My cell phone rang at 3:09 that morning. It was Carlos Carrasco, the chief operating officer (COO) of Orlando Health Orlando Regional Medical Center (ORMC), asking if I had heard about the shooting. I was a bit confused because two days earlier, on Friday, June 10, 2016, Christina Grimmie — a contestant on the TV show “The Voice” — was shot and killed in Orlando. She had just completed a performance at a local venue and was signing autographs when a crazed fan approached her table and shot her at close range. She was rushed to ORMC’s Level One Trauma Center. Unfortunately, she didn’t make it. So when Carlos called and woke me from a sound sleep, I wasn’t quite “all there.” It wasn’t until he told me about a shooting down the street from the hospital and said, “This time I think it’s real,” that I knew something very bad was happening. I immediately jumped up, started scanning social media channels, phoned my media relations manager who was on call that weekend, and we both headed into the hospital where we immediately went into Incident Command.

Synopsis

My department consists of six people — four managers, an administrative assistant and me, the director. We basically perform four functions: 1) proactive outreach to the press, 2) responding to press inquiries, 3) managing issues and 4) managing the press in times of crises. On an average day, we pitch three to four proactive stories to reporters, field four to five press inquiries and manage two to three issues. In the first week after the Pulse tragedy, those numbers dramatically increased to where we were interacting with around 100 reporters each day.

Preparation

Our crisis plan consists of approximately 150 pages divided into 15 sections. The sections include Hospital Incident Command (HICS) roles and responsibilities, a few prepared statements, guidelines for more than 20 emergency scenarios, media staging-area instructions with photos, sample media alerts and press releases, policies that are relevant to crises situations, and (what would become the most important page that day) the names and cell phone numbers of our crisis communication committee (CCC). At the time, the CCC consisted of approximately 30 individuals with whom the media relations team on a typical work-day has infrequent interactions — people such as our director of patient experience, our director of government relations and our web master.

The crisis plan is a “working” document, meaning that it does not sit on a shelf collecting dust. Each media relations team member has an electronic version of the plan as well as a hard copy that is contained in a four-inch, bright red binder. We try to always have the red binder with us -- either in the car, in our computer case, at home or somewhere that makes it easily accessible.

We refer to the plan almost on a daily basis for various purposes, but certainly during crisis drills. When drills occur, everyone in the department has a role as either the HICS Public Information Officer (PIO) or media relations support for the PIO. Following normal Incident Command procedures, the team member who is serving as the PIO will craft and distribute information to the “pretend press.” The rest of the media relations team will serve as 1) members of the “pretend press” pummeling the PIO with questions and requests expected of the news media or 2) follow “pretend” directives given by the PIO, which could be anything from scheduling a press conference to escorting a reporter to a specific location. Once drills are complete and while they’re still fresh in our minds, we return to our office to conduct a debrief specific to media relations to help us identify what went well and areas of opportunities.

Other crisis preparation tools in our portfolio include a video studio that is located directly across the street from ORMC’s main entrance and adjacent to the media relations office building. The studio is outfitted with a lighting grid that can illuminate one or all six permanent sets, which include a logoed backdrop for use during press conferences.

Another element we had established prior to the Pulse tragedy, and one that would become invaluable during the weeks and months that followed, was a single email address that reaches the entire media relations department. We received hundreds, maybe even thousands, of email inquiries related to Pulse through that address during the weeks and months that followed.

In addition to these elements, our social media (SM) channels and website also were critically important. We have several SM channels that were created since 2010, but the most important ones during the Pulse response were Twitter and Facebook. All SM channels are managed by a local vendor with whom we’ve developed extremely close relationships. The vendor works with multiple Orlando Health departments and facilities to create and distribute information, including messages during crises. The morning of Pulse, two vendor representatives were in HICS sitting with me and our internal communication director/co-PIO. This three-legged stool of communication — internal, external and social — is the foundation of all Orlando Health crisis communications.

Response

After receiving the call and gathering my thoughts, I turned on the lights and the television, and started scrolling through emails and social media sites to see if there was any press interest or coverage at that point. There wasn’t. I phoned my manager who was on-call that weekend to see what he knew. A light sleeper, he had been awakened by the “bings” on his cell phone of incoming emails from our security team. We spoke a few minutes, and then both of us got dressed and headed toward the hospital.

It takes about 15 minutes to drive from my house to ORMC when traffic is light. Since it was 3:45 in the morning, traffic was particularly light. When I got about three blocks from ORMC, I noticed a few people pacing on the sidewalk in front of a 7-Eleven. There were two men and a woman wearing a short dress or skirt and holding in one hand a pair of high-heeled shoes, which was odd. Almost immediately, I looked in the direction I was driving and could only see flashing police lights. The most I had ever seen. They stretched from one side of the four-lane street to the other. I managed to get to the valet circle at ORMC, where I parked, put my business card on the dash so the valet runners would see it and went into the hospital to Incident Command.

Other HICS officers started to filter in and Carlos, the hospital COO, briefed us on what had happened. The room went silent while we all contemplated what we had just heard. I remember thinking, This can’t be real. This is Orlando! But there was no time for grief. We had work to do. I took the PIO seat and my manager grabbed our crisis plan and started calling members of the CCC.

We distributed the first press message around 5:00 am to our local news outlets. The initial message simply provided information about our hospitals and for team members. It read: “ORMC was placed on lockdown around 2:00 a.m. after receiving several gunshot victims. Only essential workers allowed access. Arnold Palmer Hospital and Winnie Palmer Hospital also placed on lock down.”

The volume of press inquiries that came into Orlando Health was initially very light but increased throughout the morning as details of the tragedy spread across the country.

Inside ORMC’s Incident Command center, we watched the press conference on television monitors. As it concluded, the chief of staff for the City of Orlando announced that a second press update would occur later that morning. We participated in the next presser just before 11:00 am.

Our CEO, trauma surgeon and I joined officials walking from the mobile command center to the press conference site. The street was teeming with law enforcement. It was a bizarre scene.

I found myself standing in the middle of a blockaded street next to an officer in body armor carrying an automatic rifle. Soon after, we heard a muffled blast. I don’t know what caused it, but assumed it was planned by law enforcement.

At this press conference, Orlando Mayor Buddy Dyer announced there were more fatalities than originally thought — 50. I heard an audible gasp from members of the press.

Dr. Cheatham provided patient statistics and conditions. These facts formed the basis of daily updates we provided to the press and on social media.

The rest of that Sunday was a blur as our team crafted messages and responded to press inquiries. We quickly realized we couldn’t respond to everyone, so we prioritized local and national reporters.

Working with local reporters was important to maintain relationships, while national press helped distribute information globally. Our goal became to secure coverage across major national outlets. We succeeded.

After the 11:00 am press conference, we returned to Incident Command. By 4:00 pm, we reached the 12-hour duty limit. I handed off responsibilities and went home.

On Monday, press activity intensified. Getting to the office required navigating satellite trucks and news crews. Communication within our team was constant.

“Who’s available to talk to ‘Good Morning America’?”

“Book the studio for Scott Pelley’s interview.”

“The New York Times wants to talk to Dr. Ibrahim.”

We hosted a major physician press conference Tuesday. It came together quickly and drew hundreds of media personnel.

Our key messages were simple: We were prepared. We are the experts. We are a team.

The patient’s story during the press conference was emotional and powerful, highlighting both the trauma and the care provided.

From that point forward, press inquiries remained constant but manageable. Overall, the professionalism of the media was impressive.

In the first four days, we received more than 2,800 mentions, reaching millions across print, television and digital platforms. Social media reach was equally significant.

After about two weeks, press inquiries began to level off, but continued monthly for a year following the tragedy.

Lessons Learned

We identified areas of opportunities by noting deficiencies or inefficiencies during the process of managing the situation. For example, we realized that we needed more people and sooner to handle various support functions such as creating a spreadsheet of all our press interactions, especially during the first few weeks. Our PR firm of record would have handled that task masterfully. But we were so busy we simply neglected to contact them.

Another area of opportunity was created as a result of the sheer volume of press. For example, the room in which we staged the Tuesday press conference was packed with people. In our crisis plan, although we have multiple press staging areas for all of our facilities, we never imagined needing a room to accommodate hundreds of people. That remains an opportunity that we are reviewing.

And finally, we failed to consider the possibility of some sort of sensational sidebar story the press latches onto that requires its own special media relations attention and thereby draws away already-strained resources.

What We Changed

We got our PR firm more involved in department operations. During our community-wide crisis drill in March 2017, the COO of the PR firm joined us in Incident Command. He also managed a few of the Pulse one-year-later stories for us and we added him to the email list, so the firm is always aware of what is happening in our department.

Conclusion

It’s been said that in times of crises, you either rise to the occasion or you crumble. I’m proud to say that my team rose to the occasion. When faced with the most demanding situation that any of us have encountered, or likely will encounter in our careers, we pulled together and successfully managed the largest press presence imaginable. The phrase “team work” so aptly applies to how we received, organized and responded to members of the press and how we collaborated with each other. There were hundreds of tasks to be met each day — securing patients, executives and physicians for press interviews, booking the studio, producing our own video news releases, ordering food, the list seemed endless. Each of us knew what needed to be done and we were empowered to do it.

The Pulse shooting affected each of us differently. Ultimately, I think it made us all more confident in our abilities. Unfortunately, it also made us realize just how vulnerable we are as individuals.ort 15 months after Pulse. In Orlando Health’s consistent spirit of sharing best practices across the industry, we provided UMCSN Foundation with guidance and reassurance on how to best handle their next steps in response to yet another senseless shooting.

Key Takeaways

You must be prepared! Have the processes and plans in place that you will need to handle a tragedy of this size.
You must practice it! Don’t leave your plan on the shelf. Create crisis situations that require you to test it. In this way, you can identify what works and what doesn’t.
You must work together as a team! A tragedy of this size requires many people managing many tasks. One person can’t do this alone.
You must be empowered! Each team member must know that they were hired not only for their experience and expertise, but also for their resourcefulness in times of extreme stress.