This is a background with safe frame and cdc logo

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Effective Emergency Risk Communication in the
Time of Terror www.cdc.gov

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Bioterrorism-related Anthrax Cases
Inhalation Case
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NYC NJ

FL
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NYC Letters
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3
2
1
0
9/14/2001
9/21/2001
9/28/2001
10/5/2001
11/2/2001
11/9/2001
10/12/2001
10/19/2001
10/26/2001
11/16/2001
11/23/2001
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Atlanta Journal-Constitution, Oct 23, 2001
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Collaboration
Coordination
Commitment
Competency
Communication
Consistency
Compassion
Clinicians Clinical Laboratories
Community Common Sense
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CDC Press CallsJanuary 2002 February 2004

Number
2002
2003
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CustomersSAFER ? HEALTHIER ? PEOPLE
Alliances
Channels
Partners
Stakeholders
Public Health Systems and Communities
Business
Health Care Delivery
FederalAgencies
Education
Coordinating Center for Health Information and
Services
National Center for Health Marketing (Dr. Sondik)
National Center for Public Health Informatics (Dr
. Loonsk)
National Center for Health Statistics (Dr. Marks)
Coordinating Center for EIO NCEH/ATSDR, NCIPC,
NIOSH (Dr. Falk) (Drs. Falk, Howard, Arias)
Coordinating Center for Infectious
Diseases NCID, NCHSTP, NIP (Dr. Cohen) (Drs.
Hughes, Cochi, Collins)
Coordinating Center for Health
Promotion NCCDPHP, NCBDDD, Genomics (Dr. Stroup)
(Drs. Mensah, Cordero, Khoury)
Office of Global Health (Dr. Blount)
Office of Terrorism Preparedness Emergency
Response (Mr. Schable)
Management Council
Executive Board
Office of Strategy and Innovation (Ms. Cahill)
Office of the Chief of Science (Dr. Snider)
Office of the Chief of Public Health
Improvement (Dr. Thompson)
Office of Human Capital and Professional
Development (Dr. Thacker)
Office of the Chief of Staff (Mr. Delaney)
Director
Office of the Chief Operating Officer (Mr.
Gimson)
CDC Washington Office (Mr. Shriber)
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Global Communication Center
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Traditional Health Communication
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Risk Communication Critical Health Issues in
the United States
Most Common Causes of Death, United States, 1996
Cardiovascular disease
Cancer
Chronic lung disease
Injuries
Pneumonia / influenza
Diabetes
HIV
Suicide
Chronic liver disease
0
5
10
15
20
25
30
35
40
Percentage (of all deaths)
National Vital Statistics Report 47 (9)
November 10, 1998 McGinnis JM, Foege WH. JAMA
1993 2702207-12
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(No Transcript)
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Smallpox Preparedness Risk Communication
Challenges

• Public complacency
• Smallpox threat perceived to be near zero since
  the end of the Iraq war
• Smallpox preparation perceived to be low priority
  or not worth the risk
• Public health and hospital workforce that is
• Not fully engaged
• Exhausted from other ongoing crises such as SARS
• Skeptical about the credibility of the smallpox
  threat
• Confused about vaccination risks
• Unaware of compensation protections

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CDC Communication Capacities

• Traditional Health Communication
• Risk Communication
• Emergency Risk Communication

http//www.cdc.gov/communication/
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Emergency Risk Communication

• Goal individuals, stakeholders, an entire
  community or a nation in crisis will make the
  best possible decisions about their well being
• Urgent time frame
• Acceptance of the imperfect nature of the
  available choices for action
• Success requires
• skillful use of risk communication theory
• understanding of human psychology

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Emergency Risk Communication Occupational
Exposure to HIV

• Occupation
  No.
• Clinical laboratory technician 16
• Nurse 23
• Physician 6
• Non-clinical laboratory technician 3
• Surgical technician 2
• Autopsy technician 1
• Health aide/attendant 1
• Housekeeper/maintenance worker 2
• Respiratory therapist 1
• Dialysis technician 1
• Total 56

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Emergency Risk Communication Success Factors

• Be Empathetic embody sincere caring
• Be First speedy communication
• First messages are lasting messages
• Being first indicates preparedness and competence
• Be Right accurate content
• Be Credible be honest and build trust

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Psychology of Crisis

• Vicarious rehearsal people away from the threat
  try on the courses of action (worried well)
• Denial discredit the threat avoid warnings or
  action steps
• Fear
• Anger
• Agitation
• Stigmatization of affected groups
• Withdrawal, hopelessness, and helplessness

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What the Public Will Ask First

• Are my family and I safe?
• What have you found that may affect me?
• What can I do to protect myself and my family?
• Who caused this?
• Can you fix it?

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What the Media Will Ask First

• What happened?
• Who is in charge?
• Has this been contained?
• Are victims being helped?
• What can we expect?
• What should we do?
• Why did this happen?
• Did you have forewarning?

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Rule 1 Be EmpatheticDeterminants of Trust in
High Stake Situations
Listening/Caring/ Empathy 50
Competence/ Expertise 15-20
Dedication/ Commitment 15-20
Honesty/ Openness 15-20
Adapted from V. Covello
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Rule 2 Be FirstCDC Emergency Operation Center
for Incident Command and Communication
CDC SARS Investigation
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Emergency Risk Communication SARS Activities at
CDC
Monday, March 17, 2003 Friday May 2, 2003

• Press calls 5634.
• Clinician Information Line 1,214 SARS calls
• Public Response Hotline 25,382 calls and 2,860
  emails
• 2,487,662 total page views on CDC SARS web site

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Rule 3 Be Right CDC Scientific Milestones in
SARS

• March 12, 2003 WHO issues alert
• March 14, 2003 CDC activates Emergency
  Operations Center
• March 22, 2003 new coronavirus identified
• March 28, 2003 new coronavirus sequenced
• April 2003 coronavirus named as a cause of SARS
• April 29, 2003 laboratory test for SARS
  distributed

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Rule 4 Be Credible CDC SARS Interim Guidance
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Be Credible CDC Emergency Communication System
Transportation Industry
Laboratorians
Academia
Media
Veterinarians
Public Health
Health Educators
Business
Clinicians
Information Content
Communication Team
Conference Calls
Research
Web
Policy
Hotline
Health Alerts
Press Briefings
Secure Network
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Clinician Preparedness Just in Case / Just in
Time
D Content / coordination
Level D
C Educators
Level C
B Clinical Specialists
Level B
A Frontline Clinicians
Level A
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(No Transcript)
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Emergency Risk Communication Spokespersons
New York Times, October 13, 2001
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Trust in SpokespersonsOctober 28, 2001

• 
  ---TOTAL---a great deal---quite a lot----
• CDC Director (J. Koplan) 48 26 22
• Surgeon General (D. Satcher) 44 21 23
• AMA President (Richard Corlin) 42 20 22
• Secretary DHHS (T. Thompson) 38 19 19
• DHS Secretary (T. Ridge) 33 18 15
• FBI Director (R. Mueller) 33 15 18

R. Blendon, Harvard Program on Public Opinion and
Health and Social Policy International
Communications Research of Media, PA
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Trust in SpokespersonsOctober 28, 2001

• 
  ---TOTAL---a great
  deal---quite a lot----
• Your own doctor 77 50 27
• Fire department official 61 32 29
• Police department official 53 24 29
• Local hospital official 53 28 25
• Health department leader 52 25 27
• Your Governor 48 23 25
• Local religious leader 46 27 19

R. Blendon, Harvard Program on Public Opinion and
Health and Social Policy International
Communications Research of Media, PA
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Spokesperson Roles

• Take your organization from an "it" to "we"
• Build trust and credibility
• Remove the psychological barriers within the
  audience
• Gain support for the public health response.
• Ultimately, reduce the incidence of illness,
  injury, and death by getting it right

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Spokesperson Rules

• Dont over reassure acknowledge uncertainty
• State steps that are in progress to learn more
• Give anticipatory guidance
• Be regretful, not defensive
• Acknowledge people's fears and the shared misery
• Express wishes - "I wish we knew more."
• Stop trying to allay panic panic is rare

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Facing Fear

• Rx action steps action binds anxiety.
• Rx things to decide decision-making enhances
  control
• Encourage appropriate anger
• Encourage love / camaraderie soldiers fight for
  their friends and family
• Provide candid leadership trust reduces fear
• Show your own fear and show you can bear it
  fearless leaders are little help to a fearful
  public

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Facing Fear SARS
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Target Audience Psychology in Risk Communication

• 1n 3p
• (one negative equals three
  positives)
• Balance negative messages with positive
  constructive / solution oriented messages
• Take care in using words like no, not, never,
  nothing, none they can be misheard,
  misperceived, and misunderstood

Vincent T. Covello, Ph.D.Director of the Center
for Risk Communication
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SARS Emergency Risk CommunicationPolling Data
April May, 2003

• 91 aware of SARS
• 26 worried that they or someone in their family
  could get SARS within the next 12 months.
• 89 knew it was important to mention travel
  history to their doctors
• 95 would agree to be isolated if infected
• 93 would agree to be quarantined if exposed

R. Blendon, Harvard Program on Public Opinion and
Health and Social Policy
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www.cdc.gov