly connect with needed resources.4 Tweets and photographs linked to timelines and interactive maps can tell a cohesive story about a recovering community's capabilities and vulnerabilities in real time. Organizations such as Ushahidi have helped with recovery in Haiti by matching volunteer health care providers with distressed areas.1 Social media have been used in new ways to connect responders and people directly affected by such disasters as the Deepwater Horizon oil spill, flash floods in Australia, and the earthquake in New Zealand with medical and mental health services.5
As with any new technology, there remain many hurdles between current use and optimal exploitation of social media. Although these media are used by people of both sexes and an expanding range of ages, it is important to recognize and explore the technology's limitations in reaching at-risk, vulnerable populations.2
Furthermore, it is not always possible to know whether social media users are who they claim to be or whether the information they share is accurate. Although false messages that are broadcast widely are often rapidly corrected by other users, it is often difficult to separate real signals of a health crisis or a material need from background noise and opportunistic scams. Careful consideration must also be given to issues of privacy and the question of who should monitor data from social media (and for what).
Studies are needed to evaluate the reliability and validity of public health–related information communicated through social media. Some relevant metrics (e.g., Twitter Analytics, Flikr Stats, and Google Analytics) already exist and are used by the business community, yet few published scientific studies have applied these tools to evaluating the capabilities or effectiveness of social media in public health emergencies. Also lacking are studies evaluating whether the integration of social media into public health efforts affects the costs, quality, or outcomes of health care.
Of course, social media cannot and should not supersede our current approaches to disaster-management communication or replace our public health infrastructure, but if leveraged strategically, they can be used to bolster current systems. Now is the time to begin deploying these innovative technologies while developing meaningful metrics of their effectiveness and of the accuracy and usefulness of the information they provide. Social media might well enhance our systems of communication, thereby substantially increasing our ability to prepare for, respond to, and recover from events that threaten the public's health.
The views expressed in this article are solely those of the authors and do not necessarily reflect the views of the U.S. Government or the Department of Health and Human Services.
Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.
Source Information
From the Department of Emergency Medicine and the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (R.M.M); and the Office of the Assistant Secretary for Preparedness and Response, Department of Health and Human Services, Washington, DC (R.M.M., S.E., N.L.).
- References
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Semenza JC ,Rubin CH ,Falter KH , et al. Heat-related deaths during the July 1995 heat wave in Chicago. N Engl J Med 1996;335:84-90
Free Full Text | Web of Science | Medline4
Palen L ,Vieweg S ,Liu SB ,Hughes AL . Crisis in a networked world: features of computer-mediated communication in the April 16, 2007 Virginia Tech event. Soc Sci Comput Rev 2009;27:467-480
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Marianne Robin Russo, Valerie C. Bryan, Gerri Penney. (2014) Emergency Preparedness. International Journal of Adult Vocational Education and Technology 3:2, 23-34
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Bella Etingen, Sherri L. LaVela, Scott Miskevics, Barry Goldstein. (2013) Health Information During the H1N1 Influenza Pandemic: Did the Amount Received Influence Infection Prevention Behaviors?. Journal of Community Health 38:3, 443-450
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Matthew P. Wadey, Robert J. Nicholls, Ivan Haigh. (2013) Understanding a coastal flood event: the 10th March 2008 storm surge event in the Solent, UK. Natural Hazards 67:2, 829-854
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Hilary N. Karasz, Amy Eiden, Sharon Bogan. (2013) Text Messaging to Communicate With Public Health Audiences: How the HIPAA Security Rule Affects Practice. American Journal of Public Health 103:4, 617-622
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Hye-Jin Paek, Thomas Hove, Jehoon Jeon. (2013) Social Media for Message Testing: A Multilevel Approach to Linking Favorable Viewer Responses with Message, Producer, and Viewer Influence on YouTube. Health Communication 28:3, 226-236
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Emergency Management Professional Development. In: Technology Use and Research Approaches for Community Education and Professional Development. IGI Global, 2013:102-116.
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Mintu P. Turakhia. (2011) JICE goes “social”. Journal of Interventional Cardiac Electrophysiology 32:2, 79-80
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