Preparing for and Responding to Bioterrorism: Information for the Public Health Workforce

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Preparing for and Responding to Bioterrorism
Information for the Public Health Workforce
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Acknowledgements
This presentation, and the accompanying
instructors manual, were prepared by Jennifer
Brennan Braden, MD, MPH, at the Northwest Center
for Public Health Practice in Seattle, WA, for
the purpose of educating public health employees
in the general aspects of bioterrorism
preparedness and response. Instructors are
encouraged to freely use all or portions of the
material for its intended purpose. The
following people and organizations provided
information and/or support in the development of
this curriculum. A complete list of resources
can be found in the accompanying instructors
guide.
Patrick OCarroll, MD, MPH Project Coordinator
Centers for Disease Control and Prevention
Judith Yarrow Design and Editing Health Policy
and Analysis University of WA Washington State
Department of Health
Jeff Duchin, MD Jane Koehler, DVM,
MPH Communicable Disease Control, Epidemiology
and Immunization Section Public Health - Seattle
and King County Ed Walker, MD University of
WA Department of Psychiatry
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Communication and Informatics
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Communication and InformaticsLearning Objectives

• Describe the Health Alert Network (HAN)
• Define and describe its purpose and functions in
  a BT response
• Identify resources available for public health
  through HAN
• Describe public health participation in HAN
• Identify factors influencing risk perception and
  risk communication

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Communication and InformaticsLearning Objectives

• Identify factors to plan for and issues to
  consider when delivering high risk information to
  the media and the public
• Describe your communication roles and
  responsibilities in a BT event or other public
  health emergency

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Detecting and Responding to BT involves

• Scanning data for suspect disease patterns
• Secure transmission of public health data
• Rapid communications within and beyond the health
  care and public health sectors
• Management and maintenance of data systems
• Distribution of health alerts, treatment
  guidelines, sampling protocols, public
  announcements, etc.
• Communication of risk to various audiences
• all of which require competence in a new
  discipline called INFORMATICS

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Public Health Informatics

• The systematic application of informatics and
  computer science and technology to public health
• Requires competence in
• The use of information per se
• The use of information technology for ones own
  professional effectiveness
• The management and development of information
  systems for ones health agency
• Explicit list of target informatics competencies
  for public health professionals is available at

• http//nwcphp.org/phi/comps

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Health Alert Network Definition

• A nationwide, integrated information and
  communications system designed to
• Ensure communications capacity at all local and
  state health departments
• Ensure capacity to receive distance-learning
  offerings from CDC, et al.
• Ensure capacity to broadcast and receive health
  alerts at every level

More on HAN...
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Health Alert Network How it Works

• Links local health departments to one another and
  to other organizations critical for preparedness
  and response
• Community first-responders
• Hospital and private laboratories
• State health departments
• CDC
• Other federal agencies

More on HAN...
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Health Alert Network

• The highway for programs such as the National
  Electronic Disease Surveillance System (NEDSS)
  and the Epidemic Information Exchange (Epi-X)
  project

More on HAN...
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Epidemic Information Exchange

• A secure, moderated, Web-based exchange for
  public health officials to
• Rapidly report and discuss disease outbreaks and
  other public health events
• Create reports and track information
• Receive daily e-mails on new information in their
  area(s) of interest
• Find contact information for key public health
  officials
• Request assistance from CDC online

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The Flow of Health Information
Clinical care providers and laboratories
Health alerts Provider education Other
communication
NEDDS Other reports
LHD
SHD/PHL
Local EOC
Epi-X Health Alerts
CDC
Media Public
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Coordinating Information Activities The Role of
the EOC and JIC

• Emergency Operations Center (EOC)
• The protected site from which state and local
  civil government officials coordinate, monitor,
  and direct emergency response activities during
  an emergency
• Joint Information Center (JIC)
• A center established to coordinate the public
  information activities on-scene

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Emergency Operations Center (EOC)

• Maintained and activated by the state/local
  emergency management department
• In a health emergency (ESF 8), consists of
• State/local health officer
• Core health department technical staff
• Representatives from supporting government and
  private agencies
• Public information officer

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The Flow of Information in an EmergencyLocal and
State Level
Clinical care providers and Laboratories
Governor
SHD/PHL
LHD
State EOC
Local EOC
State EMD
Media and Public
Media and Public
Local EMD
Other state agencies
Other local agencies
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Incorporation of a Joint Information Center (JIC)
State EOC
FEMA CDC Other federal agencies
Local EOC
JIC
Media and Public
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Risk Communication in a Public Health Emergency

• Effective risk communication can
• Give community members a sense of control
• Help allay panic and social disruption, and
  increase cooperation
• Dispel myths and rumors
• Increase trust in public health authorities and
  their decisions
• Ineffective risk communication can
• Do just the opposite!

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Communication With the MediaDisasters Are a
Media Event

• Drama, conflict, problems, rising and falling
  action
• Absence of media in disasters can create enormous
  difficulties
• Media (newspapers, TV, and radio) most important
  sources for public to obtain information

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Crisis How News Media Operate

• Media onslaught within minutes
• Public curiosity feeds the media frenzy
• Instant experts and authorities
• 24-hour news coverage
• Pack journalism pressures

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Information Sought by Media

• Casualty numbers, condition, treatment
• Property damage
• Response and relief activities
• Resulting effects (e.g., anxiety, stress)
• Questions are predictable

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Media Different in Disasters

• Diminished information verification
• Diminished adversarial role
• Domination by national versus local media
• Command post perspective (official government
  sources)
• Difficulty with technical information

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Risk Communication Models

• Describe how risk information is processed, risks
  perceived, and risk decisions made
• Risk Perception Model
• Mental Noise Model
• Negative Dominance Model
• Trust Determination Model

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Factors Influencing Risk Perception

• Whether the risk is perceived to be
• Voluntary/imposed
• Controlled by individual/controlled by others
• Of clear benefit/little or no benefit
• Fairly distributed/unevenly distributed
• Natural/man-made
• From a trusted source/untrusted source
• Familiar/exotic

Source Fischhoff et al. 1981 ATSDR - Health Risk
Communication Primer
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Mental Noise

• When people feel what they value is being
  threatened,
• Resulting emotions ? mental noise
• Limits the amount and complexity of information
  they are able to process at one time

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Negative Dominance

• In a high-concern situation, people put a greater
  emphasis on losses than on gains

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Factors Influencing Trust Determination

• Third-party endorsements
• Caring and empathy
• Dedication and commitment
• Competence and expertise
• Honesty and openness

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Communicating With the Public Crisis
Communication Basics

• Give positive action messages
• Repeat clear messages and be consistent
• Give bias-free messages
• Give guidance in threes, when possible
• Correct misinformation

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Delivering The Message

• Listen to the publics specific concerns
• Be honest, open, and reassuring
• Coordinate with other credible sources
• Speak clearly and with compassion
• Use plain words, no jargon
• Humor may be inappropriate

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Prepare to Answer These Questions

• How are those who are ill getting help?
• Is this thing being contained?
• What can we expect?
• Why did this happen?
• Why wasnt this prevented?

• What else can go wrong?
• When were you notified about this?
• What does this information/results mean?
• What bad things arent you telling us?

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Planning for Calls From the Public

• Do you expect calls from your
• clients and stakeholders?
• What EOC hotline resources exist now?
• Identify people and equipment and provide
  training now
• Consider recruiting volunteers and train them in
  using risk communication principles

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Planning for the Release of Information to the
Public

• Develop information release policies
• Identify a public information officer
• Identify critical baseline information
• Identify effective channels of communication

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Planning for the Release ofInformation to the
Public

• Identify special populations, and means of
  reaching
• Geographically isolated
• Without access to traditional channels of
  communication (e.g., television, radio,
  telephone)
• Limited understanding due to language, health, or
  developmental barriers
• Different cultural groups

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Planning for Partner Relationships

• Identify and plan to update stakeholders
• Join with partners to build shared trust
• Clarify roles and release of information
• Think about new partners in crises and how to
  reach out to them (e.g., post office)
• Think about alternates and delegate
  responsibilitythe CEO cant talk to all

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Little Things Make Big Problems

• Do you know where your EOC is located?
• Get telephone numbers NOW and update
• Keep the team informed and stagger staffing
• Identify resources and how to get more
• Know your community and share your knowledge with
  state and federal partners

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Internal Communication IssuesRoles and
Responsibilities

• Make sure each department knows what the other is
  doing
• Clearly define communication roles and
  responsibilities
• Critical baseline information
• When to refer questions and to whom
• Specify a call-down roster with 24 hr contact
  information

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Internal Communication IssuesTechnical

• Communication equipment
• Know how to use it
• Security of information exchange
• Redundant mechanisms
• Have more than one way to disseminate a message,
  i.e., fax, e-mail, phone
• Periodically test and exercise systems

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If You Suspect or Have Been Informed of an
Emergency

• Notify your supervisor, as outlined in your
  agency emergency response plan
• The local health officer, administrator, or
  division head will
• Notify FBI and local law enforcement, if
  appropriate
• Notify the state health department
• Activate the emergency response plan, if
  appropriate

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Notification Procedures in a BT EventConfirmed
or Threatened
Local Health Officer is informed of a
bioterrorist incident or threat
FirstNotify FBINotify local lawenforcement
NextNotify involve State HD and other
response partners
State HD Notifies CDC
Modified from CDC
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Notification Procedures in a BT EventSuspected
Local health officer suspects that cases of
illness may be due to a bioterrorist incident
FirstInform involve State HDHD notifies
CDC Conduct investigation 
Is BT incident confirmed or thought to be
probable?
No
Yes
Notify FBI Notify other pre-determined response
partners
Continue investigation
Modified from CDC
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Summary of Key Points

• The Health Alert Network is a system designed to
  facilitate communication between public health
  agencies and officials, and provide secure
  transmission for laboratory and disease reporting
  information.
• Consistent and effective communication with the
  media, other involved agencies, and the public is
  an important element in the public health
  response to an emergency.

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Summary of Key Points

• Risk communication planning requires anticipating
  how the risk, the message, and the messenger will
  be perceived by those receiving the message.
• Risk communication messages should be accurate,
  clear, positive, and succinct.
• Communication roles and systems within an agency
  should be periodically exercised and updated.

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Resources

• Health Alert Network
• Risk Communication Vince Covello resources
• Risk Communication ATSDR primer

http//www.phppo.cdc.gov/han
http//healthlinks.washington.edu/nwcphp/covello.h
tml
http//www.atsdr.cdc.gov/HEC/primer.html