Effective Education

The goals of risk communication are to ensure responders have the information they need and to prevent panicked reactions by the public.

• By Dale M. Petroff
• May 01, 2004

A risk communication strategy is an important component of the response to any event. Risk communication has two major components: hazard communications to emergency responders and to the public. Both audiences must be kept informed of the hazards surrounding an incident as rapidly and as accurately as possible, but they require two levels of information.

Responders will need detailed technical information about which hazardous materials are involved, their properties, and which protective measures are necessary. Members of the public will want to know what has happened, is there any danger to them, what is being done to ensure their safety, and what should they do. To be effective, risk communication requires planning and training, as does any other emergency response function. Risk communication is more than safety briefings to the responders and incident updates to the press.

On Sept. 16, 2003, The Washington Post published an article by Theodore Rockwell under the headline "Radiation Chicken Little." The author had just observed an emergency drill based on a "dirty bomb" attack. He reported the following: "A few minutes into the simulated exercise, a leader of the drill pleaded for some action, warning that radiation was killing people and hospitals were being overwhelmed. This bothered me, because it is well documented by all our official agencies that the radioactivity in dirty bombs is unlikely to seriously hurt anyone. People not injured by the conventional explosion itself could walk away and be out of danger. If concerned about possible contamination, they could remove their clothes and take a shower." The article pointed out that the responders and their leaders were unaware of the real hazards surrounding the relatively small amount of radioactivity that the drill postulated being released. Its author further stated that if you tell people to panic, they will.

It should be remembered that emergency responders in the first line were being affected. A lack of information regarding the actual hazards of the released radioactive material was diverting the emergency responders' attention from more important tasks and causing unnecessary protective measures to be put in place. This drill demonstrated the participating response organizations had not prepared for this hazard. If the responders are unaware of the hazards involved, the public is not going to be properly informed.

An example specifically related to emergency responders was cited in a 2002 RAND report, "Protecting Emergency Responders: Lessons Learned from Terrorist Attacks." This report covers a conference held with emergency responders in December 2001; it addresses the response to the World Trade Center and the Pentagon on 9/11 and the Oklahoma City bombing in 1995. One of the report's findings was this: "Although many organizations and agencies were actively monitoring health and safety hazards at the terrorist-incident sites, problems in producing and disseminating hazard information reduced the effectiveness of their efforts." Successful risk communication requires obtaining the right information and then ensuring that it gets to those who need it.

Calming Fears
Risk communications presents a challenge to public leadership and emergency responders because of the need to educate the public concerning the potential threat of a hazardous material incident or an emergency such as a terrorist attack without causing too much fear or excitement. Additionally, the needs of the emergency responders must be addressed--their ability to respond effectively rests heavily on their knowledge of the hazards they are facing.

It must be remembered that emergency responders are also members of the public, as most likely they will have family and friends they are concerned about while executing their duties. Unsubstantiated or extreme fears, such as the fear of dying from the contamination caused by a dirty bomb or the effects of a major chemical release, may be enough to trigger widespread phobias, even among first responders. These fears may prevent people from acting rationally and cause them to experience a fight-or-flight reaction.

Media coverage of disasters has increased public expectations for government response. The media are anxious to report what the government is or is not doing during any disaster. Any event that could affect the safety of the public will provide the opportunity for spectacular live coverage by the media and evoke strong emotions and reactions from the public. A plan needs to be in place to deal with the public's emotions and expectations.

A successful risk communications program attains and maintains trust and credibility. It starts with the principal objectives of reducing risk to the public and enabling those affected to comprehend the scope of the problem, make informed decisions, and take appropriate actions.

The general public and technical experts generally use different methods to evaluate risk. Technical experts use statistics and cost/benefit analysis to quantify risk. The public tends to evaluate risk or risk communication messages on perceptions of control, familiarity, mortality, and fairness. Based on these factors, activities that would be considered statistically equal in risk are perceived differently by the public. Events or activities would be considered more risky if they were perceived as being involuntary, unfamiliar, uncontrollable, controlled by others, unfair, memorable, dreaded, acute, focused in time or space, fatal, delayed, artificial, individual mitigation possible, and undetectable.

Seven Cardinal Rules
A number of years ago, I was given a copy of a pamphlet developed in 1988 by Vincent Covello and Frederick Allen. I have found "Seven Cardinal Rules of Risk Communication" to be most concise guide on risk communication I have come across in 20 years of working in emergency management and planning. The document can be ordered from EPA's Chemical Emergency Preparedness and Prevention Office (yosemite.epa.gov/oswer/ceppoweb.nsf/content/index.html).

The seven rules are:
1. Accept and involve the public as a partner.
Your goal is to produce an informed public, not to defuse public concerns or replace actions.

3. Listen to the public's specific concerns.
People often care more about trust, credibility, competence, fairness, and empathy than about statistics and details.

4. Be honest, frank, and open.
Trust and credibility are difficult to obtain; once lost, they are almost impossible to regain.

5. Work with other credible sources.
Conflicts and disagreements among organizations make communication with the public much more difficult.

6. Meet the needs of the media.
The media are usually more interested in politics than risk, simplicity than complexity, danger than safety.

Never let your efforts prevent your acknowledging the tragedy of an illness, injury, or death. People can understand risk information, but they may still not agree with you; some people will not be satisfied.

To follow these rules requires an understanding of the needs of the target audience (responders or public) and preparation to meet those needs before the event happens. I have found that even when briefing responders, these basic rules should be followed. These rules and other guidance on risk communications can be found at a Centers for Disease Control and Prevention Web site titled "A Primer on Health Risk Communication Principles and Practices" (www.atsdr.cdc.gov/HEC/primer.html).

Available Resources
Risk communication strategy is based on the knowledge that the general public and sometimes first responders do not have an accurate perspective on the dangers presented by various hazardous materials or acts of terrorism. Further, providing information and the proper perspective on the hazardous material, expected areas affected, health effects, countermeasures, and preventive measures will serve to reduce the impact of an actual incident or the threat of one.

A person knowledgeable about the hazards of the incident should make better decisions about how to react. The goals of risk communication are to ensure responders have the information they need and to prevent panicked reactions by the public.

The timeframe where the most can be done to educate both the senders and the receivers of risk communication messages is before the event, during the planning phase. This is the time when a risk communication message will have the most impact because the receiver has the time to listen rationally and process the message. During initial stages of an actual incident, the public will not be receptive to information other than what immediate actions they can take to protect themselves, their family, and their property. If the first time a risk communications message is given to the public is during the event, the public may not believe the data and may doubt your motivation for telling them something contrary to their own fears and beliefs. In other words, they will not accept the information because it contradicts their beliefs. This might cause the public to disregard the message and instead act on fears and panic. Before the event is the time to educate.

While not all hazards can be anticipated, many local hazards have been identified as a result of EPA's Risk Management Program (RMP) and annual reports required under the Emergency Planning Community Right to Know Act (EPCRA). These should be part of a public education program. The threat of a terrorist action is very real, so information on the hazards from a terrorist attack involving chemical, biological, or radiological hazards should be developed and included. There are a number of sources available on the Internet for information on such hazards. Among the better federal sites for emergency responders are ones from CDC (www.bt.cdc.gov), the Occupational Safety & Health Administration (www.osha-slc.gov/SLTC/emergencypreparedness/index.html), and the Central Intelligence Agency's handbook on Chemical, or Biological, or Radiological weapons (www.cia.gov/cia/reports/cbr_handbook/cbrbook.htm). The CDC and OSHA sites offer links to other sources of information.

Identifying information resources for various types of hazards is critical. This includes experts who can address questions regarding risks and protective actions with authority. As part of the planning process, develop a list of experts (private and government) who are willing to assist. They must be included in planning and drills. They are an important resource for informing the public and assisting first responders.

Training and Terminology
Training programs should be implemented to educate government leadership, first responders, and the public on the risks from the hazardous materials that have been specifically or generically identified. This training should be general enough to cover transportation accidents, releases from industrial/power plants, and other sources of materials.

Acts of terrorism should be included in this training but should not be the centerpiece. These groups must be provided with enough information so they can understand the threat. Understanding the threat includes a discussion of the types and characteristics of events--natural disaster, transportation accident, or terrorism.

Standard accepted terminology is needed for the various types of events so that everyone speaks the same language. This will minimize public confusion over terms as different spokespeople discuss the event. Routine scientific or engineering terms and principles that technical experts might take for granted in communication are completely foreign to the general public. The public will not understand terms such as LD/50, IDLH or know that Grays and Rads are two different systems for measuring the risk from radiation. Experts may use terminology unfamiliar to responders.

Risk communication messages should be prepared in different languages and tested with people representing different cultural backgrounds. Risk communication is a team effort and an effective, consistent communication strategy and message could reduce the impact of an event.

The public and the media should be informed about the actions they might see and/or take in the event of a hazmat event. For instance, sheltering in place or evacuation might be recommended or ordered. They also need to understand the images they will see of first responders moving through the potentially affected areas wearing protective clothing and respiratory protection. The public may see decontamination stations being set up and possibly contaminated people entering these facilities. They will certainly see these activities as part of the media broadcasts. Showing images of the response to the event and explaining what activities will happen during and after an event will help the public remain calm.

Educating the media will reduce confrontational interviews during periods of high stress. Remember, the media will be experiencing the same fears as the general public. It also will empower the media to help get the right messages out to the public, minimize speculation, and help keep rumor control in check. The media are critical to the success of risk communications to the public. Messages issued by governmental bodies will not be enough. The media will report on the event and if an adversarial situation develops, the battle to build confidence in the response effort is lost. Remember that responders also monitor media reports if they feel they are not being kept informed.

Media Relations
It is important to establish a plan to deal with the media before an event. An early step should be to create an educational program for reporters--maybe even for their families--to address their own personal anxieties. An Office for Domestic Preparedness publication, "After the Attack: The Psychological Consequences of Terrorism, Perspectives on Preparedness," No. 7, August 2002, says a plan to deal with the media should include the following eight components:
1. Establish what media outlets exist and what they can do.
2. Establish the media's potential in a disaster.
3. Develop a plan for dealing with the media and do that planning in cooperation with them.
4. Identify those personnel capable of putting the plan into effect.
5. Test the plan with the media playing an active role in the test.
6. Evaluate and revise the plan in light of the test, ensuring that the media's criticisms are taken in to account.
7. Make sure the plan becomes known to all those involved in the disaster response, including the public.
8. Make sure the plan is constantly revised in light of changing conditions, regular tests, and actual experiences.

It is critical to build a relationship with the media and establish your response organization as a trusted source of information before there is an incident. A very successful Local Emergency Planning Committee in a southeastern state understood that a good relationship with the media was very important. A reporter from a major newspaper in the area was invited to attend meetings of the LEPC and reported accurately on various issues. When the Risk Management Program was implemented for that area, the various industries presented the results of their hazard analysis to the public at a local civic center. The event was well planned; many members of the community attended, and the results were well received. This was due partly to the many news articles published about the program and the event before results of the hazard analysis were released. Another factor that assisted in the success of this risk communication program was that leaders of community, including clergy, were invited to LEPC meetings and were given regular briefings on the development of the Risk Management Program for the various industries involved.

The county's Emergency Management Director was a member of that LEPC. This director made herself accessible for media interviews. She regularly appeared on local television news programs when severe weather threatened the area, in regard to the RMP, and when exercises were being held. She became known as a source of reliable information. It is important to identify "credible sources" and "trusted spokespersons," target communications to the public, work with the media, develop realistic drill scenarios, and prepare for misinformation and varied reactions. This director worked skillfully to become a credible source.

Building the Team
Government and community leaders should identify a risk communication team before the event occurs. The team should consist of speakers and experts who are trusted by the public, community, and the media. The media should become familiar with these experts to the point of establishing a working relationship. These risk communication teams should be formed at all levels of government and should include a trusted spokesperson and support people.

A typical team should be made up of the following:

• A technical expert who can answer technical questions about the hazardous materials involved in the event, health effects, the extent of contaminated areas, and actions the public can take to remain safe.
• A physician trained in the health effects of the material (chemical, radiological) who can calm fears about exposure and contamination, instruct the public on whether and when they should seek medical care, and discuss health concerns surrounding the event. Physicians carry a great degree of trust from the communities that they serve.
• A public information officer (PIO) trained in crisis communication who can help frame the risk communication messages in a proper content to ensure the messages have a calming effect and not the opposite.
• A law enforcement officer or other member of the public safety community who will reassure the public that civil order is being maintained, and who provides public safety information concerning things such as traffic patterns, evacuations, and decontamination facilities.
• A trusted person who delivers the communications message to the community. This person could be a member of the emergency response agency, government leadership, or anyone in the local community who has the trust of its residents. The trusted person should be the person to deliver the messages to the media and the public. This person may be the PIO.

Teams should practice their roles through tabletop and functional exercises using real reporters asking the questions. Exercises will help solidify the team and build critical working relationships with the media.

Rumor Control
Rumor control is another feature of a sound risk communications program. There are two ways to address the problems of rumors. The first is an effective public information officer working with the media to keep the public informed and up to date. When resources permit, the other method is to establish special phone numbers for members of the public to call. Trained personnel should be assigned to answer these phones and provide information to the public. As part of this effort, the types of questions the public may ask should be anticipated and answers prepared. A number of agencies have posted anticipated questions and answers in regard to acts of terrorism.

In the "Seven Cardinal Rules of Risk Communication," the authors closed with the following three points:

• Regardless of how well you communicate risk information, some people will not be satisfied.
• Never let your efforts to inform people about risks prevent you from acknowledging and saying that any illness, injury, or death is a tragedy.
• If people are sufficiently motivated, they are quite capable of understanding complex risk information, even if they may not agree with you.

A Solid Cornerstone
Risk communication is one of the most complex issues in emergency response. This article has addressed risk communication from a planning perspective. As hazards change, so must the risk communication programs of emergency response organizations change. If an emergency response organization during an event cannot provide credible risk information, the media will provide information from any source they can find.

Risk communication to the public and responders will have dramatic impacts on the effectiveness of the response and protective actions. A panicked public will not heed instructions if they do not believe. First line responders will assume the worst if they do not have a clear picture of what they are facing. Preparation before the event is the cornerstone on which all emergency response actions are built.

This article originally appeared in the May 2004 issue of Occupational Health & Safety.