The initial stages of the HINI flu virus raised much alarm due to the real fear that it could turn into a major health disaster. Although widespread, it has fortunately proven to have limited lethality thus far. Nonetheless, the H1N1 pandemic stressed and continues to place heavy demands on our public health response systems, and it demonstrates that we need to remain vigilant and ready to act, because the next pandemic is surely around the corner, and its severity and impact could be much worse. The Spanish Flu pandemic of 1918 killed an estimated 20 to 50 Million people worldwide may seem anachronistic because modernity offers us advanced medical care, the modern environment offers new challenges in disease transmission through a a highly mobile world where a single infected individual in Hong Kong can infect hundreds in New York in less than 24 hours. Much like a category 5 hurricane that looms offshore ready to potentially strike, public health and civil emergency preparedness organizations need to be prepared for the potentially catastrophic effects of a major pandemic that is highly contagious and lethal. In any large scale pandemic with significant lethality, there is a low, but nonetheless real risk that basic social systems may unravel through a series of cascading and interdependent events. While the health care system remains ground zero in any pandemic outbreak, other sectors of society that provide essential services can be significantly impacted or disrupted in major outbreak. Major civil strife can be triggered when a critical mass of individuals no longer trust that the basic support mechanisms of civil society will protect them and they begin to change behavior and challenge public order because it is in their best interest to do so. Public information officers are front in center in preempting these events before they reach an unmanageable and self reinforcing state. While public officials struggled to communicate with large portions of the population in 1918, the opposite problem exists today. Ironically, the virulent and uncontrollable virus which could be the catalyst for major disorder is not the actual virus itself, but our modern viral communications environment. The Internet and a 24x7 news media culture enable sensationalism, misinformation and distortions to be quickly and uncontrollably and indiscriminately spread far and wide. Social media sites, blogs, email, and text messaging are power mediums that allow individuals to quickly disseminate and propagate information, opinions, and speculations. With the increasing presence of mobile cameras coupled with web enabled publishing and viewing forums, inflammatory content can be captures and instantly broadcasted throughout cyberspace. The opportunity to instill fear, insight panic and instigate hostility has never been greater for so many with such little consequence for so few, whether they are willful or sadly in error. Additionally, due to the legacy of Hurricane Katrina, today’s citizenry is conditioned to embrace messages that affirm a view of the government which is dispassionately incompetent in handling large scale emergencies. Consequently, the pervasive modern digital media environment has made communications ground zero for public information officers and liaison officers. Improved communications and sophisticated dissemination strategies must be used to effectively combat and counteract disinformation, and ensure vital public information reaches its audience. At the core of the of this effort, emergency response planners and officials must pro-actively manage and disseminate information, enlist and collaborate with key community representatives and groups, and anticipate and seek to mitigate inaccurate information before its emerges with irreversible momentum. The recommendations listed below are not exhaustive (fn 1), but serve to demonstrate the many issues and dynamics that come into play when a major pandemic or mass health crisis strikes. Pandemic planning must be comprehensive and take an expanded view of the social dynamics and impacts that occur at both the community and individual level when engaging in disaster communications. The audience, substance, truthfulness, timing, consistency, frequency and method of delivery are all important factors in successfully achieving an effective and sustained communications initiative. It might be that a few well placed words could be the difference between devolution into chaos or a quieting refuge that safely weathers the storm.
H1N1 Pandemic Flu Public Safety Preparedness and Communications Management Tips
1. Frontline Multi-agency Communication and Information Sharing. Basic, accurate and consistent health information should be shared among all agencies and their personnel. Information includes facts about prevention and precautions, symptoms, treatments, recovery rates, high risk groups, and fatality rates. Agency personnel that interface with the public must project confidence and a general command of the subject matter.
2. Cross Agency Collaboration and Policy Consistency. While agencies may serve different functions, they will intersect and overlap in key areas and interdependent ways. Ensure that each agency’s policies and procedures dovetail with one another in collaborative response scenarios. Agencies that are subject matter experts within their functional domain should take the lead in establishing recommended inter-agency policies coordination, and judgments should not be supplanted by non-expert agencies. For example, disorderly conduct and civil control should be established by law enforcement professionals, while first aid response and emergency medical treatment procedures should be established by medical professionals. Although expert agencies should take the lead, expert agencies need to collaborate and refine procedures to deal with unique concerns or issues that may be raised other agencies in relation to the particular health emergency circumstance.
3. Interoperable Emergency Communications. Key agencies such as public health agencies, hospitals, EMS, Offices of Emergency Management, and police should have effective real time interoperable communications and information sharing systems in place.
4. Engaged Public Information Management. Proactive and engaged public information out reach is necessary to educate the citizenry and also preempt and combat misinformation and distortions. Engaged public information management includes:
a. Educating and Preparing Public Leadership. Ensure the timely dissemination of official positions and policies among chief executives and other public officials that may interact with the media or public. Information should be updated frequently and address evolving issues and circumstances. Officials empowered with information will pre-empt speculative, conflicting or speculative commentary which may raise uncertainty among the public.
b. Deal Straight with the Public.
i. Truth and Accuracy. Provide truthful, accurate and complete information. Withholding, minimizing or slanting information will be quickly exposed and undermine public confidence and fuel anxiety.
ii. Use Plain Language. Use plain language, data driven facts, be explanatory and avoid jargon. If medical terms or jargon must be used, explain it.
iii. Explain Your Policies and What People Can Expect. Explain your health emergency policies, activities and policies, and the rationale for them in advance. By explaining your rationale in advance it will diffuse misconceptions and potential claims of bias, arbitrariness or insensitivity. Also, describing what people can expect when interfacing with the public health system will help alleviate anxiety.
c. Modernize Your Communications Strategyi. Communicate Routinely and Frequently. Merely establishing a web site, even if it is chock full of information and updated often, is still a passive form of communication. It requires individuals to consciously seek out and choose to visit on a repeated basis. Officials should use multi-channel strategies to disseminate information that leverage and reinforce one another, including methods that push information to subscribers. Routinely providing updates is an important strategy to maintain the public’s attention and establish an ongoing conversation.
ii. Proactively Engage Traditional Media. Make access easy for traditional news media by updating journalists and reporters on a frequent basis, and making sure key representatives are available to speak with them. A public media relations officer should be designated as a single point of contact to disseminate news briefing information and assist journalists in establishing contact with various representatives. Requests that are received by operational officials should be directed back to the central point of contact to eliminate confusion, eliminate overlap and distractions, and improve resource and time efficiencies.
iii. Proactively Use New Media Venues. Use real time notification technologies and new social media venues to quickly disseminate important information. Email, SMS, MMS, and RSS subscription based alerting should be routinely employed to push out informational alerts with embedded HTML links to informational landing pages with more information. Using share enabling and viral bookmarking and tagging tools should also be employed like Digg, Del.icio.us, Furl, and Reddit, StumbleUpon. Social media venues like Twitter, FaceBook, and MySpace should also be employed.
iv. Disinformation Management. Another important strategy that can pay dividends is actively monitoring popular internet gathering places and communities for information and rumors that are erroneous or distorted, and taking steps to disseminate corrective or clarifying information. Simple methods such as using Google Alerts with custom key words can help bring new information to your attention. Similarly, establishing a Twitter Account and following parties with relevant topical or subject matter interests can also provide an automated way to check the pulse of public concerns in near real time. Formally designating a member of your public information office to undertake these efforts is recommended.
d. Establish Advisory Communications with Frontline Clinical Health Points. Establish known and repeatable methods of communication for information updates and advisories for all frontline health care professionals, such general practitioners, pediatricians, visiting nurses and emergency room personnel. Advisory information should extend to best practices for waiting room management and segregation, updates on symptoms, treatments, public health reporting, monitoring, testing and hospitalization. As noted previously, employing email alert blasts and other push oriented information delivery methods should be used.e. Establish Outreach and Communications with Key Groups:
i. Critical Infrastructure and Key Business Assets. Officials should establish key sector outreach representatives to interact with large business, critical infrastructure entities and other important community assets. (fn 2) Pandemic planning documents should be made available to assist business leaders and facilities operators in handling an outbreak and ensuring continuity of operations. Additionally, functional capacity and operational impact reporting should be considered so that public emergency management officials can monitor potential interruption or degradation of key services due to workforce impacts. Areas of monitoring include utilities, particularly field technicians and facilities repair personnel, municipal and regional transportation operators and personnel, such as bus drivers and train operators, law enforcement and fire personnel, acute and primary care facilities. Additionally, specific communications channels should be opened for all mass gathering facilities such as stadiums, theaters, malls and similar venues.
ii. Historically Underserved Populations. Officials should actively engage community leaders, including churches, educators, and neighborhood advocacy groups, to explain policies and procedures, shares information and resources, and provide an official liaison contact to mitigate any problems with access and delivery.
iii. Aged, Handicapped and other Vulnerable Populations. Officials should actively engage group homes and retirement communities to explain policies and procedures, shares information and resources, and provide an official liaison contact to address elderly issues. Special emphasis should also be placed on establishing methods of communication for the blind and hearing impaired.
iv. Schools and Universities. Officials should actively engage with schools and universities (fn 3), both private and public, to regarding recommended prevention, response policies and procedures, monitoring and reporting. Grade schools should also be used as a vehicle to disseminate information back into community households. The state, regional and local education officials should be continually collaborating with public health officials, means for advisory communication and updates should be established and an official liaison contact should be provided.
v. Immigrant and Multilingual Populations. As our society has become increasing diverse and mobile, officials should be aware that there are many non-English speaking residents and visitors, and all critical materials and instructions should be accessible in all major languages represented within the community. Appropriate emergency staffing and response should also include multi-lingual speakers and translators.
5. Monitoring and Preempting Escalation. Officials should be vigilant in monitoring trends in behavior, particularly any rise in occurrence of acts of public disorder and the circumstances under which and places where they are occurring. As discussed, potential flash points are emergency rooms, inoculation centers and dispensaries, among others. Threats and incidents that have any reasonable nexus to the pandemic should be reported into a central repository for analysis and establishing prevention and mitigation strategies. For example, if significant potential for disturbances are occurring at hospitals, then deploying uniformed law enforcement personnel at these locations may temper behavior, but also help contain any disturbance. Implementing real time interoperable communications between security personnel and law enforcement and establishing video monitoring at key locations with real time video sharing with law enforcement is also be a good strategy for force multiplication, situation awareness, and reducing response times.
6. Legal Services Collaboration. Pandemics impact not only the sick, but also their families and care givers. Many people do not have the basic legal documents in place to effectively manage and care for incapacitated family members and friends, such as healthcare proxies to make medical decisions and durable powers of attorney to handle financial affairs. Even worse, the restrictions imposed by medical privacy laws, such as HIPPA, in many cases denies care givers, family members and friends access to important information about their loved one’s medical condition and even works to block information from being given regarding the admission status of a patient at health care facilities. It is essential that individuals be properly advised regarding the need to establish HIPPA privacy waivers for their friend and relatives. Moreover, many have not attended to fundamental matters regarding estate management, particularly if they are younger individuals. In the event of a major pandemic, officials should be working with state and local Bar Associations and other legal profession organizations to build a network of available support advocates for patients and families. The recommendations listed above are not exhaustive (fn 4), but serve to demonstrate the many issues and dynamics that come into play when a major pandemic or mass health crisis strikes. Pandemic planning must be comprehensive and take an expanded view of the social dynamics and impacts that occur at both the community and individual level. In the age of real time electronic and social media, there are opportunities to improve effective communication and planning, but there is also a potential downside. These powerful technologies can act as a major catalyst for panic and social disorder, and emergency response planners and officials must pro-actively manage and disseminate information, enlist and collaborate with key community representatives and groups, and anticipate and seek to mitigate behavioral risks before they emerge and gain irreversible momentum.
Footnotes:
[1] There are a significant number of resources available from international, federal and state agencies covering a broad array of planning issues. The following informational guide is directed specifically at information officers: Effective Media Communication during Public Health Emergencies, WHO Handbook (2005). Ref. at: http://www.who.int/csr/resources/publications/WHO%20MEDIA%20HANDBOOK.pdf. The U.S. Centers for Disease Control and Prevention (CDC) has also created an online instructional course for public information officers called “Crisis and Emergency Risk Communication Training “. It is located at: http://emergency.cdc.gov/cerc/CERConline/index.html.
[2] For a comprehensive resource guide, please see Pandemic Influenza, Preparedness, Response and recovery, Guide for Critical Infrastructure and Key Resources, Department of Homeland Security (2006). Ref.: http://www.pandemicflu.gov/plan/pdf/cikrpandemicinfluenzaguide.pdf.
[3] See, CDC Guidance for State and Local Public Health Officials and School Administrators for School (K-12) Responses to Influenza during the 2009-2010 School Year at http://pandemicflu.gov/professional/school/schoolguidance.html. For universities, see, CDC Guidance for Responses to Influenza for Institutions of Higher Education during the 2009-2010 Academic Year at http://pandemicflu.gov/professional/school/higheredguidance.html.
[4] There are a significant number of resources available from international, federal and state agencies covering a broad array of planning issues. The following informational guide is directed specifically at information officers: Effective Media Communication during Public Health Emergencies, WHO Handbook (2005). Ref. at: http://www.who.int/csr/resources/publications/WHO%20MEDIA%20HANDBOOK.pdf. The U.S. Centers for Disease Control and Prevention (CDC) has also created an online instructional course for public information officers called “Crisis and Emergency Risk Communication Training “. It is located at: http://emergency.cdc.gov/cerc/CERConline/index.html.
