Cerc 2014edition PDF

Version 15.
0908
2014 EDITION
B E F I R S T. B E R I G H T. B E C R E D I B L E .
2014 EDITION
This manual introduces the reader to the principles and practical tools of crisis
and emergency risk communication (CERC). Principles in this manual adapt
(1) writings of classical rhetoricians; (2) a wealth of modern crisis, issues
management, communication theory, and psychological theory; and (3) lessons
learned from the real and often painful world of experience, old-fashioned trial
and error.
CERC addresses a number of topics critical to successful public, partner,

and stakeholder communication during crises and emergencies. This is not
intended to be an in-depth manual on risk communication, issues management,
crisis communication, or disaster communication. It is an amalgamation of all
of these, incorporated from theory and practical applications. CERC draws on
the work of many experts including Drs. Peter Sandman and Vincent Covello;
therefore, no single chapter is a complete source for a specific discipline. The
chapters are meant to help those who are charged with these responsibilities,
but who may not be steeped in these subjects, to manage the task of planning
and implementing CERC activities. When possible, we have provided resource
sites that offer more in-depth materials on a particular subject.
CERC is the attempt by public health professionals to provide information

that allows individuals, stakeholders, and entire communities to make the best
possible decisions for their well-being during a crisis or emergency. CERC
includes communicating to these groups regarding decisions made by response
organizations within nearly impossible time constraints. CERC principles teach
us to accept the imperfect nature of choices as the situation evolves.
i
Contents
Chapter 1: Introduction to Crisis and Emergency Risk
Communication
1 Communicating During a Public Health Crisis
2 Types of Disasters
2 A Changing World
3 Increased Population Density in High-risk Areas
3 Increased Technological Risks
3 Our Aging U.S. Population
4 Emerging Infectious Diseases and Antibiotic Resistance
4 Increased International Travel
5 Increased Terrorism
5 Defining Crisis and Emergency Risk Communication

6 Crisis Communication
7 Risk Communication
7 Issues Management Communication
7 Crisis and Emergency Risk Communication
8 Emergencies, Disasters, and Crises
9 The Communication Lifecycle

10 The Pre-crisis Phase
11 The Initial Phase
12 The Maintenance Phase
13 The Resolution Phase
14 The Evaluation Phase
14 The Role of CERC
16 Conclusion
19 References
20 Resources
Chapter 2: Psychology of a Crisis

21 Four Ways People Process Information during a Crisis
21 We simplify messages.
22 We hold on to current beliefs.
22 We look for additional information and opinions.
23 We believe the first message.
23 Mental States in a Crisis

23 Uncertainty
24 Fear, Anxiety, and Dread
25 Hopelessness and Helplessness
25 Denial
26 What about Panic?
27 Media Coverage of Crisis and Potential Psychological Effects
28 Behaviors in a Crisis
28 Seeking Special Treatment
29 Negative Vicarious Rehearsal
30 Stigmatization
31 Harmful Actions Brought About by Crisis-Related Psychological Issues
ii Crisis and Emergency Risk Communication 2014 Edition

31 Positive Responses following a Crisis
32 Risk Perception
34 EPAs Seven Cardinal Rules of Risk Communication

39 Crisis and Emergency Risk Communication During Different Stages of Crisis
39 Pre-crisis Phase
40 Initial Phase
41 Maintenance Phase
42 Resolution Phase
44 References
46 Resources
Chapter 3: Messages and Audiences

49 Understanding Your Audiences
53 How Audiences Assess Messages in a Crisis
57 Making Facts Work in Your Message
60 Using CERC Principles
60 Pre-crisis Phase: Building Consensus for Actions
61 Culture and Your Message
63 Organizing Information for Emergency Response Presentations

64 Presentation Types Based on Situation
67 Presentational Dos and Donts
68 Additional Considerations for Presentations Before, During, and After a Crisis
69 Group Influences on the Effects of Your Messages
70 Communicating About Death One-on-one
72 Audience Feedback
75 Case Study: Hurricane Katrina Emergency Communication Response By CDC,
U.S. Gulf Coast, 2005
81 Conclusion
82 References
83 Resources
Chapter 4: Crisis Communication Plans

85 Crisis Phases
86 Pre-crisis phase
87 Initial Phase
90 Maintenance Phase
91 Resolution Phase
91 Evaluation Phase
92 A Seat at the Table for Communication

93 An earthquake and a tsunami
95 Developing the Plan
95 Knowing what to include
96 Plan Characteristics
97 Longer is not better.
98 Nine Steps for Success
Crisis and Emergency Risk Communication 2014 Edition iii

105 NIMS
110 The Importance of Establishing an Emergency Operations Center
111 Planning for JIC Requirements
115 Applying the Plan During the First 24 to 48 Hours

115 Be First, Be Right, Be Credible
115 Tell the Media and the Public What You Know
116 Verification
116 Notification and Coordination
117 Initial Media Response: Is the Media Beating on Your Door?
118 Get Your Information Out Early
118 Evaluate Required Response
119 Next Media Response Step
120 Assignments
121 Applying the Crisis Plan Throughout the Response

121 Step 1: Verify the Situation
121 Step 2: Conduct Notifications
122 Step 3: Conduct Crisis Assessment (Activate Crisis Plan)
123 Step 4: Organize Assignments Quickly
125 Step 5: Prepare Information and Obtain Approvals
125 Step 6: Release Information Through Prearranged Channels
126 Step 7: Obtain Feedback and Conduct Crisis Evaluation
127 Step 8: Conduct Public Education
127 Step 9: Monitor Events
128 Conclusion
148 References
149 Resources
Chapter 5: The Spokesperson

153 Giving Your Organization a Human Form
154 Choosing the Right Spokesperson is Important
155 The Role of the Spokesperson in Crisis Communication

157 What Makes a Good Spokesperson?
160 Spokesperson Pitfalls (and How to Avoid Them) During an Emergency
160 Working with the Media

161 General Media Interview Goals
161 General Media Interview Pitfalls
162 Media Briefing or Press Conference Tips
163 In-Person Interview Tips
163 Telephone Interview Tips
164 Special Considerations for Television and Radio Interviews
165 Handling Techniques Sometimes used by Television and Radio Interviewers
166 Radio Interviews
167 Television Interviews
167 What to Wear on Television
168 Spokespersons in Public Meetings

168 When Emotions and Accusations Run High During an Emergency Public Meeting
171 Assessing Spokesperson Skills

173 Conclusion
175 References
176 Resources
iv Crisis and Emergency Risk Communication 2014 Edition

Chapter 6: Working with the Media
178 The Medias Role in a Crisis, Disaster, or Emergency
180 Interacting with the Media
181 Facilitating Positive Media Relationships
181 Equal Access Matters
182 Think Local Media First
183 Giving Reporters What They Need

183 What Do Reporters Want?
184 Media Operations in a Crisis
186 Getting Emergency Information to the Media

186 Press Releases
188 Press Conferences or Media Opportunities
189 Satellite Media Tours
190 Press Conferences by Telephone and Webcast
191 E-mail Distribution and Broadcast Faxes
191 Websites, Video Streaming, and Webinars
192 Response to Media Calls
193 Social Media
194 Writing for the Media during a Crisis

195 Prepare to Provide Basic Background on Issues to the Media . . .
195 What Should Your Media Release Include?
197 Press Statements Versus Press Releases
198 Media Fact Sheets and Backgrounders
199 Visuals, Video Press Releases, and B-Roll
200 Communicate Early and Often
200 Meeting Media Needs Throughout an Emergency

200 Where to Hold the Press Conference
201 How and When to Invite the Media
202 Whom to Invite
202 How to Conduct the Media Opportunity
204 Using Visuals
204 Handouts
205 Responding to Media Regarding Significant Errors, Myths, and Misperceptions

205 1. Remain calm.
206 2. Analyze the situation.
207 3. Know what to request.
208 4. Know whom to contact.
209 5. Know what you want to communicate.
209 6. Have a plan before you need it.
210 Monitoring the Media for Public Response to Crisis Management
210 Conclusion
211 References
212 Resources
Crisis and Emergency Risk Communication 2014 Edition v

Chapter 7: Stakeholder and Partner Communication
213 Common Interests and Challenges
213 Expectations
214 Potential Stakeholders
216 Communicating with Stakeholders
218 Assessing Stakeholder Reactions
219 Responding to Your Stakeholders
220 Partnership Development

221 Coordinating with Partners
223 Differences Between Crisis Coordination and Crisis Collaboration
224 Working with Communities

224 Community Partnerships
224 Consensus Building
225 Convening a Community Forum
225 Task Forces and Advisory Groups
226 Effective Listening
226 Dealing with an Angry Public
227 Allow the Audience to Participate in Finding Solutions
228 Questions to Help People Persuade Themselves
230 De-escalating Conflict
230 Dont Say But. Say, Yes, and
231 Conclusion
234 References
235 Resources
Chapter 8: Other Communication Channels

237 Communication Channel Attributes
237 Channels of Communication during a Crisis
238 The Demographics
239 Channel Characteristics and Features

239 Multiple Options Available
240 KPBS Radio and the 2007 San Diego Wildfires
240 Questions to Ask When Selecting Channels
241 Telephone Call Centers during an Emergency
241 E-mail Services
242 Social Media
242 Applying Specific Communication Tools

242 Making Your Selection
242 Briefings
243 Community Mailings
245 Exhibits
246 Flyers
247 Newsletters
249 Open Houses and Availability Sessions
250 Presentations
251 Public Meetings
252 Small Group or Focus Group Meetings
253 Personal Telephone Contacts
254 Conclusion
255 References
256 Resources
vi Crisis and Emergency Risk Communication 2014 Edition

Chapter 9: CERC, Social Media, and Mobile Media Devices
258 Social Medias Relationship with Mainstream Media
258 What Is Social Media?
259 Technological Advances
259 Converged Media
261 Social Media Forums, Attributes, and Users

261 Social Media Forums
265 Social Media Attributes
266 Additional Attributes
267 Social Media Users
268 Working with Social Media Before and During a Crisis

268 Before a Crisis
269 Preparedness 101: CDCs Zombie Apocalypse Venture
270 During a Crisis
273 Writing for Social Media during a Crisis

275 Using Social Media during the H1N1 and the Seasonal Flu Outbreak
276 Providing Links to Other Key Information Sources
278 Keeping Up with Social Media during a Crisis

278 How to Keep Up
278 Using Social Media for Internal Organizational Communication
280 Mobile Media and Its Role during a Crisis

280 Mobile Devices
280 Using Mobile Devices
282 Mobile Devices Used in Disasters
284 Opportunities
285 Challenges
286 Responding to Social Media Regarding Serious Errors, Myths, and Misperceptions
287 Suggestions for Using Mobile Devices for Social Media
288 Conclusion
293 References
295 Resources
Chapter 10: Terrorism and Bioterrorism Communication

Challenges
298 Chemical, Biological, Radiological, Nuclear, or Explosive (CBRNE) Events
298 Terrorist Events are Real
300 Traits of a Terrorist Attack
301 Law Enforcement and Public Health in Terrorist Events
302 CDCs Strategic National Stockpile
303 Communication Challenges

303 How a Terrorism Incident Is Different From Other Crises
305 Terrorism and Public Information
305 Coordinating with State and Local Response Agencies
306 Traits of Biological Terrorist Events
306 Preparing Public Health Agencies for Biological Attacks
Crisis and Emergency Risk Communication 2014 Edition vii

307 Bioterrorism Versus Emerging Infectious Diseases and Hoaxes
307 Recognizing and Responding to Outbreaks
309 Identifying Bioterrorism
311 CDC Media Strategy during a Possible Undeclared Bioterrorism Event
312 Preparing for a Hoax
313 Foot and Mouth Hoax in New Zealand
313 Psychological Responses to Terrorism

314 The Strategic National Stockpile (SNS) and Emergencies
314 The SNS Program
315 SNS Communication Concerns
319 Conclusion
320 Pre-event Planning
322 Information about the Drugs the Public Must Take
323 References
325 Resources
Chapter 11: Human Resources for CERC

329 Working with Responders from Varied Backgrounds
330 Appropriate Staffing and Preparation to Maintain the Well-Being of Communicators
330 First Responder Stress
331 Disaster Trauma P ost - Traumatic Stress Disorder
332 Pre-crisis Planning for Human Resources
333 Stress Management Techniques to Consider
335 Determining Staffing Levels
336 Assessing Individual Capacity in Public and Media Response
338 Emotional Health Issues for Those Responding to a Crisis

338 Coping
341 Encouraging Mental Health and Rejuvenation
342 Emotional Health Issues for Families of Deployed Emergency Response Workers
343 Conclusion
344 References
346 Resources
Chapter 12: Understanding Roles of Federal, State, and Local

Community Health Partners
349 The Many Players and Partnerships in Emergency Response
350 Change is a Core Factor
350 Community-based Approaches to Emergencies

351 FEMAs Whole Community Framework
352 Community Preparedness
353 Japans Disaster Prevention Day
354 List of International Agencies, Federal Agencies, NBOs, and FBOs

356 International Health Regulations
viii Crisis and Emergency Risk Communication 2014 Edition

357 Federal Emergency Management Agency (FEMA)
357 National Response Framework (NRF)
357 NRF, the Emergency Support Function (ESF) Annex #8
357 NRF, Public Affairs Support Annex
358 Excerpt from the NRF Public Affairs Support Annex
359 NRF, Incident Annexes
359 National Preparedness Directorate (NPD)
359 Department of Health and Human Services (HHS)

359 Office of the Assistant Secretary for Preparedness and Response (ASPR)
360 HHS National Disaster Medical System (NDMS)
360 ASPR Response Playbooks
361 Agency for Toxic Substances and Disease Registry (ATSDR)
361 Centers for Disease Control and Prevention (CDC)
363 Conclusion
364 References
366 Resources
Chapter 13: Media and Public Health Law

369 Understanding the Legal Environment
369 Freedom of Speech and the Press

370 Espionage Law and the News Media
370 Laws of Defamation

370 Defamation
371 Retractions
372 Defamation and the Internet
372 Defamation in Emergency Response
372 Copyright Law

373 Copyright Limitations: Fair Use
373 The Publics Right to Know

374 Emergency Planning and Community Right-to-Know Act
375 Public Record Laws
375 Freedom of Information Act (FOIA)

378 Privacy Act of 1974
379 Sample Privacy Act Notification Statement
379 Health Insurance Portability and Accountability Act (HIPAA) Privacy Regulations
380 Privacy: Legal and Practical Considerations
380 Working with Sensitive Information
381 Public Health Laws

381 Sources of Authority
381 State Public Health Powers
382 Local Public Health Powers
383 Law and Public Health Agencies
384 Public Health Powers and Liabilities

384 Interaction among Levels of Government
384 Limitations on Public Health Powers
385 Constitutional Rights
388 Public Health Officials Responsibilities and Liabilities
Crisis and Emergency Risk Communication 2014 Edition ix

394 State Public Health Emergency Powers
395 Restrictions on Personal Liberty
398 Restrictions on Property
399 Modern Day Example of Emergency Response and Communication: H1N1
400 Conclusion
401 References
404 Resources
Acronyms 405
Epidemiology Terms 413
Index 421
x Crisis and Emergency Risk Communication 2014 Edition

Tools
74 Message Template 31. Message Development for Emergency Communication
129 Checklist 41: First 48 Hours
131 Checklist 42. Notification Schedule
133 Checklist 43. Public Information Emergency Response Call Tracking
135 Checklist 44. Incident Media Call Triage Sheet
136 Checklist 45. Needs Assessment for Crisis and Emergency Risk Communication
174 Pocketcard 51. Youre the SpokespersonWhat You Need to Know
232 Worksheet 71. Stakeholder Reaction Assessment
289 Worksheet 91: Social Media Communications Strategy Worksheet
320 Checklist 101. Strategic National Stockpile Communication Needs Assessment
320 Checklist 101. Strategic National Stockpile Communication Needs Assessment
Crisis and Emergency Risk Communication 2014 Edition xi

Figures
9 Figure 11. Crisis and Emergency Risk Communication (CERC) Lifecycle
52 Figure 31. Audience Relationship to the Event
56 Figure 32. Elements of Successful Communication
264 Figure 91. Google Map of 2011 Minot, North Dakota, Flooding (Otis & James, 2011)
Tables
17 Table 11. Specific Hazards Under CDC Emergency Preparedness and Response
18 Table 12. National Response Framework Incident Categorization
43 Table 21. Effective Communication Recommendations
66 Table 31. Types of Emergency Response Presentations
80 Table 32. Phased Message Dissemination for Hurricanes and Floods*
105 Table 41. NIMS Sample JIC for a Large Incident
122 Table 42. General Guidelines for Notification
171 Table 51. Spokesperson Media Task Analysis
222 Table 71. Summary of Three Perspectives of Disaster Response Coordination
354 Table 121. Response Agencies (not an all-inclusive list)
xii Crisis and Emergency Risk Communication 2014 Edition

Acknowledgments
Crisis and Emergency Risk Communication

2014 Edition
First Edition Authored By:

Barbara Reynolds, Ph.D., Centers for Disease Control and Prevention
In Collaboration with:
Julia Hunter Galdo, Prospect Center of the American Institutes for Research
Lynn Sokler, Prospect Center of the American Institutes for Research
2014 Edition Authored By:

Barbara Reynolds, Ph.D., Centers for Disease Control and Prevention
Matthew Seeger, Ph.D., Wayne State University
Chapter 9 Authored By:

Michael Palenchar, Ph.D., University of Tennessee
Chapter 13 Authored By:

Lance Gable, J.D., M.P.H., Wayne State University
Ralph Holsinger
Babette Neuberger
Tom Christoffel
2014 Edition Edited by:

Centers for Disease Control and Prevention
Joanne Cox, M.C. Nicole Margaritha Maiden, M.P.A.
Molly Gaines-McCollom, M.P.H., CHES Dagny Olivares, M.P.A.
Nikki Grimsley, CHES Thomas Sinks, Ph.D.
Arnetra Herbert, M.S. Vivi Siegel, M.P.H.
Jonathan Lynch Caitlin Shockey, J.D.
Laurel Berryman, M.A., Deloitte Consulting LLP

Laura E. Pechta, Ph.D., McKing Consulting Corporation
Paula Orlosky Williams, M.A., Deloitte Consulting LLP
Crisis and Emergency Risk Communication 2014 Edition xiii

2012 Edition Edited by:
Dahna Batts, M.D. Sandriel McKnight, M.P.A.
Jennifer Brooks, M.P.H. Maria-Belen Moran
Denise Hofmann Roger Pippin, M.A.
Sharon KD Hoskins, M.P.H. Kara Stephens, M.S.A.
LaBrina Jones, M.P.A. Taka L. Allende, M.P.A.
Barrett Kanne Gail Williams, M.P.H.
Judith Kanne, RN Jude Wilson, M.A.
Jason McDonald Mark Wooster, Ph.D.
Stephanie Church, M.A., Wayne State University

Bill Hall, Director, News Division, Department of Health and Human Services
First Edition Edited by:

Vicki F. Freimuth, Ph.D., Centers for Disease Control and Prevention
Chad R. Wood, M.B.A., Centers for Disease Control and Prevention
Alicia Eberl-Lefko, M.H.S., CHES, Prospect Center of the American Institutes for Research
Linda Weinberg, RD, Prospect Center of the American Institutes for Research
Elizabeth Williams, Prospect Center of the American Institutes for Research
Anna Zawislanski, M.P.H., Prospect Center of the American Institutes for Research
xiv Crisis and Emergency Risk Communication 2014 Edition

Development, preparation, and implementation of this course
were made possible through the contributions of the following:
Centers for Disease Control and Prevention and

Agency for Toxic Substances and Disease Registry
Bret M. Atkins, M.A. Cheryl Lackey, M.P.H., CHES

Erik Auf der Heide, M.D., M.P.H. Maureen Lichtveld, Ph.D.
Nadya Belins, M.A. Max Lum
April Bell, M.P.H. Katherine Lyon Daniel, Ph.D.
Varian Brandon Barbara McCollum
Bernadette Burden Jennifer Morcone
Bruce Burney Joan Morrissey
Joan Cioffi, Ph.D., M.S., BPharm James Andy Mullins, D.V.M.
Linda Cockrill Phil Navin
Galen Cole, Ph.D., M.P.H., M.A. Glen Nowak, Ph.D.
Judith Courtney, M.P.S., M.A. Ralph OConnor, Ph.D., M.D.
Bill Crews Claudia Fishman Parvanta, Ph.D.
Dave Daigle, M.A. Bobbie Person, M.P.H.
John Doyle, M.P.A. Bill Pollard
Rita Ford Christine Prue, M.S.P.H., Ph.D.
Vicki Freimuth, Ph.D. Susan Robinson, M.A.
Judy M. Gantt, M.Ed. Von Roebuck
Donna Garland E. Roberta (Bobbi) Ryder
Kay Golan Cyndi Shaffer
Barbara Govert, M.S. Melissa Shepherd
Howard E. Hall, Jr. Tom Skinner
Gail Hayes, M.S. Diana Swindel
Meredith Hickson, M.P.H. Amanda Tarkington, M.C.
Alan Janssen, M.S.P.H. Oscar Tarrago, M.D., M.P.H.
Ali Khan, M.D., M.P.H. Jana Telfer, M.A.
Sean Kaufman, M.P.H., CHES Marsha Vanderford, Ph.D.
Richard W. Klomp, M.O.B., M.S., LPC, BCPC
National Public Health Information Coalition (NPHIC)

Laura Espino, Georgia Rita Obey, Texas
Thom Berry, South Carolina Manuel Rodriguez, Washington, D.C.
Kim Deti, Wyoming Mari-jean Siehl, Ohio
Jeanene Fowler, Arizona Thomas Slater, New Jersey
Bill Furney, North Carolina Kristine A. Smith, M.A., New York
Nanci Gonder, Missouri Kevin Teale, M.A., Iowa
Larry Hill, Virginia Nancy Erickson, Vermont
Roger Naylor, Georgia
Crisis and Emergency Risk Communication 2014 Edition xv

Public Health Partners and Associations
David Bergmire-Sweat, American Social Health Association
Steven Berry, Federal Bureau of Investigation, Department of Justice
Bonnie Piper, Environmental Protection Agency
Clete DiGiovanni, Jr., M.D., National Naval Medical Center
Ronnie Goodstein, Penellis County, FL, Department of Health
Bill Hall, Department of Health and Human Services
Stacey Hoffman, Georgia Department of Public Health
Robert DeMartino, M.D., Substance Abuse and Mental Health Services Agency
Marc Wolfson, Department of Health and Human Services
Donald Stephens, Atlanta American Red Cross
William Reynolds, Atlanta American Red Cross
Darren Irby, American Red Cross
Caroline Hall, American Red Cross
Sabrina Edgington, M.S.S.W., National Healthcare for the Homeless Council
Mollie Melbourne, M.P.H., MEP, National Association of Community Health Centers
Professional Consultants
Vincent Covello, Ph.D. Ruth Schultz, M.H.A., CHES
Susan W. Hodges, B.S. Tim Tinker, Ph.D.
Peter Sandman, Ph.D.
University Reviewers, Authors, and Consultants

William Benoit, Ph.D., University of Missouri
Thomas Carlton, Ph.D., Vanderbilt
Stephanie Church, M.A., Wayne State University
Louise Comfort, Ph.D., University of Pittsburgh
Kathleen Fearn-Banks, Ph.D., University of Washington
Baruch Fischhoff, Ph.D., Carnegie Mellon University
Vicki Friemuth, Ph.D., University of Georgia
Lance Gable, J.D., M.P.H., Wayne State University
Dennis S. Gouran, Ph.D., Penn State University
Brenda Granillo, M.S., University of Arizona
Keith Hearit, Ph.D., Western Michigan University
Robert Heath, Ph.D., University of Houston
Tara OToole, M.D., Johns Hopkins University
Michael Palenchar, Ph.D., University of Tennessee
Laura Pechta, M.A., Wayne State University
Charles Perrow, Ph.D., Yale
Elizabeth Petrun, M.A., University of Kentucky
Jasmin Riad, Dromedary Disasters International, Inc.
Matthew Seeger, Ph.D., Wayne State University
xvi Crisis and Emergency Risk Communication 2014 Edition

Timothy L. Sellnow, Ph.D., University of Kentucky
Don Stacks, Ph.D., University of Miami
Jeannette Sutton, Ph.D., University of Colorado, Colorado Springs
Robert Ulmer, Ph.D., University of ArkansasLittle Rock
Steven Venette, Ph.D., University of Southern Mississippi
Shari Veil, Ph.D., University of Kentucky
Kim Witte, Ph.D., Michigan State
Debra Worley, Ph.D., Indiana State
Prospect Center of the American Institutes for Research

Charles Buki, Consultant Publications Department
Tom Hendrick, Audiovisual Consultant Susan Bratten, Senior Editor
Lisa E. Scaun, M.S.W. Kenneth Halter, Publications Manager
Nicole M. Wise, M.A. Lissa Hurwitz, Consultant Editor
Support Staff Angele Jehle, Production Coordinator
Michael Burke, Ph.D., Research and Evaluation Patricia Louthian, Document Specialist
Simani Price, Ph.D., Research and Evaluation Karen Ward, Consultant Document Specialist
Shawna Williams, Analyst Francesca Oneto, Presentation Specialist
Creative Department Production Department

Martha Mater, Traffic Manager Rin London, Production Assistant
Mitch Nydish, Consultant Graphics Artist Drew Melton, Production Specialist
Oak Ridge Institute for Science and Education (ORISE)

John H. Sorensen, Ph.D., Oak Ridge National Laboratory
Logistics Management Institute (LMI)

Joseph Karwatka, M.S.
John W. Yasalonis, M.S., CIH, RHSP
Crisis and Emergency Risk Communication 2014 Edition xvii

xviii Crisis and Emergency Risk Communication 2014 Edition
Crisis and Emergency Risk Communication 2014 Edition xix
Chapter 1:
Introduction to Crisis and
2014 EDITION Emergency Risk Communication
The next chapter follows this title page.

Chapter 1:
Introduction to Crisis and
Emergency Risk Communication
This chapter will promote understanding in the

following areas:
CERC is a way to talk to people, a
Types of hazards and contributing factors that increase set of principles that allow us, in the
the risk of crisis heat of a crisis when the unthinkable
Definitions of crisis and emergency risk communication happens, to be able to get a message
(CERC) concepts through to people in a way that they
The lifecycle of CERC and how communication works can actually understand it and act
at each stage on it.
Communicating During a Dr. Barbara Reynolds,

Centers for Disease Control
Public Health Crisis
and Prevention
The public wants to know what the responders know during
a public health crisis. They view every move and watch every
passing emotion of those responding during a disaster, crisis,
or emergency. In a crisis, every word counts. Our job as public
health and emergency communicators is to offer the information
the public needs and counter some of the harmful behaviors
that are common during an emergency, so we can effectively We will always be giving people the
support the public, our colleagues, and the organizations that best information we have and the
are offering help. best recommendation based on what
we know the best information is right
The material here cannot promise that you, as a community
leader faced with an emergency, crisis, or disaster, will overcome now. Thats one of the ways you can
all communication challenges in a crisis by reading this book. be first and be credible, because it
However, by applying crisis and emergency risk communication sets the expectation that things will
(CERC) principles, you can learn what to say, when to say it, change and we are working to learn
and how to say it to help you preserve or win the publics trust. more. Thats always a challenge, but I
More importantly, it can save lives. think it is our best practice.
CERC is a term used to cover both the urgency of crisis Dr. Marsha Vanderford,
communication and the need to explain risks and benefits Centers for Disease Control
to stakeholders and the public. Todays public and your
and Prevention
stakeholders demand immediate and credible communication in
real time during a crisis response.
1
Throughout this book, six principles1 of effective crisis and risk communication are emphasized:
1. Be First: Crises are time-sensitive. Communicating information quickly is almost

always important. For members of the public, the first source of information often becomes
the preferred source.
2. Be Right: Accuracy establishes credibility. Information can include what is known, what is not
known, and what is being done to fill in the gaps.
3. Be Credible: Honesty and truthfulness should not be compromised during crises.
4. Express Empathy: Crises create harm, and the suffering should be acknowledged in words.
Addressing what people are feeling, and the challenges they face, builds trust and rapport.
5. Promote Action: Giving people meaningful things to do calms anxiety, helps restore order, and
promotes a restored sense of control.
6. Show Respect: Respectful communication is particularly important when people feel
vulnerable. Respectful communication promotes cooperation and rapport.
Well-planned and well-executed CERC, fully integrated into every stage of the crisis response, helps
ensure that limited resources are managed well and can do the most good.
Types of Disasters
The most common disasters2 are natural disasters, but the line between natural and manmade often
blurs, as it did with Hurricane Katrina. Based on the disaster, both CDC and the Federal Emergency
Management Agency (FEMA) have grouped them by type (see lists of specific types extracted from
publications by both agencies in Table 11 and Table 12 at the end of this chapter).
While there are many types of disasters, most planners try to take an all-hazards approach. Most
planners create general plans that are designed such that they can be adapted to specific situations,
rather than trying to plan separately for every possible type of disaster. In addition, all disasters are
managed locally until local resources are overwhelmed, at which point state, regional, national, and
international resources are deployed. While an all-hazards approach works in operational response,
there will be important distinctions in the way communication is executed by type of disaster and these
differences require consideration during planning.3
A Changing World
Disasters test emergency response capabilities. The ability to deal effectively with disasters is becoming
more relevant, because the factors that tend to increase risks are also increasing.
2 Chapter 1 Introduction to Crisis and Emergency Risk Communication

Increased Population Density in High-risk Areas
As areas become more densely populated, more potential victims are at risk when a disaster strikes.4
Part of this increase in density occurs in disaster-prone areas including the following:
High-risk floodplains
Locations near earthquake faults
Coastal hurricane areas
Unstable hillsides
Regions subject to wildfires
Areas adjacent to hazardous waste landfills, airports, and nuclear power plants
Increased Technological Risks

New technologies are adding to the list of disaster agents at an ever-increasing rate.5 We live in a society
that depends on computers and other products of modern technology:
Approximately 2.2 billion tons of hazardous chemicals6 travel annually in this country, often
over old bridges and decaying railroad tracks. As the amount of hazardous chemicals being
transported increases, so does the risk of a spill or airborne release of those chemicals.
The U.S. is becoming more dependent on technology, making society even more vulnerable to
problems, such as mass power outages or transportation disruptions.
Complex technology can interact in unpredictable ways, creating added danger.
Our Aging U.S. Population

The U.S. is on the brink of a longevity revolution. With this increase in the population of people over 65
comes a responsibility, as disasters of all kinds disproportionately affect older adults.7 This is especially
true when it comes to chronic diseases and disabilities. This aging population presents new challenges
for disaster response, including medical requirements, mobility, and extra assistance with daily tasks.
By 2030, the number of U.S. adults aged 65 or older will more than double to about 71 million.8
The growing number and proportion of older adults places an increased demand on public
health systemsmedical and social services are taxed as well.9
In 2004, 80% of Americans over 65 had at least one chronic condition, and 50% had two.10
Over two-thirds of current health-care costs are for treating chronic illnesses.
Among older Americans, chronic diseases use about 95% of our health-care expenditures.11
A large body of evidence indicates that the health conditions and needs of older adults are
different from other segments of the population.
Chapter 1 Introduction to Crisis and Emergency Risk Communication 3

Infectious diseases remain a danger to all people, no matter their age, gender, lifestyle, ethnic
background, or economic status. They remain among the most common causes of suffering and death.
These infections impose a huge cost to society. Since it is never certain when or where new diseases will
arise, we must always be prepared.
Emerging Infectious Diseases and Antibiotic Resistance

In the years following World War II, it was widely believed that humans were winning the war against
infections. We learned antibiotics could treat life-threatening bacterial diseases. Dreaded childhood
diseases, such as polio, could be prevented through vaccinations. However, this hopefulness was
premature. Listed are just a few events over the last 60 years that demonstrate that infections
are here to stay:
As early as the 1950s, penicillin began losing its ability to cure Staphylococcus aureus
infections, also known as staph.12
In the 1970s, there was a resurgence of sexually transmitted diseases.12
Also during the 1970s, new diseases were identified, such as Legionnaires disease, toxic shock
syndrome, and Ebola. 12
At the same time, antibiotic-resistant bacteria became more common in hospitals, spreading to
patients and into communities. 12,13
In 1981, AIDS was first reported by CDC.14
Flu season remains a yearly threat. Experts say it is possible that a new pandemic strain might
emerge that could span the globe and reduce the worlds population.15
In 1997, the avian influenza, H5N1, scare in Hong Kong raised the specter of a possible global
pandemic and jolted the world.16
The emergence of H1N1 in 2009 was yet another sign that a deadly pandemic is possible.16
Increased International Travel

International travel and trade play a role in the rapid spread of disease and the resistance to antibiotics.
A microbe originating in Africa or Southeast Asia can arrive on North American shores within 24 hours.
In the U.S., published reports show that the majority of multidrug-resistant typhoid cases originated in
six developing countries.
The exact number varies, depending on population criteria and how city limits are defined, but
according to one source,17 as of January 2012, 26 cities worldwide had populations above 10 million.
While there are many heavily populated cities in developed countries, experts suggest that future
growth in urban areas will occur mainly in developing countries. These are where we are likely to see
the following problems:

Poverty
Population density
Lack of sanitation
Bacteria and viruses growing and rapidly spreading
The threat from terrorism is real, ongoing, and evolving. State-sponsored terrorism appears to have
declined recently, but transnational groups are emerging. They tend to have dispersed networks
and decentralized leadership that is harder to disrupt. Increasingly, terrorists acts are initiated and
executed at lower levels and decentralized units.
Increased Terrorism18
Terrorists are increasingly adept and technically savvy in their ability to defeat counter-terrorism
measures. As security around government and military facilities improves, terrorists are seeking out
vulnerable targets for mass casualties. They do this according to well-conceived plans, such as:
Employing advanced tools, such as improvised explosive devices
Using strategies such as simultaneous attacks, which kill or injure many people at once
An act of biological or chemical terrorism may range from the dissemination of anthrax spores to
intentional food product contamination. Accurately predicting when and how such an attack may occur
is impossible. The probability of biological or chemical terrorism cannot be ignored. The possibility of
mass causalities plus widespread social and economic disruption means threats must be taken seriously.
Defining Crisis and Emergency Risk Communication

Communication experts and theorists tend to develop very precise and narrow definitions for fields
of communication. For the purposes of this book, the following terms are defined in ways that are
consistent with the work of many communication researchers:
Crisis communication
Risk communication
Issues management communication
Crisis and emergency risk communication
These definitions will give you a firm foundation for understanding how CERC integrated these types
of communication into a cohesive framework for crisis response. Communication expertise based on

study and practice can fulfill a basic need for public health professionals as they react to a public health
emergency. This book reflects the special combination of crisis and emergency risk communication.
Together, they help us create effective strategies.
Crisis Communication
The term crisis communication is generally used in two ways:
1. It describes the communication activities of an organization or agency facing a crisis. They

need to communicate about that crisis to their organization, various partners, and the public.
Typically, a crisis:
yy Occurs unexpectedly
yy May not be in the organizations control
yy Requires an immediate response
yy May cause harm to the organizations reputation, image, or viability
As an example, the 1984 Bhopal gas leak in India19 was a crisis confronted by an organization
that faced blame for the situation. The company faced legal challenges and negative public
reactions for many years after the crisis. This organization faced some legal or ethical
responsibility for the crisis (unlike a disaster, where, for example, a tornado does the damage).
The public and many stakeholders judged the organization based on their actions throughout
the response.
2. The term crisis communication is associated more with emergency management and the need
to inform and alert the public about an event. In this case, crisis communication might refer to
the community leaders efforts to inform the public.
For example, leaders might need to evacuate a community in advance of a hurricane. In this
definition, the organization is not facing a threat to its reputation or image. The effort to inform
and warn the public is universally recognized as important. Many public alert systems, like the
old Emergency Broadcast System and the new Commercial Mobile Alert System are based on
this form of crisis communication.
The underlying thread in both forms of crisis communication is that an unexpected and
threatening event requires an immediate response. The content, form, and timing of the
communication can help reduce and contain the harm or make the situation worse. Crisis may also
imply lack of control by the involved organizations based on the timing of the incident.

Risk Communication
The field of environmental health elevated the prominence of risk communication. Through risk
communication, the communicator hopes to provide the audience with information about the expected
type (good or bad) and magnitude (weak or strong) of an outcome from a behavior or exposure.
Typically, risk communication involves a discussion about adverse outcomes, including the probabilities
of those outcomes occurring. In some instances, risk communication has been used to help an individual
make a decision in response to many questions, including the following:
Should I undergo a medical treatment?
What are the risks of living next to a nuclear power plant?
Do I elect to vaccinate a healthy baby against whooping cough?
In some cases, risk communication is used to help individuals adjust to something that has already
occurred, such as exposure to harmful carcinogens, possibly putting them at greater risk for cancer.
Risk communication would prepare people for that possibility. If warranted, the communication would
offer steps to take to lower their chance of dying from cancer, such as screenings.
Issues Management Communication

Issues management communication can be similar to crisis communication. An issue is a public question
that has generated some interest by stakeholders. Questions about vaccine safety, for example, have
generated concern among some groups. Their worry has sparked a great deal of public debate. Issues
management involves using communication to influence how the organization responds to the issue
and how it is potentially resolved. In some cases, an issue can become a crisis. Issues managers have
forewarning that an issue is developing. Issues may develop more slowly and continue over extended
periods. Managers typically have more time to respond to issues than they would to a crisis. Again, the
organization or agency is central to the event.

CERC combines the elements of crisis communication and risk communication as they are used during
an emergency response. CERC involves experts who provide information allowing individuals or an
entire community to make the best possible decisions about their well-being. Communicators must also
help people accept the imperfect nature of choices during the crisis. CERC also differs from pure risk
communication in that a decision must be made within a narrow time constraint. The decision may be
irreversible, the outcome of the decision may be uncertain, and the decision may need to be made with
imperfect or incomplete information.
Communicators must inform and persuade the public in the hope that they will plan for and respond
appropriately to risks and threats. The work presented here shows that your organization should
follow CERC principles when responding to a crisis. If you fail to use CERC, you may fail to effectively
communicate key information that could save lives.

Emergencies, Disasters, and Crises
What do emergencies, disasters, and crises have in common? Simply that something bad has happened
or is happening, that it is surprising on some level, and that an immediate response is required. When
something bad or unexpected happens, it may be called an emergency, a disaster, or a crisis depending
on who is involved, the magnitude, and the current phase of the event.
A crisis involves many players and, depending on the location and the nature of the event, different
agencies and groups take different roles. Government agencies that may be involved in the response at
some level include the following:
Local public health agencies
State public health agencies Numerous after-action reports

from major incidents throughout
Federal public health agencies
the history of emergency
FEMA management in our nation have cited
The U.S. Department of Homeland Security communications difficulties among
the many responding agencies as
Other types of organizations that may be involved a major failing and challenge to
include the following: policymakers.
Police departments The National Emergency
Fire departments Communications Plan
Emergency medical services
Health-care organizations
Nongovernmental response organizations such as the American Red Cross
Faith-based organizations
Businesses
It is important to remember that at the center of any crisis are those individuals, groups, and
communities most directly affected. All disasters are local. The community is the first and most
important responder.
The role of government agencies is outlined by a set of federal guidelines called the National Incident
Management System (NIMS).20 NIMS is a national standard for organizing agencies and improving
coordination of incident management operations. Communication is a key part of NIMS. It applies to
creating systems where agencies can communicate with each other, what is called interoperability. It
also ensures that good communication occurs with the public.

The Communication Lifecycle
Understanding the pattern of a crisis can help communicators anticipate problems and appropriately
respond. For communicators, its vital to know that every emergency, disaster, or crisis evolves in
phases. The communication, too, must evolve through these changes. By dividing the crisis into the
following phases, the communicator can anticipate the information needs of the media, agencies,
organizations, and the general public. For each of these phases, specific types of information need to be
created and delivered to your audience.
Figure 11. Crisis and Emergency Risk Communication (CERC) Lifecycle
Be prepared. Acknowledge the event Help the public more Improve appropriate Evaluate communication
Foster alliances. with empathy. accurately understand its public response in future plan performance.
own risks. similar emergencies
Develop consensus Explain and inform Document lessons
Provide background through education.
recommendations. the public, in simplest learned.
forms, about the risk. and encompassing Honestly examine
Test messages. information to those problems and mishaps, Determine specific
Establish agency
who need it. and then reinforce what actions to improve
and spokesperson
worked in the recovery crisis systems or the
credibility. Gain understanding and
and response efforts. crisis plan.
support for response and
Provide emergency
recovery plans. Persuade the public to
courses of action,
Listen to stakeholder and support public policy and
including how and
audience feedback, and resource allocation to the
where to get more
correct misinformation. problem.
information.
Commit to Explain emergency Promote the activities
recommendations. and capabilities of
stakeholders and the
the agency, including
public to continue Empower risk/benefit reinforcing its corporate
communication. decision-making. identity, both internally
and externally.
The movement through each of the phases will vary according to the triggering event. Not all crises are
equal. The degree or intensity and longevity of a crisis will make a difference in the required resources
and staff. An assessment for emergency communication response and a decision tree are provided in
Chapter 4.

The Pre-crisis Phase
Communication objectives during the pre-crisis phase target communication and education campaigns.
These campaigns inform the public and the response community. The communicators job is to be
prepared by facilitating the following:
Monitor and recognize emerging risks.
Educate the general public about the risks.
Prepare the public for the possibility of an adverse event.
Increase self-efficacy by suggesting actions that reduce the likelihood of harm.
Provide warning messages regarding an imminent threat.
Collaborate and cooperate by developing alliances with agencies, organizations, and groups.
Develop consensus recommendations by experts and first responders.
Create messages and test them for use in later stages.
Build and test communication systems.
The pre-crisis phase is where the planning and preparation work is done. During this phase, your
organization will:
Predict and address the types of disasters you are most likely to face.
Anticipate and develop likely preliminary answers to audience questions.
Draft initial messages; specific details can be filled in later.
Identify spokespersons, resources, and resource mechanisms well ahead of time.
Practice following the response plan, using the messages you have already created, followed by
refining the plan and messages as needed.
Foster alliances and partnerships to ensure that experts are speaking in a coordinated manner
(using one voice).
Develop and test communication systems and networks.

The Initial Phase
Communication objectives during the initial phase include rapid communication to the general public
and rapid communication to affected groups. These communication efforts seek to do the following:
Convey empathy and reassurance. Reduce emotional turmoil.
Designate crisis or agency spokespersons, and identify formal channels and methods of
communication.
Establish general and broad-based understanding of the crisis circumstances, consequences,
and anticipated outcomes based on available information.
Reduce crisis-related uncertainty as much as possible.
Help the public understand the responsibilities of the various organizations involved in the
response.
Promote self-efficacy (explain to people that they can help themselves or reach a goal) through
personal response activities, and share how and where they can get more information.
When communicating in the initial phases of an emergency, it is important to present information that is
simple, credible, accurate, consistent, and delivered on time.
The initial phase of a crisis is characterized by confusion and intense media interest. Information is
usually incomplete, and the facts are sparse. An information deficit exists. Channels of communication
are often disrupted. Its important to recognize that information from the media, other organizations,
and even within response organizations may not be completely accurate. It is important to learn as
much about what happened as possible, to determine the organizations or agencys communication
responses, and to confirm the magnitude of the event as quickly as possible.
In the initial phase of a crisis, you must be accurate while recognizing that not having all the facts
available early will not alleviate responders from the responsibility of communicating, even if that is
an honest we dont know. Accuracy in what is released and the speed in which response officials
acknowledge the event are critical at this stage.
One of the best ways to limit public anxiety in a crisis is to provide useful information about the event
and tell the public what they can do. During the initial phase of an event, response organizations and
spokespersons should take steps to establish their credibility. This is explored further in Chapter 5.
Even when there is little information to offer, it is still possible to communicate how the organization

is handling the event and when more information will be available. Commit to the public that you will
continue to provide new information as it becomes available.
At the very least, messages should demonstrate that organizations are engaged and addressing the
issues directly. This means that approaches are reasonable, caring, and timely, and all available
information is being provided. At the same time, the pressure to release information prematurely can
be intense. In most cases, all information must be cleared by the appropriate leaders or designated
clearance personnel before its offered to the media. If clearance procedures are too slow or
cumbersome, they should be challenged during exercises and in planning.
Although the types of information that people need will vary according to the specific crisis, in the initial
phase of a crisis, an information vacuum often exists. People want that vacuum filled. They want timely
and accurate facts about what happened, what is being done, and most importantly, what they should
do. People will question the immediate threat to them, the duration of the threat, and who is going to fix
the problem. Communicators should be prepared to answer these questions as quickly, accurately, and
fully as possible while acknowledging the uncertainty of the situation. At the same time, they will need
to direct people to places where more information is available.
The Maintenance Phase

Communication objectives during the crisis maintenance phase include talking with the general public
and other partners:
Ensure that the public is updated, understands ongoing risks, and knows how to
mitigate these risks.
Provide background and supportive information to those who need it.
Encourage broad-based support and cooperation with response and recovery efforts.
Gather feedback from the affected publiclisten, learn, and assess.
Correct misunderstandings, rumors, or unclear facts.
Continue to help people believe they can take steps to protect themselves, their families, and
their community. Continue to explain those steps.
Support informed decision-making by the public based on their understanding of
risks and benefits.

As the crisis evolves, anticipate sustained media interest and scrutiny. Unexpected developments,
rumors, or misinformation may place further media demands on organization communicators. Other
experts, professionals, and those not associated with the response will comment publicly on the issues.
Sometimes they will contradict or misinterpret your messages. Criticism about the response is inevitable
and to be expected.
Staying on top of the information flow and maintaining close coordination with others is essential.
Processes for tracking communication activities and audiences become increasingly important as the
workload increases.
The crisis maintenance phase includes an ongoing assessment of the event and allocation of resources.
The Resolution Phase

Communication objectives for the resolution phase will likely include continued communication to the
general public and affected groups. During this phase, communicators should do the following:
Explain ongoing cleanup, remediation, recovery, and rebuilding efforts to your audience.
Motivate them to take action if needed.
Facilitate broad-based, honest, and open discussion about causes, blame, responsibility,
resolutions, and adequacy of the response.
Improve individual understanding of new risks.
Promote behaviors that avoid risks.
Promote personal preparedness.
Promote the activities and capabilities of agencies and organizations by reinforcing positive
identities and images.
Persuade the public to support public policy and resource allocation to the problem.
As the crisis resolves, there may be a return to the status quo, with a better understanding about what
took place. Complete recovery systems are activated. This phase is depicted by much less public and
media interest. Once the crisis is resolved, you may need to respond to intense media scrutiny of how
the response was handled.
An opportunity may exist to reinforce public health messages while the issue is still current. The
organization may need to start a public education campaign or change its website. A community is more
likely to respond to safety and public health messages at this time.

The Evaluation Phase
Objectives during the evaluation phase include communication directed toward the response
community. Responders will evaluate and assess the effectiveness of responses, including the following:
Discuss, document, and share lessons learned.
Determine specific actions to improve crisis communication and crisis response capability.
Evaluate the performance of the communication plan.
Implement links to pre-crisis activities.
Typically, an after-action report, sometimes called a hot wash or lessons learned, is generated
through a process of reviewing records and consulting the key people involved. No response is ever
perfect, and there is always something to learn.
The Role of CERC

I want to acknowledge the
Crises, emergencies, and disasters happen with surprising
importance of uncertainty. At the
frequency. One of the reasons disaster responses are difficult
early stages of an outbreak, theres
to coordinate is that disasters are different from routine daily
emergencies. much uncertainty, and probably
more than everyone would like. Our
The difference is more than just one of magnitude. guidelines and advice are likely to be
interim and fluid, subject to change
Crises by definition create very high levels of uncertainty, as we learn more.
and they cannot be adequately managed merely by increasing
personnel and material. During crisis situations, decision makers Dr. Richard Besser,
are often unable to collect and process information in a timely CDC Acting Director,
manner. They rely on established routines for situations that are,
H1N1 Press Conference,
by definition, not routine.
April 23, 2009
Communication during a crisis requires a different mindset. In
major disasters, the incident may be so shattering that the basic
understanding of what is occurring and the means to rebuild
that understanding fall apart. CERC is vital to helping people cope and begin to rebuild. The right
communication helps to bring a sense of order and understanding to otherwise chaotic situations where
people may feel their lives have been turned upside down.

By using CERC principles, your communication can work to counter some of the harmful behaviors and
perceptions that are common during a public health crisis. These potentially harmful individual, group,
organizational, or community behaviors may include, but are not limited to, the following challenges:
Demands for unnecessary treatment
Needless social and organizational disruption CERC can work to counter some of the
Disorganized and occasionally destructive group behavior
harmful behaviors and perceptions
that are common during a crisis.
Bribery and fraud
Reliance on special relationships for favors and treatment
Increased drug, alcohol, and tobacco use
Increased multiple unexplained physical symptoms
Unreasonable trade and travel restrictions
Loss of agency credibility and lower levels of government trust
The odds of a negative public response increase when poor communication practices are added to
a crisis situation. Proper planning, coordination, research, and training can improve communication
practices. Potentially harmful practices to avoid include the following:
Mixed and conflicting messages from multiple sources
Late release of critical information
Overly reassuring and unrealistic communication
Advice without a reality check
Paternalistic approach to communication
Unaddressed or uncorrected myths and rumors
Spokespersons who engage in poor behavior, exhibit a lack of appropriate emotion, use
inappropriate humor, or offer inaccurate statements
Public power struggles, conflicts, and confusion
Perception that certain groups are getting preferential treatment
The purpose of an official response to a crisis is to efficiently and effectively reduce and prevent illness,
injury, and death, and return individuals and communities to normal as quickly as possible. During a
response, the possibility of harmful human behaviors, combined with poor communication practices, can
lead to overwhelming and harmful public outcomes.

The following are some of the negative situations public health professionals may face:
Public demands for misallocation of limited emergency response resources
Public mistrust or avoiding public health recommendations
Opportunists who play on peoples fears or uncertainties to provide fraudulent or ineffective

health treatments
Overreaction with wasted fiscal and medical resources during the emergency response
Self-appointed experts who offer questionable advice
Increased destruction, disease, and death
Good communication can reduce harmful human behavior and prevent negative public health response
outcomes. Trained communicators will do the following:
Develop messages following CERC principles
Reduce high levels of uncertainty
Use an effective crisis communication plan
Be the first source for information
Express empathy and show concern
Exhibit competence and expertise
Remain honest and open
Coordinate with other response officials
Commit and remain dedicated to the response and recovery
Subsequent chapters will explain how to use these practices to communicate effectively. Without
effective communication, people affected by a crisis are far more likely to engage in damaging
behaviors. The crisis will only get worse.
Conclusion
No response is perfect, and events can develop in surprising ways. In the following chapters, we provide
a roadmap that includes specific tools to improve communication effectiveness during emergencies.
Helping organizations and agencies fulfill their mission, maintain public trust, manage limited resources,
and limit harm and disruption is critical. Well-planned and well-executed CERC, fully integrated into
the activities of every phase, is critical to an effective response.

Tables
Table 11. Specific Hazards Under CDC Emergency
Preparedness and Response
Type of Hazard Definition Examples

Bioterrorism Deliberate release of viruses, bacteria, or yy Anthrax
other germs (agents) used to cause illness yy Botulism
or death in people, animals, or plants. yy Brucellosis
yy Plague
yy Smallpox
yy Tularemia
Chemical An emergency involving the intentional or yy Carbon monoxide

Emergencies unintentional release of a chemical that yy Chlorine
could harm peoples health. yy Mercury
yy Nerve agents
yy Oil Spill
yy Ricin
Infectious Disease An emergency involving unintentional yy Cholera

Outbreaks release of viruses, bacteria, or other yy E. coli infection
microorganisms that causes illness or death yy Pandemic flu
in people, animals, or plants. yy MRSA infection
yy Whooping cough
yy Salmonella infection
Natural Disasters and A disaster in which the proximate cause yy Earthquakes

Severe Weather is a natural hazard. Due to their scope yy Floods
and scale, a natural disaster can be a mass yy Hurricanes
causality event. It can be accompanied by yy Landslides/mudslides
severe economic impact. Natural disasters yy Tornadoes
are particularly severe in infrastructure yy Wildfires
poor regions and nations. yy Winter weather
Radiation An emergency involving the release of yy Nuclear accident

Emergencies radiation that could harm peoples health. yy Nuclear blast
yy Radiation dispersal device
(dirty bomb)
yy Transportation accident
Explosions Explosion or blast producing numerous yy Industrial explosions

casualties with complex, technically yy Terrorist bombings
challenging injuriesnot commonly seen yy Military strikes
after natural disasters.

Table 12. National Response Framework Incident Categorization
Type of
Incident Definition Examples
Biological Naturally occurring biological diseases yy Anthrax
Incident (communicable and non-communicable) yy Botulism
in humansas well as those used in a yy H1N1 flu
terrorist event. yy Ricin
yy Smallpox
Cyber Any incident of national significance with yy Cyber attacks against Internet
Incident cyber-related issues. yy Cyber attacks against critical
infrastructure information systems
yy Technological emergencies
Food and This is a threat to public health, animal yy E. coli infection

Agricultural health, food production, aquaculture, yy Mad Cow Disease
Incident livestock production, wildlife, soils, yy Melamine contamination
rangelands, and agricultural water supplies. yy Salmonella infection
Natural A disaster caused by natural events. Due yy Earthquakes

Disaster to their scope and scale, a natural disaster yy Floods
can be a mass casualty event. yy Hurricanes
yy Landslides/ mudslides
Natural events are almost always yy Severe weather
accompanied by a severe economic effect. yy Severe winter weather or ice storms
They are particularly harsh in poor regions yy Tornadoes
and nations, where bridges, buildings, and yy Wildfires
structures do not remain intact.
Nuclear or Release of radioactive material that poses yy Nuclear accident

Radiological an actual or perceived hazard to public yy Nuclear blast
Incident health, safety, national security, or the yy Radiation Dispersal Device
environment. yy Transportation accident
Oil and Hazardous A threat to public health, welfare, or the yy Chemical spill
Materials Incident environment caused by an event from oil yy Ground water contamination
or other hazardous materials. yy Oil spill
yy Waste transportation accident
Terrorism A threatened or actual terrorist incident yy Biological threats

Incident within the United States. yy Chemical threats
yy Explosions
yy Nuclear blast
yy Radiological dispersion device

References
1. Reynolds BJ. Principles to enable leaders to navigate the harsh realities of crisis and risk communication. J
Bus Contin Emer Plan 2010 Jul;4(3):26273.
2. Ready.gov. Natural Disasters [online]. 2012. [cited 2012 May]. Available from URL: http://www.ready.gov/
natural-disasters.
3. Reynolds BJ, Seeger M. Crisis and emergency risk communication as an integrative model. J Health Commun
2005;JanFeb;10(1):4355. Erratum in: J Health Commun 2007 AprMay;12(3):313.
4. Canadian Red Cross/Croix-Rouge canadienne. Integrating emergency management and high-risk populations:
survey report and action recommendations [online]. 2007 Dec. [cited 2012 May]. Available from URL: http://
www.redcross.ca/cmslib/general/dm_high_risk_populations.pdf.
5. Auf der Heide E. Disaster response: principles of preparation and coordination [online]. 1989. [cited 2012
May]. Available from URL: http://coe-dmha.org/Media/Disaster_Response_Principals.pdf.
6. Bureau of Transportation Statistics, Research and Innovative Technology Administration. Hazardous material
highlights2007 commodity flow survey [online]. 2011 Jan. [cited 2012 May]. Available from URL: http://
www.bts.gov/publications/special_reports_and_issue_briefs/special_report/2011_01_26/html/entire.html.
7. Aldrich N. CDCs disaster planning goal: protect vulnerable older adults. [online]. Benson WF, ed. [cited 2012
May]. Available from URL: http://www.cdc.gov/Aging/pdf/disaster_planning_goal.pdf.
8. CDC. Healthy aging: helping people to live long and productive lives and enjoy a good quality of life [online].
2009. [cited 2012 May]. Available from URL: http://www.cdc.gov/chronicdisease/resources/publications/aag/
aging.htm.
9. CDC. Public health and aging: trends in aging. United States and worldwide. MMWR 2003;52(06):101106.
10. Aldrich N, Benson WF. Disaster preparedness and the chronic disease needs of vulnerable older adults. Prev
Chronic Dis [online] 2008 [cited 2012 May]; 5(1). Available from URL: http://www.cdc.gov/pcd/issues/2008/
jan/07_0135.htm.
11. CDC and The Merck Company Foundation. The state of aging and health in America 2007. Whitehouse
Station, NJ: The Merck Company Foundation; [online]. 2007. [cited 2012 May]. Available from URL: http://
www.cdc.gov/aging/pdf/saha_2007.pdf.
12. U Ottowa. Society, the individual, and medicine. Infectious diseases. [online]. 2012. [cited 2012 May].
Available from URL: http://www.med.uottawa.ca/sim/data/Infectious_Diseases_e.htm.
13. Testimony of Thomas R. Frieden, M.D., M.P.H., Director, Centers for Disease Control and Prevention: Hearing
before the Subcomm. on Health of the House Comm. on Energy and Commerce [online]. 2010 Apr. [cited
2012 May]. Available from URL: http://www.cdc.gov/drugresistance/pdf/FriedenTestimony42810.pdf.
14. CDC. First report of AIDS. MMWR 2001 Jun; 50(No. 21):429444 [online] [cited 2012 May]. Available from
URL: http://www.cdc.gov/mmwr/pdf/wk/mm5021.pdf.
15. Taubenberger JK, Morens DM. Pandemic influenza, including a risk assessment of H5N1. Rev Sci Tech[online]
2009 Apr [cited 2012 May];28(1):187202. Available from URL: http://www.ncbi.nlm.nih.gov/pmc/articles/
PMC2720801/.

16. Flahault A. Zylberman P. Influenza pandemics: past, present and future challenges. Public Health Reviews
[online]. 2010 Jul [cited 2012 May];32(No. 1):319-340. Available from URL: http://www.publichealthreviews.
eu/upload/pdf_files/7/18_Flahaut_final.pdf.
17. World City Information. News and information on the best and the worst cities in the world. World
megacities. [online]. [cited 2012 May]. Available from URL: http://www.city-infos.com/world-megacities/.
18. Central Intelligence Agency. Statements on terrorism & Usama bin Laden. Statement by DCI Tenet before
the Senate Select Committee on Intelligence (SSCI) on the worldwide threat 2001: national security in
a changing world. [online]. 2001 Feb 7. [cited 2012 May]. Available from URL: https://www.cia.gov/news-
information/cia-the-war-on-terrorism/pub_statements_terrorism.html.
19. BBC (British Broadcasting Corporation). On this day 19502005 [online]. [cited 2012 May]. Available from
URL: http://news.bbc.co.uk/onthisday/hi/dates/stories/december/3/newsid_2698000/2698709.stm.
20. Federal Emergency Management Agency. National Incident Management System.[online]. [cited 2012 May].
Available from URL: http://www.fema.gov/emergency/nims/.
Resources
Best, Jr. RA. Library of Congress. CRS Report for Congress. Intelligence and law enforcement: countering
transnational threats to the U.S. Updated December 3, 2001. Order code RL30252 [online]. [cited 2012 May].
Available from URL: http://www.fas.org/irp/crs/RL30252.pdf.
CDC. Emergency preparedness and response: What CDC is doing [online]. 2010. [cited 2012 May]. Available
from URL: http://emergency.cdc.gov/cdc/.
Population Division, Department of Economic and Social Affairs, United Nations Secretariat. World
urbanization prospects: The 2001 revision, data tables and highlights [online] 2002. [cited 2012 May].
Available from URL: http://www.un.org/esa/population/publications/wup2001/wup2001dh.pdf.
U.S. Census Bureau. National population projections. Population profile of the United States. The U.S.
population will be older than it is now [online]. [cited 2012 May]. Available from URL: http://www.census.gov/
population/www/pop-profile/natproj.html.

Chapter 2:
Psychology of a Crisis
2014 EDITION

Chapter 2:
Psychology of a Crisis
Crises, emergencies, and disasters happen. Disasters are different from personal and family
emergencies, and not just because they are larger in scale. Disasters that take a toll on human life are
characterized by change, high levels of uncertainty, and complexity.1
In a crisis, affected people take in information, process information, and act on information differently
than they would during non-crisis times.2,3 People or groups may exaggerate their communication
responses. They may revert to more basic or instinctive fight-or-flight reasoning.
Effective communication during a crisis is not an attempt at mass mental therapy, nor is it a magic
potion that fixes all problems. Nonetheless, to reduce the psychological impact of a crisis, the public
should feel empowered to take actions that will reduce their risk of harm.
This chapter will briefly describe how people process information differently during a crisis, the mental
states and behaviors that tend to emerge in crises, how psychological effects are different in each phase
of a crisis, and how to communicate to best reach people during these changing states of mind.
Four Ways People Process Information during a Crisis

By understanding how people take in information during a crisis state, we can better plan to
communicate with them. During a crisis:
We simplify messages.4
Under intense stress and possible information overload, we tend to miss the nuances of health and
safety messages by doing the following:
Not fully hearing information because of our inability to juggle multiple facts during a crisis
Not remembering as much of the information as we normally could
Misinterpreting confusing action messages
To cope, many of us may not attempt a logical and reasoned

approach to decision making. Instead, we may rely on habits and
Use simple messages.
long-held practices. We might follow bad examples set by others.
21
We hold on to current beliefs.5,6
Crisis communication sometimes requires asking people to do something that seems counterintuitive,
such as evacuating even when the weather looks calm.
Changing our beliefs during a crisis or emergency may be difficult. Beliefs are often held very strongly
and not easily altered. We tend not to seek evidence that contradicts beliefs we already hold.
We also tend to exploit any conflicting or unclear messages about a subject by interpreting it as
consistent with existing beliefs. For example, we might tell ourselves, I believe that my house is a
safe place. Before an impending hurricane, however, experts may recommend that we evacuate from
an insecure location and take shelter in a building that is stronger and safer. Although the action
advised is actually for us to evacuate our house to seek a safer shelter, we can easily misinterpret the
recommendation to match our current beliefs. We might say, My
home is strong and safe. Ive always been secure in my home.
When we left last time, the hurricane went north of us anyway.
Ill just stay here. Messages should come
Faced with new risks in an emergency, we may have to rely
from a credible source.
on experts with whom we have little or no experience. Often,
reputable experts disagree regarding the level of threat, risks,
and appropriate advice. The tendency of experts to offer
opposing views leaves many of us with increased uncertainty and fear. We may be more likely to take
advice from a trusted source with which we are familiar, even if this source does not have emergency-
related expertise and provides inaccurate information.
We look for additional information and opinions.7,8

We remember what we see and tend to believe what weve experienced. During crises, we want
messages confirmed before taking action. You may find that you or other individuals are likely to do the
following:
Change television channels to see if the same warning is

being repeated elsewhere
Try to call friends and family to see if others have heard Use consistent
the same messages messages.
Turn to a known and credible local leader for advice
Check multiple social media channels to see what our

contacts are saying
In cases where evacuation is recommended, we tend to watch to see if our neighbors are evacuating
before we make our decision. This confirmation firstbefore we take actionis very common in a crisis.
22 Chapter 2 Psychology of a Crisis and Principles of Risk Communication

We believe the first message.9
During a crisis, the speed of a response can be an important factor in reducing harm. In the absence
of information, we may begin to speculate and fill in the blanks. This often results in rumors. The first
message to reach us may be the accepted message, even though more accurate information may follow.
When new, perhaps more complete information becomes available, we compare it to the first messages
we heard.
Because of the ways we process information while under stress,

when communicating with someone facing a crisis or disaster,
messages should be simple, credible, and consistent. Speed Release accurate
is also very important when communicating in an emergency. An
effective message must do the following:
messages as soon
as possible.
Be repeated
Come from multiple credible sources
Be specific to the emergency being experienced
Offer a positive course of action that can be executed
Mental States in a Crisis

During a disaster, people may experience a wide range of emotions. Psychological barriers can interfere
with cooperation and response from the public. Crisis communicators should expect certain patterns, as
described below, and understand that these patterns affect communication.
There are a number of psychological barriers that could interfere with cooperation and response from
the public. A communicator can mitigate many of the following reactions by acknowledging these
feelings in words, expressing empathy, and being honest.
Uncertainty
Unfortunately, there are more questions than answers during a crisis, especially in the beginning. At
that time, the full magnitude of the crisis, the cause of the disaster, and the actions that people can take
to protect themselves may be unclear. This uncertainty will challenge even the greatest communicator.
To reduce their anxiety, people seek out information to determine their options and confirm or
disconfirm their beliefs. They may choose a familiar source of information over a less familiar source,
regardless of the accuracy of the provided information.7 They may discount information that is
distressing or overwhelming.
Chapter 2 Psychology of a Crisis and Principles of Risk Communication 23

Many communicators and leaders have been taught to sound confident even when they are uncertain.
While this may inspire trust, there is a potential for overconfidence, which can backfire. It is important
to remember that an over-reassured public isnt the goal. You want people to be concerned, remain
vigilant, and take all the right precautions.
Acknowledge uncertainty. Acknowledge and express empathy for your audiences uncertainty and
share with them the process you are using to get more information about the evolving situation. This
will help people to manage their anxiety. Use statements such as, I cant tell you today whats causing
people in our town to die so suddenly, but I can tell you what were doing to find out. Heres the first
step
Tell them
What you know
What you dont know
What process you are using to get answers
Although we can hope for certain outcomes, we often cannot promise that they will occur. Instead of
offering a promise outside of your absolute control, such as were going to catch the evil people who
did this, promise something you can be sure that response officials will do, such as were going to
throw everything we have at catching the bad guys, or stopping the spread of disease, or preventing
further flood damage.
Former New York City Mayor Rudolph Giuliani cautioned, Promise only when youre positive. This
rule sounds so obvious that I wouldnt mention it unless I saw leaders break it on a regular basis.10 A
danger early in a crisis, especially if youre responsible for fixing the problem, is to promise an outcome
outside your control. Never make a promise, no matter how heartfelt, unless its in your absolute power
to deliver.
Fear, Anxiety, and Dread

In a crisis, people in your community may feel fear, anxiety, confusion, and intense dread. As
communicators, our job is not to make these feelings go away. Instead, you could acknowledge them in a
statement of empathy. You can use a statement like, weve never faced anything like this before in our
community and it can be frightening.
Fear is an important psychological consideration in the response to a threat. Bear in mind the following
aspects of fear:
In some cases, a perceived threat can motivate and help people take desired actions.

In other cases, fear of the unknown or fear of uncertainty may be the most debilitating of the
psychological responses to disasters and prevent people from taking action.
When people are afraid, and do not have adequate information, they may react in inappropriate
ways to avoid the threat.
Communicators can help by portraying an accurate assessment of the level of danger and providing
action messages so that affected people do not feel helpless.
Hopelessness and Helplessness

Avoiding hopelessness and helplessness is a vital communication objective during a crisis.
Hopelessness is the feeling that nothing can be done by anyone to make the situation better.
People may accept that a threat is real, but that threat may loom so large that they feel the situation
is hopeless. Helplessness is the feeling that people have that they, themselves, have no power to
improve their situation or protect themselves. If a person feels helpless to protect him- or herself, he or
she may withdraw mentally or physically.
According to psychological research, if community members let their feelings of fear, anxiety, confusion,
and dread grow unchecked during a crisis, they will most likely begin to feel hopeless or helpless.11
If this happens, community members will be less motivated and less able to take actions that could
help themselves.
Instead of trying to eliminate a communitys emotional responses to the crisis, help community members
manage their negative feelings by setting them on a course of action. Taking an action during a crisis
can help to restore a sense of control and overcome feelings of hopelessness and helplessness.11 Helping
the public feel empowered and in control of at least some parts of their lives may also reduce fear.
As much as possible, advise people to take actions that are constructive and directly relate to the
crisis theyre facing. These actions may be symbolic, such as putting up a flag, or preparatory, such as
donating blood or creating a family check-in plan.
Denial
Denial refers to the act of refusing to acknowledge either imminent harm or harm that has already
occurred. Denial occurs for a variety of reasons:
People may not have received enough information to recognize the threat.
They may assume the situation is not as bad as it really is because they have not heard the most
recent warnings, didnt understand what they were told, or only heard part of a message.

They may have received messages about a threat but not received action messages on how
people should respond to the threat.
They may receive and understand the message, but behave as if the danger is not as great as
they are being told. For example, people may get tired of evacuating for threats that prove
harmless, which can cause people to deny the seriousness of future threats.
When people doubt a threat is real, they may seek further confirmation. With some communities, this
confirmation may involve additional factors, such as the following:
A need to consult community leaders or experts for specific opinions
The desire to first know how others are responding
The possibility that the warning message of the threat is so far outside the persons experience
that he or she simply cant make sense of itor just chooses to ignore it
Denial can, at least in part, be prevented or addressed with clear, consistent communication from a
trusted source. If your audience receives and understands a consistent message from multiple trusted
sources, they will be more likely to believe that message and act on it.
What about Panic?

Contrary to what you may see in the movies, people seldom act completely irrationally during a crisis.12
During an emergency, people absorb and act on information differently from nonemergency situations.
This is due, in part, to the fight-or-flight mechanism.
The natural drive to take some action in response to a threat is sometime described as the fight-or-
flight response. Emergencies create threats to our health and safety that can create severe anxiety,
stress, and the need to do something. Adrenaline, a primary stress hormone, is activated in threatening
situations. This hormone produces several responses, including increased heart rate, narrowed blood
vessels, and expanded air passages. In general, these responses enhance peoples physical capacity to
respond to a threatening situation. One response is to flee the threat. If fleeing is not an option or is
exhausted as a strategy, a fight response is activated.13 You cannot predict whether someone will choose
fight or flight in a given situation.
These rational reactions to a crisis, particularly when at the extreme ends of fight-or-flight, are often
described erroneously as panic by the media. Response officials may be concerned that people will
collectively panic by disregarding official instructions and creating chaos, particularly in public places.
This is also unlikely to occur.

If response officials describe survival behaviors as panic, they will alienate their audience. Almost no
one believes he or she is panicking because people understand the rational thought process behind their
actions, even if that rationality is hidden to spectators. Instead, officials should acknowledge peoples
desire to take protective steps, redirect them to actions they can take, and explain why the unwanted
behavior is potentially harmful to them or the community. Officials can appeal to peoples sense of
community to help them resist unwanted actions focused on individual protection.
In addition, a lack of information or conflicting information from authorities is likely to create

heightened anxiety and emotional distress. If you start hedging or hiding the bad news, you increase the
risk of a confused, angry, and uncooperative public.
Media Coverage of Crisis and Potential Psychological Effects

As we will see later in this chapter, most of us tend to have stronger psychological and emotional
reactions to a crisis if its manmade or imposed.14 These types of crises also tend to have increased
media exposure. The media will often show repeated negative images, such as the following:
People who are dying or in distress
People who lack food and water
Animals that have been abandoned, hurt, or covered in oil
Landscapes, such as collapsed buildings, flooded homes, or oil floating on top of water
Those who are indirectly affected by the crisis through media exposure may personalize the event or
see themselves as potential victims. For example, on September 11, 2001, adults watched an average
of 8.1 hours of television coverage, and children watched an average of 3.0 hours.14 Several studies
show that the amount of time spent watching TV coverage and the graphic content of the attacks
on September 11 was associated with increased post-traumatic stress disorder (PTSD) and clinical
depression symptoms.15,16,17 This was even true for those far away from disaster sites. In addition, those
who were directly affected by the attacks and watched more television coverage had higher rates of
PTSD symptoms and depression than those who did not.
As you are planning your communication strategy, remember that even those people not directly
affected by an emergency may have substantial psychological effects. Communication targeted at them
will also need to use sound crisis and emergency risk communication principles.

Behaviors in a Crisis
Proper crisis communication can address a variety of potentially harmful behaviors during a crisis.
Although it may be difficult to measure the impact, using good communication to persuade people to
avoid negative behaviors during a crisis will save lives, prevent injuries, and lessen the misery people
experience. Some of these negative behaviors are listed here, with advice on communication strategies
to address them.
Seeking Special Treatment

Some people will attempt to bypass official channels to get special treatment or access to what they
want during a crisis. For instance, in Richard Prestons book Demon in the Freezer, an account of
the eradication of smallpox, neighbors and friends approached the wife of a prominent government
smallpox researcher asking for help to obtain smallpox vaccine in case of a bioterrorist attack with
smallpox.18 The vaccine was not available for these people through official channels, so they reached out
to someone with influence, who they thought could assist them.
This behavior may result from the following:
A persons sense of privilege
A belief that officials cannot guarantee the persons well-being
An inflated need to be in control
A lack of awareness of available resources
Whatever the cause, seeking special treatment can be damaging to the harmony and recovery of
the community. If there is a perception that favored people get special help, it invites anger among
community members and chaos when resources are made available.
Some supplies or treatments may first be given to priority groups who are either especially vulnerable
to the disaster, such as children and elderly people, or whose safety is critical to an effective response,
such as healthcare workers. The term priority groups may confuse some people, who may be unclear
about what criteria are used to define priority and may assume they are important enough to be in a
priority group. To avoid this, communicators can discuss those groups who have the greatest need for
treatment without referring to them as priority groups.
Good communication can reduce some of these reactions. The more honest and open government
officials are about resources, the better odds officials have of reducing the urge among people in the
community to seek special treatment. The following communication strategies can help communicators
persuade the public to avoid seeking special treatment:
Explain what resources are available.
Explain why some resources are not available.

Explain that limited supplies are being used for people with the greatest need.
Explain who the people are with the greatest need.
Describe reasonable actions that people can take, so that they do not focus on things they
cannot have.
Keep open records of who receives what and when.
Remember, both people directly affected by the crisis and those who anticipate being affected by the
crisis need enough information to help them manage anxiety and avoid behaviors that may divide the
community.
Negative Vicarious Rehearsal

In an emergency, many communication and response activities are focused on audiences who were
directly affected, such as survivors, people who were exposed, and people who had the potential to be
exposed. However, these targeted messages will also reach people who do not need to take immediate
action. Some of these unaffected observers may mentally rehearse the crisis as if they are experiencing
it and practice the courses of action presented to them.
In many cases, this mental rehearsal can help to prepare people for the actions they should take in an
emergency. This may reduce anxiety and uncertainty. As a communicator, you may encourage this type
of mental rehearsal by asking an audience not yet affected by an emergency to create an emergency
plan of action according to your recommendations.
Other times, spectators farther away from the emergency may be much more critical about the value of
your recommendations because they have more time to decide their chosen course of action. In some
cases, they may reject the proposed course of action and choose another. If a person rejects an action,
it may be harder for that person to take that action in the future. For example, if people hear a story
about a search and rescue effort for someone lost in the wilderness they may mentally rehearse how
they would act in a similar situation. If they plan out creating an elaborate shelter, starting a fire, and
finding food, instead of finding a simple shelter and water and waiting for rescue, then those are the
actions they might choose to take in the event that they do find themselves lost in the wilderness. This
would decrease their survival chances because they would waste their energy and resources on less
important actions.
People practicing negative vicarious rehearsal might decide that they are at the same risk as those
directly affected by the emergency and need the recommended remedy, such as a visit to an emergency
room or a vaccination. These people, sometimes referred to as the worried well, may heavily tax
response resources by requesting medical treatment they do not need. For example, during the 2011
Japan Earthquake, Tsunami and Radiation Disaster, people who lived on the west coast of the United

States and Canada began to worry about radiation exposure coming across the ocean from Japan.
Because people very close to the danger in Japan had been advised to take potassium iodide (KI) to
mitigate effects of radiation, some people in North America thought they should take KI too. In fact,
when unneeded, KI has dangerous side effects and should not be used.
Communicators can help to address the effects of negative vicarious rehearsal by creating simple
action steps that can be taken by people not directly affected by the emergency. Simple actions in an
emergency will give people a better sense of control and will help to motivate them to stay tuned to
your messages. During the Japan emergency, communicators related to people on the West Coast what
they could do to help people in Japan; what they could do to learn more about actual levels of radiation
reaching the United States; and directed them to fact sheets about when KI was and was not necessary.
Let your friends know KI can be dangerous when not needed became a new action people could take.
When communicators create messages, they are likely to segment their target audience into groups who
need to take different types of action. The challenge is to convince people unaffected by the emergency
to delay taking the same action recommended to people directly affected unless it is circumstances
change. Create alternative action messages for those people who are vicariously experiencing the
threat, but who should not take the action currently being recommended to those directly affected.
Stigmatization
Stigmatization can affect a product, an animal, a place, and an identifiable group of people. It occurs
when the risk is not present in the stigmatized minority population but people associate the risk with
that population group. Stigmatization is especially common in disease pandemics.
If a population group becomes stigmatized, members of this group may experience emotional pain from
the stress and anxiety of social avoidance and rejection. Stigmatized people may be denied access to
health care, education, housing, and employment. They may even be victims of physical violence.
Crisis communicators must be aware of the possibility that, although unintentional and unwarranted,
segments of their community could be shunned because some perceive them as being identified with the
problem. This could have both economic and psychological impact on the well-being of members of the
community and should be challenged immediately. This stigmatization can occur without any scientific
basis. It can come not only from individuals, but entire nations. During the first avian influenza outbreak
in Hong Kong during 199798 and during the first West Nile virus outbreak in New York City in 1999, the
policies of some other nations banned the movement of people or animals, despite the absence of clear
science calling for those measures.
Communication professionals must help to counter potential stigmatization during a disaster. You should
be cautious about images you share repeatedly and understand that constant portrayal of a segment of
the population in images may contribute to stigmatization. For instance, if the images accompanying a

news story about a disaster consistently show members of a particular ethnic group, this may reinforce
the idea that the disaster is associated with members of that ethnic group. If stigmatizing statements or
behaviors appear, public health officials must offset this with accurate risk information that people can
understand, and speak out against the negative behavior.
It is important to remember that even if stigmatization decreases through the beginning of the crisis
lifecycle, the stigma may return in the resolution phase. As misery and anger turns to fault-finding and
blame, the group of people perceived to be responsible for the disaster could be stigmatized once again.
Keep this in mind when creating your communication strategy.
Harmful Actions Brought About by Crisis-Related Psychological Issues

Without communication from a source that is trusted by the audience to lessen the psychological
impact, negative emotions may lead to harmful individual or group behaviors. These behaviors may
affect the publics safety by slowing the speed, quality, and appropriateness of a crisis response and
recovery. Crisis-related psychological issues may lead to further loss of life, health, safety, and property.
Harmful actions may include the following:
Misallocating treatments based on demand rather than medical need
Accusations of providing preferential treatment and bias in providing aid
Creating and spreading damaging rumors and hoaxes directed at people or products
Offering unfounded predictions of greater devastation
Encouraging an unfair distrust of response organizations
Attempting bribery for scarce or rationed treatments and resources
Depending on special relationships to ensure considerations based on desire, not need
People in a crisis tend to have more unexplained physical symptoms. Stress caused by a crisis situation
will give some people physical symptoms, such as headaches, muscle aches, stomach upsets, and low-
grade fevers.19 In emergencies involving disease outbreaks, these symptoms could confound the effort to
identify those people who need immediate care versus those who need only limited treatment or limited
access to medication.
Positive Responses following a Crisis

Crises do not only create negative emotions and behaviors. Positive responses might include coping,
altruism, relief, and elation at surviving the disaster. Feelings of excitement, greater self-worth,
strength, and growth may come from the experience. Often a crisis results in changes in the way the
future is viewed, including a new understanding of risks and new ways to manage them.

How quickly the crisis is resolved and the degree to which resources are made available will make
a difference. Many of these positive feelings associated with a successful crisis outcome depend on
effective management and communication. Positive responses may include the following:
Relief and elation
Sense of strength and empowerment
New understanding of risk and risk management
New resources and skills for risk management
Renewed sense of community
Opportunities for growth and renewal
Risk Perception20,21
Not all risks are perceived equally by an audience. Risk perception can be thought of as a combination
of hazard, the technical or scientific measure of a risk, and outrage, the emotions that the risk evokes.
Risk perception is not about numbers alone.
Dont dismiss outrage. The mistake some officials make is to measure the magnitude of the crisis
only based on how many people are physically hurt or how much property is destroyed. Remember that
we must also measure the catastrophe in another way: the level of emotional trauma associated with it.
As a communicator, expect greater public outrage and more demands for information if what causes
the risk is manmade and, especially, if its intentional and targeted. Unfairly distributed, unfamiliar,
catastrophic, and immoral events create long-lasting mental health effects that lead to anger, frustration,
helplessness, fear, and a desire for revenge. A wide body of research exists on issues surrounding
risk communication, but the following explains how some risks are more accepted than others:
Voluntary versus involuntary: Voluntary risks are more readily accepted than imposed risks.
Example: elective knee surgery v. emergency appendectomy
Personally controlled versus controlled by others: Risks controlled by the individual or
community are more readily accepted than risks outside the individuals or communitys control.
Example: choosing to house a nuclear reactor in the community v. having a nuclear
reactor built in your community against your wishes
Familiar versus exotic: Familiar risks are more readily accepted than unfamiliar risks.
Example: seasonal influenza v. a new respiratory illness
Natural origin versus manmade: Risks generated by nature are better tolerated than risks
generated by man or institution. Example: a natural disaster v. an oil spill
Reversible versus permanent: Reversible risk is better tolerated than risk perceived to be
irreversible. Example: having a broken leg v. having an amputated leg

Endemic versus epidemic: Illnesses, injuries, and deaths spread over time at a predictable
rate are better tolerated than illnesses, injuries, and deaths grouped by time and location.
Example: seasonal influenza v. pertussis (whooping cough) outbreak
Fairly distributed versus unfairly distributed: Risks that do not appear to single out a
group, population, or individual are better tolerated than risks that are perceived to be targeted.
Example: water pollution that is citywide v. water pollution in a minority neighborhood
Generated by trusted institution versus mistrusted institution: Risks generated by a
trusted institution are better tolerated than risks that are generated by a mistrusted institution.
Example: air pollution by coal plant that is a longtime area employer v. air pollution by
new and unknown company
Adults versus children: Risks that affect adults are better tolerated than risks that affect
children. Example: lead paint in an office building v. lead paint in a school
Understood benefit versus questionable benefit: Risks with well-understood potential
benefit and the reduction of well-understood harm are better tolerated than risks with little or
no perceived benefit or reduction of harm. Example: chemotherapy for cancer is a risk with
a well-understood benefit.
Statistical versus anecdotal: Statistical risks for populations are better tolerated than risks
represented by individuals. Example: an anecdote shared with a person or community, even
if it is explained to be a one in a million event, can be more damaging than a statistical
risk of one in 10,000 presented as a number.

EPAs Seven Cardinal Rules of
Risk Communication
Various other sources give advice that supports what is found in this manual. The
following rules are adapted from the Environmental Protection Agencys Seven Cardinal
Rules of Risk Communication:22
1. Accept and involve the public as a legitimate partner.

Two basic tenets of risk communication in a democracy are generally understood and
accepted. First, people and communities have a right to participate in decisions that
affect their lives, their property, and the things they value. Second, the goal should be to
produce an informed public that is involved, interested, reasonable, thoughtful, solution-
oriented, and collaborative. You should not try to diffuse public concerns and avoid action.
Guidelines:
Show respect for the public by involving the community
early, before important decisions are made.
Clarify that decisions about risks will be based not only on the
magnitude of the risk but on factors of concern to the public.
Involve all parties that have an interest or a stake in the particular
risk in question.
Recognize that people hold leaders accountable and
follow the highest moral and ethical standards.
2. Listen to the audience.

People are often more concerned about issues such as trust, credibility, control, benefits,
competence, voluntariness, fairness, empathy, caring, courtesy, and compassion. They are
not as interested in mortality statistics and the details of a quantitative risk assessment. If
your audience feels or perceives that they are not being heard, they cannot be expected
to listen. Effective risk communication is a two-way activity.

Guidelines:
Do not make assumptions about what people know, think, or want done
about risks.
Find out what people are thinking by using techniques such as interviews,
discussion groups, advisory groups, toll-free numbers, and surveys.
Listen to all parties that have an interest or a stake in the issue.
Identify with your audience and try to put yourself in their place.
Recognize peoples emotions.
Let people know that you understand their concerns and are addressing them.
Understand that audiences often have hidden agendas, symbolic meanings,

and broader social, cultural, economic, or political considerations that complicate
the task.
3. Be honest, frank, and open.

Before a risk communication message can be accepted, the messenger must be perceived
as trustworthy and credible. Therefore, the first goal is to establish trust and credibility.
Short-term judgments of trust and credibility are based largely on verbal and nonverbal
communications. Long-term judgments are based largely on actions and performance.
Once made, trust and credibility judgments are resistant to change. In communicating
risk information, these are your most precious assets. Once lost, they are difficult to
regain.
Guidelines:
State your credentials, but do not ask or expect to be trusted by the public.
Express willingness to follow up with answers if the question cannot be answered

at the time you are speaking.
Make corrections if errors are made.
Disclose risk information as soon as possible, emphasizing appropriate reservations

about reliability.
Do not minimize or exaggerate the level of risk.

Lean toward sharing more information, not less, to prevent people from thinking
something significant is being hidden.
Discuss data uncertainties, strengths, and weaknesses, including the ones
identified by other credible sources.
Identify worst-case estimates and cite ranges of risk estimates when appropriate.
4. Coordinate and collaborate with other credible sources.

Allies can be effective in helping communicate risk information. Few things make risk
communication more difficult than public conflicts with other credible sources.
Guidelines:
Coordinate all communications among and within organizations.
Devote effort and resources to the slow, hard work of building bridges,
partnerships, and alliances with other organizations.
Use credible and authoritative intermediaries.
Consult with others to determine who is best able to answer questions about risk.
Try to release communications jointly with other trustworthy sources, such as:
yy University scientists
yy Physicians
yy Local or national opinion leaders
yy Citizen advisory groups
yy Local officials
5. Meet the needs of the media.

The media are primary transmitters of risk information. They play a critical role in
setting agendas and in determining outcomes. The media generally have an agenda
that emphasizes the more sensational aspects of a crisis. They may be interested in
political implications of a risk. The media tend to simplify stories rather than reflect the
complexity. Often the media emphasize wrongdoing, blame, and danger.

Guidelines:
Remain open with, and accessible to, reporters.
Respect their deadlines.
Provide information tailored to the needs of each type of media, such as sound
bites, graphics, and other visual aids for television.
Agree with the reporter in advance about specific topics and stick to those during
the interview.
Prepare a limited number of positive key messages in advance and repeat the
messages several times during the interview.
Provide background material on complex risk issues.
Do not speculate.
Say only those things that you are willing to have repeated. Everything you say in
an interview is on record.
Keep interviews short.
Establish long-term trust relationships with specific editors and reporters.
6. Speak clearly and with compassion.

Technical language and jargon are barriers to successful communication with the public.
In low-trust, high-concern situations, empathy and caring carry more weight than
numbers and technical facts.
Guidelines:
Use plain language.
Remain sensitive to local norms, such as speech and dress.
Strive for brevity, but respect peoples needs and offer to provide more
information if needed.
Use graphics and other pictorial material to clarify messages.
Personalize risk data by using anecdotes that make technical data come alive.
Acknowledge and respond to emotions that people express, such as anxiety, fear,
anger, outrage, and helplessness.
Recognize and respond to what the public deems as important in evaluating risks.

Use comparisons to help put risks in perspective.
Avoid comparisons that ignore distinctions that people consider important.
Include a discussion of actions that are either underway or can be taken.
Promise only what can be delivered.
Follow through with promises and commitments.
Understand and convey that any illness, injury, or death is a tragedy.
Avoid distant, abstract, unfeeling language about deaths, injuries, and illnesses.
7. Plan carefully and evaluate performance.

Different goals, audiences, and media require different risk communication strategies.
Risk communication will be successful only if carefully planned and evaluated.
Guidelines:
Begin with clear, explicit objectives.
Provide information to the public.
Offer reassurance that something is being done.
Encourage protective action and behavior change.
Stimulate emergency response.
Involve partners, businesses, and colleagues in dialogue and joint problem solving.
Assess technical information about risks. Know its strengths and weaknesses.
Pretest messages.
Identify important organizations and subgroups within the audience.
Aim communications at specific groups and subgroups in the audience.
Recruit spokespersons with effective presentation and human interaction skills.
Train staff, including technical staff, in communication skills.
Recognize and reward outstanding performance.
Evaluate efforts and learn from mistakes.

During Different Stages of Crisis
In addition to the principles of risk communication described, such as expressing empathy and being
respectful, its important to consider how the situation changes during each phase of a crisis and how
risk communication can be applied during each phase.
Although these phases were discussed in our introduction, its helpful to have a more in-depth picture of
each category.
Pre-crisis Phase
Important information and assumptions are set during the pre-crisis stage even before a crisis occurs.
Develop plans and establish open communication during this phase.
Provide an open and honest flow of information to the public: Generally, more harm is done
by officials trying to avoid panic by withholding information or over-reassuring the public, than is done
by the public acting irrationally in a crisis. Pre-crisis planning should assume that you will establish an
open and honest flow of information.
During the pre-crisis phase:
Messages should be developed that anticipate and consistently answer expected questions.
Messages can be tested by audiences to ensure they are culturally and demographically
appropriate.
Resist talking down to an audience before a crisis by telling them they have nothing to worry about,
especially when there is little action they can take before a crisis.
Emphasize that there is a process in place: Define the crisis response process, describe the roles
and responsibilities for response, and outline possible solutions. Helping people understand the process
before a crisis will make it easier for them to coordinate and take appropriate actions. It also gives you
greater credibility.

Initial Phase
During this stage of acute danger, the priority for all is basic safety and survival. Most people respond
appropriately to protect their lives and the lives of others.23 To reduce the threat, they create
spontaneous efforts to cooperate with others. However, some may behave in disorganized ways and
may not respond as expected. The more stress felt in a crisis, the greater the impact on the individual.
Important causes of stress include the following:
Threat to life and encounters with death

Feelings of powerlessness and helplessness
Personal loss and dislocation, such as being separated from loved ones or home
Feelings of being responsible, such as telling oneself I should be doing more.
Feelings of facing an inescapable threat
Feelings of facing malevolence from others, such as deliberate efforts that cause harm
During the initial phase, the following CERC principles are important:
Dont over-reassure: Express appropriate and accurate levels of concern. Do not placate.
Reassurance can backfire. Agree that the situation is indeed shattering and being afraid is a
natural reaction.
Acknowledge uncertainty: Offer only what you know. Show your distress, listen to your
audience, and acknowledge their distress. Use messages such as, It must be awful to hear we
cant answer that question right now
Emphasize that a process is in place to learn more: Use messages such as, We have a
system (plan, process) to help us respond (find answers). Explain what you know, what you are
doing to help, and when you will know more (or a time for the next press conference).
Be consistent in providing messages: Provide consistent messages, and qualify them in
reference to a changing situation:
yy Alert the public that the messages or recommendations may change as more information
becomes available.
yy Be sure that all responsible participants and any third-party communicators and partners are
immediately aware when the message changes.
Put the good news in secondary clauses: For example, its too soon to say were out
of the woods, even though we havent seen a new anthrax case in X days. The main clause
indicates that you are taking the situation seriously and that you are responding aggressively.
The secondary clause includes the reassuring information without over-reassuring.

Maintenance Phase
During this phase, the crisis magnitude, the concept of personal risk, and the initial steps toward
recovery and resolution are in motion. Emotional reactions vary and will depend on perceptions about
the risk and the stresses people experienced or anticipated. At first people may appear to be elated,
despite surrounding destruction or death, because they are relieved they survived. However, as the
maintenance phase evolves, people may experience varied emotional states, including numbness, denial,
flashbacks, grief, anger, despair, guilt, and hopelessness.
The longer the maintenance phase lasts, the greater these reactions. Once basic survival needs are met,
other needs for emotional balance and self-control emerge. People often become frustrated and let
down if they are unable to return to more normal conditions. Early selfless responses to the emergency
may fall away and be replaced by negative emotions and blame.
The following CERC principles apply to the maintenance phase:
Acknowledge fears: Understand that it is normal to be frightened. Dont tell people they
should not be afraid, as they have a right to fear the worst.
Express wishes: Use statements such as the following:
yy I wish we knew more.
yy I wish our answers were more definitive.
yy I wish we had a quick and easy solution.
Give people things to do: In some emergencies, suggested actions are directed toward
those who have been exposed to harm, or may yet be exposed. In an emergency, simple tasks
will help people gain back a sense of control and help keep them motivated to stay tuned
to what is happening. Even those who do not need to take immediate action will be looking
at recommendations and possibly vicariously rehearsing them. They might benefit from a
meaningful role. Suggest a range of responses: a minimum response, a maximum response, and a
recommended middle response.
Acknowledge shared misery: Some people may be less frightened and instead feel high
levels of misery and hopelessness. Others may feel defeated. Acknowledging the misery of a
catastrophic event may help people move toward hope, particularly if there are actions that
organizations and agencies can recommend.
Give anticipatory guidance (foreshadow): If you are aware of possible future negative
outcomes, such as side effects from antibiotics, let people know what to expect. If outcomes
might be bad, tell them.

Address the what if questions, when appropriate: These are the questions everyone is
thinking about and want answered by experts. It may be impractical to answer them if the crisis
is contained and not likely to affect many people. It is reasonable to answer these questions if
they could happen and people need to be emotionally prepared. If you do not answer the what
if questions, someone else will answer them for you. If you are not prepared to address what
ifs, you lose credibility and the opportunity to frame the what if questions with reason and
valid recommendations.
Be a role model and ask more of people: People seek direction during the uncertainty of a
crisis. As a spokesperson, especially one who is onsite and at some personal risk, you can model
appropriate behavior. Good role models:
yy Remain calm while acknowledging and reflecting the experiences people are having.
yy Remember that people can tolerate considerable risk, especially voluntary risk.
yy Recognize the severity and complexity of the risk and acknowledge fears. This will help others
tolerate risk during the emergency and work toward solutions.
yy Demonstrate a true willingness to go on with normal life as much as possible and to make
reasonable choices.
yy Remain strong and steadfast.
yy Encourage and demonstrate altruism, hope, and resolve. The natural tendency to recover
and rebuild are very common responses to crises. Encouraging those inherent traits will help
people cope with uncertainty, fear, and despair.
Resolution Phase
When the emergency is no longer on the front page, those who have been most severely affected
will continue to have significant emotional needs. Emotional symptoms may present as physical
health symptoms such as sleep disturbance, indigestion, or fatigue. They may cause difficulties with
interpersonal relationships at home and work. At this point, organized external support often starts to
erode and the realities of loss, bureaucratic controls, and permanent life changes come crashing down.
To maintain trust and credibility during the resolution phase, keep the expressed commitments from
the initial phase. Failures or mistakes should be acknowledged and carefully explained.

Table 21. Effective Communication Recommendations
CERC Principles During Pre-crisis Through Resolution
Pre-crisis yy Provide an open and honest flow of information to the public.

yy Emphasize that there is a process in place.
Initial yy Dont over-reassure.

yy Acknowledge uncertainty.
yy Emphasize that a process is in place to learn more.
yy Be consistent in providing messages.
Maintenance yy Acknowledge fears.

yy Express wishes.
yy Give people things to do.
yy Acknowledge shared misery.
yy Give anticipatory guidance (foreshadow).
yy Address the what if questions, when appropriate.
yy Be a role model and ask more of people.
Resolution yy Acknowledge failures.

References
1. Seeger MW, Sellnow TL, Ulmer RR. Communication and organizational crisis. Westport (CT): Praeger; 2003.
2. Covello VT, Peters RG, Wojtecki JG, Hyde RC. Risk communication, the West Nile virus epidemic, and
bioterrorism: responding to the communication challenges posed by the intentional or unintentional release
of a pathogen in an urban setting. J Urban Health 2001;78(2):382391.
3. Glik DC. Risk communication for public health emergencies. Annu Rev Public Health 2007;28: 3354.
4. Hill D. Why they buy. Across the Board 2003;40(6):2733.
5. Andreasen AR. Marketing Social Change: Changing Behavior to Promote Health, Social Development, and the
Environment. San Francisco: Jossey-Bass Publishers;1995.
6. Brehm SS, Kassin S, Fein S. Social Psychology. 6th ed.Boston: Houghton Mifflin Co.;2005.
7. Brashers D E. Communication and uncertainty management. J Commun 2001;51(3):477497.
8. Sellnow TL, Ulmer RR, Seeger MW, Littlefield RS. Effective risk communication: A message-centered
approach. New York: Springer Science+Business Media, LLC;2009.
9. Solso RL. Cognitive Psychology. 6th ed. Boston:Allyn and Bacon;2001.
10. Giuliani, R. Leadership. New York: Miramax; 2005: 164165.
11. Benight CC, Bandura A. Social cognitive theory of posttraumatic recovery: The role of perceived self-efficacy.
Behaviour research and therapy, 42(10), 11291148;2004.
12. Clarke, L. The problem of panic in disaster response. [online]. 2003. [cited 2014 May]. Available from URL:
http://www.upmchealthsecurity.org/our-work/events/2003_public-as-asset/Transcripts/clarke.html.
13. Sellnow TL, Seeger MW. Theorizing crisis communication. Malden (MA): Wiley-Blackwell; 2013. p. 7.
14. Novac A. Traumatic stress and human behavior. Psychiatric Times [online] 2001 Apr [cited May 2012]; 18(4).
Available from URL: http://www.psychiatrictimes.com/display/article/10168/50361.
15. Ahern J, Galea S, Resnick H, Kilpatrick D, et al. (2002). Television images and psychological symptoms after
the September 11 terrorist attacks. Psychiatry, 65(12), 289300;2002.
16. Schuster MA, Stein BD, Jaycox LH, Collins RL, Marshall GN, Elliott MN, Berry SH. A national survey of stress
reactions after the September 11, 2001, terrorist attacks. New Engl J Med, 345(20), 15071512;2001.
17. Schlenger WE, Caddell JM, Ebert L, Jordan BK, Rourke KM, Wilson D, Kulka RA. Psychological reactions
to terrorist attacks: findings from the National Study of Americans Reactions to September 11. J Am Med,
288(5), 581588;2002.
18. Preston R. The demon in the freezer. New York: Random House; 2003.
19. Stuart JA, Ursano RJ, Fullerton CS, Norwood AE, Murray K. Belief in exposure to terrorist agents: reported
exposure to nerve or mustard gas by Gulf War veterans. Journal of nervous and mental disease, 191(7),
431436; 2003.

20. Cohn V. Reporting on risk: getting it right in an age of risk. Washington (DC): The Media Institute; 1990.
21. Covello V. Communicating Radiation Risks. Crisis communications for emergency responders. EPA Document
402-F-07-008 [online]. 2007. [cited 2012 May]. Available from URL: http://tinyurl.com/6lva2sk
22. Agency for Toxic Substances and Disease Registry. A primer on health risk communication principles and
practices. Overview of issues and guiding principles [online]. 1994. [cited 2012 May]. Available from URL:
http://www.atsdr.cdc.gov/risk/riskprimer/index.html.
23. U.S. Department of Veterans Affairs. National Center for PTSD. Phases of traumatic stress reactions in a
disaster. Impact phase [online]. 2007 Jan. [cited 2012 May]. Available from URL: http://www.ptsd.va.gov/
professional/pages/phases-trauma-reactions.asp.

Resources
American Psychological Association. The effects of trauma do not have to last a lifetime [online]. 2004 Jan 16.
[cited 2012 May]. Available from URL: http://www.apa.org/research/action/ptsd.aspx.
Covello VT, Allen FW. U.S. Public Health Service. Prevention report [online]. 1995 FebMar. [cited 2012 May].
Available from URL: http://odphp.osophs.dhhs.gov/pubs/prevrpt/archives/95fm1.htm.
DeWolfe, DJ. Mental health response to mass violence and terrorism: A field guide. DHHS Pub. SMA 4025.
Rockville (MD): Substance Abuse and Mental Health Services Administration [online]. 2005. [cited 2012
May]. Available from URL: http://store.samhsa.gov/product/Mental-Health-Response-to-Mass-Violence-and-
Terrorism-A-Field-Guide/SMA05-4025.
DiGiovanni C Jr. Domestic terrorism with chemical or biological agents: psychiatric aspects. Am J Psychiatry
1999 Oct;156(10):15005.
Everly GS Jr, Mitchell JT. America under attack: the 10 commandments of responding to mass terrorist
attacks. Int J Emerg Ment Health 2001 Summer;3(3):1335.
Krug EG, Kresnow M, Peddicord JP, Dahlberg LL, Powell KE, Crosby AE, et al. Suicide after natural
disasters. N Engl J Med 1998 Feb 5;338(6), 373378.
National Center for Post-Traumatic Stress Disorder. Disasters and substance abuse or dependence. A fact
sheet from the National Center for PTSD [online]. 2005. [cited 2012 May]. Available from URL: http://www.
samhsa.gov/csatdisasterrecovery/outreach/disastersAndSubstanceAbuseOrDependence.pdf.
Reynolds BJ. When the facts are just not enough: credibly communicating about risk is riskier when emotions
run high and time is short. Toxicol Appl Pharmacol 2011 Jul 15;254(2):20614.
Schuster MA, Stein BD, Jaycox LH, Collins RL, Marshall GN, Elliott MN, et al. A national survey of stress
reactions after the September 11, 2001 terrorist attacks. N Engl J Med 2001;345(20), 15071512.
The Peter M. Sandman Risk Communication Website. Risk = hazard + outrage [online]. [cited 2012 May].
Available from URL:http://www.psandman.com/index.htm.
Tinker T, Vaughan E. Risk and crisis communications: Best practices for government agencies and non-profit
organizations [online]. 2010. [cited 2012 May]. Available from URL: http://www.boozallen.com/media/file/Risk-
and-Crisis-Communications-Guide.pdf .
U. S. Department of Veterans Affairs. National Center for PTSD. Psychological first aid: Field operations
guide [online]. 2006. [cited 2012 May]. Available from URL: http://www.ptsd.va.gov/professional/manuals/
psych-first-aid.asp.
U.S. National Library of Medicine. Current bibliographies in medicine 20002007. Health risk communication
[online]. 2000 Oct 31.[cited 2012 May]. Available from URL: http://www.nlm.nih.gov/archive/20061214/pubs/
cbm/health_risk_communication.html.

Notes:

Notes:

Chapter 3:
Messages and Audiences
2014 EDITION

Chapter 3:
Messages and
Audiences
In this chapter you will learn about:
Understanding your audiences
Making facts work in your message
Using CERC principles
Organizing information for emergency response presentations
Audience feedback
The Message: Content Counts in an Emergency

Communication is a dynamic process involving many elements, including a sender, channel, message,
receiver, and context. Audiences and messages are key parts of the process. Once the audience is
analyzed, the message can be improved for effectiveness.
For any crisis, there will be multiple audiences. The needs and interests of those different audiences
will change as the crisis develops. Basic communication principles can improve the effectiveness of
your communication.
Understanding Your Audiences

Understanding the needs, cultural background, community history, location, and values of your
audiences is one of the most important factors in effective communication. This understanding allows
you to match your message to audience characteristics, such as interests, cultural background, location,
and their preferred communication channels.
One way to think about the people you are trying to reach is their psychological proximity to the event.
People may be psychologically close to an event, because they are physically and emotionally involved.1
They may have family members who are affected. They may be emergency workers trying to help.
Perhaps their jobs or industries will be hurt by the crisis. It is important to understand them and the
way they receive important messages.
Also bear in mind that they do not just receive information; they also send it. With changing media
technologies, including social media services like Twitter and Facebook, and the ability to use digital
media and the Internet, people in a disaster zone can post real-time information. They will often repost
and retweet official messages. They also have the ability to post unofficial messages and rumors.
49
The receiver of your official communication will be assessing and judging the content
based on the following:
The message
The messenger
The method of delivery
All three elements must be considered when planning CERC efforts. Bear in mind that the publics
awareness of government is heightened during a crisis. They are listening to what you say. Government
agencies become the primary source for critical information. Meeting the audiences needs means being
as honest, open, and transparent as possible in any situation.
The needs of the members of your audience can be judged three ways:
1. Their relationship to the incident
2. Their psychological differences
3. Their demographic differences
Your audiences will likely be diverse and have very different needs and interests. Remember that
the needs and interests of the audience will change as the crisis evolves. Your audiences may include
the following:
Public within the circle of the disaster or emergency for whom action messages
are primarily intended: Their first concerns are personal safety, family safety, pet safety,
and property protection. They may also be worried about stigma, which could arise if an event
singles out individuals with circumstances that could bring about negative reactions from others.
Examples include people with HIV, illegal immigrants, and those who cannot afford medical
care.
Public immediately outside the circle of the disaster or emergency for whom
action messages are not intended: Their primary concerns include personal safety, family
safety, pet safety, and interruption of their normal activities.
Emergency response and recovery workers and law enforcement involved in the
response: Their concerns include having the resources to manage the response and recovery,
as well as their personal safety and that of their family and pets left behind.
Public health and medical professionals involved in the disaster response: Their
primary medical concerns are ensuring treatment and response protocols, and having enough
medical resources. They, too, are concerned about their safety, their familys safety, and pet
safety.
50 Chapter 3 Messages and Audiences

Family members of victims and response workers: Their primary concerns include
personal safety, safety of victims, and safety of response workers.
Health-care professionals outside the response area: Their primary concerns may
include rehearsal of treatments and recommendations, ability to respond to patients with the
appropriate information, and access to medical supplies if needed.
Civic leaders (local, state, and national): Their primary concerns include response and
recovery resources, liability, and leadership. They also focus on the quality of the response
and recoverys planning and implementation. Civic leaders will be looking for opportunities to
express concern. They may also need to handle issues with trade and international diplomatic
relations.
Congress: They will need to inform their constituents about the disaster. They will want to
make sure they can meet the needs of their constituents. This may include reviewing laws and
regulations to see if current rules will work for this situation or need adjustment. Members of
Congress will also be looking for opportunities to express concern.
Business, trade, and industry: They will be concerned about maintaining business
continuity. They will want to avoid business interruptions, loss of revenue, and liability. They
will also need to take steps to protect their employees.
National community: Their primary concerns are the following:
yy Vicarious rehearsal,2 in which they experience the crisis through communication

mechanisms rather than directly, and consider courses of action presented to those
who are directly affected
yy Getting readiness efforts started
International neighbors: Their primary concerns are also vicarious rehearsal and getting
readiness efforts started.
International community: Their primary concerns include vicarious rehearsal and exploring
their level of readiness.
Stakeholders and partners specific to the emergency (discussed in more detail in
Chapter 7): Their primary concerns are being included in the decision-making process, access
to information, and understanding their role in the response.
Media: Their primary concerns are personal safety, access to information and spokespersons,
and meeting their urgent deadlines.
Chapter 3 Messages and Audiences 51

Figure 31. Audience Relationship to the Event
Each audience will be looking for specific messages based on their characteristics. As a risk
communicator, you must prioritize the development of messages for each audience based on their
involvement.
Basic principles are important when creating messages. You will need to consider audience
segmentation and demographics as well as their physical and psychological relationship to the
event. When you consider the communication needs of your audience, bear in mind the following
characteristics:
Education
Income level
Current subject knowledge and experience
Age
Languages spoken and read

Cultural background norms and values
Geographic location
Religious beliefs
Communication channels are very important during a crisis, and systems to reach these audiences
should be developed. This may require assigning staff as liaisons, to ensure that your organizations
messages reach critical audiences. During a crisis, established communication channels are often
disrupted. This may force you to develop alternative ways of communicating.
In the aftermath of Hurricane Katrina, for example, CDC staff could not rely on television or radio to
reach people in the hurricane zone.3,4 They turned instead to printed flyers for information about the
safety of food and water.3
Some audiences may be the responsibility of groups other than communication staff. For example,
health-care or emergency-management professionals may be communicating with others in your
organization. Messages, however, should remain coordinated and consistent. The Hurricane Katrina case
study at the end of this chapter illustrates how messages should be adapted to meet the demands of a
specific event.
Also see Template 31, Message Development for Emergency Communication, at the end of this
chapter. This worksheet is designed to help develop targeted messages during a crisis.
How Audiences Assess Messages in a Crisis

Audiences receive, interpret, and evaluate messages before they take action. Expect your audience to
immediately judge the content of your message for speed, factual content, and trust and credibility:
Speed of communication: Was the message timely without sacrificing accuracy? One of
the primary dilemmas of effective Crisis and Emergency Risk Communication (CERC) is to be
speedy in responding but maintain accuracy even when the situation is uncertain:
yy Being first to communicate establishes your organization as the primary source of information.
The public may judge how prepared your organization was for the emergency based on
how fast you responded. Speedy responses suggest that there is a system in place and that
appropriate actions are being taken.
yy If the public is not aware of the response, for them, there is no response. The public may
then lose confidence in the organizations ability to respond. Messages then must attempt to
catch up in convincing the public that the system for response is working. Remember that if
agencies are not communicating, audiences will turn to other, less credible sources.
yy First impressions are lasting impressions, and its important to be accurate. Responding
quickly with the wrong information or poorly developed messages damages credibility. This

doesnt necessarily mean having all the answers; it means having an early presence, so the
public knows that agencies are engaged and that there is a system in place to respond.
yy People tend to compare future messages to the first message they received. For example,
if you issue an evacuation message and then retract it, the second message will be assessed
based on the first one.
Factual content of the message: The public will be listening for factually correct
information, and some people will expect to hear specific recommendations for action.
Therefore, you should do the following:
yy Get the facts right.
yy Repeat the facts often, using simple nontechnical terms.
yy Avoid providing sketchy details in the early part of the response.
yy Ensure that all credible sources share the same facts. Speak with one voice. Inconsistent
messages will increase anxiety, quickly undermining expert advice and credibility.
In 2003, a massive blackout affected Ohio, Michigan, and parts of Canada.5,6 Communities had no
power and people worried about food and water safety.5 In Michigan, two public health officials
from adjacent counties were being interviewed in succession about boiling water to make it safe
for drinking, cooking, and cleaning dishes. Even though they were applying the same state food
law and safety codes, the two health departments had not compared notes:
yy An official from County A health department said restaurants were closing and werent going
to reopen until they had been inspected.
yy The County B health department decided not to close the restaurants, because they had
previously required all food managers to be certified in their food safety program, which
included what to do in an emergency.
These two conflicting messages resulted in intense media scrutiny of the two county health
department policies, as well as a confused public. Restaurant owners from County A were angry
because they were forced to close their restaurants and lose business, while restaurants across
the street in County B stayed open. Consistent messages are vital, especially when asking people
to take actions or steps that are unfamiliar.
Trust and credibility of the message: One of the most important factors in effective
communication is credibility. Establishing credibility through communication depends on three
basic elements:
yy Intention toward the receiver
yy Expertise
yy Trustworthiness

Dont try to fake these elements. Audiences are very good at determining when a communicator
is sincere. Credibility is a resource that can be built up during normal times and used during a
crisis. Communication researchers often advise that you build a reservoir of goodwill with your
audiences and stakeholders; this will prove to be an important resource.
All messages, written or spoken, can incorporate these elements of credibility. These are
especially important to communicate during an emergency when it is critical for the audience to
trust the messenger and believe what they are being told.
yy Intention: Intention toward the receiver involves many factors, including the following:
Empathy Commitment
Caring Dedication
Empathy and caring should be expressed within the first 30 seconds of a message. Your audience will
be more likely to receive and act on your messages if they see you as being empathetic and caring.
It is important that you acknowledge fear, pain, suffering, and uncertainty. Establish commitment
and dedication by stating, up front, your organizations objectives for the emergency response and
committing to reaching them.
Dedication means you may have to share in the sacrifice and discomfort of the emergency situation.
However, dont fake hardship for the TV cameras. There are many examples of officials trying to do so
and coming across as insincere and manipulative. For example, effective governors know theyd better
walk the territory when declaring a state disaster area. Dedication also means not leaving until the
emergency is under control. This may require staying in touch with the community long after the media
loses interest in the story. Your organization should commit to resolution and follow-up from the start
and carry through until the end.
yy Expertise: This concerns basic questions of competence and knowledge. People recognize
the following types of expertise:
Education Title
Position Organizational roles and missions
People will view you as more competent if you possess previous experience and demonstrated
abilities in handling situations like the current one. It will help if you build a relationship with
your audience before an emergency. If that is not possible, have a third party, who has already
established the confidence of the audience, express his or her confidence in you or your
organization.
Sometimes elected officials may appear with experts to present a unified front and bolster
the credibility of each. One example would be letting a medical professional speak about an
infectious disease as opposed to a congressman whose background is law.

Expertise may extend beyond technical or scientific
knowledge to knowledge about a specific community
As far as dealing with the public,
or a specific issue.
you have to be totally honest. You
yy Trustworthiness: This is achieved in part by being cant hide anything. If you dont
honest and open. Honesty means facing the realities of know the answer, dont be afraid to
the situation and responding quickly and appropriately. say that. Tell the people what you
It does not mean releasing information prematurely. know and what you dont know.
Accuracy is always required; however, there is almost
always tension in balancing the competing demands Dennis Walaker,
for information that is complete and information that is Mayor,
delivered quickly. Establish trust with your audience by Fargo, North Dakota
considering the following communication guidelines:
Dont be paternalistic. Instead, give people

choices and enough information to make informed
personal decisions.
Communication systems and procedures may limit your ability to reveal information. Be
realistic about this. Dont pretend the information is not available. Instead, explain why the
information isnt available for release at the time. You might offer an explanation such as,
We are checking the information or We are notifying our organization.
Openness means allowing the public to observe the process while reminding them that it is
what drives the quality of the emergency response.
Avoid using professional jargon and euphemismsthey imply insecurity and lack of honesty.
There is simply no substitute for an honest and open response.
Figure 32. Elements of Successful Communication

Making Facts Work in Your Message
Message characteristics are important elements to consider in the overall communication process. You
may have control over the message content, form, and timing. However, communication during a crisis
is different than routine communication.
The following factors are important to consider when creating initial messages about a crisis:
Present a short, concise, and focused message with limited detail: Use a 6th-grade
reading and comprehension level. When people are scared or anxious, they have a hard time
taking in and remembering large amounts of information. Get the bottom line out first. Very
soon, the public will want more information. It should be made available in ways that allow the
public to access as much as they want. A method for assessing reading level can be found at
www.sph.emory.edu/WELLNESS/reading.html.
Cut to the chase: Only include immediately relevant information in the very first messages.
Dont start with a lot of background information. Dont spend a lot of time establishing yourself
or your organization. A sentence or two should be enough. Provide whats critical for the
public to know.
Give action steps in positives, not negatives:
Use messages such as, In case of fire, use stairs,
During a crisis, its really hard for
Boil drinking water, and Stay calm, which are
positive messages. Negative messages are messages people to really hear what youre
such as, Do not use elevator, Dont drink the water, saying. So repetition becomes
and Dont panic. essential. But with repetition, you
Repeat the message: Reach and frequency are have to make sure your messages are
common advertising concepts. They suggest that consistent.
messages are more apt to be received and acted upon
Richard Besser, M.D.,
when the number of people exposed to the message
(reach) and the number of times each person hears the Former Acting Director,
message (frequency) go up. Repetition also helps with Centers for Disease Control
recall, especially during a crisis. and Prevention
Create action steps in threes or fours, or
create an acronym: These are ways to make basic
information easier to remember, such as clean,
separate, cook, and chill for food safety or stop, drop, and roll as a fire safety technique.
KISS (keep it short and simple) is an acronym often used to describe effective communication.
In an emergency, people absorb about three simple directions at any one time. Somewhere
between three and seven pieces of information is the limit for most people to hold in short-term
memory. It makes sense in the stress of an emergency to ask your audience to remember fewer
bits of information.

Here are two examples of messages that provide a few basic points that are easy to remember:
yy Anthrax is a bacterium that is treated with antibiotics. Anthrax is not transmitted from
person to person. Seek medical care if you believe you have symptoms of anthrax: fever, body
aches, and breathing problems.
yy Take time to get a flu vaccine. Wash your hands regularly to help prevent the spread of
germs. Take flu antiviral drugs if your doctor prescribes them.
With messages like these, the public will soon want access to much more information.
Use personal pronouns for the organization: Pronouns personalize the message and
help with credibility and identification. Use phrases such as, We are committed to or We
understand the need for
When Lieutenant General Russel Honor, a native of Louisiana, came to New Orleans to take
over Hurricane Katrina relief efforts, he recognized that the people had been waiting days for
relief and were frustrated with FEMA efforts. In his comments to CNN on September 2, 2005,
Honor showed he was one of them and would keep the focus on humanitarian relief.7 He said:
The mood here, of the people, are they are anxious to get out of here. They would
rather be home. And we are going to take them from here, and get them to a place
where they can have more of a normal life, with a place to sleep, and with some degree
of comfort. But the people, by and large these are families that are just waiting
to get out of here. And they are frustrated. I would too. I get frustrated at the cash
register counter when the paper run out. This is not an instant solution. And its hard
work, and they are frustrated. And in a way, we are too. But were doing our best. We
got the resources started, and were going to continue to flow them now were at the
Convention Center.8
Avoid technical jargon: Jargon creates a barrier between the sender and receiver. Avoid
creating this barrier by saying certain things in less complex ways. For example:
yy Instead of saying people may suffer morbidity and mortality, say people exposed may
become sick or die.
yy Instead of epidemic or pandemic, say outbreak or widespread outbreak.
yy Instead of deployed, say sent or put in place.
yy Instead of correlation, say relationship (avoid using cause).
yy Instead of surveillance, say monitoring.
Do not use unnecessary filler: Background information and details can be saved for other
times and outlets, such as fact sheets.

Avoid condescending or judgmental phrases: Do not use statements such as:
yy You would have to be an idiot to try to outrun a tornado.
yy Only hypochondriacs would need to walk around with a prescription for Cipro.
Both ideas have crossed the minds of people who are neither idiots nor hypochondriacs. Nothing
good happens by insulting audiences with words or the tone of your voice. That doesnt mean
you should condone the behavior. Instead, you should validate the impulse, but offer a better
alternative and the reason why its better.
Attack the problem, not the person or organization: If criticism of a person is absolutely
necessary, such as someone who has given wrong information, first address the information, and
then suggest that there may be better sources.
Promise or guarantee only what can actually be delivered: Promise what you can
deliver. Furthermore, promise to remain committed throughout the emergency response. In
general, the principle of under-promising and over-delivering is particularly important during a
crisis.
Avoid speculation and assumptions: Avoid playing worst-case scenario. Stick to the known
facts. If there is no information suggesting an outbreak involves Ebola, avoid mentioning it.
If the facts are not known, dont fall into the what ifs. Instead, describe the steps you are
using to get the facts and help the audience deal with the uncertainty while all the facts are
uncovered. Speculation weakens credibility and may create needless anxiety.
Avoid discussion of money: In the initial phase, discussion of the magnitude of the problem
should be in context of the health and safety of the public or environment. Loss of property is
secondary. The amount of money spent on the crisis is not a substitute for the level of concern
and response from organizations.
Avoid discussing liability: Questions of cause, blame, responsibility, and liability often follow
a crisis. It is not appropriate to discuss them at the early stages. Instead, use statements like
Our focus right now is on containing the situation.
Do not use humor: Seldom if ever is humor a good idea. People rarely get the joke when they
are feeling desperate. Humor is a great stress reliever behind closed doors. However, be aware
that microphones are often on and cell phones can easily capture a behind-the-scenes moment.
Anyone who has responded to an emergency knows that inappropriate humor sometimes
creeps in as a coping mechanism. Be cautious not to offend others who are responding to an
emergency, even behind closed doors. Remain sensitive when speaking to the public. One
persons attempt at humor may be anothers insult.

Using CERC Principles
Pre-crisis Phase:
Building Consensus for Actions
The pre-crisis phase is an important time when consensus can be developed about response strategies.
Leaders should be pressured to finalize protocols for action. These pre-crisis actions can save valuable
time during an emergency. In addition, audiences can be educated about risks and encouraged
to prepare. It is also a time when carefully crafted messages can help build consensus around
recommendations for action and facilitate planning. Messages built around the following strategies will
help increase effective planning and preparation:
Increase the expected gains from planning and preparation and decrease the expected costs.
Increase the social pressure for preparation and planning.
Improve the individuals ability to act by educating and providing information.
Decrease the desirability of competitive alternative actions that may be taken

instead of planning.
For example, if you want to encourage a community to prepare family emergency kits, consider doing
the following:
Increase expected gains: Share anecdotes about families who had kits and how
they benefited from them in earlier disasters. Offer several possible cases where the kit
would be important.
Decrease the expected costs: Decrease the expected cost for a kit and explain what
a family can receive for the price. Point out its longevity and value as a safety product
for the home.
Increase social pressure: Involve the community neighborhood watch program in promoting
the development of kits. Ask community- and faith-based organizations to also help promote
emergency kits. Ask neighbors to help each other develop kits specific to the communitys
anticipated needs. Use all communication channels to share information about civic groups
involved in kit projects.
Improve the individuals ability to act: Make the list of kit items easy to use and widely
available. Encourage partner retailers to discount safety kit items during key times of the year,
such as during hurricane season in Florida.

Decrease competitive alternatives: Explain how putting together kits need not cost much,
nor take much time. Explain that expensive prepackaged kits are less desirable, because they
are not designed for each familys individual needs.
Consider a second example. What if theres a targeted population that remains indoors during the
course of an infectious disease outbreak? This group may not want to travel to the emergency room or
hospital during the outbreak, but you might consider the following:
Increase the expected gains: Self-imposed isolation will protect people from unnecessary
exposure. It is possible to avoid red tape and emergency room waiting time if they call a
community nurse hotline. A trained nurse will assess their risk by phone and empower them to
make the best decision about additional care.
Decrease the expected costs: If the nurse agrees that a doctor or hospital visit is needed,
an e-mail of the hotline contact with the patients name will be placed on a reservation list at the
medical facility. This will give the patient priority in the waiting room, meaning he or she will be
placed ahead of those who have not gone through the screening process.
Increase present social pressure: Engage community, civic leaders, and trusted health-care
professionals to present the benefits of using the hotline. Messages by leaders can explain the
reduction of confusion by allowing dedicated health-care workers to treat those in immediate
need of care.
Improve the individuals ability to act: Widely publicize a toll-free number, ensure that
contact is made with little or no waiting, and ensure that a satisfaction check is made before
the call ends.
Culture and Your Message

Culture is a complex set of values, ideas, attitudes, and symbols that shape behavior.9 It consists of the
language, beliefs, behaviors, objects, and traditions that are characteristic of members who belong to
a particular group. This may be a society, a nation, an institution, a regional group, or an ethnic group.
Bear in mind the following aspects of culture:
People self-identify through their cultural affiliation and take meaning from their experiences.
Cultural norms are transmitted from one generation to the next and to new members as they
identify with that group.
People can belong to several cultural groups at the same time. Most people identify to
one degree or another with their primary culture. But people are also members of smaller
subgroups within this larger culture. This includes groups based on community, region,
religion, or ethnicity.
Culture is adaptive. As the needs of a society change, its values change to meet those
needs. Because cultural norms influence how people live and behave, culture has important
implications for communication, including emergency communication.

The United States is culturally diverse, and growing more so. According to the 2010 U.S. Census Bureau
report, minorities are about 35% of the U.S. population. In addition, almost 20% speak a language other
than English at home and 12% are foreign-born. It is estimated that these minority populations will
become the majority by 2042 with one in three U.S. residents being Hispanic. By 2023, more than half of
all children will be of a minority race.
Public health communicators need to be aware of the cultural diversity in the populations they serve.
They also need to be aware of how cultural factors affect communication during a crisis:
Language: About 30 languages are commonly spoken in U.S. households. English is the most
common, spoken by about 82% of the population. Spanish is the second most common, spoken
by about 12%.10
The perception of risk: Different cultures have very different experiences with risk11 and
have often developed specific methods of risk management. For example, African Americans
in New Orleans saw how Hurricane Katrina affected their community disproportionately. Some
communities have cultural practices, such as eating potentially harmful foods, that enhance
their risk of illness. Discussions of risk should be sensitive to these cultural differences.
Beliefs about institutions, including government: Cultural and ethnic groups
often develop their own institutions, such as faith-based organizations, social groups,
nongovernmental organizations, and political organizations and identify with those institutions.
Some may have had different experiences with government agencies and may not trust that
agencies are always helpful or care about their values.
Credible sources of information: Cultural groups often develop their own networks
of communication. Ethnic media outlets, such as newspapers, radio stations, television
stations, and Internet-based media, are among the fastest growing media in the country.
They are particularly important sources of information
for new Americans.
Rituals for grieving and death: Most cultures have Some tribes still place a lot of stock
specific, relatively unique beliefs, rituals, and practices in their spiritual leaders. So you have
for death, dying, and grieving. These may be impacted
to work in conjunction with them in
during a crisis. For example, some cultures believe that
order to get that message out to the
grieving should be intensely private. They may feel that
the presence of the media interferes with this practice. people on the reservation or within
that community.
Beliefs about family relationship and roles: Many
cultures and ethnic groups look to their family as the Sharon KD Hoskins;
main point of cultural reference. Families can exert Office for State, Tribal, Local, and
strong influences on individual behavior. In fact, specific
Territorial Support;
expectations and roles can develop for various family
Centers for Disease Control
members such as a father, mother, and first-born son.
and Prevention

Beliefs about acceptable and appropriate forms of communication: Cultures may
dictate communication protocols, including rules for who talks to whom and who represents or
speaks for the family or even a community. Norms may exist for how direct messages can be and
which nonverbal messages, such as eye contact or hand movement, are appropriate.
Emphasis on the individual versus the group: Some cultures emphasize that the rights
and needs of the individual are more important than those of the group or community. Others
believe that the needs of the group should take priority. These differences may influence the
kinds of risk messages that are prepared and the ways in which communities respond to a crisis.
In one case, vaccinations may be offered to individuals and promoted as a way to protect ones
self. In the other case, families may be encouraged to get vaccinated as a group.
Culture is among the most complex communication issues to manage during a crisis. The more you
know about a particular cultural group, the greater the chance your communication will be effective.
Theres little time to acquire detailed cultural knowledge during a crisis. You may need to turn to a
cultural agent, a person from that culture, perhaps a leader or respected elder, who can help you
understand how a particular culture will view an issue. Be aware that cultures are not always unified. It
may be challenging to find a cultural agent who is accepted by all. It is important to build ties to various
ethnic and cultural communities before a crisis occurs, as illustrated by the case presentation at the end
of this chapter.
Organizing Information for

Emergency Response Presentations
Public health emergencies come in varied sizes and durations. After the initial response occurs, you may
need to present updates or background information to community leaders, decision makers, Congress,
or citizens. Perhaps you will need to explain certain recommendations made at each step of the
recovery effort.
Depending on the purpose of the presentation and any expected resistance to the message, the way
your information is presented can help open audiences to receive it. Consider the following points in
arranging key ideas:
If a message arouses exceptionally intense feelings of anxiety, people tend to ignore any
message content that follows. People must be prepared for messages, especially those likely to
evoke emotion. Give listeners an opening statement to increase their recognition and attention
level. Your introduction should:
yy Prepare the audience for the upcoming subject.
yy Acknowledge its emotional effect.
yy Tell them that you will go over the material as many times as necessary.

Listeners will tune the speaker out if they suspect that his or her message will not confirm their
beliefs or opinions. Look for those elements you know you share with your audience and upon
which you agree. Start with those common elements and build on them.
Messages can inoculate audiences by providing a small dose of a counter argument first. This is
similar to the way a mild dose of a disease organism can inoculate a person. With controversial
issues, it is helpful to acknowledge to your audience that other perspectives and opinions exist,
and that some people may disagree with your position.
See Hurricane Katrina Emergency Communication Response, U.S. Gulf Coast, 2005, at the end of this
chapter for a case study of how communication messages were adapted by CDC to meet the audiences
needs for the long duration of the response.
Several kinds of presentations are described in the following sections. They relate to presentations
public health officials may be asked to make during and after a crisis. In all cases, developing an outline
of the main points and supporting information before creating the message works well. Information
can be organized and presented using a variety of patterns. (See Table 31 below for a list of the
presentation patterns discussed here)
Presentation Types Based on Situation

Sharing New Information When Facing Little or No Resistance:
yy Using a direct pattern for organizing main ideas, as well as a conclusion, is often effective in
presenting crisis information:
Develop the idea with supporting information.
Present the bottom line up front; this will be preferred by most busy decision-makers.
Dont save the big idea or main conclusion until last. This will increase expectations. For
example, if you waited until the end of the presentation to announce that the actions you
advise will decrease the spread of infection by 25%, your audience may be expecting that
these actions would stop all spread of the disease. They will be disappointed. By stating
projected outcomes first, you can set clear expectations.
yy Persuasive presentations sometimes benefit from a more indirect pattern. This may involve
building the argument with secondary concepts until you offer the most powerful argument.
You might choose to list each of the benefits of a new public health policy and finish by saying
something like, it will save lives and also save billions over the next 10 years.
Progress Reports and Instructions:
yy Often, progress reports and step-by-step instructions are best organized chronologically.
Progress reports, such as updates on a response, might begin with the first actions taken and
then proceed to the most recent. This chronological pattern helps the listener follow where
youve been and where youre going. However, this technique can be overused, especially if

there are frequent updates. It remains a useful pattern if listeners need to understand the
ongoing development of ideas.
yy Also consider a priority order pattern for progress reports. In this pattern, the most
significant point is presented first with other developments following in descending order of
importance.
yy When offering step-by-step instructions, such as how to assemble an emergency kit, present
information using a chronological pattern. Number the steps. This makes it much easier for
the audience to follow instructions. Also, keep the instructions brief, yet easy to understand.
Remember that people generally can only retain about five to seven pieces of information in
their short term memory.
Problem Solving:
Use the criteria-application pattern for presentations that offer a solution to a problem:
yy Early in the presentation, suggest criteria or standards for evaluation; then, compare
solutions or choices against those standards. The criteria should describe the best possible
case and then explore available options.
yy This approach highlights the underlying reasoning and decision-making process.
yy As long as the audience agrees with the decision criteria, it can be very persuasive. It invites
the audience into the decision-making process.
Explain Why Something Happened:
Use the cause-effect pattern to explain how something occurred or to help predict the
consequences of an action:
yy Its easy to confuse cause and effect, so apply this pattern carefully. Cause is not always clear,
particularly when it involves a crisis.
yy Be careful not to simplify your conclusions or make them too optimistic with statements such
as, If only we had a training program for administrators, we wouldnt have such difficulty
getting decisions finalized in an emergency.
yy Be very careful not to speculate when using this approach.
Teach a New Concept or Process:
One way to teach a new concept is for the speaker to begin with something familiar or
already known by the listeners and move to the unknown or more complex. By using an
increased difficulty pattern, you can help your audience take in complex information in a
way they can accept.

Table 31. Types of Emergency Response Presentations
Type of Methods of Benefits

Presentation Organizing
Sharing New Direct Pattern: The main idea or Direct Pattern: This makes the main
Information conclusion is presented first, and then idea clear so the audience doesnt
When Facing developed with supporting information. assume certain expectations of solution
Little or or outcomes.
No Resistance Indirect Pattern: This approach builds
an argument with secondary concepts Indirect Pattern: This shows specific
and provides the most powerful examples or lines of reasoning that lead
argument at the end. audience to a particular conclusion.
Progress Reports Chronological Pattern: This shows Chronological Pattern: This helps the
and Instructions how several events developed over a listener follow progress points of where
period of time or offers step-by-step youve been and where youre going,
instructions. and makes it easier for the audience to
follow instructions.
Priority Order Pattern: This presents
the most significant point first with Priority Order Pattern: This is good
other developments following in for progress report presentations when
descending order of importance. there are time constraints or when youve
already given several progress reports.
Problem Solving Criteria-application Pattern: Criteria-application Pattern: This

Criteria or standards for evaluation are is persuasive because it highlights your
suggested first and then solutions or underlying reasoning (as long as the
choices are compared against criteria. audience agrees on decision criteria).
It also invites the audience into the
Criteria should describe the best decision-making process.
possible case and then explore
available options.
Explain Why Cause-effect Pattern: This explains Cause-effect Pattern: This is

Something how something occurred or helps persuasive, but be careful that
Happened predict the consequences of an action. conclusions arent too simple, too
optimistic, or based on speculation.
Teach a New Increasing Difficulty Pattern: Start Increased Difficulty Pattern: This
Concept with something known by the audience helps the audience take in complex
or Process and add more complex concepts. information in a way they can accept.

Presentational Dos and Donts
Speaker credibility is a key factor in holding audience attention and persuading them through your
message. The following are some dos and donts that can enhance your presentationas well as your
credibility.
Dress for success:
yy Do wear something that conveys professionalism and experience, such as a suit, uniform, or
lab coat. It should also be comfortable.
yy Dont wear costumes that reflect someone other than who you are and what you do. For
example, dont wear a white lab coat and stethoscope if you are not a clinician.
Be prepared:
yy Do know your presentation information.
yy Do know the room and the technology in the room.
yy Do anticipate potential questions ahead of time.
Keep the target audience in mind:
yy Do focus your presentation on whom you are trying to reach, such as the public, public health
officials, or government officials.
yy Do remember that reporters are there to help get your message to the public. They are not the
final or only audience.
Start the presentation well:
yy Do choose the right opening. The wrong opening words can destroy credibility.
yy Dont start by apologizing with statements like, Unaccustomed as I am to public speaking, or

Im here to bore you with a few more statistics.
yy Dont begin with something that may be considered offensive, like an off-color joke or a
sarcastic or ridiculing statement. Dont start with a gimmick like writing the word sex on
your presentation graphic.
yy Dont start with the same opening regardless of audience or situation, because the audience
will recognize a canned presentation.
yy Do get the audiences attention by introducing your subject, establishing your credibility, and
previewing your main ideas.
Use supporting visual aids:
yy Dont use visual aids that are distracting. They should support the information you are
presenting. Visual aids such as PowerPoint presentations should emphasize main points. They

may also help your audience understand complex or statistical information via
charts and tables.
yy Dont make visuals and text complex by using too many bullet points, text, fonts, or colors
that are difficult to read.
yy Dont have too much information crammed on a single screen.
yy Dont use images that are too graphic.
yy Dont use colors that traditionally show danger such as red or orange.
yy Dont use presentational gimmicks, such as distracting visual effects, for images when
discussing a crisis.
yy Do practice with presentation aids ahead of time. This is imperative. Your message is lost if
your audience is focused on why the next slide isnt working or why the video wont run.
Convey appropriate emotions:
yy Do convey calmness and confidence through posture, tone of voice, facial expressions, and
gestures. Because your audience will make emotional connections with you through your
delivery, your calm and confident nonverbal cues will help the audience remain calm and
confident in their own actions.
yy Dont fidget or smile while talking about a tragic situation. This can contradict what you are
saying.
yy Do use empathy to convey care and concern towards the public during your presentation.
Additional Considerations for Presentations Before, During, and After a Crisis

When the purpose of communication is to make a call to action or change behavior, it is important to be
aware of the target audience. Crises take a wide variety of forms. It is often hard to predict what issues
or factors might arise. Ask yourself questions like the following:
Who are they?
What do they believe now?
Are you a credible source of information for them?
These types of questions will help you build a successful presentation. In addition to knowing the
audience specifically, there are a number of points to keep in mind. This is especially true when
building a case for action. Some factors you as communicators should take into account when preparing
messages follow:
Audiences selectively receive and interpret messages based on their existing knowledge,
attitudes, beliefs, and current needs.

Listeners are more receptive to a message that is consistent with their attitudes and beliefs.
Messages phrased in terms of the listeners interests and needs are more successful than
those given from the speakers point of view. Using statements such as, Follow the rules
for safe generator use; help protect you and your family from carbon monoxide poisoning,
demonstrates a benefit for the audience.
Persons with high self-esteem are less readily influenced than those with low self-esteem.
Overtly hostile or excessively apathetic listeners are less likely to be influenced by your
messages.
Mental, verbal, or physical listener participation improves the chance that messages will
influence them. For example, you might say something like, Raise your hand if you have
planned an evacuation route.
Some audiences respond more to facts or logical appeals. Some respond more to emotional
appeals, and some are influenced primarily by the speakers credibility.
Group Influences on the Effects of Your Messages

Group influences are critical, especially during the uncertainty of a crisis. A persons intention to take
a particular action will depend both on his or her perception of consequences and on the perception of
others wishes. Health-care workers and physicians can be important sources of social influence, as can
family, community, and culture.
For someone to move to action, he or she must see a personal benefit to taking the action and believe
the action can be accomplished. Seeing or hearing that others are taking actions, such as getting a flu
shot, can be a powerful social influence. Consider the following points about your audience:
Listeners are often influenced by beliefs shared by those around them.12 Their tendency is to
conform.
Listeners may discount the speakers message if it is counter to the norms of the group. A
listeners tendency to accept that message is inversely related to the value he or she places on
group membership.
Audience members will be searching for nonverbal cues13 from other audience members to
confirm or refute the speakers message.
Some members of your audience may be influenced by seeing others take action. This is a
critical factor in some recommended emergency actions, such as evacuations.
Your audience may see that their behavior will involve a tradeoff between positive and negative
consequences. Your target population will be asking themselves many of these questions:
yy What will I gain if I accept this proposed behavior?
yy What will it cost me to do it?

yy What do those who are important to me want me to do?
yy What are other people around me doing?
yy Can I actually carry it out? Do I have the resources and capacity?
yy How can I confirm this information?
If answers to those questions are offered in a candid and satisfactory manner, the proposed action may
be more readily accepted. The more socially desirable and easily undertaken a recommended action is,
the more likely that it will be accepted.
Communicating About Death One-on-one

During a catastrophic event, where people are ill, dying, or in need of treatment, it might be your
job to talk with individuals about the current situation. A significant body of literature describes
the importance of expressing empathy and empowering decision making14,15 between the medical
professional and the patient in a medical-care setting. However, most of this work assumes the luxury of
time that usually does not exist in a crisis situation.
You may be recruited for the first time to educate patients or speak to groups during a crisis, even if you
do not have much experience with patient-professional dialogue.
In addition, if an evolving disease outbreak in a community begins to involve members of the response
teams or their families, supervisors and team leaders may find themselves engaged in supportive
conversations. The following are some basic thoughts about communication in an intimate but highly
emotional public health emergency situation:
Empathize with the person and their family:
yy People indulge in serious, intense, and meaningful communication only for short time periods.
yy Small talk can provide important hints about a persons concerns.
yy Privacy and confidentiality are important requirements. Ensure that all information shared will
be kept private, and find private spaces for these types of conversations.
yy Allow communication free from interruptions. Strong reactions such as crying shouldnt be
interrupted.
yy Do not to answer questions outside of your area of expertise. Get permission from the
individual to refer him or her to an expert.
yy Emergency-response personnel sometimes try to mask their emotions behind their

professional role. Professional counseling should be made available as soon as possible.

Listen carefully:
yy Place the speakers needs above your own.
yy Use open and accepting body language; do not cross your arms.
yy Always be honest in responding.
yy Do not interrupt to give advice.
yy Accept moments of silence.
yy Much communication is nonverbal, particularly during highly emotional times.
Be careful:
yy Think about the meaning of the words and the gestures.
yy Value judgments may hinder communication and understanding.
yy Teasing belittles the individual.
yy Assigning blame can cut off communication.
yy If a person tenses at your touch, withdraw.
Use personal messages:
yy Use the name of the person to whom you are talking in the conversation.
yy Ask a clarifying question like, Can you help me understand?
yy Allow the conversation to evolve. Accept silence and dont push a dialog where you hope it will
go, if it doesnt go there naturally.
yy Be sensitive to a persons nationality, ethnicity, religion, age, and emotional state.
yy When possible, use the words the person uses.
yy Self-disclosure may help the person expand on the topic.
yy When responding to someone, say youre crying instead of youre sad. This allows the
person opportunity to share the feeling behind the action.
yy How something is said is often more important than what is said.
When speaking to grieving family members :
yy Presence is often more important than conversation.
yy Family members may voice feelings with strong emotion such as I dont know how Im going
to live without my husband or Why would God allow this to happen?

yy Short statements of condolence, such as Im so sorry, This is a sad time, or Youre in my
prayers, are enough of a response.
yy Use death or dying, not softer words, as many people feel uncomfortable with statements
like expired or received his heavenly reward. Use the same words as the grieving person to
respect cultural differences.
yy Refrain from platitudes like, She lived a good life or She is no longer sufferingstatements
like that can trivialize the familys loss.
yy Avoid sharing your personal experiences of death and grief, so you can keep the focus on the
family member.
yy Be careful to avoid sending signals that you are distracted or need to do something else.
For example, dont glance at papers, your watch, the elevator, the clock, or others in a
conversation. Focus on the person, and speak gently, without haste.
yy Offer support, dont wait to be asked.
Audience Feedback
Feedback is a critical part of the communication process. It allows the sender to understand how
the message is received and how it is being interpreted. The sender then has the ability to adjust the
message and improve its effectiveness. Unfortunately, emergency and crisis conditions are usually not
conducive to effective feedback.
Pre-event planning is the time to develop the mechanisms you use to obtain and analyze feedback from
target populations. Understand how this information will be used in reassessing communication. When
you plan your feedback mechanisms, consider the following points:
Response operations should be planned. When they are, you will have straightforward methods
of obtaining feedback.
Listen to your target populations. Comments will be direct or through the media. In addition,
community leaders and advocates, congressional representatives, and lawyers will have their say.
Be sure there are open channels between the public and your organization. Solicit public
feedback.

Reality Check
In the heat of a public health emergency, public feedback can be too little or too much:
People in a disaster zone may not have any means of communicating with you.
Feedback can be so frequent as to overwhelm your operation. It may be impossible

to answer every person individually.
It is possible to employ an automated system that says were interested in what
you have to say and offers a place where frequently asked questions can be found.
Provide the public with toll-free public information lines, an e-mail address, and a U.S. postal address
for comments before and during an emergency. The more public outrage the event generates, the more
opportunities people will need to express themselves. These messages can be valuable to you as a
communicator. They will help you understand:
What questions need answers
What is most upsetting
Which items need further explanation
Which recommendations are not working
A member of the public may begin with a question during a phone call but end with a concern. Be sure
public response services can answer questions and detect trends in public comments. Its not just about
pushing information out; its also about receiving feedback.
Its possible that the questions from the public may provide clues as to what the media will soon be
asking. For example, immediately after the September 11, 2001, tragedy, CDC public response lines
were indicating topic trends from the public before information reached the media. The predictive value
of early feedback can help your communication team manage issues instead of simply reacting to them.
In addition to monitoring direct feedback, you can also get a feel for the publics responses to the
emergency through traditional and social media monitoring. If a rumor takes flight on the Internet, you
must know about it in order to respond. The media can reflect public reaction.
Use common content or trend analyses to compile a useful report for your public health emergency
leaders. Tell them quickly when your analysis shows that something is or is not working. You may not be
the most popular member of the team in this role, but its vital that the publics input is taken into account.

Message Template 31. Message Development for Emergency Communication
First, consider the following:

Audience Purpose of Message Method of Delivery
yy Relationship to event yy Give facts/update yy Print media release
yy Demographics yy Rally to action yy Web release
(age, language, yy Clarify event status yy Through spokesperson
education, culture) (TV or in-person appearance)
yy Address rumors
yy Level of outrage yy Radio
(based on risk principles) yy Satisfy media requests
yy Other
(e.g., recorded phone message)
Six emergency message components:

1. Expression of empathy
2. Clarifying facts/Call for action
Who
What
Where
When
Why
How
3. What we dont know:
4. Process to get answers:
5. Statement of commitment:
6. Referrals:
For more information
Next scheduled update

Finally, check your message for the following:
Positive action steps No jargon
Honest, open tone No judgmental phrases
Say we not I No humor
Careful with early promises No extreme speculation

(can you do it?)
Use simple words, short sentences
Apply CERC principles
Case Study:
Hurricane Katrina Emergency Communication Response
By CDC, U.S. Gulf Coast, 2005
(Extracted from Vanderford, Nastoff, Telfer, and Bonzo, 2007)3
One recent case where crisis communication principles were applied to public health was CDCs
response to Hurricane Katrina in 2005. This case study discusses the strategies and tactics used by
CDCs Emergency Communication System (ECS) during the Hurricane Katrina response and how they
were adapted to the situations. These strategies helped meet the challenges posed by the extended
nature of the disaster and by the failure of most electronic communication systems in the disaster zone.
Hurricane Katrina made landfall three times during August 2329, 2005, when it reached Louisiana. The
hurricane produced storm surges greater than any previously recorded. About 80% of New Orleans
485,000 residents were evacuated, and an estimated 1,220 deaths were blamed on the storm. Along the
Gulf Coast, about 1.7 million households in Alabama, Florida, Georgia, and Mississippi were without
power. In response to the extensive destruction and related public health threats, CDC deployed more
than 600 staff members to provide technical assistance in affected areas. Another 500 were deployed
to CDCs Emergency Operations Center to execute response plans, develop needed resources, provide
offsite leadership about potential health risks, and mitigate adverse health effects.
Along with providing science and medical professionals, CDC activated its ECS. The ECS included
health communication, education, and public affairs specialists. They provided a coherent
communications framework, coordinated surge capacity, and ensured that critical health protection
messages could be delivered to diverse audiences, including clinicians, affected communities, and state
and local public health officials, through multiple channels, including the Web, mass media outlets,
hotlines, and CDCs Health Alert Network.

Communication Activities and Challenges During Emergency Response
As Hurricane Katrina made landfall, creating flooding and power outages, CDCs communication
specialists were faced with three primary challenges: to distribute health and safety messages rapidly, to
adapt messages to diverse communities, and to address evolving needs for health information.
Challenge Number 1: Rapid Message Distribution

The speed with which an agency responds to the public can be a sign of how prepared they are. A fast
response accomplishes the following:
It builds credibility.
It lets the public know there is a system in place.
It reassures the public that appropriate actions are being taken.
For the response to Hurricane Katrina, power outages were more extensive and sustained than
in previous efforts. This prevented rapid distribution of health messages to the public and other
public health officials. In addition, CDCs dependence on electronic channels like websites, radio,
and television, severely hindered its ability to deliver health information. When CDC tried to deliver
printed copies of the information, delivery services and CDC trucks could not reach the area because of
impassable roads.
CDC turned to local, face-to-face channels for delivering health-protection messages. Thirty health
communication, health education, and public affairs specialists were sent to local and state health
departments in Louisiana, Mississippi, and Texas. The staff helped identify and fill information needs,
helped Atlanta-based staff develop and adapt needed health messages, and identified and used whatever
local communication channels were available. They also assisted local agencies by hand delivering
printed copies of health information to workers and affected communities.
CDC used emerging partnerships with organizations such as the American Red Cross, faith-based
organizations (FBOs), major home improvement retailers, and long-term shelters and evacuation
centers. FBOs were seen by the public as trusted sources of health information and were already
established in their communities. CDC sent health information to approximately 300 FBOs during the
response. In turn, the FBOs made CDC aware of available communication methods and delivered health
messages to underserved populations.
Challenge Number 2: Message Adaptation for Local Use

Despite developing health messages to reflect literacy levels and diverse cultural contexts prior to the
disaster, the Hurricane Katrina response revealed that substantially more adaptation was necessary. A
primary request was to rewrite messages for low-literate audiences. In addition, requests for primarily
visual messages or pictograms created a special challenge to maintain scientific accuracy of information

while persuading individuals in their current circumstance to use the information. For example,
chainsaw safety messages included wearing pants, boots, and long sleeves as well as buying ear and eye
protective gear. However, these recommendations were not accepted. They were ignored in the hot,
humid Gulf Coast or were seen as too expensive.
In response to this problem, ECS created easy-to-read versions for low-literate audiences on topics
ranging from mold cleanup to hand sanitation. CDC also created a set of cards similar to playing cards
that contained simple prevention messages. The cards were later adapted for Hispanic-American and
Vietnamese-American evacuees. In addition, text was translated to pictures, and some pictures were
simplified to line drawings or pictograms that used international symbols. Graphic artists worked with
ECS for 10 days to develop these pictograms. They included accurate, credible information that was
also easy to understand and culturally appropriate.
CDC also adapted public health messages to increase the credibility of the information. Many Gulf Coast
residents blamed the federal government for the slow and inadequate response to the storm. Some
state and local agencies thought local residents would not find health information from federal agencies
credible. To overcome this opinion and relay CDCs health protection messages, CDC helped state and
local agencies replace the CDC logo with logos of local agencies.
Challenge Number 3: Extended Emergency Response

Most emergency communication plans treat the crisis response stage as one unified stage needing
a single set of health information messages. In an extended emergency, however, it may cause you
problems if you overlook the multiple, distinct phases that represent the response stage.
The emergency response stage of Hurricane Katrina lasted for more than a month. Early in a response,
primary needs include the following:
Accessing clean water
Acquiring shelter
Maintaining personal safety and security
Until those primary needs were met, providing information on topics such as chainsaw injury
prevention, stress management, and mold cleanup was not practical.
CDC soon discovered that new health information needs became known and evolved as the crisis
response focus changed. For example, health information was initially needed to protect people from
storm winds and falling debris. Later, information was needed to prevent drowning, avoid driving in
flood waters, protect against electrical hazards, and prevent carbon monoxide poisoning. As evacuees
packed evacuation centers, other health information needs emerged such as promoting hygiene,
controlling infection, managing stress, and managing chronic diseases.

Lessons Learned by CDCs Communication Staff
Katrina demonstrated many challenges to effective health information in the aftermath of a large-scale
natural disaster. These included how to develop low-technology delivery systems for public health
and safety information, how to create systems for easier and faster adaptation of hurricane-related
messages, and how to release disaster-related health information in phases, particularly in an extended
emergency.
Improving Low-tech Information Delivery: Local organizations are essential links between
residents at disaster and recovery sites, and federal agencies trying to distribute health
protection information.
CDC continues to solidify and formalize partnerships with local groups encountered in the
later stages of Katrina, including the American Red Cross, Salvation Army, home improvement
retailers, and FBOs. This includes increasing CDCs understanding of these groups needs and
interests by developing relationships before an emergency occurs.
Developing Systems for Faster Adaptation: CDC continues to develop automated systems
to quickly and easily tailor materials. These systems include the following:
yy Key documents that allow images, including logos, to be inserted and deleted easily
yy An image library with visual elements that are appealing to different audience segments
yy Versions reflecting different literacy levels
yy Versions with and without CDC and HHS logos
The system allows for new versions of critical messages to be created quickly while maintaining
consistent messaging. Although power outages may prevent health departments from accessing
the system, CDC staff members in Atlanta can meet adaptation needs of local communities
more quickly. In addition, CDC provides multiple versions of the same messages identified by
the following:
yy Literacy level
yy Audience
Clinicians News media

Public Emergency responders
Public health workforce

yy Context
Schools Source
Clinics With CDC logos
Evacuation centers Without CDC logos
These multiple versions are offered to provide an enhanced library of health messages to
meet local needs.
Releasing Messages in Multiple Phases During Crisis Response:
Based on reviews of communication during Hurricane Katrina, CDC has developed a

multiphased approach (see Table 32) to emergency response for extended disasters relating to
hurricanes and flooding. The following list provides an example of a multiple-phased approach.
yy The period immediately preceding the storm through the first 24 hours after the storm
yy 13 days after the storm
yy 37 days after the storm
yy 24 weeks after the storm
yy 1 month and longer after the storm
You can use monitoring and analysis during a disaster to determine whether messages distributed
in early phases need to be reissued later. This may be done to address persistent health threats or
previously ineffective or unevenly distributed health information.
The phased approach to disaster planning can help communication responders deliver health
information to meet immediate needs and forecast long-term needs at the same time.

Table 32. Phased Message Dissemination for Hurricanes and Floods*
(Extracted from Vanderford, et al. 2007, p. 21, with modification)
Period of Topics
dissemination
Immediately preceding Hurricane readiness, preparations for power outages, preparation related
landfall through first 24 to prescription medications, evacuating the area of a hurricane, staying
hours after the storm safe in your home during a hurricane, worker safety in a power outage,
CO poisoning prevention, flood readiness, electrical safety, prevention of
heat-related illnesses, hand hygiene in emergency situations, coping with
traumatic events, emergency wound care, protecting your pets, animals
in public evacuation centers
13 days after the storm Re-entering your flooded home, how to clean a flooded home safely,
worker safety after a flood, preventing chainsaw injuries during tree
removal, preventing injuries from falls (ladders/ roofs), personal protective
equipment and clothing for flood response, managing acute diarrhea after a
natural disaster, cleaning and sanitation after an emergency, keeping food
and water safe after a natural disaster or power outage
37 days after the storm Protection from animal- and insect-related hazards, electrical safety and
generators, infection control and prevention in evacuation centers, impact
of power outages on vaccine storage and other medicines, preventing
violence after a natural disaster, animal disposal after a disaster
14 weeks after the storm Rodent control after hurricanes and floods, trench foot or immersion
foot, environmental health needs and habitability assessments, protection
from chemicals released during a natural disaster, respiratory protection
for residents re-entering previously flooded areas and homes
One month and longer Suicide prevention, issues surrounding school-age hurricane evacuees
after the storm (emphasis attending new schools, mold removal from flooded homes, mold allergies
is on long-term health related to flood cleanup
consequences)
*This table represents anticipated periods of dissemination; however, the actual periods will vary
depending on location, climate, time of year, and other factors.

Summary of case study
Hurricane Katrina was a reminder of the impossibility of completely preparing for disasters.
Communication during a crisis is dynamic and creates needs to adapt systems, procedures, channels,
and messages. Each disaster is unique, and while basic principles of effectiveCERC can be expected to
operate in most crisis contexts, flexibility and innovation should be included in the CERC toolkit.
Conclusion
Communication is a dynamic process involving many elements. Understanding the audience as the
primary message target is critical to effective communication. Audience analysis and feedback allow
the message to be adapted to fit audience needs, interests, cultures, and values. Many audiences will
be associated with most crises. Plans should be developed to reach them all. Important principles of
message design, along with audience analysis and feedback, will help you develop effective messages.

References
1. Trope Y, Liberman N. Construal-level theory of psychological distance. Psychol Rev 2010 Apr;117(2):44063.
2. Cole G, Sokler L. CDCynergy. Emergency risk communication (ERC) edition. CDC. Office of Communication
[online]. 2004. [cited 2012 May]. Available from: http://www.orau.gov/cdcynergy/erc/Content/
activeinformation/essential_principles/EP-psychology_content.htm#vicarious.
3. Vanderford ML, Nastoff T, Telfer JL, Bonzo SE. Emergency communication challenges in response to
Hurricane Katrina: lessons from the Centers for Disease Control and Prevention. J Appl Commun Res,
2007 Feb;35(1): 925.
4. CDC. Public health response to Hurricanes Katrina and RitaLouisiana, 2005. MMWR 2006 Jan; 55(02):
2930. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5502a1.htm.
5. Berg R. Food safety in the dark. J Environ Health. 2004 JanFeb;66(6):5560.
6. Nye DE. When the lights went out: a history of blackouts in America. Cambridge(MA): MIT Press; 2010.
7. Troops enter New Orleans bringing relief; Laura Bush speaks in Louisiana [online transcript] CNN.com.
September 2, 2005. [cited 2012 May]. Available from URL:
http://transcripts.cnn.com/TRANSCRIPTS/0509/02/lol.02.html.
8. CNNs Kyra Phillips talks to Lt. Gen. Russel Honor about the military effort to restore the chaos in New
Orleans [online transcript]. CNN.com. September 2, 2005. [cited 2012 May]. Available from URL:
http://www.american-buddha.com/katrina.cnnkyraphilipsgenruselhonore.htm.
9. Purnell LD. Transcultural diversity and health care. In: Purnell LD, Paulanka BJ, editors. Transcultural health
care: a culturally competent approach. 3rd ed. Philadelphia (PA): FA Davis; 2008. p. 510.
10. Bureau of the Census. Language use in the United States: 2007. Table 3A. Detailed languages spoken at
home by English-speaking ability for the population 5 years and older: 2007 [online]. 2007. [cited 2012 May].
Available from URL: http://www.census.gov/hhes/socdemo/language/data/acs/appendix.html.
11. de Zwart O, Veldhuijzen IK, Elam G, Aro AR, Abraham T, Bishop GD, et al. Perceived threat, risk perception,
and efficacy beliefs related to SARS and other (emerging) infectious diseases: results of an international
survey. Int J Behav Med 2009 Jan 6;16:3040. [online ]. [cited 2012 May]. Available from URL:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2691522/.
12. U.S. Department of Health and Human Services. Risk communications during a terrorist attack or other
public health emergency. Terrorism and other public health emergencies. A guide for media [online] 2005
Sep. [cited 2012 May]. Available from URL:
www.phe.gov/emergency/communication/guides/media/Documents/11.pdf.
13. Jonassen DH, Land SM., editors. Theoretical foundations of learning environments. Mahwah (NJ): Lawrence
Erlbaum Associates; 2000.
14. Verlinde E, De Laender N, De Maesschalck S, Deveugele M, Willems S. The social gradient in doctor-patient
communication. Int J Equity Health 2012 May;11:12. doi:10.1186/1475-9276-11-12 [online]. [cited 2012 May].
Available from URL: http://www.equityhealthj.com/content/pdf/1475-9276-11-12.pdf.
15. The Joint Commission. Advancing effective communication, cultural competence, and patient- and family-
centered care: a roadmap for hospitals Oakbrook Terrace (IL): The Joint Commission, 2010.

Resources
Andreasen AR. Marketing social change: Changing behavior to promote health, social development, and the
environment. San Francisco (CA): Jossey-Bass; 1995.
Bormann EG. Discussion and group methods: theory and practice. 2nd ed. New York (NY): Harper and Row;
1975.
Butler BA, Rutherford RM, Snyder MA, Luckett D. When bad news is good news. U.S. Department of Defense
joint course in communication. Department of Communication, University of Oklahoma [online]. 1998. [cited
2012 May]. Available from URL: http://www.ou.edu/deptcomm/dodjcc/groups/98D2/abstract.html.
Cohn V. Reporting on risk: getting it right in an age of risk. Washington (DC): The Media Institute;1990.
Cooper L, translator. The rhetoric of Aristotle. Englewood Cliffs (NJ): Prentice Hall; 1932.
Federal Emergency Management Agency. Effective communication. Independent study: 242.a. May 2010
[online]. 2010 May. [cited 2012 May]. Available from: URL: http://training.fema.gov/EMIWeb/IS/IS242A.pdf.
Fischer HW. Response to disaster. Lanham (MD): University Press; 1998.
Graeff JA, Elder JP, Booth EM. Communication for health and behavior change: a developing country
perspective of America. San Francisco (CA): Jossey-Bass Publishers; 1993.
McCroskey JC, Young TJ. Ethos and credibility: The construct and its measurement after three decades.
Central States Speech Journal, 1981 Spring;32: 2434.
Shewe CD, Smith RM. Marketing concepts and applications. New York (NY): McGraw-Hill; 1983.
Tracy L. Muddy waters: The Legacy of Katrina and Rita. Washington (DC): American Public Health
Association; 2007.
U.S. Department of Health and Human Services. Federal Occupational Health. A LifeCare guide to helping
others cope with grief. [online] 2001. [cited 2012 May]. Available from URL: http://www.foh.dhhs.gov/NYCU/
copingtips.pdf.

Notes:

Chapter 4:
Crisis Communication Plans
2014 EDITION

Chapter 4:
Crisis Communication Plans
This chapter will promote understanding in the following areas:
Crisis phases
A seat at the table for communication
Developing the plan
Applying the plan during the first 2448 hours
Applying the crisis plan throughout the response
Planning is probably the most important step that ensures effective actions. While a plan cannot
guarantee successful management, it can create a template and process for initial actions and
decisions. The process of planning may be more important than the resulting plans themselves, as
the relationships and trust built during the process become invaluable in a crisis situation.
Crisis Phases
Understanding the pattern of a crisis can help you, as a communicator, anticipate problems
and respond effectively. While every crisis is unique and develops in its own way, these
generalized patterns have been shown to be part of most events. By dividing the crisis into phases,
communicators can anticipate the information needs of the media, stakeholders, and the general
public. Therefore, your communication efforts must evolve. Each of the following phases has its
own unique informational requirements.
Progression through each of the phases will vary according to the following:
The event that triggered or initiated the crisis
Level of harm
Adequacy of the response, including the level of community resilience
The intensity and longevity of the crisis, which will impact required resources and manpower
In the following sections, each of the stages is discussed along with the associated
communication requirements.
85
Pre-crisis phase
The communication objectives during the pre-crisis phase include the following:
Plan and prepare.
Foster alliances with stakeholders.
Develop consensus recommendations.
Develop systems and redundancies such as hotlines, joint information centers (JICs), and
websites.
Test messages.
The pre-crisis phase is where the most important planning work should be done. While pre-crisis
planning and preparation will not ensure successful crisis management, the lack of it puts your
organization at an extreme disadvantage.
Crises develop over time. This is especially true if there have been years of poor planning and lack of
preparation, which would worsen a crisis when it occurs. For example, a lack of preparation for a severe
drought could lead to mass famine when a drought actually happens.
The pre-crisis phase may last for years. If handled properly, this phase involves proactive planning with
stakeholders to anticipate and prepare for crises. When a crisis happens, it may involve a naturally
developing threat, a manmade catastrophe, or an interaction of the two. For example, the Japanese
crisis of 2011 involved an earthquake and a subsequent tsunami interacting with human developments
and coastal communities, and severe damage at a nuclear power plant.
The types of crises that your organization is likely to encounter are somewhat predictable based on
history, location, and other risk factors. Once an assessment identifies the most likely crises, its easier
to begin planning. You might anticipate crises such as floods, fires, infectious disease outbreaks, and
chemical spills. You can then anticipate reasonable questions for various crises and draft preliminary
answers.
You can draft initial communication strategies and messages with blanks to be filled in if a crisis occurs:
Identify spokespersons, resources, and resource mechanisms.
Develop training and refine plans and messages.
86 Chapter 4 Crisis Communication Plans

Foster alliances and partnerships to ensure that officials and experts speak with one voice and
that resources are available and shared.
Consider conducting an emergency public health communication needs assessment to clarify
what needs to be done (see Checklist 45. Needs Assessment for Crisis and Emergency Risk
Communication at the end of this chapter).
Several checklists and worksheets are presented along with a detailed discussion of crisis planning at
the end of this chapter. These may be useful in your pre-crisis planning.
Be sure to develop a plan during the pre-crisis phase. This is the biggest step you can take during this
phase for improving your crisis communication.
Initial Phase
The initial phase of a crisis can be characterized by confusion, uncertainty, and intense media interest.
Information is usually incomplete and the facts scattered. It is important to recognize that information
from the public, the media, other organizations, and from within your organization may not be accurate.
Situational awareness is at a premium.
Information will come to you from a variety of sources, some credible and some not. New information-
sharing technologies deserve special consideration. Todays technology allows people to immediately
provide updates and post information on social media sites. Some of this information may be useful for
personnel working in an emergency operation center. At the same time, some of this information may be
misleading. High volume or overloads of communication systems like phone systems, internal computer
servers, and Internet servers can also be problematic.
The federal government helps to provide up-to-date situational awareness for local, state, and federal
public health officials via CDCs Health Alert Network, often referred to as CDC HAN.1 Urgent health-
related messages are sent in real time to public health and safety agencies in affected areas. State
health departments may then send these messages to local health departments, police and fire
departments, clinicians, and other personnel whose job it is to protect the public during emergencies,
natural disasters, outbreaks, and other health threats. After they are shared with public health officials,
CDC HAN messages are also shared with the public.
Chapter 4 Crisis Communication Plans 87

A critical part of the communicators role is to manage the following:
Collect information about what happened.
Interpret and separate the factual information from rumors.
Determine the communication response.
Coordinate with other response groups and agencies.
Verify the magnitude of the event as quickly as possible.
Decisions in the initial phase have critical implications. There are few second chances to get
communications right during this phase of a crisis. Organizational reputations are at stake. But its
important to recognize that agencies may be forced to communicate even when they do not have
all the facts.
Emergency managers use the axiom all disasters are local to emphasize that crises happen in a specific
place and affect a specific community or group of communities. In most cases, communities will need to
manage the crisis during this phase using local resources. This includes community organizations and
groups, local businesses, faith-based groups, and neighbors. Typically, a community should expect to be
largely on its own for the first 72 hours.
Communication objectives during this phase will require that you as the communicator:
Acknowledge the event with empathy.
Explain to and inform the public in simple and clear terms about their risk.
Establish organization and spokesperson credibility.
Provide emergency courses of action, including how and where to get more information.
Coordinate messages with other organizations and agencies.
Commit to stakeholders and the public to continue communication and remain accessible.
When communicating in the initial phase of an emergency, it is important to present information that is
simple, credible, accurate, consistent, and delivered on time.
This is the time to establish your organization as credible. A crisis creates high uncertainty. You can
reduce public anxiety by providing useful information about the nature of the problem and what the
public can do about it. Even when there is little information to offer, you can share how the organization
is investigating the event and when more information will be available. At the very least, messages
should demonstrate that the organization is addressing issues head-on. This means that its approach is
reasonable, caring, and timely, and that it is responsive to the publics need for information.

At the same time, the pressure to release information
prematurely can be intense. In most cases, all information must
be cleared by the appropriate leaders or designated clearance Crisis is a high uncertainty event
personnel before its offered to the media. and agencies will not be able
to quickly verify all the facts.
In the initial phase of a crisis or emergency, the public wants Organizations reputations are
information about the situation immediately, including who,
on the line, however, and getting
what, where, when, and why:
information right is critical.
Provide timely and accurate facts, including where the
crisis occurred.
Say what is being done now.
Give credible answers regarding the magnitude of the crisis, including possible
threats to the public.
Share the possible duration of the crisis.
Explain as much as you can about who will fix the problem, and when.
Communicators should be prepared to answer questions like these quickly, accurately, and as
fully as possible.
Communicators should avoid overstating what is known or over-reassuring. The public can recognize
wildly optimistic statements. Such statements will reduce credibility. It is more appropriate to offer
qualifications such as, Based on what we currently know or The situation is still evolving. During the
SARS outbreak of 2003, Dr. Julie Gerberding, then CDC Director, noted:2
There were a lot of times during SARS where we were trying to balance being first,
being credible, and being right. And we at CDC made the conscious decision that our
credibility was the most important thing. And so that honesty of we dont know, were sorry
we dont know, we feel terrible we dont know and that were all in this predicament, is
a much better message than trying to pretend that you know something when you dont or
try to reassure people when there really is no foundation for the reassurance.
Often the most honest and credible response is to acknowledge that, This is an evolving emergency,
and we simply do not have all the answers. As soon as we have them, we will inform you. This is what
we know now.

Maintenance Phase
The maintenance phase generally begins when most or all of the direct harm is contained, and the
intensity of the crisis begins to subside. As one crisis communicator commented, You know you
have reached the maintenance phase when you get to go home and take a shower. Communication
objectives during this phase include the following:
Help the public more accurately understand its own risks.
Provide background and encompassing information to those who need it. Work to answer
questions such as the following:
yy How could this happen?
yy Has this happened before?
yy How can we keep this from happening again?
yy Will I be all right in the long termwill I recover?
Generate understanding and support for response and recovery plans.
Listen to stakeholder and audience feedback and correct any misinformation.
Explain emergency recommendations.
Empower risk/benefit decision making.
As the crisis evolves, anticipate sustained media interest and scrutiny. Unexpected developments,
rumors, or misinformation may place further demands on your organizations communicators. Experts,
professionals, and others not associated with the response organization will comment publicly on the
issue and sometimes contradict or misinterpret your messages. You are likely to be criticized about your
handling of the situation. Resist becoming defensive. Plan to respond with information and explanations.
Staying on top of the information flow and maintaining close coordination with other agencies and
spokespersons is essential. Processes for tracking communication activities become increasingly
important as the workload increases. Tracking can be done electronically or with paper forms. For
example, several crisis-response agencies have been utilizing commercially available collaboration
software to track response tasks and agency incident reports. This allows all emergency response
personnel to see the larger picture without duplicating services.
The crisis maintenance phase also includes an ongoing assessment of the event and continued allocation
of resources for the response.

Resolution Phase
The maintenance phase and the resolution phase often blend into one another as the crisis continues to
wind down. It is important to acknowledge the resolution phase may take considerable time as details of
the event and especially responsibility and blame are addressed. CERC objectives for this phase include:
Improve appropriate public response for future similar emergencies through education.
Honestly examine problems and mishaps, and then reinforce what worked and address what
didnt work in the recovery and response efforts.
Persuade the public to support public policy and resource allocation to the problem.
Promote the activities and capabilities of the organization. Help reinforce the identity of your
organization as capable and responsive.
As the crisis resolves, there is a return to some form of normality. Often, this is a new normal, which
includes an increased understanding of risks and new ways to avoid them. While in some cases complete
recovery takes years, in the resolution phase, most of the recovery systems are in place. This phase is
also characterized by a reduction in public and media interest.
Once the crisis is resolved, you may need to respond to intense media scrutiny about how the event was
handled. This may include an opportunity to reinforce public health messages while issues are current.
Your organization may need to initiate a public education campaign or make changes to your website.
Research shows that a community is responsive to risk avoidance and mitigation education directly after
a crisis has occurred.3,4
Evaluation Phase
When the crisis is over, it is important to evaluate the performance of the communication plan,
document lessons learned, and determine specific actions to improve crisis systems or the crisis plan. A
crisis is a very important learning opportunity. Failure to learn the lessons from it increases the chance
of a failed response in the future. It is easy for us to focus on the level of tactics and implementation and
not consider our overall communication strategy. When the crisis is over:

Evaluate responses, including communication effectiveness.
Document and communicate lessons learnedwhat worked and where were the challenges?
Determine specific actions to improve crisis communication and crisis response capability.
Create linkages to pre-crisis activities.
A Seat at the Table for Communication

A critical element in your communication plan is integration with the overall emergency response plans
for your organization. A media and public information plan that seems perfect but cant be executed
because of resistance or lack of understanding by leadership is a failed plan. It is very important that
the communication perspective be represented when key crisis decisions are made. In some situations,
communications may be the only tool an organization may have in the early phases of a crisis.
Treating the communication function as a secondary concern, or worse, just as the way to convey
decisions, often leads to blunders. Communication needs a permanent seat at the table where key crisis
response decisions are made. There are many important reasons why this is true:
Communication has been recognized as a core emergency response function by the Department
of Health and Human Services and the Department of Homeland Security.5
Dramatic cases of failed or ineffective communication have made crises much worse. Examples
of this include the following:
yy Hurricane Katrina in 20056
yy The attacks of September 11, 20017,8
An effective response plan requires communication. Even the best, well-informed, and creative
decision will not work if it is not effectively communicated.
A decision may appear to be effective based on sound science until someone considers
how the decision could be perceived by the public and the barriers to effectively
communicating the decision.
Helping ensure that communication is a key emergency function involves several activities:
Make sure that everyone on the communication staff is an ambassador of communication.

They should take every opportunity to promote the value of communication efforts to others
in the organization. Every department of the organization involved in emergency planning and
response should know the communication staff.
Meet with planners and ask them how they think better communication with the public,
partners, and stakeholders would help accomplish their mission.

Engage leaders with straightforward objectives for communication in a crisis.
Explain that communications in an emergency is more than public safety radios or television
interviews. It involves dynamic two-way exchanges with stakeholders through many channels,
including the Web and the media.
Explain to leadership how the overall response and recovery operation benefits through an
investment in public information activities.
An earthquake and a tsunami

In 2011, a 9.0 magnitude earthquake and resulting tsunami in Japan caused tens of thousands
of deaths. Communications surrounding the subsequent nuclear power plant incident have
been criticized, but communications and preparedness for the earthquake and tsunami
have been regarded positively. Many experts and reporters cited Japans culture of disaster
preparedness as preventing much higher causalities than, for example, the estimated 200,000
killed in the 2010 Haiti earthquake and 230,000 who died in the 2004 Indian Ocean tsunami.
After the Japanese government was criticized for its slow response to the Kobe earthquake
of 1995, Japan spent billions of dollars in strengthening buildings, developing early warning
disaster and communication systems, and continually educating and drilling the public on what
to do in case of an earthquake or tsunami.
Disaster supplies such as reflector blankets, collapsible water containers, and hand-cranked
cell phones are easily found in Japanese convenience and department stores. Neighborhoods
are organized with water storage facilities. Parks, shrines, and temples are designated as
congregation points in case of disaster. Most schools and offices keep helmets and first-aid
kits handy. Disaster training begins early and Disaster Preparation Day is observed every year.
This day commemorates those killed in previous quakes and reminds people that another big
earthquake is always possible.9,10
When the 2011 Japan earthquake and tsunami occurred, the worlds most
sophisticated early warning system for earthquakes was credited with giving most industrial,
energy, and transport operators vital time to shut down. It also alerted residents through
the media and mobile networks that a quake was imminent. Television channels immediately
switched from normal programming to live coverage of the aftermath. The names of the
affected areas flashed on the screen, along with details of the quakes intensity in each area.
A map of Japan showing coastal areas subject to tsunami warnings was a constant presence in
the corner of the screen.10 Japans massive public education program could, in the end, have
saved the most lives, said Rich Eisner, a retired tsunami preparedness expert. Matthew Francis
of URS Corporation and a member of the civil engineering societys tsunami subcommittee also
said that education may have been the critical factor. For a trained population, a matter of 5
or 10 minutes is all you may need to get to high ground, Francis said.11

When communication professionals have a seat at the decision-making table,
they can provide the following:
Customer and audience focus:
yy Represent the perspective of diverse audiences and stakeholders.
yy Empower local decision making.
yy Provide feedback to responders.
yy Represent fair and responsible resource allocation.
yy Advocate for a return to well-being and normality.
Organizational focus:
yy Coordinate and facilitate response and recovery efforts.
yy Build consensus and consistency of messages.
yy Generate support for crisis management plans and activities.
yy Clarify communication obligation and processes.
yy Avoid misallocation of limited resources.
yy Acquire and present critical information and facts.
yy Reduce and respond to rumors.
Process understanding and longer-term thinking:
yy Represent the competing demands and interests in decisions.
yy Provide considerations of longer-term implications and needs.
yy Avoid statements and decisions that limit future flexibility.
yy Understand the need for multiple partners and perspectives in a response.
The role of communication with emergency operations center (EOC) planners and leaders should be
explored and discussed in advance. Events such as Hurricane Katrina7 and the Red River floods in North
Dakota12 provide powerful examples of how communication can help drive decisions made by policy
makers. Participation, education, and credible execution during planning phases can ensure a seat for
communication experts at the table during a crisis.

Developing the Plan
Your crisis communication plan should be developed with realistic expectations in mind and take into
account the possibility of a worst-case scenario. Crisis researchers often describe fantasy planning
assumptions, such as calm seas for several days following an oil spill, or that all members of a
community will have access to personal transportation for evacuation.13 At the same time, worst-case
scenarios can sometimes be so overwhelming that planning seems impossible.
Your communication plan should be fully integrated into the overall emergency-response plan for your
organization. It should also be included in your local, state, or national response plan. A true public
health emergency will involve a number of agencies and departments, and an effective plan will reflect
that coordination. An important benefit is the opportunity to mobilize shared resources, such as a
unified website used by all agencies that connects to individual websites and telephone hotlines.
Knowing what to include

At a minimum, the following elements should be part of your communication plan:
Signed endorsement from senior leadership, such as directors and senior managers
Designated responsibilities for public information teams
Internal information verification and expedited clearance procedures
Agreements on information-release authorities (who releases what, when, and how)
Regional and local media contact lists, including after-hours news desks
Procedures to coordinate with public health organization response teams, including procedures
for developing a JIC
Designated spokespersons for public health issues and third-party validators in an emergency
Emergency response team members after-hours contact numbers
Contact lists for emergency response information partners:
yy Governors public affairs officer
yy Local FBI public information (special agent in charge)
yy Local or regional agricultural department or veterinarian public information officers (PIOs)
yy Red Cross, and other nongovernmental organizations
Agreements and procedures to join the JIC within the EOC, if activated
Procedures to secure needed resources such as space, equipment, and personnel, to operate
the public information and media operation during a public health emergency 24-hours-a-day,
7-days-a-week, if needed

Information dissemination methods that can be used to communicate to the public,
stakeholders, and partners during a crisis include the following:
yy Websites
yy Social media channels, such as Twitter feeds
yy E-mail lists
yy Listservs
yy Broadcast fax
yy Door-to-door leaflets
yy Press releases
Lists of likely or key stakeholders, ways to reach them, with demographic and
background descriptions
Plan Characteristics
Your plan is not a step-by-step or how-to document. It provides
a basic, general structure that can be adapted to emergency More than anything, your crisis
response situations. It should not be overly long detailed. It communication plan is a resource
should, however, address all of the roles, lines of responsibility,
of information, the go to place for
and resources you can reasonably expect to encounter
as you provide information to the public, media, and partners must have information.
during a public health emergency. It should be designed to assist
with the immediate decisions, providing you time to assemble
facts and plan responses.
More than anything, your crisis communication plan is a focused, accessible resource that provides
must-have information. Many communication professionals keep media contacts in their cell phones or
on their laptops. Often, this information is disorganized and incomplete. Part of the planning process
involves updating and organizing this information.
The single most important communication responsibility

The single most important
that can be assigned to someone in the organization is the duty
to keep the plan current. Update the plan regularly, usually communication responsibility that
annually. Schedule the review; dont just wait for a certain can be assigned to someone in the
number of changes to occur. When updates are neglected, the organization is the duty to keep
plan is outdated as soon as it is pulled off the shelf. the plan current.

Longer is not better.
The plan does not have to spell out every required task. It must be the reference that will keep
everyone on track and enable staff to complete tasks quickly. Emergencies are chaotic enough
without the disorganization of an office that has a poor plan or none at all. A crisis is not the time to
build lines of authority and relationships with response partners. Too often, the initial confusion and
conflicting messages that can cripple an organizations credibility come from a lack of clear roles and
responsibilities, and poorly defined lines of authority.
Dont discount the other important benefits of planning, they may be as important as the actual plan:
Collecting information
Working through decisions
Building relationships and teams
Assessing risks
Considering various scenarios and contingencies
Seeking consensus
Use a committee to write the plan. Choose this committee carefully so that all topics covered in the
plan are represented by people who are knowledgeable on those topics. Meet regularly throughout the
planning process and after the plan is complete. As new risks emerge or other organizations experience
crises, have the team meet to discuss the implications for the plan.
When leadership changes, as this often occurs during a response, bring them into the planning process
by asking them to review the plan and make suggestions. Some researchers point out that crisis
planning is an ongoing process14,15 that is never actually completed because risks, resources, and people
are always changing.
Reality Check
Dont be surprised if agreements made in the sunshine of business-as-usual are
suddenly changed during the bleak realities of a crisis.
Keep the plan simple and remain flexible.
Get done whats in your control.
Try to move your important public health messages forward in a way that reaches
the public and partners as quickly and accurately as possible.

Nine Steps for Success
Planning ahead does not eliminate risk. Its purpose is to make the most efficient use of time and
resources. The value of planning should not be judged by the accuracy of its predictions, but by whether
it helps optimize results in a changing environment.16
The following nine steps will be helpful during your planning phase:
1. Obtain signed endorsements from senior leadership: Senior leadership, such as directors
and senior managers, must support the need for the crisis-planning process. Make certain they
know the following:
The process has been thought through
The response planning is coordinated
They have an important role in the plans ownership
A couple of paragraphs endorsing the plan are sufficient. Senior management should sign and date the
plan. They should sign and date it again, when it is updated. A sample introduction for a CDC crisis
communication plan follows:
CDC comes together during a crisis to help protect the health and safety of Americans. We also need to
calm public fears during a crisis by communicating credible information and by promoting appropriate
health actions.
Experts agree that most crises take an organization by surprise.17,18 Appropriate and timely
communication allows CDC to work effectively with partners, engender public trust in its scientifically
based health recommendations, and perform its public health mission.
Crisis communication planning helps CDC deal effectively with those unexpected crises or emergencies.
This framework of action incorporates the ethical, professional, and guiding principles needed by CDC
during a crisis to communicate to the media and public with confidence and credibility. We cannot
predict or always avoid future crises, but we can do our part to be prepared.
2. Designate responsibilities for the media, public, social media, and partner
information teams: Decide who is in charge of the release of information to the public, including
the media and partners. This information keeps partners and the public updated on the process,
response outcomes, and any public health recommendations. It is also the information needed to
respond to the public and partners based on their feedback. Whether individuals or teams of people
attend to these tasks, its important that they understand their responsibilities in advance.
If your organization is incapable of meeting the likely media, social media, partner, and public
information needs during a public health emergency internally, ensure that the plan identifies where

this response support will reside. This may include a role as part of a citys or states EOC. It is your
responsibility to ensure that appropriate public health information is reaching the public and partners
through the various available channels. Given the diversity of audiences and range of channels,
this is critical.
Staff responsibilities can be defined through the National Incident Management System (NIMS).19 It
provides a structure for the coordinated response, including four core functions:
Information gathering
Information dissemination
Operations support
Liaisons
You should include NIMS staff designations in your crisis communication plan. This will provide a clear
means of determining staff responsibilities. Because NIMS is widely used, partner organizations and the
media will recognize and understand the staff roles.
For further information on using NIMS as part of your communication plan, please see the NIMS
subsection after this list for a discussion of communication activities in NIMS.
3. Information verification and clearance procedures: One core function of crisis

communication is information clearance. Does your plan specify who absolutely must review a new
piece of information before its released from the organization or before its incorporated into an
overall release from a higher authority? Crisis communication involves a fundamental tension
between two elements:
The need to ensure that information is confirmed to be accurate through a clearance process
The need to ensure that information is communicated quickly
Important clearance-related guidelines include the following:
Release accurate information quickly. If you dont, your

organization may publicly fall flat on its face. Use the
following approaches:
Release accurate information
quickly. If you dont, your
yy Prioritize information as need to know versus
organization may publicly fall
want to know and get moving on what must be
flat on its face.
answered first.
yy If an answer to a need to know question has not

yet been formulated, give the media and the public
information about your process or system for getting that answer.

Have three people clear a document before its released from the organization:
yy The communication director responsible for your organizations reputation
yy The policy director who is responsible for ensuring that the information does not counter
organization policy
yy A subject matter expert (SME) who is both fast and knowledgeable
Keep the legal department out of the clearance process unless the subject has
specific legal implications.
If appropriate, you may have others review and comment on the document, but not
delay its release.
Follow your organizations protocol to receive clearance from higher authorities.
Ensure that response partners know what new information youre planning to release as a
courtesy to those partners.
Have the mechanism in place to give a courtesy check to those response agencies with a
stake in your communication.
Focus on content and information rather than form. Limit excessive tinkering with phrases.
While the form of a message matters, form is not the function of the clearance process.
Clear all information simultaneously and in person, whenever possible. Unless it is possible to
get the primary clearance authorities in one room with
the door closed and no phones, do the following:
yy Make three copies. Clear all information
simultaneously and in person,
yy Take one copy to each person. Wait while he
whenever possible.
or she reviews and approves the document.
yy Point out any part of the document that

needs careful consideration.
yy Ask if he or she would be comfortable seeing this as a news headline.
yy Reinforce that the information youve compiled and are attempting to get cleared answers
important questions from the public, the media, and partners. It may also answer questions in
response to troubling trends from your own analysis of where the subject might be headed.
Work with personnel in your organization to keep the clearance process seamless:
yy Its difficult to delegate clearance; be prepared to do it yourself.
yy Be realistic about the time clearance will take, and build it into your schedule.

yy The communication director will be busy and may delegate a surrogate to handle his or her
part of the clearance chain. Accept this delegation.
yy Educate everyone involved in the development and release of information about clearance
steps. Set an expectation for time from development to release.
yy Help responsible authorities understand that it is worse to release nothing than to release
information that is not yet complete.
yy Get need to know information out the door fast.
yy Get want to know information released as soon as possible without straining relationships
with authorities who must clear new information.
Have as much information on a topic precleared

as possible. This is a key aspect of emergency
One key aspect of emergency
communication:
communication is to have as
yy Make sure that predeveloped information is sensitive to
much information on a topic
the conditions of the current crisis before it is released.
precleared as possible.
yy Choose words carefully from the start. People are far
more sensitive in crises.
4. Establish agreements on release authorities (who releases what, when, and how):
One ongoing challenge is coordination and determination of who is responsible for what. Inadequate
understanding can lead to slow release of information. When drafting agreements, consider
the following:
Use this aspect of preplanning to reduce damaging conflicts.
Place formal agreements on release authority in writing, but expect changes.
Know that information is usually not exclusively owned by any one organization or agency.
Typically, many levels of a response command could release information. Learn to work together
on the release of information. Ask yourself these questions:
yy Does it really matter who releases this information?
yy Isnt getting information out quickly and accurately what really matters?
Once its released, its possible to incorporate the information into other messages for other
public groups, partners, and audiences.

5. Have all media contact lists, including after-hour numbers, in place: At the heart of any
crisis communication plan are contact lists. These lists include key leaders and representatives of
stakeholder groups, partners, and, especially, members of the media. While many crisis plans maintain
this information in database form on thumb drives or secure servers, it is also helpful to have access to
hard copies as backup.
Try to have contacts for all major media outlets. These contact lists are the most vital part of the plan.
When you create these lists, do the following:
Include cell and landline phone numbers, e-mail addresses, and fax numbers.
Include information about how to contact news directors and editors after hours; thats often
when you will need them.
Verify e-mail addresses and fax numbers periodically because they change regularly. This
verification can be part of an annual tabletop exercise.
6. Plan procedures to coordinate with public health response teams: In a crisis, no

communications team can function in isolation. The communication function should be part of the
formal decision system. It should also be integrated into the larger crisis response team. This usually
means having a formal, recognized role. Communication and coordination cant be an afterthought.
When you create these procedures, do the following:
Include an organizational chart in your plan so you can quickly find people who
are key resources.
If you dont operate out of the EOC, find out who is in the EOC and make sure they know to
contact you immediately.
Let others in your organization know that, in some cases, you may be the first person to hear
about a public health emergency, often from the media.
Make sure that telephone numbers and after-hours contact information is included in the first
emergency notification list.
Similar procedures should be in place for other response organizations or partners:
Share contact information for your organization with partner organizations. They should be
included as part of their communication plans. Swap names, e-mail addresses, phone numbers,
after-hours numbers, and expected roles and responsibilities.
Obtain public health organization emergency response team after-hours contact numbers.

7. Designate spokespersons for public health issues and third-party validators: The crisis
communication plan should specify public health emergency spokespersons and designated backup
personnel. When you make a list of spokespersons, do the following:
Do not include people solely based on their position in the organization. Rather, people should
be selected according to their ability and availability.
Prepare and elevate trained speakers to a higher authority, if they are needed.
Identify all off-hour contacts, as emergencies often happen during nonworking hours.
Train and refresh speakers frequently, perhaps as part of an annual tabletop exercise or more
often. In addition, even if a key spokesperson, such as an elected official, will be speaking at the
daily press conference, there are many other opportunities for others to communicate with the
media at work or at public meetings.
Include lists of likely speakers who have been trained.
Line up experts outside the organization who can perform some of these duties and keep the
public informed. Media and civic groups will appreciate the offer of alternative spokespersons.
8. Have agreements and procedures to join the EOCs JIC, if activated: The principle behind
EOCs is that one centralized location for decisions facilitates coordination.18 Multiple EOCs operating
within a local region will defeat that purpose. During the planning stage, it is important to connect
with your EOC. Make sure your EOC operations chiefs plan includes a role for your organization and
its communication team. Usually, but not always, the EOC operations chiefs plan will specify a JIC to
coordinate communication functions and help integrate information systems. When you make these
agreements, consider the following:
Agree ahead of time on personnel staffing for the JIC and make this part of your plan.
Establish the role key communication personnel will have in the JIC.
Know that a considerable amount of work must be accomplished outside of the JIC.
Remember that with smaller agencies you may not be able to operate 24/7 during a large-scale
or long-term crisis. A combined EOC/JIC may be a critical resource.
A JIC is usually made up of PIOs of the responding agencies to coordinate and disseminate information
to the public, typically via the media. They will also work to control any rumors or misinformation. The
JIC typically uses the traditional public relations methods. JIC personnel do the following:
Distribute press releases
Post information on websites
Hold press conferences transmitting information to the public

Increasingly, JICs incorporate social media into their communication practice by doing the following:
Establishing or updating their own social media pages and feeds to respond to
questions and comments
Monitoring social media sites for rumors or misinformation that can be addressed
9. Develop procedures to secure needed resources: Space, equipment, and personnel to

operate 24/7 during a crisis will be needed. At the local level, your JIC can help address resource needs.
However, some public health emergencies that can tax an organization may not be large enough to
trigger the operation of an EOC and a JIC.
Obtain agreements with other local or nongovernmental organizations for support if a JIC is not
activated. During a crisis, supplies, personnel, equipment, and space are still needed. Based on a pre-
crisis assessment, do the following:
Identify needs and procurement mechanisms.
Connect with the logistics part of the organization.
Learn the procedures for acquiring resources and put that information into your plan.
Tell emergency response commanders what your communication team needs before there is an
emergency; dont wait until after one starts.
Make a checklist of resources that should be included in the plan. An example can also be found
at the end of this chapter. Office resources may include the following:
yy Space
yy Personnel
yy Equipment (computers, printers, scanners, telephones and lines, cell phones,

and fax machines)
yy Basic office supplies, including pens and notebooks
yy Additional supplies such as cell phone chargers, extra batteries, and nonperishable
food items like bottled water

NIMS
In Chapter 1, the National Incident Management System (NIMS) was introduced as a set of federal
procedures used by government agencies to organize crisis response. Under the nine steps for success
in the Developing the Plan section of this chapter, it was explained that NIMS provides a logical means
of designating staff responsibilities that will be understood by partner organizations and the media.
The public information systems described in NIMS were designed to effectively manage the two-way
flow of public information in a crisis, regardless of the size and complexity of the situation or the
number of agencies involved in the response.
Positions that PIOs and their staff may have to fill under NIMS are located under the JIC. Review the JIC
structure and functions for a large-scale incident represented in Table 41. One person may do many
functions, or one function may be staffed by many people, depending on the scope of the incident.
Table 41. NIMS Sample JIC for a Large Incident20

The four core functions of NIMS19,20 should be part of the overall crisis communication plan:
1. Information gathering
2. Information dissemination
3. Operations support
4. Liaisons
While these are described as separate components, they must be closely integrated. With smaller
incidents, an individual can serve in more than one of these communication functions.
Information gathering: This is critical not only to promote situational awareness but also to receive
feedback on messages and how they are received and interpreted. Media monitoring and analysis,
including social media, is a central function because the media remains a source of timely information
during any crisis. Close coordination with other response agencies and partners, and their PIOs, to
gather the most current information is also critical.
Information dissemination: This includes using a variety of channels to reach multiple audiences.
These activities include general media relations, working with designated spokespersons, organizing
news conferences, and providing briefings and updates. Inquiries and questions from the general public
must also be addressed and should be documented through contact logs. In addition, officials and other
key leaders must be briefed. These information dissemination activities should extend to Web support
and social media.
Operation support: This involves a variety of communication activities, including addressing special
needs and multilingual audiences through translation and other services. Facilities support activities
involve ensuring sufficient communications capacity to support operations.
Liaisons: They can provide two-way communication and coordination with key stakeholders
and partners. Close coordination is necessary to achieve an effective response and create
consistent messages.
The NIMS structure for the public information function is designed to be scalable and flexible.
Smaller, regional incidents of shorter durations may require fewer resources and may not involve all
activities. The general communication functions described by NIMS should be included in crisis plans.
Some of the other general responsibilities that must be planned for as part of the emergency response
include the following:
Official responsible for command and control:
yy Activates the plan based on careful assessment of the situation and the expected demands for
information by the media, partners, and the public

yy Calls the crisis communication team together
yy Directs the work related to the release of information to the media, public, and partners
yy Coordinates with horizontal communication partners, as outlined in the plan, to ensure that
messages are consistent and within the scope of the organizations responsibility
yy Provides updates to the organizations director, EOC command, and other headquarters, as
determined in the plan
yy Advises the director and chain of command regarding information to be released, based on the
organizations role in the response
yy Ensures that CERC principles are employed in all contacts with media, public, and partner
information release efforts
yy Knows incident-specific policy, science, and situation
yy Reviews and approves materials for release to the media, the public, and partners
yy Obtains required clearance of materials for release to the media on policy or sensitive topic-
related information
yy Determines the operational hours and days, and reassesses these throughout the
emergency response
yy Ensures that resources are available, including personnel, technical resources,

and mechanical supplies
Official who directly interacts with the media:
yy Assesses media needs and organizes mechanisms, such as daily briefings in person, social
media and website updates, and RSS feeds, to fulfill those needs during the crisis
yy Triages the response to media requests and inquiries
yy Ensures that media inquiries are addressed as appropriate
yy Supports and briefs spokespersons
yy Oversees the maintenance of media contact lists and contact logs
yy Produces and distributes media advisories and press releases
yy Produces and distributes materials such as fact sheets, Facebook and Twitter feeds, widgets,
podcasts, and B-roll video

yy Oversees media-monitoring systems and reports, including social media:
Analyzing environment and trends to determine needed messages
Determining what misinformation needs to be corrected
Identifying concerns, interests, and needs arising from the crisis and the response
yy Ensures that risk communication principles designed to build trust and credibility are
incorporated into all public messages delivered through the media
yy Acts as a member of the JIC or field site team for media relations
yy Serves as a liaison between organizations through the JIC
Official who directs public information activities:
yy Manages the mechanisms for responding to public requests for information via social media,
telephone, in writing, or by e-mail
yy Oversees public information monitoring systems and reports:
Analyzing environment and trends to determine needed messages
yy Oversees and activates social media, telephone, and public e-mail correspondence
response systems
yy Organizes and manages the emergency response websites, Web pages, and social media
yy Establishes and maintains links to other emergency response websites
Official who directs partner and stakeholder information activities:
yy Establishes communication and coordination protocols based on prearranged agreements with

identified partners and stakeholders
yy Arranges regular partner briefings and updates, and establishes liaisons
yy Solicits feedback and responds to partner information requests and inquiries
yy Oversees partner and stakeholder monitoring systems and reports:
Analyzing environment and trends to determine communication strategy

yy Helps organize and facilitate official meetings and briefings to provide information and receive
input from partners or stakeholders
yy Oversees development lists and contact logs of key decision makers such as officials,
legislators, and special interest groups
yy Responds to special interest groups, and official requests and inquiries
Official who develops content and material for public health emergencies:
yy Develops and establishes mechanisms and protocols to rapidly receive information

from the EOC
yy Translates EOC situation reports and meeting notes into information appropriate for public
and partner needs
yy Works with subject matter experts (SMEs) to create situation-specific fact sheets, Q&A
documents, and updates
yy Compiles information on possible public health emergency topics for release when needed
yy Manages the development and testing of messages and materials for cultural and language
requirements of special populations
yy Coordinates with other communication team members regarding content and message needs
yy Adapts messages based on analyses from media, social media, public, and partner monitoring
systems and feedback
These systems of communication should also be linked and coordinated so that messages are consistent.
For example, CDC evolved a system during the anthrax event that is still used: a press conference that
is recorded is transcribed quickly. Both the text and the recording are put on the
Web and archived. All groups have simultaneous access to the written record, thus helping to ensure
greater accuracy and consistency. Internal staff uses these transcripts to help prepare other materials,
such as FAQs.

The Importance of Establishing an Emergency Operations Center
During an emergency, it is imperative that organizations not only manage the crisis but
also maintain normal, daily operations. By establishing an EOC in 2001, the individuals
who were investigating and managing the anthrax case in Palm Beach, Florida, had the
resources that were necessary for maintaining a unified and centralized approach to
managing the crisis:
Broadcast studio Added equipment (for effectively

investigating the situation and
Computers
reporting information to the media
Workstations and the public)
Telephones
Their EOC was instrumental in allowing those involved in the crisis to focus on the
situation in an environment that was dedicated to crisis management and resolution.
During a CDC emergency response, the EOC brings together scientists, program experts,
and policy experts from across CDC to efficiently exchange information and connect
with public health emergency response partners.
For multistate emergencies, or emergencies that affect many people, CDC provides
additional public health resources and coordinates response efforts across multiple
jurisdictions, both domestically and internationally. The improved 24,000-ft2 EOC facility
became operational in 2006. When fully staffed, it can accommodate up to 230 personnel
per shift, for one to three shifts per day, to handle situations ranging from local interests
to worldwide events.
CDCs Division of Emergency

Operations (DEO) manages the EOC.
To support state and local efforts during
an emergency response, EOC staff
coordinates deployment of CDC staff
and equipment that CDC responders
may need.

Planning for JIC Requirements
JICs are a crucial part of any EOC. They will need space, personnel, agreements, supplies, and
equipment. Space will be needed not only for staff, but also for the JIC and for any press briefings.
Personnel are key to an effective response. In many cases, there will simply not be enough trained
communication personnel available in your agency. Agreements with other agencies to loan personnel
can build surge capacity for a response. Supplies and equipment are necessary for any response, but
you dont want to be hunting for them after the response has started. When you plan for using certain
equipment, you will need to bear in mind certain technology considerations. Specific details on these
items are listed:
Space:
yy Find space to operate communication teams (and the JIC) outside of the EOC.
yy Locate space for bringing media onsite when needed. It should be separate from the
EOC and the JIC.
yy Find quiet space to train and brief spokespersons.
yy You will need conference space for team meetings.
yy An office should be dedicated for equipment that is exclusively used by communication

personnel. You cannot stand in line for copier use when facing media deadlines.
yy You will need space to take breaks when necessary, whether for eating, sensory deprivation,
rest, or even a nap.
yy Identify offsite space your team can use in case the event damages your original space.
Personnel:
yy Include trained personnel to either operate a 24/7 public and media information center or to
support a JIC as part of a local EOC.
yy Identify people qualified to take phone inquiries and respond to questions and comments on
your social media sites like Facebook and Twitter. Consider staff from throughout the health
department as well as in partner organizations. Some agencies may contract out these services
but a liaison is still required.
yy In accordance with the policies and procedures of local jurisdictions, consider recruiting
volunteers from the medical community, especially infectious disease specialists, to help with
responding to other public health professionals in the area.
yy An abundance of trained staff will save you from your worst errors by reducing fatigue and
catching mistakes.

yy Information technology and social media staff must be onsite and ready to handle
technological difficulties, including high volume or overloads of communication systems like
phone systems, internal computer servers, and Internet servers.
yy To prevent burnout, personnel need scheduled breaks and other qualified people need to be
available as replacements if the crisis response is prolonged.
Contracts and memoranda of agreement:
yy Consider a contract with a comprehensive newswire service that will disseminate your
information across a wide variety of platforms, such as print and broadcast news, the Internet,
and social media sites. Think about using varied tools such as press releases, videos, images,
e-mail, and social media tagging.
yy Look into contracts with writers or public relations personnel who can augment your staff,
especially with social media writing and monitoring expertise, if your organization doesnt
have that type of staff.
yy Think about contracting for administrative support and technical support.
yy Consider using a contractor that can supply phone menus directing the caller to the type of
interaction desired. The phone menu may offer the following options:
General information about the threat
Tip line listing particular actions people can take to protect themselves
Reassurance and counseling
Referral information for media requests for data or interviews
Health-care worker referrals
Referral information for epidemiologists or others needing to report cases
Laboratory and treatment protocols
Managers looking for policy statements for employees
Supplies: Keep a store of typical office supplies for emergency only to ensure they are there
when you need them:
yy Copier toner (what you start with is yy Pens, pencils, markers, highlighters, and
never enough) erasable markers
yy Printer ink yy Mail supplies and supplies for express

delivery services such as DHL, FedEx,
yy Paper, notepads, and notebooks
UPS, and the U.S. Postal Service

yy Sticky notes yy Expandable folders, with alphabet or
days of the month
yy Standard press-kit folders
yy Staplers (lots of them)
yy Flash drives (thumb drives) and portable
yy Paper hole punch
hard drives
yy Three-ring binders
yy Color-coded everything (copy paper,
folders, inks, etc.) yy Organizations press kit or its
logo on a sticker
yy Baskets to contain items that youre not
ready to throw away yy Organizations letterhead
yy Paper clips (all sizes)

yy Organizers to support your clearance and
release system yy Tape
Equipment: Equipment to support communication to media and partners should be obtained

before the crisis. Contracting during a crisis will create what will likely be damaging delays.
Determine what you may need to do to provide this equipment if a crisis persists:
yy Computers (desktop or laptop) loaded with secure Internet access, software programs, and
documents needed for crisis communication and information sharing (e-mail lists, crisis
communication plan, collaboration software, etc.)
yy Dedicated computer servers with bandwidth to handle increased Internet traffic
yy Landline phones with dedicated lines and 800MHz radios in case of a power outage or cell
phone network overload
yy Cell phone chargers and plenty of extra batteries
yy Fax machines with numbers preprogrammed for broadcasting fax releases to

media outlets and partners
yy Computer printers, including at least one color printer
yy A color copier machine and backup
yy Extension cords
yy Visible calendars, flow charts, bulletin boards, easels, and white boards
yy Designated personal message board
yy Press conference audio-visual equipment, such as portable microphones, a sound system, a

projector and screen, and recording devices
yy A podium or lectern and microphone
yy TVs with cable or satellite hookup

yy A DVD player
yy A paper shredder
yy An alternative power supply, such as a generator, for the EOC and the JIC
yy Portable cots
Technology considerations: Different channels and mechanisms of communication are

appropriate at different times and for different audiences. The mechanisms most appropriate to
communicate with the media, the public, and partners are listed:
yy Phone, including hotlines and cell phone numbers of direct contacts
yy Fax, including broadcast preprogrammed fax
yy E-mail, including the listservs or distribution lists used
yy Broadcast messaging systems, such as text messages, reverse 9-1-1, and e-mail
yy Web technologies such as social media (Facebook, Google+), blogs (yours, other
health-related blogs, WordPress), microblogs (Twitter, Tumblr), and photo and
video (for YouTube, Flickr, Skype)
yy Agency and partner websites
yy A partnership with other emergency response groups to use their e-mail and distribution lists
yy Mail and shipping services, such as the U.S. Postal Service, FedEx, and UPS
yy Face-to-face meetings using Web resources, including town hall meetings or press briefings
yy Partner association membership lists
yy Contracted press release wires
yy Media channels, such as radio, print, Web, and TV
As a general rule, it is appropriate to use multiple channels of communication to reach the broadest
audience possible while ensuring that the messages are consistent.

Applying the Plan During the First 24 to 48 Hours
Be First, Be Right, Be Credible

The CERC values to be first, be right, be credible were presented in Chapter 1. These are critical
during the highly chaotic, uncertain, and threatening first 24 to 48 hours of an emergency. Planning
for the initial phase is vital because this phase can influence the subsequent development of the crisis.
The initial phase will be triggered either by an organizations identification of an unfolding event as a
potential crisis or by intense media inquiry that is expected to be sustained for an indefinite amount of
time. This phase is marked by the need for a quick assessment of the following:
Potential response level required
Facts to be assembled
Actions to secure the necessary resources needed to meet the expected buildup of media and
public information demand
Crisis communication planning should be designed to help manage the first 2448 hours of an
emergency and its associated intense media and public scrutiny.
Critical tasks during the initial phase of the crisis include:
Verification
Notification and coordination
Assessment
Initial media response
Assignments
Resource allocation
Tell the Media and the Public What You Know

Quickly update the media and the public on the status of research, facts, and investigations
when an event arises. When Mount St. Helens erupted, many local residents may have
questioned the dangers of the volcanic ash and dust cloud.21,22 Although U.S. Geological
Survey scientists requested several weeks to have a panel review and evaluate the possible
dangers, people needed answers quickly.
In a disaster situation, you have to provide people with the information you currently have
and know to be true, and give them regular updates as you obtain additional information.

Verification
Early information about a possible crisis event, either from the media or from health-care professionals,
may be unintentionally slanted. Evaluate the information, attempt to verify the magnitude of the event,
and seek additional information to put the event into perspective regarding public and media interest.
Helpful questions might include the following:
Where did the information originate?
Is the source credible?
From which of the following did the information come?
yy Formal channels of communication, such as a CDC message or an Epi-Aid report
yy Informal channels of communication, such as a call from a county health official
yy Rumor, such as an e-mail chain, or a social media post
Is the characterization of the event plausible and consistent with other events of this type?
Is the information consistent with other sources that are reporting on the event?
Notification and Coordination

Once you have verified the event, notify managers in your organization immediately. The more
quickly you notify the chain of command, the more rapidly you will be able to coordinate with partner
organizations. This translates into more efficient responses with less difficulties. The communication
plan should designate all of the people who must be notified.
Make sure the notification message only contains information that has been verified. Rumors are very
destructive. Describe the event from a public or media perspective. If you anticipate, based on your risk
analysis, that the event will produce intense media and public interest, share that opinion with those
being notified. If the event has potential to grow, share that view as well.
Coordination means notifying people who may not be in the formal chain of command for emergency
response but who may be partners in the response. You may be coordinating with members of your own
organization or with partners outside your organization. For example, the director of health should
be notified if the media alerted you to an emergency. Coordinating the emergency response with the
communication representative of the local American Red Cross chapter may also be important.
Notification is formal and comes first. Coordination is generally less formal and is based on mutual
respect and understanding of the organizations role in the community. Communication plans should
identify those core people for notification and coordination who would work with your office during

any public health emergency. The plan should also identify those people or organizations that should
be notified or with whom activities should be coordinated, according to the type of emergency that
has occurred. For example, if the emergency involved animals, coordination with veterinary health
representatives and the local humane society is in order.
Initial Media Response: Is the Media Beating on Your Door?

Assembling the facts is a priority for your team. One of the best ways to satisfy the medias (and, in
some cases, the publics) need for information is to control the flow of information while establishing
your organization as a credible information source:
Do not give in to pressure to confirm or release

information before it is confirmed by experts or One of the challenges in public
emergency operation centers. health, when talking to the media, is
talking to the media before you have
Take the lead if you have the lead. If another
all the information During a crisis,
organization is rightfully the lead, defer to them,
continue to coordinate, and be as helpful as possible. during a new outbreak where its all
unknown, youre not going to have all
Release some information initially, but be honest that
the information youd like to have, but
your organization is still gathering information. The
following are suggested responses for the media that you still have to talk.
give the time necessary to collect the facts:
Richard Besser, M.D.,
yy Weve just learned about the situation and are trying Former Acting Director,
to get more complete information right now. Centers for Disease Control
yy All of our efforts are directed at bringing the situation and Prevention
under control. Im not going to speculate about the
cause of the incident at this time.
yy Im not the authority on this subject. Let me have [name of authority] call you right back.
yy Were preparing a statement on that now. Can I send it in about two hours?
For more information on notification, please review Checklist 42, Notification Schedule, at
the end of this chapter.

Get Your Information Out Early
It is important, particularly with regard to disasters, to give the public some idea of the kinds
of plans and procedures your organization is formulating to manage the crisis.
When documented cases of anthrax from spores being sent through the U.S. Mail were
rampant, laboratories in Denver, Colorado, were unable to rule out the possibility of anthrax
exposure in the case of a postal worker who was being treated for a suspicious respiratory
illness. In turn, postal workers in Ft. Collins, who were not identified as being in direct threat
of anthrax exposure, showed up at a clinic to receive antibiotics that were unnecessary.
In another situation in 2000, before state and local officials had made a formal decision about
how the public should respond to a hurricane, many people in Florida and Georgia self-
evacuated based on their analysis of what they saw on The Weather Channel.23
Evaluate Required Response

During the initial phase, do a quick initial evaluation of the situation to help you plan the level of public
information and media response that will be required. The following questions should be considered:
Is the event acute? What if the event has already occurred and your organization is faced with
explaining the event and the aftermath? For example, this could happen following a chemical
release or a mistake in a Level 4 lab.
Is the event evolving? The event is uncertain and may become more or less serious (such as
identifying a novel influenza virus).
Is the event a legitimate public health emergency requiring swift and widespread public
education to prevent further morbidity and mortality? One example would be a multistate
listeriosis outbreak.
Is this the first, worst, biggest, etc.?
Is the interest generated because of the events novelty or is it a legitimate

public health concern?
Is the event occurring in a metropolitan area with many media outlets versus a sparsely
populated area with fewer media outlets?
Is the event regional, national, or international?
Does the event involve children or special populations?
Is the human outcome of the disease uncertain, such as long-term health effects?

Is there a product, service, or industry potentially involved?
Are there sensitive international trade or political relations involved?
Is there, or will there be, an ongoing criminal investigation?
The following is a list of assessment questions that will help with the next critical task, assignments:
Is this event within the scope of responsibility for your organization? Are you, or
should you be, involved?
Is the state or city health department at the epicenter of the event well-equipped and trained to
manage a media response of this magnitude?
Is the situation being managed? If so, how and by whom? What is the science behind
the program?
Next Media Response Step

If, based on this evaluation, the public health emergency is wholly or partly within the jurisdiction of
your agency, then release as many of the facts as possible to the media and the public. Credibility often
relates to the following:
The speed at which an agency appears to be involved in the recovery and response
The accuracy of the information you provide
Your level of openness, empathy, and determination to see it through
Present these elements in the first official statement or appearance with the media. It may take some
time to develop a solution to the crisis. You will gain valuable time for your organization by sharing with
the media the process your organization is developing to produce a reasonable and caring operation
to resolve the crisis. In addition, you build goodwill. Take the opportunity to communicate early,
but be careful not to speculate. Stick to the facts and to a commitment to a process to release more
information as soon as possible.
As the crisis evolves, and before facing the media again, prepare answers to the following frequently
asked questions about safety.
Individuals want your message to answer the following questions:
Am I safe? How can I protect my family?
What have you found out that my family and I should know about?
Who or what caused this problem?
Can you fix it? When?

The media and communities want your message to answer the following questions:
Who is in charge?
How are those who got hurt getting help?
Is this thing being contained?
What can we expect?
What should we do?
Why did this happen? (Dont speculate. Repeat the facts of the event, describe the data
collection effort, and describe treatment from fact sheets.)
Did you know ahead of time that this might happen? Why wasnt this kept from happening
(again)?
What else can go wrong?
When did you begin working on this (were notified of this, determined this)?
What do these data (information, results) mean?
What bad things arent you telling us? (Dont forget the good.)
Assignments
Important areas of responsibility in a crisis communication operation include the following:
Hands-on response to the media (messenger)
The person or team who is in charge of managing the crisis communication operations
(messenger)
Collection of accurate and timely public health information translated into lay language valid to
the media, the public, stakeholders, and partners (message)
Environmental scanning and analysis to identify rumors, myths, errors, and trends (message)
Rapid execution of support tasks that keep the information flowing (delivery method)
Continued operation of tasks not related to the crisis event

Applying the Crisis Plan Throughout the Response
The first few hours of any event are usually very chaotic. This is a time of very high uncertainty
where quick response can be critical. It is also a time where community-based organizations may be
on their own. In many ways, a crisis communication plan is designed to preset these initial decisions
so the organization can respond very quickly. While every event is unique, the following steps are
largely universal.
Step 1: Verify the Situation

Situational awareness is the first step in an informed response. Information will be scarce, and
many established channels of communication may be disrupted. Consider the following points while
verifying the situation:
Get the facts, and (to the degree possible) verify them with secondary sources.
Find out where information originated and determine credibility. Was this a formal source, such
as a Health Alert Network message; a communication from another agency; a CDC Epi-Aid; or
from an informal channel, such as a nongovernmental partner?
Question possible rumors or hoaxes, which can be found through traditional and social media.
Determine whether the information is consistent with other reports.
Determine whether the characterization of the event is plausible.
Clarify information and understanding through SMEs.
Assess the scope and scale of the event by answering questions such as, how much? how
many? and how big an area?
Begin to identify staffing and resource needs for the expected media and public interest.
Consider ways to access additional information.
Decide who should be notified of this potential crisis.
Step 2: Conduct Notifications

It is essential to carefully identify to following:
Who should you include in your chain of command?
Up to what level?
Where within the scope of organization?

Some notifications may be mandatory while others may be necessary for a coordinated and effective
response. Record who you notified, when, how, and if they were reached.
As noted in Table 42, notification procedures vary by state and local jurisdictions. Know what
procedures govern this particular area of responsibility.
Table 42. General Guidelines for Notification
Local agencies State agencies Federal agencies

yy Law enforcement yy State public health yy DHS
yy Public health organization yy State yy FEMA
yy Emergency Medical Services yy DHSEmergency yy FBI
yy Hospitals Management Agency yy CDC
yy Fire departments yy Law enforcement yy U.S. Public Health Service
yy Medical examiner yy Emergency Medical Services yy Department of Defense
yy Local Department of Homeland yy State fire service yy U.S. Department of Agriculture
Security (DHS)Emergency yy National guard (USDA)
Management Agency
yy Local general service
organizations*
* Varies depending on crisis, but could include schools, faith-based organizations, nonprofit disaster relief
agencies (e.g., American Red Cross, Salvation Army), and public works (e.g., water, power, sewer).
Step 3: Conduct Crisis Assessment (Activate Crisis Plan)

Throughout the event, it is important to continue to gather information and update situational
awareness. Try to determine the severity of the situation, what information should be communicated,
the target audience, and the potential harm on communication operations, resources, and staffing.
These updates require ongoing research through media monitoring and through working with
other response agencies, public health partners, and the public. The following questions will help
focus these efforts:
What organization, office, or individual is in charge of managing the crisis? Ensure that direct
and frequent contact with the office in charge is possible.
What happened and what responses are occurring? Continue to gather and check the facts.
What is your organization doing to address this crisis?
What other agencies are collecting information and how is that being compiled?

What are other agencies and organizations doing in the response?
Who is being affected by this crisis? What are their perceptions? What do they want
and need to know? How can they be reached?
What should the public be doing?
What is being reported on the Web and in the media? Activate formal and informal
monitoring systems.
What is being said about the event? Is the information accurate? Determine the consistency of
information across sources.
Step 4: Organize Assignments Quickly

The initial organization around an event involves assigning people responsibilities. Much of this will be
predetermined by the crisis plan. Some modifications may be required based on availability of personnel
and the nature of the event. Organizational processes can be divided according to the immediate and
the ongoing issues.
Immediate issues:
yy Determine who is managing the event from an operations, programmatic,

and scientific perspective.
yy Consider how communication coordinates with the program staff in charge of managing the
crisis. What meetings should communication staff attend?
yy What are the crisis communication teams (media, Web, public, partner, stakeholder, and
support)? Are they operational?
yy What are the current, most pressing priorities?
yy What resources are needed? Is staffing sufficient?
yy Who is the spokesperson for this event and what support might he or she need (i.e., SMEs as
additional spokespersons, additional briefing or training, cultural liaisons)?
yy At this point, should communication teams operate 10, 12, 20, or 24 hours per day and
5, 6, or 7 days per week?
yy Will communication staff be expected to travel?
yy Are supplemental funds needed?
yy Is contractor support needed?

Ongoing organizational issues:
yy What is the potential for the crisis to get worse?
yy Will events result in more intense public or media interest?
yy Have rumors or points of conflict emerged?
yy How should the organization respond to these issues? Is there a current response
and is it adequate?
yy Should the organization continue to be a source of information to the media about this crisis?
Would some issues be more appropriately addressed by other groups or agencies?
yy Are the teams operating with approximately equal effectiveness? How could
efficiency be improved?
yy Is the clearance process operating efficiently? How can it be improved?
yy Are resources sufficient? Should staff resources be reallocated?
yy Should the organization reset times for daily updates to the media or cancel
the regular updates?
yy Are daily or weekly subject matter expert briefings appropriate to reduce the demand for one-
on-one interviews with these experts?
yy Should personnel who have been temporarily assigned to the crisis be returned
to normal duties?
yy Should hours of operation be increased or reduced?
yy Are supplemental funds needed to meet public and media demand for information?
yy What is the organization learning from the public and the media that could be useful to
outbreak investigators and policy managers?
In both immediate and long-term issues, partner coordination is critical. Questions about partner
involvement might include:
Who are the partner organizations (traditional and emergent) of this event? Have they been
briefed? Are they concerned about their own reputations?
Which partners are or should be involved in the response? How can coordination occur?
Can a partnership improve the response? If so, who and how will you engage them?
Do partners wish to get involved in the response? If so, who and how?

Step 5: Prepare Information and Obtain Approvals
Rapid clearance of information for release comes with inherent tension and challenges. The approval
process is unique to each organization. This function includes all message and development activities,
the approval process, and the coordination of information within an organization. Several questions are
important to the approval process:
Who are the audiences, both immediate and remote? Whos been affected by this event? Whos
upset or concerned? Who needs to be alerted?
What are the audiences perceptions, backgrounds, and values?
What are their immediate and long-term information needs and wants?
What do media personnel want to know?
How can your organization demonstrate appropriate empathy?
What are the facts? What happened?
What is the organizations stance on the issue? Are there policies or values that
are relevant to this issue?
What is your organization doing? How is your organization solving the problem?
What can your organization do to keep this from happening again?
What other agencies or groups are involved and what are they saying?
What should the public be doing?
What public information is available and when will more information be available?
Step 6: Release Information Through Prearranged Channels

The crisis and emergency communication function at its core is about releasing information to key
audiences. Anticipating likely questions from the media and recognizing their role can improve the
effectiveness of communication. Like emergency management professionals, reporters are professionals
doing an important job and are likely to be cooperative, particularly during the initial stage of a crisis.
When information is effectively delivered to the media, the chances of inaccurate reporting are reduced.
It may help you to anticipate likely media questions such as the following:
Whos in charge?
What are you doing for the people who are hurt?
Is the situation under control?
What can we expect?
Why did this happen?

Why wasnt this prevented?
When did you begin working on this (were notified of this, determined this)?
What do these data or results mean?
Are there bad things you arent telling us?
When can we get more information?
When talking to the media, some basic kinds of information can generally be provided:
Provide only information that has been approved and cleared by the appropriate channels.
Dont speculate and dont over-reassure.
Repeat the facts about the event.
Describe the data collection and investigation process.
Describe what your organization is doing about the crisis.
Describe what other organizations are doing.
Explain what the public should be doing.
Describe how to obtain more information about the situation.
Step 7: Obtain Feedback and Conduct Crisis Evaluation

As soon as practical following a crisis, conduct an evaluation of the organizations response. Get direct
feedback from key audiences. Assess what is being reported in the mainstream and new media. This will
allow messages to be adjusted to address deficiencies or correct problems. These assessments are also
important in the learning process:
Keep notes or audio record observations made during the initial phase of the crisis.
Identify the needs of special audiences, including any special-needs populations

or stigmatized groups.
Compile and analyze comments and criticisms from various audiences, partners,
agencies, and stakeholders.
Gather and analyze media coverage and Web activity.
Conduct a hot wash (an immediate review of what happened, what went right,
and what went wrong) to capture lessons learned.
Develop a Strengths, Weaknesses, Opportunities, and Threats report on the crisis
communication operation. Report your results to your organizations leadership.

Share results within your organization.
Determine the need for any changes to the crisis communication plan.
Determine if there is a need to improve policies and processes.
Incorporate changes with appropriate training into your organization.
Revise crisis plan policies and procedures based on lessons learned.
Step 8: Conduct Public Education

Once the crisis begins to subside, your organization may need to carry out additional public education
activities. Because the public is attending to the event, this may be a chance to improve public
understanding, support, and preparation. The public may also be more receptive to information and
behavioral change. Consider the following activities:
Assess the need for your organization to educate your audience about related
public health issues related to this crisis.
Determine the publics perceptions and information needs related to this crisis.
Are there any misperceptions or misunderstandings that need to be corrected?
Does the public understand the organizations health messages on this issue?
Is the public taking appropriate actions?
Decide if audiences not involved in the crisis should be targeted for public education.
Should a public health message related to this crisis event be incorporated into other health
communication activities such as Public Health Week or National Infant Immunization Week?
Should this event be used to highlight any related public health messages?
Should any websites be updated as a result of this crisis?
Should any of the crisis materials be institutionalized?
Would a series of postcrisis, preproduced articles be useful in this situation?
Step 9: Monitor Events

Monitoring should occur at all points. It provides ongoing feedback and determines how messages or the
general communication strategy should be changed. Crisis monitoring protocols include the following:
Media monitoring, including television, radio, mainstream print, and specialized print
Internet monitoring, including social media and related websites
Ongoing exchange of information with key partners, such as other organizations and
state health departments, SMEs, and partners
Public opinion monitoring and collection of other relevant information

Conclusion
Planning is the most important step to ensure an effective response using CERC. It takes considerable
time and effort to develop and maintain a crisis communication plan. Understanding the features of a
plan, as well as the types of information to include and the kinds of questions asked, are vital to the
plans success.
Plans should not try to answer all the questions or determine all the decisions, but they should reveal
a process. This is especially true in the first 24 to 48 hours. By doing so, your plan buys the crisis
communicator important time and helps ensure that the initial response is effective.

Checklist 41: First 48 Hours
Checklist 41: First 48 Hours
Critical First Steps After Verification:
Notification:
Use your crisis plans notification list. Make certain that your chain of command has been
notified and they know you are involved.
Ensure that your leadership is aware of the emergency, especially if awareness of the event
comes from the media and not the EOC. Let them know you are involved.
Give leadership your first assessment of the emergency from a communication perspective and
inform them of your next steps. Remember: Be first, be right, be credible.
Coordination:
Contact your local, state, and federal partners now.
Contact your FBI counterpart, if there is potential for criminal investigation.
Secure a spokesperson as designated in the plan.
Initiate alert notification and call in extra communication personnel, per the plan.
Connect with the EOC and make your presence known.
Media:
Be first: Provide a statement that your agency is aware of the emergency and is
involved in the response.
Be right: Begin monitoring the media for misinformation that must be corrected.
Be credible: Tell the media when and where to get updates from your agency.
Give facts: Dont speculate. Ensure partners are saying the same thing.
The public:
Trigger your public information toll-free number operation. Do this now if you anticipate that
the public will seek reassurance or information directly from your organization. Adjust hours of
operation and the number of on-call managers as needed.
Use your initial media statement as your first message.
Ensure that your statement expresses empathy and acknowledges public
concern about the uncertainty.
Give the precleared facts you have and refer the public to other information
sources as appropriate.
Remind people that your agency has a process in place to mitigate the crisis.
Start call monitoring to catch trends or rumors now.

Partners and Stakeholders:
Send a basic statement to partners and stakeholders to let them know you are thinking about
them. Get them involved as needed.
Use your prearranged notification systems, preferably e-mail lists.
Engage leadership to make important first phone calls, based on your plan. Have them reach
partners and key stakeholders to let them know your agency is responding.
Use the internal communication system, probably e-mail, to notify employees that their agencies
are involved in the response and updates will follow. Ask for their support.
Resources:
Disseminate contact lists as appropriate.
Conduct the crisis risk assessment and implement assignments and hours
of operation accordingly.
Stake out your preplanned place in the EOC or adjoining area.

Checklist 42. Notification Schedule
Checklist 42. Notification Schedule
Emergency Risk Communication: Immediate Response to Inquiries
By phone to media:
Weve just learned about the situation and are trying to get more complete information now.
How can I reach you when I have more information?
All our efforts are directed at bringing the situation under control, so Im not going to speculate
about the cause of the incident. How can I reach you when I have more information?
Im not the authority on this subject. Let me have XXXX call you right back.
Were preparing a statement on that now. Can I fax it to you in about two hours?
You may check our website for background information and I will fax or e-mail you with the
time of our next update.
At the incident site or press availability:
Response to inquiries (you are authorized to give out the following information):
Date:________________ Time:________________ Approved by:___________________________________
This is an evolving emergency and I know that, just like we do, you want as much information as
possible right now. While we work to get your questions answered as quickly as possible, I want to tell
you what we can confirm right now:
At approximately ________ (time), a (brief description of what happened)
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
At this point, we do not know the number of (persons ill, persons exposed, injuries, deaths, etc.)
We have a system (plan, procedure, operation) in place for just such an emergency and we are being
assisted by (police, FBI, EOC) as part of that plan.
The situation is (under) / (not yet under) control and we are working with (local, state, federal)
authorities to (contain this situation, determine how this happened, determine what actions may be
needed by individuals and the community to prevent this from happening again).

We will continue to gather information and release it to you as soon as possible. I will be back to you
within (amount of time, e.g., 2 hours or less) to give you an update. As soon as we have more confirmed
information, we will provide it. We ask for your patience as we respond to this emergency.
Source: CDC Public Health Training Network satellite and Web broadcast CDC Responds: Risk
Communication and Bioterrorism, December 6, 2001, Barbara Reynolds, CDC Crisis Communication
Plan, Draft 1999.

Checklist 43. Public Information Emergency Response Call Tracking
Checklist 43. Public Information
Emergency Response Call Tracking
Time of call:______________ A.M. P.M.
Nature of call:
Specific information contained in stock materials:

Disease or illness-related
Treatment-related
Prevention-related
Clarify recommendations
Current status of the incident
Hot topic 1 ___________________________
Hot topic 2 ___________________________
Request for referral:

For more health information
For medical attention
Other ________________________________
Feedback to agency:
Complaint about specific contact with agency
Complaint about recommended actions
Concern about ability to carry out recommended action
Report possible cases or markers (e.g., dead birds for West Nile or
increased absences from place of employment)
Rumor or misinformation verification (briefly describe)
Outcome of call:
Calmed caller based on scripted information
Referred caller to:
Health expert outside the department
Personal doctor or health care professional
Emergency room
Red Cross or other non-government organization
FEMA or state emergency management agency
Action Needed:
None
Return call to:
Callers name: ___________________________________________________
Telephone number: ______________________________________________
Gender: M F
Return Call urgency:
Critical (respond immediately)
Urgent (respond within 24 hours)
Routine Call taken by: _____________________________________
Date: ______________

Checklist 44. Incident Media Call Triage Sheet
Checklist 44. Incident Media Call Triage Sheet
Deadline: 2 hours Today A.M. Today P.M. ASAP Other
Media outlet:
Local ____ TV ____ Magazine ____ Blog ____ Other
Regional ____ Radio ____ Daily/Wire ____ Website
National
Callers name (print first and last):
Callers contact information: Phone(s):

Fax:
E-mail:
Request: Topic:
SME* questions Numbers
Interview (by name request?) Response/Investigation
__________________________ Health/disease issue/treatment
Background/B-roll Hot issue 1 ________________
Fact check Hot issue 2 ________________
Update Other
Return call to press officer
Action needed: Comments:

Return call expected from PA**
or press officer
Return call expected from SME*
PA** suggested triage priority: No action needed; call closed by:

Critical(respond immediately) PA** answered question
Urgent (respond within 24 hours) PA referred to Internet
Routine PA referred to CIO
PA referred to outside CDC
PA other
Taken by: ________________________________
Time: ______ A.M. ______ P.M. * SME = Subject Matter Expert
** PA = Press Assistant
Date: S M T W T F S _______________

Checklist 45. Needs Assessment for Crisis and Emergency Risk Communication
Checklist 45. Needs Assessment for
Planning, Research, Training, and Evaluation
Yes No Does your organization have an crisis and emergency risk communication
operational plan for public information and media, partner, and
stakeholder relations?
Yes No Have you coordinated your planning with the community or state
emergency operation center?
Yes No Have you coordinated your planning with other response organizations
or competitors?
Yes No Have designated spokespersons received media training and risk

communication training?
Yes No Do the spokespersons understand crisis and emergency risk communication

principles to build trust and credibility?
If Your Organization Has a Plan, Does It Have the Following Elements:

Yes No Designated responsibilities for public information team?
Yes No Information verification and clearance procedures?
Yes No Agreements on information release authorities (who releases what, when, and how)?
Yes No Regional and local media contact list, including after-hours news desks?
Yes No Procedures to coordinate with the public health organization response teams?
Yes No Designated spokespersons for public health issues in an emergency?
Yes No Public health organization emergency response team after-hours contact numbers?
Yes No Contact numbers for emergency information partners such as governors public
affairs officer, local FBI public information special agent in charge, local or regional
department of agriculture or veterinarian public information officers, Red Cross
and other nongovernmental organizations?
Yes No Agreements and procedures to join the Joint Information Center (JIC) of the
emergency operations center, if activated?

If Your Organization Has a Plan, Does It Have the Following Elements:
Yes No Procedures to secure needed resources such as space, equipment, and personnel,
to operate the public information operation during a public health emergency 24
hours per day, 7 days per week, if needed?
Yes No Identified methods of information dissemination to public, stakeholders, and

partners such as websites, Twitter feeds, e-mail lists, broadcast fax, door-to-door
leaflets, and press releases, during a crisis?
Message and Audiences

Yes No The following are types of incidents that could require intense public information,
media, and partner communication responses:
Infectious disease outbreak

(e.g., pandemic influenza, cholera, E. coli infection)?
Bioterrorism (e.g. anthrax, smallpox)
Chemical emergencies (e.g., nerve agents, oil spill)
Explosions (e.g., explosions, terrorist bombing)
Natural disasters and severe weather
(e.g. earthquakes, hurricanes, tornadoes)
Radiation emergencies (e.g., dirty bomb, nuclear accident)
Yes No Have you identified special populations, such as the elderly, people who speak a
first language other than English, Tribal communities, and border populations?
List any specific subpopulations, such as tribal nations, persons with chronic
respiratory illnesses, and unvaccinated seniors, that need to be targeted with
specific messages during a public health emergency related to your organization.
Yes No Have you identified your organizations partners who should receive direct
information and updates (not solely through the media) from your organization
during a public health emergency?
Yes No Have you identified all stakeholder organizations or populations who should
receive direct communication during a public health-related emergency? These
are groups or organizations your organization believes have an active interest
in monitoring activities, to whom you are most directly accountable, other than
official chain of command.
Yes No Have you planned ways to reach people according to their reactions to the incident
(fight or flight)? Are messages, messengers, and methods of delivery sensitive to
all types of audiences in your area of responsibility?

Message and Audiences
Yes No Are there mechanisms and resources in place to create messages for the media
and public under severe time constraints, including methods to clear these
messages within the emergency response operations of your organization? Make
sure to include cross clearance in this consideration.
Yes No Have you identified how you will perform media evaluation, content analysis,
and public information call analysis in real time during an emergency to ensure
adequate audience feedback?
Yes No Have you developed topic-specific pre-crisis materials for identified public health
emergency issues, or identified sources of these materials if needed:
Yes No Topic fact sheet (e.g., description of the disease, public health threat,
treatment?)
Yes No Public Questions and Answers?
Yes No Partner Questions and Answers?
Yes No Resource fact for media, public, or partners to obtain additional information?
Yes No Web access and links to information on the topic?
Yes No Recommendations for affected populations?
Yes No Background B-roll for media use on the topic?
Yes No List of subject matter experts outside your organization who would be effective
information sources for the public and the media regarding your activities
during a public health emergency?
Messenger
Yes No Have you identified public health spokespersons for media and public appearances
during an emergency?

If Yes, Have You
Yes No Identified persons by position, such as a media spokesperson or a community

meeting speaker, to act as spokespersons for multiple audiences and formats about
public health issues during an emergency?
Yes No Ensured that the spokespersons understand their communication roles and
responsibilities and will incorporate them into their expected duties during the crisis?
Methods of Delivery and Resources
Yes No Does your organization have go kits for public information officers who may have to
abandon their normal place of operation during a public health emergency or join a JIC?
Do the Kits Include
Yes No Computer(s) with access to the Internet and e-mail?
Yes No CD-ROM, DVD, or flash drives containing the elements of the crisis communication
plan, including media contact lists, public health contact lists, organization contact
lists, partner contact lists, and information materials?
Yes No Cell phone or satellite phone, wireless device, etc.?
Yes No Funding mechanism, such as a credit card, that can be used to purchase
operational resources as needed?
Yes No Manuals and background information necessary to provide needed information to

the public and the media?
Yes No Care and comfort items for the public information operations staff?
Yes No Have you identified the mechanisms that are or should be in place to ensure
multiple channels of communication to multiple audiences during a public health
emergency?
Channels of Communication
Yes No Have you identified the mechanisms that are or should be in place to ensure multiple
channels of communication to multiple audiences during a public health emergency?

If Yes, Do Mechanisms Include
Yes No Media channels such as print, TV, radio, and Web?
Yes No Websites, Facebook, Twitter, and other social media?
Yes No Phone banks?
Yes No Town hall meetings?
Yes No Listserv e-mail?
Yes No Broadcast fax?
Yes No Letters by mail?
Yes No Subscription newsletters?
Yes No Submissions to partner newsletters?
Yes No Regular or special partner conference calls?
Yes No Door-to-door canvassing?
Yes No Are contracts or agreements in place to post information to

broadcast fax or e-mail systems?
Yes No Have locations for press conferences been designated and resourced?
Personnel
Yes No Have you identified employees, contractors, fellows, and interns currently working
for you or available to you in an emergency that have skills in the following areas:
Yes No Public affairs specialist?
Yes No Health communication specialist?
Yes No Communication officer?
Yes No Health education specialist?
Yes No Training specialist?
Yes No Writer/editor?
Yes No Technical writer/editor?

Personnel
Yes No Audio/visual specialist?
Yes No Internet/Web design specialist?
Yes No Social media specialist?
Yes No Others who contribute to public and provider information?
Yes No Have you identified who will provide the following expertise or execute these
activities during a public health emergency (including backup):
Command and Control
Yes No Directs the work related to the release of information to the media,
the public, and partners?
Yes No Activates the plan, based on careful assessment of the situation and the expected
demands for information by the media, partners, and the public?
Yes No Coordinates with horizontal communication partners, as outlined in the

plan, to ensure that messages are consistent and within the scope of the
organizations responsibility?
Yes No Provides updates to the organizations director, EOC command, and higher
headquarters, as determined in the plan?
Yes No Advises the director and chain of command regarding information to be released,
based on the organizations role in the response?
Yes No Ensures that risk communication principles are employed in all contact with the
media, the public, and partner information release efforts?
Yes No Advises on incident-specific policy, science, and the current situation?
Yes No Reviews and approves materials for release to the media, the public, and partners?
Yes No Obtains required clearance of materials for release to the media on policy or
sensitive topic-related information not previously cleared?
Yes No Determines the operational hours and days, and reassesses throughout the
emergency response?
Yes No Ensures resources are available, such as personnel, technical resources, and
mechanical supplies?

Media
Yes No Assesses media needs and organizes mechanisms to fulfill media needs during the
crisis, such as daily briefings in person versus a website update?
Yes No Triages the response to media requests and inquiries?
Yes No Ensures that media inquiries are addressed as appropriate?
Yes No Supports and briefs spokespersons?
Yes No Develops and maintains media contact lists and call logs?
Yes No Produces and distributes media advisories and press releases?
Yes No Produces and distributes materials such as fact sheets and B-roll?
Yes No Oversees media monitoring systems and reports (e.g., analyzing environment and
trends to determine needed messages, determining what misinformation needs to
be corrected, identifying concerns, interests, and needs arising from the crisis and
the response)?
Yes No Ensures that risk communication principles to build trust and credibility are
incorporated into all public messages delivered through the media?
Yes No Acts as member of the JIC of the field site team for media relations?
Yes No Serves as liaison between organizations through the JIC?
Direct Public Information
Yes No Manages the mechanisms for responding to public requests for information via
social media, telephone, in writing, or by e-mail?
Yes No Oversees public information monitoring systems and reports (e.g., analyzing
environment and trends to determine needed messages; determining what
misinformation needs to be corrected; identifying concerns, interests, and needs
arising from the crisis and the response)?
Yes No Oversees and activates social media, telephone, public e-mail correspondence
response systems?
Yes No Organizes and manages the emergency response Web sites, Web pages, Facebook
page and other social media?

Direct Public Information
Yes No Establishes and maintains links to other emergency response Web sites?
Partner and Stakeholder Information

Yes No Establishes communication protocols based on prearranged agreements with
identified partners and stakeholders?
Yes No Translates EOC situation reports and meeting notes into information appropriate
for public and partner needs?
Yes No Works with subject matter experts (SMEs) to create situation-specific fact sheets,
Q&As, and updates?
Yes No Manages the development and testing of messages and materials for cultural and
language requirements of special populations?
Yes No Coordinates with other communication team members regarding content and
message needs?
Yes No Adapts messages based on analysis from media, social media, public, and partner
monitoring systems, SME clearance, and feedback?
Yes No Guides documents through formal clearance process before they are released to
the media, the public, or partner organizations?
Content and Material for Public Health Emergencies

Yes No Develops and establishes mechanisms and protocols to rapidly receive information
from the EOC
Yes No Translates EOC situation reports and meeting notes into information appropriate
for public and partner needs
Yes No Works with subject matter experts (SMEs) to create situation-specific fact sheets,
Q&As, and updates
Yes No Manages the development and testing of messages and materials for cultural and
language requirements of special populations
Yes No Coordinates with other communication team members regarding content and
message needs

Content and Material for Public Health Emergencies
Yes No Adapts messages based on analysis from media, social media, public, and partner
monitoring systems, SME clearance, and feedback
Yes No Guides documents through formal clearance process before they are released to
the media, the public, or partner organizations
Suggestions to Consider about Resources

Space
Yes No You have space to operate communication teams or the JIC outside the EOC. A place
is also needed to bring media on site that is separate from the EOC and the JIC.
Yes No You have quiet space to quickly train and brief spokespersons.
Yes No You have conference space for team meetings.
Yes No You have office space dedicated for equipment exclusive to your use. You cannot
stand in line for the copier when facing media deadlines.
Yes No You have space where staff can take breaks when necessary, whether for eating,
sensory deprivation, rest, or even a nap.
Yes No An offsite space is identified in case the crisis damages your original space.
Contracts and Memoranda of Agreement(s)
Yes No Consider a contract with a comprehensive newswire service that will disseminate
your information across a wide variety of platforms, such as print and broadcast
news, Internet, and social media sites. Also consider using a variety of
communication tools, such as press releases, videos, images, e-mail, and social
media tagging.
Yes No Consider contracts with writers or public relations personnel who can augment
your staff, especially persons with social media writing and monitoring expertise, if
your organization doesnt have those personnel.
Yes No Consider a contract for administrative support and technical support.

Contracts and Memoranda of Agreement(s)
Yes No Consider a phone system/contractor that can supply a phone menu that directs the
type of caller and level of information desired:
General information about the threat

Tip line listing particular actions people can take to protect themselves
Reassurance/counseling
Referral information for media requests for information or interviews
Referral information for health-care/medical facility workers
Referral information for epidemiologists or others needing to report cases
Laboratory and treatment protocols
Managers looking for policy statements for employees
Equipment
Yes No Computers (desktop or laptop) loaded with secure Internet access, software
programs, and documents needed for crisis communication and information
sharing. These items include e-mail lists, the crisis communication plan, and
collaboration software.
Yes No Landline phones with dedicated lines and 800 MHz radios, in case of power outage
or cell phone network overload
Yes No Fax machines with numbers preprogrammed for broadcast fax releases to media
outlets and partners
Yes No Dedicated computer server with additional bandwidth to handle

increased Internet traffic
Yes No Computer printers, including at least one color printer
Yes No Tables (You will need a large number of tables.)
Yes No Color copier machine and backup
Yes No Cell phones, pagers, personal data devices, and e-mail readers
Yes No Extension cords
Yes No Visible calendars, flow charts, bulletin boards, and easels

Equipment
Yes No Designated personal message board
Yes No Small refrigerator
Yes No A/V equipment to host press conferences such as portable microphones, sound
system, multibox or press box, projector and screen, and recording devices
Yes No Podium
Yes No TVs with cable hookup
Yes No DVD player
Yes No Paper shredder
Yes No Alternative power supply, such as a generator, for the EOC and the JIC
Yes No Portable cots

Equipment
Yes No Supplies (all labeled for emergency only use):
Copier toner
Printer ink
Paper, notepads, and notebooks
Pens, pencils, markers, highlighters, and erasable markers
Supplies for mail, FedEx, UPS, and other shipping services
Sticky notes
Standard press kit folders
Flash drives and portable hard drives
Color-coded everything (copy paper, folders, inks, etc.)
Baskets to contain items that youre not ready to throw away
Organizers to support your clearance and release system
Expandable folders with alphabet or days of the month
Staplers (lots of them)
Paper punch
Three-ring binders
Organizations press kit or its logo on a sticker
Organization letterhead
Paper clips (all sizes)
Tape

References
1. CDC. Health Alert Network (HAN) [online]. 2012 Apr. [cited 2012 May]. Available from URL: http://
emergency.cdc.gov/han/.
2. Reynolds BJ. Crisis emergency risk communication: by leaders for leaders [online]. 2004. [cited 2012 May]. p.
40. Available from URL: http://emergency.cdc.gov/erc/leaders.pdf.
3. Cole G, Sokler L. CDCynergy. Emergency risk communication (Beta version). CDC, Office of Communication
[online]. 2003. [cited 2012 May]. Available from: http://www.orau.gov/cdcynergy/erc/.
4. Reynolds BJ. CDC. Crisis emergency risk communication. Quick guide [online]. 2008. [cited 2012 May].
Available from URL: http://emergency.cdc.gov/cerc/pdf/cerc_guide_basic.pdf.
5. U.S. Department of Homeland Security. National Response Framework [online]. 2008 Jan. [cited 2012 May].
p. 58 59. Available from URL: http://www.fema.gov/pdf/emergency/nrf/nrf-core.pdf.
6. Cole TW, Fellows KL. Risk communication failure: a case study of New Orleans and Hurricane Katrina. South
Commun J. 2008 JulySep;73(3):211228.
7. Kapucu N. Interagency communication networks during emergencies: boundary spanners in multiagency

coordination. Am Rev Public Adm 2006;36(2):207225.
8. National Commission on Terrorist Attacks upon the United States. The 9/11 commission report: Final report
of the national commission on terrorist attacks upon the United States. New York (NY): W.W. Norton &
Company; 2004.
9. Hall K, Landsberg M. Earthquake in Japan, shock and fury. Los Angeles Times Home Edition. [online] 2011
Mar 12. [cited 2012 May].
10. McCurry J, Sample I. Japans earthquake preparation has spared it from a far worse fate. The Guardian. UK
and world news. [online]. 2011 Mar 11. [cited 2012 May]. Available from URL: http://www.guardian.co.uk/
world/2011/mar/11/japan-earthquake-preparation.
11. Glanz J, Onishi N. Japans strict codes and drills are seen as lifesavers. The New York Times [online]. Late ed.
2011 Mar 12. [cited 2012 May]. Available from URL: http://www.nytimes.com/2011/03/12/world/asia/12codes.
html?pagewanted=all.
12. Sellnow TL, Seeger MW, Ulmer RR. Chaos theory, informational needs, and natural disasters. J Appl Commun
Res 2002;30(4);269292.
13. Clarke LB. Mission improbable: using fantasy documents to tame disaster. Chicago (IL): The University of
Chicago Press; 1999.
14. Light PC. Predicting organizational crisis readiness: perspectives and practices toward a pathway to
preparedness [online]. 2008. [cited 2012 May]. Available from URL: http://www.nyu.edu/ccpr/pubs/
OrgPreparedness_Report_NYU_Light_8.18.08.pdf.
15. U.S. Department of Education, Office of Safe and Drug-Free Schools. Practical information on crisis planning:
a guide for schools and communities [online]. 2007 Jan. [cited 2012 May]. Available from URL: http://www2.
ed.gov/admins/lead/safety/emergencyplan/crisisplanning.pdf.
16. Dyal W. Program management: a guide for improving program decisions. U.S. Department of Health and
Human Services, Centers for Disease Control and Prevention. Atlanta, Georgia. 1990.

17. Sellnow TL, Seeger MW, Ulmer RR. Effective crisis communication: a definition of crisis communication. 2nd
ed. Thousand Oaks (CA): Sage Publications, Inc.; 2011. Chapter 1, p. 5.
18. Telg R. Risk and crisis communication: when things go wrong. University of Florida, Institute of Food and
Agricultural Sciences [online]. 2010 Jul. [cited 2012 May]. Available from URL: http://edis.ifas.ufl.edu/wc093.
19. Federal Emergency Management Agency. National Incident Management System (NIMS).[online]. 2008 Dec.
[cited 2012 May]. Available from URL: http://www.fema.gov/pdf/emergency/nims/NIMS_core.pdf.
20. Federal Emergency Management Administration. Basic guidance for public information officers (PIOs).
National Incident Management System (NIMS). [online] 2007 Nov. [cited 2012 May]. Available from URL:
http://www.fema.gov/library/viewRecord.do?id=3095.
21. Baxter PJ, Ing,R, Falk H, French J, Stein GF, Bernstein RS, et al. Mount St. Helens eruptions, May 18 to June
12, 1980: An overview of the acute health impact. JAMA 1981;246(22):25859.
22. Zais D. May 18, 1980: The day the sky fell, managing the Mt. St. Helens volcanic ashfall on Yakima,
Washington, U.S.A. [online transcript]. 2001 Feb 14. [cited 2012 May]. Available from URL: http://volcanoes.
usgs.gov/ash/dickzais.html.
23. Lyons S. Time to make your hurricane evacuation plan. 2008 Apr 22. [cited 2012 May]. In: WeatherInsights:
The Weather Channel Blog [online]. Atlanta (GA): The Weather Channel, LLC. Available from URL: http://
www.weather.com/blog/weather/8_15416.html.
Resources
Abkowitz M. Lessons learned the hard way: what catastrophes can teach us about planning, communication
and luck. Vanderbilt Magazine [online]. 2008. [cited 2012 May]. Available from URL: http://www.vanderbilt.
edu/magazines/vanderbilt-magazine/2008/10/lessons-learned-the-hard-way/.
CDC. (2011). Emergency Operations Center (EOC) [online]. 2012 [cited 2012 May]. Available from URL:
http://www.cdc.gov/phpr/eoc.htm.
CDC. Emergency preparedness and response: What CDC is doing [online]. 2010. [cited 2012 May]. Available
from URL: http://emergency.cdc.gov/cdc/.
Reynolds BJ. Principles to enable leaders to navigate the harsh realities of crisis and risk communication. J
Bus Contin Emer Plan 2010 Jul;4(3):26273.
Reynolds BJ. Response to best practices. J Appl Commun Res 2006;34(3):249252.
Seeger MW. Best practices in crisis communication: An expert panel process. J Appl Commun Res
2006;34(3):232244.

Notes:

Notes:

Notes:

Chapter 5:
The Spokesperson
2014 EDITION

Chapter 5:
The Spokesperson
This chapter will promote understanding in the following areas:
The role of the spokesperson in crisis communication
What makes a good spokesperson?
Working with the media
Spokespersons in public meetings
Assessing spokesperson skills
Giving Your Organization a Human Form

The most important role in responding to a crisis is the formal, designated spokesperson. The
spokesperson brings the organization to life. He or she embodies the organization and personifies
the response. A spokesperson takes the organization from an it to a we and is a critical human
connection to the various audiences.
In an ideal world, every organization would have a caring and articulate spokesperson who exhibits
charisma and confidence. In many cases, there is little choice about who ultimately speaks for the
organization during a crisis. One thing communication staff can control is to insist spokespersons are
trained. Few people are born crisis spokespersons. In a crisis, even the most skilled communicator can
make mistakes. No person should represent the entire organization in these situations unless he or she
has invested time and energy in developing the appropriate skills.
Whats important is not how a person looks on television but the ability to effectively connect with the
audience, either through the use of the media or in person.
Spokespersons allow the public to put a face to the act of responding to, investigating, and resolving a
crisis. How a spokesperson handles public and media inquiries, in addition to what he or she says, helps
establish credibility for an organization. It also contributes to the publics transition from the crisis stage
to resolution and recovery stages. An organization should carefully choose spokespersons. The selection
should be based on the individuals familiarity with the subject matter and his or her ability to talk about
it in a way that is understandable and conveys confidence.1
153
Choosing the Right Spokesperson is Important
Spokespersons allow the public to put a face to the act of responding to, investigating,
and resolving a crisis. How a spokesperson handles public and media inquiries, in
addition to what he or she says, helps establish credibility for an organization. It also
contributes to the publics transition from the crisis stage to resolution and recovery
stages. An organization should carefully choose the personnel who will represent it. The
selection should be based on two factors:
The individuals familiarity with the subject matter
His or her ability to talk about it clearly and with confidence
Consider two similar cases with different outcomes:

Case 1: In this situation, the CEO of a corporation accused of polluting
groundwater called a news conference where he expressed anger at being
unfairly accused. In this news conference he acted condescending toward his
critics. A member of the audience presented him with a glass of water from
her well and asked him to drink it. He did and in the process choked. Had this
incident happened recently, it would likely have been recorded and loaded on
YouTube.
Case 2: This is a situation in which children are among the victims diagnosed
with cancer in a town where the people believe the activities of a major
corporation are linked to the towns prevalence of cancer. At one point during
the meeting, in front of national media, a 9-year-old child with a jar of dirty
water demands assurance that the water she is drinking is safe. The CDC
spokesperson who was present for the meeting was both knowledgeable about
the issue and trained to talk about it in an effective and consistent manner.
As a result, the spokesperson responded to this line of questioning effectively,
without anger, and was able to defuse a potentially difficult situation.
The right selection and training of a spokesperson can lead to better outcomes. If
possible, have the crisis spokesperson appear in public often to help establish familiarity
and credibility for your organization. He or she should not be a new face. For example,
throughout the duration of the Brentwood postal facility anthrax case, an Epidemic
Intelligence Service (EIS) officer met with the Brentwood workers several times to
discuss antibiotic prophylaxis. When the CDC recommended 30 days of therapy in
addition to the anthrax vaccine, an activist in the crowd started shouting inflammatory
comments. But because the EIS officer had established himself as a credible and trusted
source of information, instead of rallying around the activist, the crowd told the heckler
to be quiet so they could hear what the EIS officer had to say.
154 Chapter 5 The Spokesperson

The Role of the Spokesperson in Crisis Communication
The spokesperson during an emergency should communicate information the public wants or needs.
This information should empower people, build trust, and reduce the level of harm. This includes short-
term and long-term psychological and physical harm. The spokesperson should seek to accomplish
several goals and be prepared to respond to a variety of questions, such as the following:
What is the incident and how severe is its magnitude

(e.g., who, what, where, when, why, and how)?
What are the health and safety risks for individuals and communities?
Who is managing the event and what are they doing to respond to the incident?
The spokesperson can orient the larger audience at the beginning of a response by
following these suggestions:
Establish an appropriate level of concern and empathy,

We, in a free democracy, owe
which can help create rapport with the audience.
the public open and factual
Remain calm while acknowledging uncertainty and communications whether its a good
avoiding the tendency to over-reassure. story or a bad story. We are a great,
Show competence and consistency in responding to help resilient nation, and weve proved
build confidence and trust. that. So we can take bad news as well
Demonstrate openness and transparency. Panic is less as good news. What we cant take is a
common than most people imagine and doesnt come block-out of no news.
from bad news, but from mixed messages or a feeling
that people arent being told the truth. Col. Terry Ebbert, USMC Retired,
Former Director,
As the event unfolds, the spokesperson may also need to address Homeland Security,
more controversial issues, including the following: City of New Orleans
The potential allocation of scarce public health and

safety resources that are seen as unfair or wasteful
People or communities choosing to ignore or circumvent public health and safety
recommendations
Questions and criticism about blame, responsibility, and whether the response is adequate
Remember your spokespersons are not solely responsible

for messages. However, they must be involved in the
development of those messages to ensure some ownership. Spokespersons dont just read a
The words and the person must match. Spokespersons dont statement; they are the statement.
just read a statement; they are the statement. If spokespersons
dont fully understand the purpose behind the messages or
Chapter 5 The Spokesperson 155

recommendations, they will have difficulty assuming a stance of confidence and conveying
believability and trust.
Others can and should help with the spokesperson role. While the primary spokesperson is the
central figure in offering the message, he or she may be joined by other experts or agency heads.
The spokesperson may turn to these supporters for answers to specific questions or to provide
additional background.
Message development is covered extensively in Chapter 3; however, its worth briefly repeating some
of the CERC principles during a crisis. The following rules help to build confidence and trust. During
an emergency, communication to the public is not business as usual. Before you can communicate the
facts and recommendations for action, you must lessen the audiences psychological barriers by openly
acknowledging their concerns.
Basic CERC rules include the following:
Dont over-reassure: The objective is not to placate but to elicit accurate, calm concern.
Consider statements such as: This is a very dangerous winter storm, but people can take
actions to limit their risk. If at all possible, stay at home and off the streets until the storm
passes and roads are clear.
Acknowledge uncertainty: Offer only what you know: The situation is developing and we
dont yet have all the facts. Based on what we do know, we expect.
Emphasize that a process is in place to learn more: Describe that process in simple
terms: Samples are taken from each person reporting flu-like symptoms. These samples are
being tested now to identify the exact strain.
Give anticipatory guidance: If you are aware of future negative outcomes, let people know
what to expect. For example, to foreshadow side effects of antibiotics, you could say, This
broad spectrum antibiotic is an effective medication, but it can cause stomach upset, including
nausea and diarrhea in some people.
Be regretful, not defensive: Say, We wish that more doses of vaccine were
currently available or We feel terrible that when acknowledging mistakes or failures
from the organization.
Acknowledge peoples fears: Dont tell people they shouldnt be afraid. They are afraid, and
they have a right to their fears. Use statements like, We understand people are concerned and
afraid, and it is normal to be frightened when facing a wildfire.
Acknowledge the shared misery: Some people will be less frightened than they are
miserable, feeling hopeless and defeated. Acknowledge the misery of a catastrophic event, and
then help move people toward the future through positive actions. Use statements like: Right
now, with so many people in shelters, its hard to see how things can return to normal. We are
working hard to start the process of returning people to their homes.
Express wishes: Say, I wish we knew more or I wish our answers were more definitive.

Be willing to address the what if questions: These are the questions that everyone is
thinking about, and to which they want expert answers. Although its often impractical to fuel
what ifs when the crisis is contained and not likely to affect large numbers of people, it is
reasonable to answer what ifs if the what ifs could happen and people need to be emotionally
prepared for them. Use statements like, We have considered the possibility that the situation
will get worse and we have identified additional locations for shelters.
Give people things to do: In an emergency, some actions are directed at victims, those
exposed, or those who have the potential to be exposed. Simple actions in an emergency will
give people a sense of control and will help motivate them to stay tuned to what is happening.
It may also be helpful to give people a choice of actions matched to their level of concern. Give
a range of responses: a minimum response, a maximum response, and a recommended middle
response. Use statements like, You may wish to cook spinach thoroughly before eating it. You
may wish to avoid eating spinach. Or, you may wish to eat only prepackaged frozen spinach.
Ask more of people: Perhaps the most important role of the spokesperson is to ask people
to manage the risk and work toward solutions with you. People can tolerate considerable risk,
especially voluntary risk. If you acknowledge the risks severity and complexity, and recognize
peoples fears, you can then ask the best of them. A spokesperson, especially one who is on
the ground and at personal risk, can model the appropriate behaviornot false happiness, but
true willingness to go on with life as much as possible and to make reasonable choices. Your
determination to face risk will help others looking for role models.
In general, research demonstrates that people respond to crises in cooperative and problem-
solving ways.2 Most often, they help their neighbors and take reasonable actions. Sparking those
inherent attributes will help people cope with uncertainty, fear, and misery. Use statements like,
We are all shocked and concerned about this tragedy. We need to stay strong, with hope for the
future, as we do our best to help each other. By staying informed and following instructions from
health officials, you can protect yourself, your family, and the community against this public
health threat.
What Makes a Good Spokesperson?

Its difficult to capture all qualities of a good spokesperson and pass them on to others. But its not
difficult to identify the qualities of a poor spokesperson.3
Nearly all speaker training starts or ends with: Be yourself. Be natural. The audience can tell when
the person appears stilted or fake. Being natural doesnt mean forgetting the seriousness of your role.
Better advice is: Be your organization. Act like your organization. Every organization has an identity.
A spokesperson should try to embody that identity. For example, CDC exists to make people safer and
healthier. Conveying that message is important.

While there are differing opinions on what makes a good crisis spokesperson, most experts agree on
these basic principles:4,5
Have a crisis communication spokesperson(s) identified and a plan in place before the crisis.
Make sure the spokesperson is visible, via the media, as soon as the crisis occurs. Have that
spokesperson explain who is in charge, and that the person in charge is concerned about the
victims. It is important to demonstrate compassion and empathy from the beginning.
Be transparent. Provide candid, accurate information, including being open to what is known
and what is unknown about the crisis.
Dont speculate, assume, or make premature promises that may have to be reversed later.
Meet the needs of the media, including being accessible and providing regular updates about the
crisis.
Present a unified message, whether it is among spokespersons of one organization or across
several organizations that are coordinating a crisis response.
The spokesperson should communicate facts and information about the crisis, including what is being
done. It is also important to communicate caring, compassion, and empathy to create public goodwill
and maintain a positive reputation for your organization.
A spokesperson must be perceived as trustworthy and credible.6 Research shows that there are five
basic elements to establishing trust and credibility through communication.7,8 All messages, written
or spoken, can incorporate these elements, especially when attempting to communicate during an
emergency:
Empathy and caring: Share your care and concern for what others are going through in a
crisis. This will increase the likelihood that the audience
will listen to and act upon your message.
Competence and expertise: Education, position,
The minute I put my foot on the
and title help establish competence and expertise; ground in New Orleans was to
additionally, previous experience in dealing with similar make it known to everybody in the
situations will enhance the perception of competence. community down there that I was
Honesty and openness: Give people enough there, there was a federal leader that
information and choices to make appropriate decisions had moved forward, there was a face
so they feel empowered in the emergency. If you do of the response on scene, and that I
not know the information, then tell the audience why was accountable.
and explain that you are notifying partners, verifying
information, and taking similar actions that will help you RADM Thad Allen, Retired,
acquire more information. Former Commandant,
Commitment and dedication: State the organizations United States Coast Guard
goal for the crisis response. Show dedication by

communicating regular follow-ups that report on the progress, including successes and
challenges of the recovery process. However, dont promise what cant be delivered. Explain the
limitations of the situation and express that everything is being done to keep the response on
track.
Accountability: Keeping promises and being accountable for the decisions made are vital
for maintaining public trust and credibility in the organization throughout the response and
recovery process.
A spokesperson should work very closely with the public information officer (PIO) to develop messages,
gather facts, and determine what information can be released at any given time. Identify a time when
your spokesperson will be available to meet with the media or the public. Determine what mechanism,
such as a press briefing, media interview, or interactive webcast, he or she will use. The media and
the public will feel reassured when they know when they will receive more information. This includes
following up on issues.
Spokespersons must know the organizations policies about the clearance process and release of
information. They must do the following:
Understand the scope of responsibilities.
Limit comments to only the emergency response event.
Avoid answering questions that are outside the organizations responsibility for the response.
Spokespersons are often involved in give and take with members of the public or the media. They may
be challenged and asked for specific information. The question may be about controversial issues or
they may be asked for information that cannot yet be released. Even in these situations, it is important
to avoid spin. Tell the truth and be open. Explain why the question cannot be answered.
The effectiveness of a spokespersons communication is enhanced with the use of visual aids,
illustrations, examples, stories, and analogies. Ensure that they help make the point and do not
minimize or exaggerate the message. Visual aids, such as charts, maps, and models, can be helpful
in communicating some kinds of information. They are particularly useful in describing a process or
showing the relationship between factors.
A spokespersons presentation should be reviewed and rehearsed. Review visual aids before using them
publicly. Practice telling stories and examples on others within the organization before telling them
publicly. It is particularly important to carefully rehearse and review responses to anticipated questions
along with possible follow-up questions.

Spokesperson Pitfalls (and How to Avoid Them) During an Emergency
Limit jargon and acronyms: Jargon impedes communication and may imply arrogance.
Acronyms are particularly common with government agencies, but their use may alienate lay
audiences. Jargon and acronyms are often used to signal that people have inside knowledge or
are members of a technical group. As such, they can interfere with efforts to build audience
rapport. If using a technical term or acronym is necessary, define it.
Tailor messages to an easy level of comprehension: Use simple short sentences and
avoid technical vocabulary.
Use humor with caution: Humor is a minefield during a crisis. Soft, self-deprecating humor
may be disarming for a hostile audience, but, in general, efforts to be funny during a crisis are
likely to be misinterpreted.
Refute negative allegations without repeating them: Repeating any message enhances
its impact. If your speaker repeats a negative accusation, it is then part of the formal message.
Use positive or neutral terms.
Gather feedback: Dont assume that the point is understood; rather, ask whether the message
has been clear and is understood. Getting feedback, and listening to it, is important in helping to
ensure effective communication.
Avoid one-liners, clichs, and off-the-cuff comments: Any statement that trivializes the
experience by saying something like, There are no guarantees in life, reduces your credibility
and rapport.
In general, comments should be limited to what is known. Keep personal opinions to a minimum.
Spokesperson messages can be tailored to the situation and the stage of the crisis. For example, money
will become an issue at some point, but during the early stage of an emergency, messages about money
should be avoided.
Working with the Media

During a crisis the media can consume your time, but they are necessary. They are the best mechanism
for reaching your audience. The media are especially important during the first hours or days of an
emergency. Social media,9 such as Twitter and Facebook, are increasingly important, and a very fast
form of communication. However, the mainstream media, particularly television and radio, still have the
widest distribution.7 In some cases, traditional media will be the best way to reach many parts of the
public during an emergency. Media professionals generally accept their community and professional
responsibilities, particularly during a crisis. However, the job of a journalist is not the same as a PIO.
The differences must be respected.

General Media Interview Goals
Have a clear purpose for your interview. Identify core messages to deliver during the interview.
Seek opportunities to repeat or restate the core message. If key messages have not been
developed, then it may not be the right time for an interview.
Make sure the reporter gets the correct name of the person being interviewed. Titles should be
kept as short as possible. Use titles that describe the job rather than titles that reflect the title
of an official position. For example, saying medical epidemiologist is better than saying acting
chief of the so and so section of the such and such branch.
Come to the interview with supporting papers that can be given to a reporter after the interview.
This is a resource that can be used as a way of confirming information and helps the reporter
with your facts.
General Media Interview Pitfalls

Dont let reporters put words in your mouth. The reporter may use inflammatory or emotional
words. Avoid repeating them with the journalist; use your own words.
If the question contains leading or loaded language, reframe the question to eliminate the
language and then answer. Sometimes its helpful to restate the question in neutral terms.
If the reporter claims someone has lodged an allegation, dont assume he or she is correct. Dont
react to new information a reporter presents. Instead, you can say, I have not heard that or I
would have to verify that before I can respond.
If a reporter holds a microphone in front of you after
youve answered the question, resist the temptation to First of all, only do what you are
add information. Do not answer the question again or comfortable doing, talk about what
add to your answer. Instead say, That was my answer.
your subject matter expertise is.
Do you have another question for me to address? Say it
matter-of-factly, without sarcasm or annoyance. Dont stretch. Dont think or provide
an opinion on things you dont know
Understand there is no such thing as off the record.
about.
Background and deep background do not mean you or
your spokesperson wont be quoted or identified. Do RADM Thad Allen, Retired,
not say anything before, during, or at the conclusion of Former Commandant,
an interview that you are not prepared to see in print
United States Coast Guard
the next day or uploaded to social media in the next
hour. The interview is not over until the reporter and all
equipment have left.
Anticipate questions. Work with PIOs to come up with expected questions and draft answers.
Nuances count. A word change here or there may make the difference in how well an answer is
received. Put the answer on paper because it will usually be too long to give in public, and then
find the bottom line. What is the key point? What rings true and doesnt sound evasive? Make
that core message the 30-second answer.

Make the key point first and have prepared supporting message points. Try to say the key point
in 30 seconds and in fewer than 90 words.
Dont pretend to have answers. If the specific piece of information is not yet available, say so.
I dont know or Thats not my area of expertise is an appropriate answer, if followed by a
commitment to find the answer.
Dont fight your battles through the media. When talking with the media dont assign blame.
Never speak disparagingly of anyone, not even in jest. Avoid critiques of other agencies or
other responses. Reporters can be reminded that professionals differ in their opinions, but
then get back on topic. Comments should be focused on what you know and what your
organization is doing.
Avoid being caught in hypothetical questions. Reframe the question in a way that addresses
legitimate concerns of the public without being sensational or offering speculation
for entertainment.
Record sensitive interviews on audio or video. Be sure the reporter knows the interview is
being recorded and make a copy available. Consider posting interviews or press statements
on your website.
Do not ask reporters to agree to let you review their articles or interviews. Instead, offer
to clarify information for them as they prepare their story. If a reporter shows you the piece,
understand that he or she expects you to correct errors in fact, not viewpoints that may
differ from yours.
Break down multiple-part questions and answer each part separately.
Dont raise issues you do not want to see on the Web, in print, or on the news.
Dont respond with no comment to a reporters question. Instead, state why you cant answer
that question. Say that the matter is under investigation, the organization has not yet made a
decision, or simply that you may not be the appropriate person to answer that question.
Media Briefing or Press Conference Tips

Determine in advance who will answer questions about specific topics. Consider having various
experts available during the briefing as part of the team.
Keep answers short, focused, and organized. They should be no longer than 2 minutes.
Realize that some press briefings may be conducted via a podcast or interactive webcast.
Practice one briefing using these technologies so you are comfortable with how they function.
Assume every microphone is liveall the timeincluding wireless clip-on microphones. Assume
that cell phone cameras and recorders are continuously capturing what you are saying and doing
for sites such as YouTube.

In-Person Interview Tips
Know who will be conducting the interview. Learn which reporters will be there and the news
outlets they represent.
Know the subjects the reporter wants to cover and limit the interview to those subjects. If the
reporter goes off in another direction, indicate that you are not the right person to answer that
question at this time.
Know the format and duration of the interview. Be willing to set limits so there is a clear end
time. Keep the interview short in duration and focus on what is important. Consider scheduling
a follow-up interview, if required.
Ask who else will be interviewed or has been interviewed about the subject.
Ask when the interview will be available and where. If that is not yet known, ask to be notified
when the decision has been made.
Do not do the following:
Try to embarrass or argue with a reporter.
Tell the news organization which reporter is preferred.
Demand that remarks not be edited.
Insist that an adversary or critic not be interviewed.
Distort, color, or spin the truth.
Demand that an answer or quote not be used.
State that what you are about to say is off the record or not attributable to you.
Telephone Interview Tips

Ask the name and affiliation of the person with whom you are talking.
Ask if the interview is being recorded.
Ask when and where the information will be used.
Obtain the reporters phone number and e-mail before the interview begins. You may wish to ask
to call the reporter back to verify that they are indeed who they claim. You may also need to call
back if the call is interrupted or if you need to provide updated information.
Spell out difficult names, technical terms, and phrases.

By participating in a telephone interview, while limiting its length, you have met your obligation to
answer important questions. Bear the following in mind:
Dont do the reporters homework. You do not have an obligation to explore every
facet of the incident.
Recommend reporters review Web-based or print materials to save time.
Schedule the interview in a quiet room.
Dont allow distractions such as cell phones. Ask that they be turned off.
Consider standing up; it strengthens your voice and makes you sound more alert.
Keep written versions of key messages at hand. Repeat those often so reporters know they are
the most relevant points.
Ask reporters for feedback to ensure they understand your key points.
Special Considerations for Television and Radio Interviews

Radio, television, and Web-based media are much more immediate and thus are more prominent in the
early stages of a crisis. Television reporters may be more likely to try to elicit dramatic or sensational
responses. Because these interviews are usually recorded, they may end up being aired repeatedly. Most
television news outlets post entire unedited interviews on their websites.
Radio interviews, either recorded onsite or over telephone, are immediate and may be aired quickly.
They, too, may appear later on a website. Interview styles should be adjusted accordingly. Review the
following list for tips:
Take the time to prepare for a television interview:
yy Rather than memorizing answers, which tends to come off as rote, the spokesperson should
thoroughly learn the ideas, facts, and anecdotes that apply to the interview topic. These can
be discussed easily and naturally during the interview.
yy As with all interviews, the PIO should help the spokesperson practice answering questions,
especially aggressive, rapid-fire questions. Practice reduces anxiety and will result in a more
relaxed and natural delivery.
yy Practice answering questions in 10- to 20-second phrases. If a question calls for a longer
answer, pause every 20 seconds. This will make it easier for the host to break in for a
commercial interruption or to edit materials.
yy Rehearse stopping after you are directed to stop; hard breaks in midsentence for a commercial
look unprofessional and desperate.

Slow down. Microphones and nerves tend to make people talk faster. Slow down and deliberately
pause between sentences to force a more relaxed and conversational pace.
Avoid monotone. Practice raising and lowering the pitch of your voice. Change the inflection and
add emphasis through vocal variety. The vocal volume should be kept conversational. Natural
animation, gestures, and facial expressions help increase credibility.
Handling Techniques Sometimes used by Television and Radio Interviewers

Most journalists are professional and respectful of the interview process. Sometimes a novice reporter
or someone seeking more controversy will use techniques designed to throw the interviewee off
message.10,11 Its important to be prepared for these techniques. Sensational or unrelated questions may
be inserted into interviews. In these cases, do the following:
Answer the question in as few words as possible. Dont repeat the sensational elements.
Return to the key messages. Recommended verbal bridges back to the key message
may include the following:
yy What I think you are really asking is
yy The overall issue is
yy Whats important to remember is
yy Its our policy not to discuss this issue, but what I can tell you is
yy What Im really here to discuss
yy Your readers/viewers really need to know
Character attacks may be part of interviews. Dont argue or confront an adversary during an
interview. Question the science, facts, or issues, but not someones character. For example, use
a phrase like, I cant speak for Dr. X. Youll have to ask her, but what I can address is...
Machine-gun questioning is a technique where a reporter fires rapid questions. Pacing is
quick and the reporter interrupts your response. The most appropriate response is to use
a phrase like the following:
yy Please let me answer this question
yy I would like to answer those questions one at a time.
Control the pace. Take the time necessary to think before responding.

Watch for microphone feeding and pausing. This technique is used to generate a longer
response. Perhaps youve given a complete answer on a controversial issue; then the reporter
pauses and cameras continue to roll. Reporters are hoping to get a longer response.
If this happens, do the following:
yy Stay on your agenda.
yy Be aware of nonverbal cues like a deer-in-the-headlights look or fidgeting.
yy Relax and let the reporter fill dead air time. Dead air doesnt make exciting viewing unless you
react with an action or expression. Dead air time will be edited out.
Remember that your microphone is always onalwaysincluding during testing and sound
checks, and after the interview is officially over.
Be aware of sensational questions with an A or B dilemma. Use positive words to reject the
dilemma and correct the inaccuracies without repeating the negative. Reject both A and B if
neither is valid. Explain, Theres actually another alternative you may not have considered and
give your message point.
Surprise props may be introduced. The reporter may attempt to hand the interviewee a report
or supposedly contaminated item. Dont take it. If you take it, you own it. React by saying, Im
familiar with that report, and what I can say is or Obviously, I havent had time to review this
report, but what is important is and then go to your key message.
Radio Interviews
Radio is an important crisis communication medium because it is immediate and portable. Reporters
often use small handheld recorders and wireless technology to file their stories. In other cases, radio
interviews are done over the telephone.
Live is different from prerecorded. Find out if the interview is live, live to tape, or taped. If the interview
is live, determine whether callers will be permitted to ask questions. It is challenging to provide useful
answers to questions from individual citizens during a crisis interview. That is usually not an effective
means to provide information.
Radio interviews include unique features. The following list provides important radio tips:
Speak in normal tones with a conversational style of speaking.
Avoid using vocalized pauses such as uh, um, and you know. Do not feel a responsibility to
fill air time. Take the time necessary to form your thoughts before answering questions.
Use notes but be aware of the rustle of papers.
Know that radio interviews will probably not be as in-depth as print interviews.
Keep key messages succinct.

Avoid lengthy scientific explanations. As with television, the radio audience has limited scientific
background. Take on your audiences point of view and speak to their level of understanding.
Be aware that reporters may ask the same question multiple times in an attempt to elicit a
different answer or to get an answer that is more concise. Avoid beginning an answer with a
phrase like As I said before because the actual audience for this interview will not have
heard your previous answer of the same question.
Understand that radio is more informal and spontaneous than television. Radio is
more community-based and reporters are likely to ask more questions from the
communitys perspective.
Television Interviews
Television is a visual medium; consider your physical presentation.12 This includes dress, gestures, and
facial expressions. While some people are more natural and comfortable on television, preparation can
help improve effectiveness.7
Avoid broad unnatural gestures or moving around in the chair. Ask for a chair that
does not swivel.
Dont look at yourself on the TV monitor. It is distracting to the viewer.
Look at the reporter, not the camera, unless directed otherwise.
When wearing an earphone, ensure that it fits securely and that you know what to do if it pops
out of your ear. Ask the producer or sound technician for help if needed.
Sit comfortably upright with a straight posture.
In taped interviews, ask to repeat your response if you believe the first attempt was not the best.
In live interviews, correct misstatements as quickly as possible.
What to Wear on Television

Clothing selection is an important consideration, particularly in televised situations, and should be
appropriate to the specific situation. For example, if youre in a field situation, a suit may not be
appropriate. Do not wear medical clothes or a lab coat unless you would be logically wearing them for
your job. Jackets with the agency name or logo may be appropriate.
For men, consider the following appearance tips:
yy Avoid patterned suits and neckties, stripes, and checks. The camera will make them wavy and
distracting to the viewer. Neckties should be somber and professional. Avoid novelty ties.
yy Button suit coats. If possible, sit on your coattails to avoid bunching around your neck and
shoulders. Light blue or gray suits are most camera-friendly. In an emergency, it is most
appropriate to look conservative, not stylish or flashy.

yy Wear white shirts to be the most conservative.
yy Wear socks that are darker than the suit. They should be knee-length. Because your pant legs
may creep up, wear long socks to prevent your ankles from showing.
yy Make sure you hair is neatly trimmed and groomed to convey professionalism.
When possible, be clean-shaven.
For women, consider the following appearance tips:
yy Wear tailored, professional clothes to convey credibility.
yy Plan neutral colors and muted patterns for a camera-friendly look. Most set backdrops are
blue or purple. Take along a contrasting shawl or scarf to ensure that you do not blend into
the background if your suit matches the set color.
yy Wear dark shoes.
yy Do not wear distracting or shiny jewelry or accessories that jangle or need adjusting.
yy Wear daytime, conservative makeup. Avoid bright fingernail polish.
For men and women, consider the following appearance tips:
yy Ask for powder if your skin is shiny under the lights. Bald men should powder the
tops of their heads.
yy Take off glasses if you can do so without squinting. If you must wear them, consider getting
antiglare glasses. Avoid tinted lenses or sunglasses during a television interview. If the light
hurts your eyes, ask that it be adjusted. Eye contact is important in establishing credibility.
Spokespersons in Public Meetings

You or your spokespersons may have to speak at public meetings. This may include a variety of
audiences, such as community members, people who are affected by the crisis, elected officials, first
responders, and members of the media. Public meetings may be accompanied by especially high levels
of emotion and create unique demands.
When Emotions and Accusations Run High During an Emergency Public Meeting
Crises often create heightened emotional responses. The following basic circumstances are more likely
to increase angry responses:
When people have been hurt
When they feel threatened by risks not of their own making
When they feel their fundamental beliefs are being challenged

When people feel weak in the face of others who are more powerful
When they feel like they havent been treated fairly or with respect
When people feel manipulated, ignored, or trivialized
If conducted in an insensitive manner, public meetings may increase dissention and outrage.4
The following approaches may help you or your spokesperson soothe these emotions and help the
community work toward a mutually agreeable solution:
Dont lose your temper: Public health and safety personnel see themselves as the good guys.
It hurts when intentions, abilities, and expertise are criticized. Consider the following points to
keep operations calm and focused:
yy Set aside your own anger or defensiveness.
yy Strive to understand. Often the anger being expressed by others is a result of an overwhelming
sense of helplessness.
yy Show empathy.
yy In cases where extreme emotion might be expected, ask for ground rules outlined by
a neutral third party.
yy Acknowledge the anger up front. Explain what might be accomplished in the public meeting. If
communication deteriorates, it may help to refer back to your meeting objectives.
Practice self-management to calm nerves in high-stress situations: It can help to

take deep breaths and give yourself mental reminders that criticism is not personal and that
there is a greater purpose to the meeting. Consider the following tips to keep the meeting calm:
yy Anticipate criticism and attacks, and practice responding calmly.
yy Let the other person vent, without interruption, for a reasonable amount of time. This may
help dissipate anger.
yy Pause before responding and acknowledge the emotion.
Let people talk: The more people talk, the better the chance that theyll judge the
meeting as successful:
yy Dont allow lectures by the spokesperson or the organizational experts.
yy Suggest ground rules to ensure order and allow those with opposing viewpoints an
opportunity to be heard.
yy Offer equal time to dissenting views among those attending. This will help avoid a
spiral of silence.

Engage in active listening: Concentrate on what the person is saying, and listen for
both feelings and content:
yy Resist forming an answer while listening to the response; it interferes with your understanding
of what the other person is saying.
yy Let your audience know all concerns are being taken seriously and take time to
frame your responses.
yy Avoid interrupting, but set limits. If a hostile speaker dominates, appeal to him or her. Explain
that it is important to address the concerns of others in the room.
Ask questions: Wait for their questions before you offer your solutions. You may be surprised
to find out that the issues that matter to your audience are not the issues you expected. The key
is not to offer solutions to problems, but to help the audience discover solutions.
Dont say but. Instead, say yes, and: Typically, people express their differences by
prefacing their responses with but. Listeners will be more receptive if you first acknowledge
their views with a yes and then preface your view with an and. Example: Yes, we want to
protect peoples rights and we want to keep them alive to enjoy those rights.
Avoid saying I know exactly how you feel: Instead, acknowledge the feeling and its
legitimacy. Use statements like the following:
yy I understand why you are angry
yy I understand your frustration and anyone in this circumstance would likely feel this way.
Respond appropriately but professionally to personal, unfair, or abusive

comments: A certain amount of anger and negative emotion directed at you is understandable.
If it becomes personal you have a right to call such behavior inappropriate and ask the person to
join with you in getting back to the issues. Try to signal to the audience when the conversation
is no longer appropriate.
Look forward, not backward. Acknowledge past mistakes: Use statements such as I
wish we had met with you sooner to hear these concerns. Then talk about where you want to go
in resolving problems rather than where you have been. Avoid rehashing old issues. Encourage
people to look forward.

Assessing Spokesperson Skills
In Ongoing Crisis Communication, W. Timothy Coombs describes tasks, knowledge, skills, and traits
that are important for being an effective crisis spokesperson.13
Table 51. Spokesperson Media Task Analysis
Task Knowledge Skills Traits

Statement
Appear pleasant on 1. Understand the value 1. Strong Delivery 1. Low communication
camera of proper delivery apprehension
Answer questions 1. Understand danger of 1. Able to think quickly 1. High stress tolerance
effectively long pauses
2. Able to use the steps to 2. Communication
2. Understand the steps effective listening competence
to effective listening
3. Able to use phrases 3. Low verbal
3. Appreciate the other than no comment aggressiveness
danger of no comment when an answer is not
statements currently known
4. Understand the 4. Able to stay calm

danger of arguing under pressure
with reporters
Present crisis 1. Appreciate the 1. Able to avoid the

information clearly problems with jargon use of jargon
2. Understand the need 2. Able to organize

to structure responses responses
continued

Task Knowledge Skills Traits
Statement
Handle difficult 1. Understand the 1. Able to identify 1. Low argumentativeness
questions characteristics of tough questions
tough questions
2. Able to ask for questions
to be reworded
3. Able to preface
tough questions in a
tactful manner
4. Able to challenge
incorrect information
in a questions
5. Able to explain
why a question cannot
be answered
6. Able to evaluate the

appropriateness of
multiple-choice responses
in a question
7. Able to respond
to questions with
multiple parts
Establishes 1. Answers questions 1. Remains calm 1. Communication

credibility effectively Assertiveness
2. Reflects the appropriate
2. Demonstrates subject level of concern
matter expertise and/or
disaster management 3. Projects an atmosphere
expertise of stability
3. Is honest and frank
Improves over time 1. Understands the 1. Ability to 1. Self reflexive

importance of feedback receive feedback
2. Flexible and adaptive
2. Seeks out advice and
constructive criticism
*Adapted and reprinted with permission from W. Timothy Coombs.

Task statements are items that you or your spokesperson should accomplish when speaking as a
representative of the organization. While looking pleasant on camera is necessary, answering questions
effectively, presenting information clearly, and handling difficult questions is what brings success. He or
she must also establish rapport and credibility with the audience.
These tasks are enhanced by knowledge of the communication process and technical expertise, such
as experience handling disasters or specific subject matter knowledge. Often, credibility emerges from
the communication situation itself. As a spokesperson demonstrates knowledge and skill, he or she is
accepted as credible by the audience.
Specific communication skills, verbal and nonverbal, are critical in being a strong spokesperson:
Maintain eye contact and be aware of facial expressions. A frown or grimace at the wrong time
can create a very negative image.
Avoid leaning on the lectern and maintain good posture, even if exhausted.
Spokespersons should have strong voices, articulate clearly, and be able to speak in a relaxed
conversational tone, even in stressful situations.
Express emotions, but be careful about extremes.
Finally, there are specific communication traits that characterize effective crisis spokespersons:
They typically have low communication apprehension and do not exhibit stress or become
overly nervous when speaking to audiences.
They are able to tolerate and manage high levels of stress and uncertainty, and generally have
low verbal aggressiveness and argumentativeness.
Effective spokespersons generally remain calm even in complex and chaotic situations.
The spokesperson role is critical to effective crisis communication. The most effective spokespersons
are able to recognize where improvement is needed and work closely with communication staff to
improve their skills. This may involve watching tapes of press conferences and participating in media
training. They should be able to receive and act upon feedback and constructive criticism. Effective
crisis spokespersons also realize that they are part of the communication team and rely on the team to
communicate during the stress and uncertainty of a crisis.
Conclusion
Organizational spokespersons have pivotal roles in crisis and emergency risk communication. They are
the face of the organization and humanize the crisis message. The role of spokesperson is challenging
and stressful. It requires careful preparation and sensitivity to the communication process and
the needs of the audiences. Credible, empathetic, and composed spokespersons are very valuable
communication resources during a crisis. A skilled spokesperson can make communicating during a
crisis much more efficient and effective.

Pocketcard 51. Youre the SpokespersonWhat You Need to Know
Prepare to Answer These Questions:

Are my family and I safe?
What can I do to protect myself
and my family?
Build Trust and Credibility by Expressing:
Empathy and caring. Who is in charge here?
Competence and expertise. What can we expect?
Honesty and openness. Why did this happen?
Commitment and dedication. Were you forewarned?
Why wasnt this prevented?
Top Tips: What else can go wrong?
Dont over-reassure.
When did you begin working on this?
Acknowledge uncertainty.
What does this information mean?
Express wishes (I wish I had answers).
Explain the process in place to find Stay on Message:
answers. Whats important is to remember
Acknowledge peoples fear. I cant answer that question,
Give people things to do. but I can tell you
Ask more of people (share risk). Before I forget, I want to tell
your viewers
As a Spokesperson:
Know your organizations policies. Let me put that in perspective
Stay within the scope of responsibilities.
CONSISTENT MESSAGES ARE VITAL
Tell the truth. Be transparent.
Embody your agencys identify.
BE FIRST. BE RIGHT. BE CREDIBLE.

References
1. Sandman PM. Criteria for choosing a spokesperson. CDCynergy [online transcript]. [cited 2012 Jun].
Available from URL: http://www.orau.gov/cdcynergy/erc/Content/activeinformation/essential_principles/EP-
spokesperson_content.htm.
2. Tierney, KJ. From the margins to the mainstream? Disaster research at the crossroads. Annu Rev Sociol
2007;33:503525.
3. U.S. Department of Health and Human Services. Public health messages for emergency situations.
Emergency risk communication addresses harmful behaviors. CDC Media Relations Training [slide set]. Slide
#8 [online]. [cited 2012 Jun]. Available from URL: http://cphp.sph.unc.edu/panflu/Messages.ppt.
4. Argenti P. Crisis communication: Lessons from 9/11. Harv Bus Rev 2002 Dec;80(12):1039, 134.
5. Luecke R. Crisis management: mastering the skills to prevent disasters. Boston (MA): Harvard Business
School Press; 2004.
6. Chandran M, DeFrancisco L, Fugler S, Sesit E. Analyzing credibility: a study examining demographic factors
and personality traits that influence military public affairs credibility. U.S. Department of Defense joint
course in communication. Department of Communication, University of Oklahoma [online]. [cited 2012 Jun].
Available from URL: http://www.ou.edu/deptcomm/dodjcc/groups/02A1/index.htm#1.
7. Reynolds BJ. When the facts are just not enough: credibly communicating about risk is riskier when emotions
8. Izard CE. Translating emotion theory and research into preventive interventions. Psychol Bull 2002;
128(5):796824.
9. Pew Research Center. Internet gains on television as publics main news source [online].
2011 Jan 4. [cited 2012 Jun]. Available from URL:
http://www.people-press.org/2011/01/04/internet-gains-on-television-as-publics-main-news-source.
10. Braud GD. Dont talk to the media until 29 secrets you need to know. USA: Diversified Media; 2010. Lesson
14, p.478.
11. Sokler L, Weinberg L, Hendrick T. Facing the media: Emergency risk communication CDCynergy support
materials. American Institutes for Research, Prospect Center [online] 2002. [cited 2012 Jun]. Available from
URL: http://www.orau.gov/cdcynergy/erc/Face%20The%20Media%20Course%20Materials/default.htm.
12. Braud GD. Dont talk to the media until 29 secrets you need to know. USA: Diversified Media; 2010.
Lessons 26, 27. p. 93105.
13. Coombs WT. Ongoing crisis communication: Planning, managing, and responding. 2nd ed. Thousand Oaks
(CA): Sage Publications; 2007.

Resources
Agency for Toxic Substances and Disease Registry. A primer on health risk communication principles and
practices. Overview of issues and guiding principles [online]. 1994. [cited 2012 May]. Available from URL:
http://www.atsdr.cdc.gov/risk/riskprimer/index.html
Barton L. Crisis leadership now: a real-world guide to preparing for threats, disaster, sabotage, and scandal.
New York (NY): McGraw-Hill; 2008.
Cohn R. The PR crisis bible: How to take charge of the media when all hell breaks loose. New York (NY): St.
Martins Press; 2000.
Coombs WT. Information and compassion in crisis responses: A test of their effects. Journal of Public
Relations Research 1999;11(2):125142.
Rodman G. Mass media issues: Analysis and debate. Chicago (IL): Science Research Associates; 1981.
Seeger MW. Best practices in crisis communication: An expert panel process. J Appl Commun Res
2006;34(3):232244.
Ucelli L. The CEOs how to guide to crisis communications. Strategy & Leadership 2002;30(2):214.
Yale DR, Carothers AJ. The publicity handbook: the inside scoop from more than 100 journalists and PR pros
on how to get great publicity coverage: in print, on-line, and on the air. New York (NY): McGraw-Hill; 2001.

Chapter 6:
2014 EDITION

Chapter 6:
This chapter will review the following:
The medias role in a crisis, disaster, or emergency
Interacting with the media
Facilitating positive media relationships
Giving reporters what they need
Getting emergency information to the media
Writing for the media during a crisis
Meeting media needs throughout an emergency
Responding to media regarding significant errors, myths and misperceptions
Understanding the Medias Role in Disasters

Disasters are major media events. Public health emergencies The media can assist in pre-
will engage the media, especially if an emergency is exotic, disaster education. They may be
catastrophic, or the first of its kind. The media are a constant
crucial to an effective warning
presence in our lives and play a critical role in informing
the public during any crisis or disaster. Its natural for those process. They can provide
responding to a public health emergency to think of the media as information and advice to victims
a bother and distraction, but a better understanding of their role and others in the wake of disasters.
in an emergency will improve the relationship. They can help activate the local
disaster response. The can assist in
For example, if a public health emergency involves the stimulating effective disaster relief.
intentional release of infectious or chemical agents, the media
will spin into high gear. Because of its inherent threat, an act of Joseph Scanlon,
bioterrorism is guaranteed to receive media attention. The public Suzane Alldred,
is always anxious to learn about the resolution of the health
Al Farrell, and
crisis and subsequent criminal investigations and will often turn
Angela Prawzick,
to the media for this information.
Coping with the Media in Disasters:
The mainstream media, those media organizations that are well- Some Predictable Problems,
known and established, have changed greatly since 2000. Many Public Administration Review, 1985
media organizations have contracted their services or merged
with other organizations.1 Audiences for print and television
network news are smaller and older. Many younger people
rely on Web-based news sources. Much of Web-based content
177
is driven by the mainstream media and many audiences still rely on traditional media such as print,
television, and radio, as their primary news sources.2 Media audiences are increasingly fragmented. No
single source of information can be expected to reach everyone. In fact, there are some people who do
not regularly read, watch, or listen to much news from any sources.
The Medias Role in a Crisis, Disaster, or Emergency

Most of us are familiar with the Emergency Broadcasting System. It was created in 1963 as a way to
use public broadcast channels to alert the public of an immediate threat. In 1997, it was renamed the
Emergency Alert System. This system alerts the public by doing the following:
Telling the public something is happening and that they need to pay attention
to receive additional information
Directing the public to sources of additional information they can use to
protect themselves from a potential risk
The Integrated Public Alert Warning System (IPAWS) aims to combine the countrys public warning
systems, including EAS, Commercial Mobile Alert System (CMAS), and National Oceanographic and
Atmospheric Administration (NOAA) Weather Radio All Hazards.3 CMAS uses cellular mobile device
technology to deliver alerts directly to the public. While CMAS and related text alert systems will
become increasingly important, the traditional media will continue to play a critical role as a source for
information following an alert.
The media continue to serve as an important emergency information system during a crisis and they
do this very well. Professional media representatives that recognize their role in public safety serve
communities around the nation.
Because of their immediacy, television and radio are particularly important in crises that develop
quickly. Radio is very resilient and flexible. In many cases, local stations have switched format to
provide 24-hour coverage of an event, including call-ins. In other cases, radio stations have linked up
with social media and Web systems like Google Maps to provide robust, real-time disaster information
services.4,5,6 In the past, organizations had 24 hours to get information to media outlets. Now, media
outlets can provide immediate and continuous updates on a crisis through contributions from people
experiencing the crisis. These contributors provide information by calling in on cell phones and sending
information, such as pictures, video, and updates on social media sites like Twitter and Facebook. This
has increased the demand on organizations to keep pace with information delivery. This is done by
using both traditional media and social media channels to provide information and updates on the crisis
response both immediately and continuously.
178 Chapter 6 Working with the Media

In a democracy, the media also serve as a watchdog. This means they report on the activities of public
institutions and government, informing the public so that officials can be held accountable. During a
crisis, this may translate into investigative reporting about the following issues:
Cause Responsibility
Blame Adequacy of the response
Typically, investigative reporting takes a back seat during early stages of a crisis. But, at some point
reporters will ask more challenging and probing questions. The media generally work according to
emerging and somewhat informal agendas. This means current issues will be covered and related stories
will likely follow. For example, during the 2011 radiological incident in Fukushima, Japan, reporters
began looking at the general topic of nuclear safety. They then reported on the safety of U.S. facilities.7
Similarly, influenza season or tornado season will result in a series of related articles.
Journalists have a responsibility to report information they believe is honest and objective. Public health
and emergency management professionals sometimes expect the media to report in way that supports
official goals. However, the media are not an adjunct to public emergency response organizations. They
have their own place in a free society and their own commitment to the public. Emergency management
planners should acknowledge the medias role in a crisis and plan to meet reasonable media requests.
Few reporters, editors, directors, or producers will abandon their efforts to obtain information and
provide perspective on a crisis just because you dont want them involved.
Its imperative that emergency operation centers (EOCs) and all government and nongovernmental
organizations involved in crisis response understand the appropriate needs of the media and how
to fulfill those needs as an ongoing and well thought-out part of the response plan. This approach
deliberately includes the media in the response.
Can you imagine emergency response if the media were not involved? The absence of mass media would
make it nearly impossible for the EOC and public officials to communicate the nature of the crisis and
the appropriate actions citizens should take to limit their harm. You may find your response team in
trucks with bullhorns moving through neighborhoods, telling people where to find shelter or not to drink
the water from their faucets without purifying it. However, for many public health emergencies, such as
those involving infectious disease outbreaks, the community infrastructure will be in place, electricity
will continue to flow, buildings will stand, and roads will be clear. In these circumstances, traditional
media outlets will quickly communicate important information to the public. Even with the advent of
social media, most people will still want to confirm information through television and radio.
Chapter 6 Working with the Media 179

Interacting with the Media
It is important to understand that reporters will not allow you to simply feed them headlines without
asking questions. They will decide what to tell their viewers or listeners about what is occurring. Dont
treat them like members of your staff. Offer suggestions, but do not dictate. This will help you establish
a cooperative relationship.
Reality Check
Reporters may seem sensitive to your needs and requirements. You may think reporters
are eager to print only positive news about your organization or agency. The reality is that
reporters have an obligation to report the facts objectively, even if they feel those facts are
contrary to your organizations goals. When an issue has national significance, reporters will
probably show some distance:
Reporters have a job to do, and they will do what it takes to get it done.
The relationship between reporters and public health communicators will be more
serious.
No favors should be expected from either side.
As a crisis unfolds, expect a widening gap between what emergency managers believe the media should
cover (or not) and what reporters want to know. You should do the following:
Remember that it is the journalists job to provide balance by looking for alternative perspectives
and interpretations of events, and ensuring that other points of view receive coverage.
Make your points clearly and consistently. Keep it easy for journalists to do their jobs. This
enhances the effectiveness of communication during a crisis.
If the media present incorrect information, especially if it could be harmful to the public, you
should quickly communicate correct information to the public and the media.
Expect only limited success in influencing that part of the crisis coverage devoted to debate,
discussion, and speculation. This is especially true in the 24-hour news arena.
Remember that emergency managers and reporters or commentators see stories from different
angles. What seem like facts to you might seem less black-and-white to
reporters and commentators.
The Poynter Institute for Journalism provides useful advice for journalists covering disasters.8 Poynter
emphasizes that reporters are often unprepared to cover events with complex scientific issues. They
explain that acquiring background information is important to getting the story right. Journalists should

be aware that they are often putting themselves in harms way when covering a disaster.9 A media
organization may also be affected by the disaster. This means its ability to function may be impaired at
the very moment the public most needs timely, accurate information. The Poynter Institute offers five
tips for journalists covering disasters:
1. Be more tolerant of uncertainty inherent to a disaster.

2. Find out who is really in charge.
3. Dig for deeper context to the story.
4. Look for takeaways, including lessons learned.
5. Find evidence to support anecdotes and critically assess the evidence.
Facilitating Positive Media Relationships
Equal Access Matters

In the first critical hours or days of an emergency, fairness is of utmost importance. The most ethical
way for a public agency to facilitate media relationships is to provide all media outlets with the same
access at the same time. Through the use of good planning with prearranged e-mail addresses, fax
numbers, and onsite media opportunities, you can maintain fairness.
Dont ignore the parameters of the journalists job; they have space and time to fill, and deadlines to
meet. One way to destroy effective professional relationships with the media is to ignore their needs. It
is imperative that you provide equal access to information and help journalists acquire that information:
Distribute messages that are essential to the well-being or safety of the public equally.
Use teleconferencing so reporters in remote locations can participate.
Attempt to give journalists a reasonable time frame in which new information will be provided.
Establish a schedule for information releases. Everyone involved will appreciate some ground
rules. Base ground rules on the type and phase of the crisis.
Understand journalism deadlines and work to accommodate them. During a crisis, it is important
to be availableif necessary, around the clockto help reporters get the facts right, before
their deadline.
Even print media outlets face short deadlines because of their online Web editions. In the past, response
to media inquiries could be prioritized by their deadlines. Today, most media outlets have the same
deadlines, and this requires a revamping of the way emergency information is provided. In general,
media outlets function in real time or close to it.

Reality Check
More than 40,000 media outlets10 operate news activities in the U.S., and many of them are
interested in breaking news, as well as health and medical news:
Providing equal access to information may mean posting the information on your
organizations Web page, rather than waiting several hours.
Equal access means not discriminating between the local network affiliates and local
independent TV stations.
Equal access means including newspapers, television, and radio stations.
Make a reasonable effort to include as many local media outlets as possible in your media
opportunities. Discuss credentialing of media outlets during the pre-crisis phase or early
during the response to provide access to your EOC media room.
Think Local Media First

Dont ignore local media in favor of the national media and well-known reporters. National media
reporters have contacts outside the local area to fill in much of what they need. They wont be
shortchanged. Local media personnel count on local response officials to work with them. Local PIOs
should think local first. At the state level, regional media or border media may take priority. At the
national level, the primary contacts may be from the national media.
International media may also become involved. Responders working at the federal level are more likely
to be contacted by international reporters. Certain events, such as an infectious disease outbreak, have
the potential to directly affect people in other countries. Other events, such as a powerful hurricane,
may be confined to one country but still cause significant damage and loss of life. This will spur the
interest of international media even though other countries were not affected. You will need to prioritize
international media, based on the nature of the event, the degree of international interest, and the
extent to which other countries are affected.
The key is to have consistent information flowing back and forth among local, state, regional, national,
and international levels. If the content of the message is consistent, it is possible to fulfill the needs of
reporters at all levels.
During the 2009 H1N1 influenza outbreak, information at the local, state, and national levels was
consistent. This happened, in part, because CDC in Atlanta was very open in making information
available, not only to media at all levels, but also to public health partners. Because the outbreak was
global, reporting was occurring at the international level. The international information flow was not
coordinated as well, which created inconsistent reports in the international media.11

Reality Check
Americans have been exposed to exaggerations of the occurrence of harmful behavior
following disasters, such as:
Panic Price gouging
Looting Scope-of-disaster estimates
Excessive media coverage of these negative incidents, or the possibility of such incidents,
may lead the public to believe that these behaviors occur at a much higher rate than they
actually do. Coverage analysis for Hurricane Katrina found that while national newspapers
were more likely to report rumors, local and regional newspapers appeared to be more
deliberate in not reporting rumors and not publishing sensational photos of the disaster.12
Giving Reporters What They Need
What Do Reporters Want?

Reporters want and need the following:
Timely answers to their questions
Access to experts
Visuals to support their news stories
These needs are the same in an emergency, only the time pressure is much greater. When a story is
seen as breaking news, time becomes paramount. Anticipating questions from the media can help you
prepare and respond. The most common media questions in an emergency include:
What is happening now?
Who is in charge?
Are those who got hurt getting help and, if so, how?
Is the crisis contained?
What can we expect to happen?
What should people do or not do?
Why did this happen? (Dont speculate. Repeat the facts of the event, describe the data
collection effort, and describe treatment from fact sheets.)

Did you have any warning this might happen?
Why wasnt this kept from happening (again)?
When did you begin working on this (e.g., when were you notified of this situation, or when did
you determine this to be true)?
What do these data/information/results mean?
What bad things arent you telling us? (Dont forget the good.)
The more you anticipate what the media needs, the more effective you will be at the following:
Informing the public
Helping them understand public health actions or recommendations
Gaining public acceptance for public health activities during response and recovery
Background information will give you a head start. This is the information that will not change during
a crisis. For example, if an outbreak involves an organism that is not a new form, its description,
incubation period, and methods of treatment will stay the same. It is easily retrievable, as CDC and
other federal agencies have developed much of the background information reporters need.
Media Operations in a Crisis

Public health emergencies change how an agency conducts daily business. This is true for the media as
well. Media outlets have their own plans to cover major breaking news, and knowing those plans helps
get the right message out.
During nonemergency times, EOC managers should invite local media into the emergency operations
center to explain how things work, the agencies that will be involved in the response, and how
media will be accommodated when the EOC is operating. If possible, there should be a designated
media room located near the command center. This could be used for media opportunities and,
when agreed to, for individual interviews. Its imperative that
the EOC or the public health department leading the response
remain ready for journalists. Keeping the media updated with
accurate information reduces
The media onslaught could start in a matter of minutes,
depending on the type of emergency. Natural public curiosity, speculation and rumors.
the need to fill 24-hour news cycles, and pressure to beat
the competition drive the media to thoroughly cover the
event. Media are most apt to exert pressure as a group. They are all looking for answers to the same
questions at the same time. If official channels cannot meet the medias needs, experts and outside
authorities will almost instantly be speculating to the media about what officials are or should be doing.

This speculation feeds rumors that require corrections. Keeping the media updated with accurate
information reduces speculation and rumors.
During an unfolding emergency, media may not react as they usually do. Expect the following:
Diminished information verification: Tentative, or even incorrect, information will be

broadcast without the usual confirmation from multiple sources.
Diminished adversarial role: Journalists are people too. They will have genuine concerns
about what is occurring. They will want to help by providing important messages to the public.
Dont expect the media to continue this throughout the entire crisis. In the beginning, however,
the them versus us ratio diminishes.
The national media might dominate: For major crises, most people will be getting their
news from the national media. Local media will be feeding information to the national media,
as stations compete for coverage. Messages meant for local audiences will have to vie for
airtime with national coverage. Respect local media deadlines. Keep information flowing to help
disseminate local public health messages.
An EOC or JIC for consolidated information is expected for some crises: Initially,
the media will accept that much of their information must come from the command post. Within
hours or days, depending on the crisis, the media will look for other perspectives and places
from which to broadcast. If you want the media to use official releases of information, youll have
to ensure that the information is timely, fresh, and easy to access. Reporters have options about
where to get information, and there are plenty of people inside and outside official channels who
are willing to talk. A well-functioning media command center or JIC within the EOC that gives
the largest amount of, most accurate, and freshest information will often trump other sources.
Inadequate scientific expertise might be a concern: During a public health emergency
or any event involving technology, most media personnel will not have the scientific background
to quickly grasp new information or the nuances of that information. Be prepared to fill in the
blanks, without being arrogant. Do not assume that everyone knows the technical jargon. Use
plain language. For example, explain the difference between bacteria and viruses. Start with the
basics and bring reporters along. They will appreciate this, and it will help them provide more
accurate information to the public.
Person-on-the-street interviews using cell phones and cameras: These are very
common during the first moments of a crisis. The sooner official news sources are available,
the less time will be given to broadcasting personal stories.
Journalists interviewing other media personnel: This will be common during the
initial moments of an event. Again, until official news sources are available, the media will use
in-house experts to fill time.

Reality Check
PIOs may face criticism from some reporters:
If this happens, dont hold grudges.
Encourage others, such as leadership and spokespersons, not to hold grudges

as well. During an emergency, emotions and tempers run high. If a reporter is
approaching coverage of the event in an inappropriate way, find a time when cooler
heads prevail to discuss it.
Dont shut the reporter out.
Dont refuse to provide an expert to a reporter. Situations change quickly and

keeping an open line of communication is your priority.
Follow the etiquette expected in the field when lodging a complaint or asking for a
correction from a reporter and his or her editor.
Getting Emergency Information to the Media

There are many ways to disseminate information to the media:
Press releases
Press conferences or media opportunities
Satellite media tours
Press conferences by telephone and webcast
E-mail distribution and broadcast faxes
Websites, video streaming, and webinars
Response to media calls
Social media (for some types of information)
Press Releases
The press or media release is a written statement and remains one of the most common ways to
announce something newsworthy. In an emergency, print information must move electronically to the
media so press releases are often distributed as e-mails or are posted on websites. It is also helpful to

distribute press releases to the media at the incident site. All releases should include a time and date.
If you are thinking about using a press release, consider the following advantages and disadvantages:
Press release advantages:
yy Consistent information is distributed to all media.
yy A chronological and historical record is on hand.
yy Background information and direction to other sources of information are included.
yy The media have something tangible and in an electronic format.
yy Questions at the top of reporters minds can be answered by using a fill-in-the-blank template
(who, what, where, why, when, and how).
yy Press releases allow for the simultaneous release of information (via e-mail and Web).
Press release disadvantages:
yy Releases take time to write and information may be changing while you are writing.
yy Clearance can be complicated and take extra time with the added layers of
an official command.
yy Reporters will expect more press releases. Be prepared to consistently offer

information this way.
yy The information must be organized through a command post or JIC. Otherwise, competing
press releases will happen. Multiple releases from different areas of your organization may
suggest a lack of clarity about who is responsible for collecting and releasing
critical information.
Press releases can be released through commercial press release services. They give organizations
access to national, regional, or specialized media outlets using Web-based distribution. Many of these
services are available 24-hours-a-day. Consider the following advantages and disadvantages:
Commercial press release service advantages:
yy These services reduce the need for your organization to maintain up-to-date specialized media
lists or lists of media outlets outside of your local area.
yy Press releases move rapidly to news organizations.
yy A list of media outlets that received the release is available.
yy Commercial press release services provide a way to reach media outlets that may not be on
your core media list but have an interest in what is occurring.

Commercial press release service disadvantages:
yy The source of funding for using the service must be in place in advance of the emergency.
yy Releases through a newswire may appear less than official for some types of emergency
information. Media outlets may expect significant releases to be sent directly from the
response organization to the newsroom.
yy Commercial press release services may not be necessary when media outlets are actively
engaged. It could be a waste of resources to use these services. However, they may be
appropriate at less intense times during the emergency response.
Press Conferences or Media Opportunities

A public health emergency is an appropriate time to consider holding a press conference. The term
press conference generally implies an event that is scheduled in advance, includes a press kit, and
is designed to allow media to ask questions of the featured experts. During a crisis, however, a media
opportunity is more appropriate for the early phases. One can be arranged at the site of the crisis and
allows for information to be released to all media outlets. It might not require press kits or a question
and answer opportunity. They have the following advantages and disadvantages:
Press conference advantages:
yy If reporters are at the site of an event, its an effective way to fulfill media interview requests
in one shot while controlling access to the site.
yy It ensures consistency in the information released.
yy The spokesperson and subject matter experts can be introduced to the public, allowing them
an opportunity to express their feelings and build credibility.
yy Response organizations can show there is a process in place to respond to the crisis,
and that even though the event is unfolding, someone is there and ready to help with
response and recovery.
yy Strict rules about questions from the media can be imposed.
yy If information is changing rapidly, or not enough is known for a press release, it fulfills the
need of electronic media to fill space and time.
yy Elected officials have a forum to present a united front.
Press conference disadvantages:
yy It is sometimes difficult to get the right people in front of the media to give updates. Good
planning can help prevent this problem.
yy Information may be sketchy and response officials may hesitate at meeting with the media
when they do not have the answers. Good training can help prevent this problem.

yy If media cannot be at the site, they will not have the information they want or need.
yy It creates expectations for additional and regular conferences with the press.
yy If coordination is poor, competing media opportunities may occur. Local, state, and federal
officials, and people across levels of other organizations, need to have a plan and agree to the
timing of media opportunities.
yy The intense rush for early news from the media will push the limits of rules set about the
length of the spokespersons availability. If a no-questions policy was appropriate, and set in
place, a press conference may also push the limits of that policy. There must be an escape
route for speakers out of the media area.
yy Media will want to follow up with individual interviews. Consistent ground rules are important.
Satellite Media Tours

At the national or regional level (or at the local level when media in other cities are pushing for access),
a satellite media tour may work well. These tours can be arranged in a matter of hours during a crisis.
If satellite trucks are parked outside the door, there will be no expense for your organization, and you
can get important messages out to the public. However, they may not be the best choice early in the
emergency.
Media tours allow communities to talk to each other, offering support, ideas, and lessons learned.
Satellite media tours are usually conducted with a single spokesperson or your field expert. They allow
the local media to interview your agencys expert on a specific topic. These interviews are typically live-
to-tape with special requirements. If you conduct a satellite media tour, do the following:
Be sure your expert has access to a teleprompter identifying the reporter.
Use the opportunity to correct misinformation on the spot.
If you are thinking of conducting a satellite media tour, consider the following advantages and
disadvantages:
Advantages of satellite media tours:
yy They allow the media to have access to the center of action with response officials.
yy They offer access when journalists are unable to be onsite or are prevented by the nature of
the public health emergency to travel to the site.
yy They provide a way for local or regional media to speak in depth to your organizations experts
and ask questions specific to a region or population.
yy They increase the chances that media in other areas will receive correct information directly
from your expert instead of translated through others.

Disadvantages of a satellite media tours:
yy If media satellite trucks are not at the site, satellite media tours can be expensive.
yy Unless resources and agreements are already in place, they are not easily arranged.
yy They have a limited reach and are not appropriate for many situations.
yy After a round-robin of similar interviews, spokespersons may burn out.
yy They are time consuming.
Press Conferences by Telephone and Webcast

Internet and telephone technology allow you to set up toll-free telephone numbers or webcast
opportunities that the media can access at specified times. Participating spokespersons can be at
different locations. In addition, the technology is interactive and can allow journalists to ask questions.
This method of delivering information offers the following advantages and disadvantages:
Advantages of telephone and webcast conferences:
yy They reach far more media outlets than just those at the site of the incident.
yy Response spokespersons will be able to reach national media outlets and local media outlets in
other communities.
yy They are easy to arrange.
yy Their cost is moderate.
yy Officials are generally comfortable with this format.
yy They have great flexibility in terms of when and where they take place.
yy They allow public information officials to have some control over who has the toll-free number.
However, the toll-free number can be forwarded further or posted on the Web.
yy These types of news conferences can be regularly scheduled to satisfy media representatives
by assuring them of regular updates.
yy These formats allow for last-minute changes in spokesperson. This may happen if a new
development requires a new expert to appear or a spokesperson is called away for unavoidable
reasons. With these formats, its easier to get a substitute.
yy They allow time for questions and the questioners name to be announced by the moderator.
yy Lists of all participants, even those not asking a question, can be provided, making news
monitoring and analysis easier.
yy Recordings of the event can be archived and made available to the media after the fact.

Disadvantages of telephone and webcast conferences:
yy These types of news conferences require a funding source or advance contract.
yy The cost can add up over time.
yy It is difficult to wean media from this format; regular calls should not be stopped abruptly.
yy Teleconferences do not fulfill the visual needs of TV news.
E-mail Distribution and Broadcast Faxes

Most media organizations prefer to receive information from other organizations through e-mail
or by fax. Electronic distribution of information allows for efficient and rapid translation to news
formats. While fax or blast fax distribution is becoming less common, they are still used by many news
organizations.
Advantages of e-mail and broadcast faxes:
yy You can almost instantly disseminate information to media outlets on e-mail contact lists at an
imperceptible cost.
yy Corrections are easy to make.
yy The organization gets credit for having contacted reporters or outlets by name.
yy They provide an open channel that allows you to feed information to the media at will.
Disadvantages of e-mail and broadcast faxes:
yy Lists require regular updating and maintenance. Media organizations and personnel move
around often.
yy They provide a passive way to give the media information; some may not get to your e-mail or
broadcast fax until its too late for them or you.
yy They are not personal and may prompt further inquiries and phone calls.
yy They require cleared print information, which is time-intensive for the public information
office and could slow information flow to the media.
Websites, Video Streaming, and Webinars

A variety of Internet-based tools have made media access much easier and more cost-effective. Releases
can be posted to media pages on your website. FAQs, background information, and event videos can
be linked to releases. Videos can be archived and streamed. Webinars can provide detailed information

and access to subject matter experts. Web-based tools have significantly bolstered access to media
organizations and direct access to the public although they are time consuming, particularly during a
crisis. They have the following advantages and disadvantages:
Advantages of websites, video streaming, and webinars:
yy They rapidly update all media simultaneously.
yy The process becomes transparent because the public and media see the same information on
the site. It allows the organization to speak directly to the public without a media filter.
yy Documents and information are organized and provide a record for the media
and your organization.
yy This allows for links to help media personnel collect background information.
yy Rumors, myths, and misinformation can be addressed immediately without

drawing undue attention.
yy Official video or pictures can be made available to media outlets in a digital format.
yy FAQs on the page provide a user-friendly way to educate during a crisis.
yy They are cost-effective tools.
Disadvantages of websites, video streaming, and webinars:
yy They are time consuming.
yy They require frequent updating.
yy On occasion, they crash with traffic overload.
yy They may frustrate journalists if too much information is provided or if the sites organization
is not clear. Journalists want it easy and immediate. You may have to walk some of them
through the site the first time.
yy They are technology-dependent and may be vulnerable to glitches or interruptions by hackers.

People in disaster zones may not have website access.
Response to Media Calls

The relationship between PIOs and the media is often grounded in phone calls from reporters
requesting specific information or an interview. In a public health emergency, the manner in which your
organization responds to these calls from reporters makes a difference in the way your organizations
responsiveness or professionalism is portrayed to the public.
If journalists do not believe your response is quick or appropriate, they may reflect this in their report.
Every organization must establish a workable plan to respond to a surge of media calls. Train, plan, and

coordinate continually. Let media outlets know ahead of time how the flow of information will work, how
to get their requests answered, and what your PIOs can or cannot do. If phone lines are overloaded,
whats the backup plan? Responses to media calls have the following advantages and disadvantages:
Advantages of timely responses:
yy Media outlets can provide information you may not be aware of, such as information about
a neighborhood leader who is complaining that the response resources are not being fairly
distributed. This can happen because some disgruntled people will call the media for
resolution before they will call the official organization responsible for these resources.
yy Media inquiries may reflect the publics level of interest. The number of calls and frequency
of subjects raised can give the response community a sense of what is important to the public
and where more information resources may need to be directed.
yy One-on-one contact with the media allows opportunities to emphasize key message points,
direct media to upcoming issues, and correct misinformation.
yy Personal contacts can help build relationships and promote trust.
Disadvantages of timely responses:
yy Returning calls takes time, which is at a premium during a crisis.
yy The potential exists for inconsistent or premature release of information. To prevent this,
press officers and spokespersons must be well-trained and the release must be coordinated
and cleared.
yy Follow-up calls may be required if information changes before a media outlet releases it. If you
neglect this, youll be guilty of not giving the right information.
yy Phone tag is frustrating to journalists working on deadlines.
yy Massive prioritization is required. Reporters will know if theyre not at the top of the list.
Social Media
Many mainstream media organizations are using social media as a way to generate content. They may
monitor social media, such as Facebook pages or Twitter feeds, for information. Many federal agencies,
including CDC and FEMA, maintain several Twitter accounts as a way to provide very timely information
on events and to update audiences, including the media. Social media offer the following advantages
and disadvantages:
Advantages of social media:
yy Social media are immediate.
yy They build and maintain dynamic relationships with the media.

yy They can be used to dispel rumors by providing
accurate information quickly.
Social media is instant
yy Social media incorporate website links where reporters information, on your time, not on
can go to get more information. the medias time.
Disadvantages of social media: Ken Pastorick,
yy They require personnel and technological resources to Public Information Officer,
maintain and monitor social media channels. Louisiana Department of
Health and Hospitals
yy They have limitations in terms of how much
information is included.
yy Follow-up and continual monitoring may be required to

update information and dispel rumors.
Writing for the Media during a Crisis

Research has shown13,14,15 that the publics belief that an emergency response was effective correlates
with how much access to information they had during the crisis. The fundamental challenge is speed
versus accuracy where both are important. If information is accurate and released after the public has
moved on to another issue, it has little value. If its out fast but is not accurate, the best-case scenario
is to admit it and move on; the worst case is that the inaccuracy causes harm to the public. The rules
of good journalism apply, with or without a crisis. There will be pressure to move the process along at a
pace that reasonable reporters and other people will perceive as responsive and credible.
Acknowledge the inherent challenge of every crisis. Push the responding officials toward releasing
accurate (but perhaps incomplete) information ASAP. You can begin by telling the story even if you are
not sure of an ending.
The following tips should be helpful:
Ask what can be committed to paper first.
Start with what can be verified.
Tell the media and the public that more information will come as it becomes available.
If decisions are not finalized, then explain that the process to reach decisions is ongoing.
If laboratory tests are not completed, explain the testing process.
Keep the media and the public engaged and involved, even if the answers to the hard questions
arent yet available.

Prepare to Provide Basic Background on Issues to the Media . . .
When a health-related disaster or event occurs, reporters who do not normally cover health
and science topics will be assigned to cover the event. At that point, you will find yourself
dealing with people who need basic information about the issue first. Have this background
information prepared and ready to share. It will prove useful when journalists begin
developing reports for the general public.
When the 2011 Japanese earthquake and tsunami resulted in a radiation emergency
from a damaged nuclear facility, the worldwide public was anxiously seeking information
about potential radiation exposure in air, food, and water. Reporters were trying to
cover a breaking story with obvious health implications. Like the public, they knew little
about a radiation emergency and its potential health effects. CDC immediately posted a
website on the situation. This site, Japan: Radiation and Health,16 contained fact sheets,
FAQs, social media information, and even Japanese translations of various radiation
emergency documents.
This helped ensure that the media received scientifically accurate and easy-to-understand
information to be communicated to the public. Many people became educated about radiation
risks. They knew what actions to take, or in the case of potassium iodide,
what action not to take.
What Should Your Media Release Include?

During the early phases of an emergency, standard press releases are the most basic form of media
communication. As the crisis evolves, consider following up with feature releases:
Stories about individuals or units involved in the response
Articles that illustrate outcomes and their successes
Personal accounts of those who were helped during the crisis
An emergency press release should be limited to one page. You will need to practice to determine what
information belongs in a fact sheet verses a press release. Think of press releases, from the very start,
as press updates.
The press release should answer the questions who, what, when, where, why, and how. Additional
information goes into an attached fact sheet or backgrounder. This method will speed up the clearance
process, reduce the opportunity to introduce errors, and help the media determine which items are
news and which are considered background.

When you create a press release, do the following:
At the top of the release, include the following information:
yy Your organizations name
yy Address
yy E-mail
yy Website
yy Telephone number
yy Contact name(s)
Give the media a 24-hour contact number. If you have a toll-free number, include it and let
reporters know its for them, not for the general public.
Place the date on the release. If more than one release is issued during a 24-hour period, place
the date and time on the release.
Give your press release a headline. Journalists can identify quickly with headlines. Create
headlines using an active voice, and summarize the core information in a few words. Never reuse
a headline during the crisis.
Use a press release number if this is standard for your organization. This may be helpful, but do
not use numbers to replace unique headlines.
Put for immediate release at the top under your contact information; dont make reporters or
editors guess about a release time.
Write in the inverted pyramid style, putting the most important information first. Do not use a
strong concluding paragraph, the strength will be up front. A well-written press release reads
like a news story.
Provide new telephone numbers or website addresses high up in the press release. Dont assume
an editor will notice it in the last paragraph.
Limit the length of sentences and paragraphs. They should rarely be more than 20 words. A one-
sentence paragraph is acceptable in a press release.
Remember, the more syllables per 100 words, the more difficult text is to understand.
Explain scientific or technical terms. Dont assume your audience will understand
what you mean.
Eliminate adjectives or emotionally loaded words.
Check your facts, especially after including revisions from subject matter experts.
Perform a security check; some information may be classified.

Perform a privacy check; some information may violate the privacy of victims and their
families.17 Consider the following:
yy Health Insurance Portability and Accountability Act of 1996 (HIPAA)
yy Your organizations policies regarding privacy
If names have unusual spellings, mark an OK note next to the name so editors know its
correct.
If a name has an unusual pronunciation, include the phonetic pronunciation so radio and TV
reporters pronounce it correctly.
If an error is detected in a press release that has already been distributed and theres time to
correct it, make the effort to send the corrected version right away.
Reality Check
Some concessions to journalistic tastes will be required to get press releases cleared
through scientific and official response channels. It helps if you:
Write press releases in advance
Use fill-in-the-blank sections
Clear them through channels (or at least have them reviewed ahead of time).
This will help officials with no media background distinguish the difference between a press
release and a situation report. The clearance process often becomes an exercise of writing
by committee and the result is often tortured texts. Focus on the goal of getting accurate
and timely information from your organization to the media and public.
Press Statements Versus Press Releases

Press statements typically are not news. They may be an official position or perspective of the
organization. They normally contain only a few paragraphs. For press statements, consider the
following:
Attribute statements to a high-ranking official in the organization.
You can use them to counter a contrary view about an important subject related to the
emergency, such as why your agency is choosing one treatment recommendation over another.
Do not use a statement to generate a peer-review debate.

Press statements may be a means for an official to be quoted as having responded to an issue
without the need for a media opportunity.
You can use them to offer words of encouragement to victims, responders, and employees.
Post statements on the organizations website in the same location as press releases. They
should include a contact number for the press office.
Use statements sparingly for best impact.
Dont state the negative thats being countered. State your organizations position without
validating a contrary point of view.
Realize that press statements require more time and a higher level of clearance.
Media Fact Sheets and Backgrounders

Fact sheets provide facts about a specific topic. Backgrounders provide the relevant background or
history. When you create fact sheets and backgrounders, consider the following:
Generally, these will be attached to a one-page press release.
Define any scientific or technical terms used.
Keep fact sheets in a bullet format with a logical progression from the broad to the specific
about a single subject.
Use paragraph form for backgrounders and provide historical and technical information that is
too in-depth for bullets.
Use frequently asked questions (FAQs) for fact sheets and backgrounders, if appropriate.
Expect to see FAQs on media websites, so make sure they are accurate.
Avoid including information in fact sheets and backgrounders that will likely change. Press
releases are the place for updates on the ongoing situation. Fact sheets and backgrounders give
the facts, as well as background or history.
Do not use quotes from officials or subject matter experts. If you do, it will turn into a poorly
written press release.
Release fact sheets and backgrounders as official documents from your organization, via the JIC
or the EOC, if activated.
Coordinate information to make certain all parties agree on whats fact and whats background.
Prepare in advance, when no emergencies are in sight. Coordinate your information

with other agencies.

Visuals, Video Press Releases, and B-Roll
Television and websites continue to be dominant sources for news. While older audiences continue to
favor television and turn to local news, younger audiences increasingly use the Web.2 News outlets use
visuals to support reports. Digital technology makes it easier and less expensive for official response
organizations to provide visual support for the media during emergencies. Videos can be loaded on
websites and news organizations can edit them into their reports.
When you create visuals, video press releases, and B-roll, consider the following:
You might want to include 10- to 20-second video sound bites from response officials and
experts that can be edited into local newscasts.
Get key messages on tape.
Video news releases may become dated and time consuming to produce in the early phases of an
emergency.
Try using B-roll (background video without narration):
yy B-roll is easier and faster to produce.
yy News directors often prefer B-roll, as reporters will build their own stories around the video.
yy B-roll serves as visual backdrops for a reporters voiceover.
Prepare B-roll in advance, if possible. Get a security check to ensure that classified information
is not being released.
Dont raise a subject in B-roll if you do not want to promote it.
Write sound bites for spokespersons. Your spokespersons will not have time to pare the main
points down to 20 seconds.
Make sure each sound bite stands alone. No need to confuse a viewer who may see only one of
five possible sound bites.
Give the video news release or B-roll a paper and on-tape index that explains who is talking or
what is being shown. For example, the index might explain that at 2 minutes into the video, a
biosafety level 2 lab technician is preparing samples for testing.
Determine distribution methods. You might consider the following:
yy Schedule a satellite feed following a media advisory.
yy Load videos on websites.
yy Provide copies of the B-roll that can be picked up by media.
yy Deliver it to the media.

yy Feed it from a local network affiliate to a national network satellite, which can be fed to other
local affiliates.
yy Send via overnight mail, requesting that the hard copy be returned to you.
Produce video news releases and B-rolls as professional products to fulfill media requirements.
Some in-house digital video can be displayed on your website.
Communicate Early and Often

Be proactive and provide recommendations and information to the media and the public
as early as possible to establish your organization as an accurate, credible, and timely news
source. Doing so will facilitate stronger relationships with the media and the public.
Example 1: In 2001, during the anthrax crisis, there was a concern that a Ft. Collins,
Colorado, postal worker may have contracted the disease. Local and state health workers
wanted to ease the concerns about potential exposure to anthrax bacteria, and quickly
decided to distribute a press release announcing the closing of that post office and the
availability of antibiotics for the other workers in that facility.
Example 2: Regardless of whether or not FEMA is in the midst of responding to a crisis,

FEMA Disaster Field Offices develop and distribute a message of the day to help establish
credibility and a rapport with the public and the media.
Meeting Media Needs Throughout an Emergency

A central question during any public health emergency: Is a press conference, media event, or other
speaking opportunity the right way to release information?
If coordination has occurred with other responding organizations or a press conference is planned,
the answer may be an easy yes. If the situation is unfolding quickly and there is a need for rapid
information dissemination, the answer may also be yes.
Where to Hold the Press Conference

To determine the location of a press conference, consider the following:
The emergency or disaster site, if it is safe for the media and it wont interfere with recovery
efforts, might be your first choice. Make certain that victims privacy will not be compromised.

Press conferences may be held at the EOC or JIC if room has been set aside that is separate
from the operations center. You dont want media personnel moving in and out of the emergency
operations center. If the conference is held in a restricted building, try to streamline the medias
screening and access to the site, even if it requires volunteer escorts for each reporter.
Consider using a separate official location, such as the town hall, the health department
headquarters, or the governors office.
Conferences may be held at a hotel meeting room convenient to the officials involved and the
media who are likely to attend.
Remember that sound equipment needs to be available or in place. Consider providing electrical
outlets (if not using street interviews) and other specialized equipment needed by the media.
How and When to Invite the Media

The following tips will help you successfully invite the media to your press conference:
Give the media advance notice, but not so much that the event is canceled because its
overtaken by other events. An hour is the absolute least amount of time from notice to the
event, unless media personnel are all standing by waiting for a formal comment.
If the emergency has gone on for some time, schedule a regular time for media opportunities,
such as daily at 2:00 p.m., and stick to it. This will eliminate the need to contact the
media each time.
If you have something really important to release and the media may not be aware of whats
coming, use the resources necessary to call reporters or their news directors and editors, and
tell them why they need to come.
Send a brief media advisory about the media opportunity. It should be only a half page long and give the
following information:
Nature of the event (media opportunity or press conference; know the difference)
Date, time, and place
Contact person, and who is scheduled to appear (by name and title, or by position and
subject matter expertise)
The topics to be covered
Keep the advisory short. Youll get it cleared more quickly and have greater flexibility if you want to
adjust messages or add topics. Be specific enough that reporters understand the urgency. This is easier
early in the emergency, but may be more difficult during later phases of the crisis.

Whom to Invite
Before announcing a media opportunity, check to ensure that spokespersons or officials are available.
Have backups on standby in case the spokesperson is called away.
Invite representatives from print and electronic media outlets, and dont forget radio stations. If
the JIC is hosting a press room, be sure to post a notice there.
Attempt to limit the number of emergency response officials in attendance who will not have a
speaking role. Reporters find it disconcerting to see a pack of people in the back of the room,
possibly wearing response uniforms or credentials, who were never identified. Also, expect that
anyone in the room from the response team could be approached by the media for comment.
Another concern is that response personnel in the pack in the back of the room might privately
discuss information not yet ready for release, and be overheard by reporters. By invitation
only holds true for response personnel, too.
How to Conduct the Media Opportunity

It is appropriate to alert the media ahead of time as to whether questions will be addressed or if only
statements of information from organization officials will be made. Reporters do not like to be restricted
from asking questions, but theyll accept it if the information is real news and they are given access
to the officials at other times to get their answers. Taking questions means giving some control of the
content over to the media. In the early phases, it may not be necessary to take questions.
The following tips will help you conduct media opportunities smoothly:
Decide the time limit, including question and answer time. Let the media know there will
be a limit.
Keep speakers out of the room until the event begins. You dont want to negotiate logistics in
front of an audience. Remember, the moment principals are visible to the media, their demeanor
and behavior is a matter of public record. Its natural to blow off steam and joke around, even
during the heat of a crisis. Do that away from the cameras. Make sure all understand that the
event is on record. It will be reported.
Let the media know at the start of the conference if there are controversial issues surrounding
the emergency that are not going to be addressed.
Whether the speakers sit or stand depends on the room, the length of the event, and whether
they are all speaking and all taking questions. If all stand, a herd effect occurs. The group will
seem more active, as if there is urgency to the situation. Thats good if thats what you want to
convey. Its not as good when attempting to promote a calm, reasoned response.
A press officer may moderate the event or the lead official may do so. Accommodate the
preferences of the official but be available on the side if they decide to go it alone.

Unless the officials are nationally known faces and names, ask speakers to introduce themselves
by name, title, and organization. They should repeat their names and organizations if they step
forward to answer a later question.
If your organization is going to accept questions at the press conference, select who will choose
reporters to ask questions. Is it the lead official or perhaps the press officer who is monitoring
the conference? Plan this in advance.
Reality Check
Be ready for the press conference to be different than you planned. The following
tips may help:
Reporters will ask whatever questions they please, despite your directions.
Be sure the officials know who will respond to controversial questions. This is the
person who will refer the reporters question back to the appropriate organization
or the subject matter expert.
Get agreement from all of the officials involved; if the answer doesnt fall within the
scope of their responsibility, they cannot respond. This may be hard for some of
them, who may have a good answer to share.
Have a backup plan for such glitches as the loss of sound equipment.
Either before the officials enter the room or at the end of the event, tell reporters
how to get more information and additional answers.
Decide ahead of time if officials are going to do standup media interviews for
individual reporters following the event. Its fine to do this if the official has the
time, wont go off-message, and theres an exit plan to end the interview. For
example, you might explain to a reporter that the official is pressed for time and
has only five minutes before his car leaves for another appointment.
If you allow a standup interview after the press conference, expect radio and print
media to surround the TV reporter conducting the interview or vice versa. These
interviews are really like another small, informal press conference. Keep control by
assigning a press officer to each official. You need to know if something has been
said requiring a reaction from your organization.

Using Visuals
It may be too much to ask officials to manage charts, PowerPoint presentations, or slides during the
briefing. If possible, position a communications expert to manage the visuals. Reporters will want copies
of any slides, graphs, or visuals used. These can be made available on websites.
Caution: If an official waves a document or report, or refers to it during the media opportunity, reporters
will be asking for copies. Try to agree on what will be mentioned and what will be available, and prepare
the visuals ahead of time. If practical, tell reporters ahead of time that they will get copies of what is
being shown. Have paper copies of visuals in case the equipment fails.
Military briefings often make extensive use of visuals. Department of Defense press conferences are
good examples of how visuals can be used effectively.
Handouts
If possible, have copies of the presentations, useful fact sheets, and backgrounders available. Reporters
like to use these to take notes and write their pieces, even if they have recorded the entire statement.
Dont forget to provide background information on the organization, such as a simple mission statement,
organizational chart, and basic facts.
If speakers are not well known, have brief bio handouts. This helps build their credibility for reporters
and the public who may read about them.
Reality Check
Record press conferences (at least on audio) if at all possible. It will help with questions
and answers after the fact, and is your record of what was said. Dont rely on memory,
especially during a crisis. Consider the following tips:
Arrange for media monitoring following your conference to see if your messages
were clearly reported.
Prepare the materials needed to push those messages out as clearly and
concisely as possible.
If the topics discussed during the media opportunity remain clear, but limited,
you have a greater chance that your desired messages will make the upcoming
broadcast or newspaper.

Following your press conference, immediately assess the following:
Were key messages delivered?
Were similar questions asked repeatedly?
How effective was the spokespersons delivery? Consider aspects such as tone,
body language, and clarity.
Do you need to prepare for any next day issues?
Is there a need to follow up with specific media outlets, based on their questions,
to clarify issues?
What can you do next time to improve the media opportunity?
Responding to Media Regarding Significant Errors,

Myths, and Misperceptions
The media have a good record of getting facts correct during crises.18 Unfortunately, sometimes media
reports can get facts wrong, report rumors, or perpetuate misrepresentations. Blog posts and social
media status updates are unfiltered and often include inaccurate information. These mistakes may not
only harm the public, they can undermine the credibility of your organization. While media rumors,
myths, and errors in press reports are usually self-correcting, sometimes the correction does not
happen fast enough.
You can speed up corrections using the following approaches:
1. Remain calm.
When you talk to the media, you are speaking for your agency Declaring war on the press,
or organization. No matter how angry you are, do not react tempting as it may sometimes be, is
thoughtlessly. Doing so will reflect negatively on you and your a game you cant win.
organization. It detracts from your mission of communicating
accurate health information to the public. Stratford P. Sherman,
Fortune Magazine
Some reporters may believe that only sensational, negative
stories are news. If its good news, its no news and if it
bleeds, it leads are two quotes frequently associated with this
type of reporting.
Also, reporters do not always have time to get their facts checked. Their jobs may depend on
turning the report around quickly. If they spend a lot of time on research, a competing reporter may
release the story first.

Reporters are just trying to do their job, so dont take negativity personally. Always try to think in terms
of educating the media and, thereby, building bridges to promote accurate stories in the future. After
all, media outlets are an important communication link to the audiences you are charged to serve. To do
this, you need a strategy.
2. Analyze the situation.

Ask the following questions:
What is your relationship with this reporter and media outlet? Is the publication,
television, or radio program credible? Have you worked with the offending reporter previously?
Following a negative news report is not the best time to make a cold call, to speak to reporters
or work with media outlets for the first time. Expressing a complaint to someone who knows
you as a credible person is easier and more productive. If the media outlet is unwilling to listen,
consider trying to get the point across to the audience through an alternative source. Try to
understand the reporters point of view and that they do not serve as your public relations firm.
Reporters have no obligation to report only positive stories for you. However, they do have a
responsibility to provide accurate information to their audience. You can and should appeal to
their sense of community service and journalistic integrity if the stories they are running are
not in the publics best interest. Remember who you are trying to reach. Do not try to win a
contest with media representatives. Try to serve the public interest by disseminating accurate
information to promote public health. No matter the response from reporters, keep anger
in check.
Did the news report attempt to express both sides of the issue? To many reporters, a
balanced report is one that examines opposing sides. Whether one point of view is an extreme
position and the other generally accepted may not be a relevant question. As long as reporters
attempt to present both sides, they often consider this fair.
Was there truly an inaccuracy, or did the reporter simply present the facts with a
negative slant? Correcting a factual error is relatively simple and straightforward. Reporters
and media outlets want to do their jobs well. They do not like mistakes. However, a difference of
opinion about a subject is not as easy to counter. Statements perceived as biased, uninformed,
or sensational may not be viewed by reporters as an error on their part. You can still respond to
the article; however, your strategy will differ from one required to correct a factual error.
Is the news report true even though it may be negative? You would prefer that only
positive stories appear in the media, but that is not always possible. There will be times when
you will not have a response to counter a report that provides negative news. There is an old
saying, in order to prevent the perception of covering up bad news, the good news must get out
fast and the bad news faster.
When there is bad news to report, it is important not to withhold or counter the information.
Reassure the public that no matter what the issue, positive or negative, being open and
responsive to the publics need for accurate information is a priority. Do not attempt to win a

contest with the media or a popularity contest with the public. Rather, communicate accurate
health information to the public. This event may be simply the time to take it on the chin to
satisfy critics who are also served by the media.
If the report is mostly accurate, and mistakes made by the reporter are minor, consider letting
the story run without comment. Arguing with a reporter over a minor point when a news
item is otherwise accurate will not help you build bridges for future positive stories. Consider
contacting the reporter to establish a dialogue for future, more accurate stories.
3. Know what to request.

Once the situation has been analyzed and it is decided that action is necessary, decide on your options
to resolve issues. There are only a few possibilities available for a reporter to respond to complaints.
Decide, ahead of time, your ideal, as well as your minimal, solution. Think of this as a negotiation. Here
are some possible requests:
Ask for a retraction or correction: A retraction is only reasonable when a serious factual
error has been made and you have supporting material to refute the report. If this happens, ask
for an immediate correction that runs as prominently as the original piece. Although this is not
likely to happen, its possible you will discourage the editor from burying the retraction.
Ask for another piece to air that presents your perspective on the issue: A follow-
up response is a reasonable request if an important point of view was completely ignored
or misrepresented in the original report. The best way to get a report redone is to provide
reporters another angle for the story. Reporters are not likely to present a follow-up piece that
simply contradicts a story they recently ran. They will not want to lose credibility. If you give
them a fresh perspective, a new angle, or new informationwhile also giving them a way to
maintain credibilitythey are more likely to develop a follow-up story.
Ask for an apology: Sometimes reporters make unintentional mistakes. If the errors are not
endangering a persons life or reputation, perhaps an acknowledgment of the mistake over the
phone by the reporter is enough. Establish yourself as a source for this reporter and develop
rapport that could lead to accurate, more positive stories in the future. The reporter may call
to verify the accuracy of a forthcoming story before running it. This provides an opportunity
to avert future inaccuracies in that reporters stories and provides forewarning if another
questionable news story is about to run.
Ask that a correction note be placed in the permanent record: Ask the reporter or
editor to file a written correction with the original piece in the permanent record. If the mistake
is a factual one, it should not be repeated (even if a correction is made). Ask the reporter
or editor to officially tie the correction to the original report. Reporters often go back to do
research, and they may report the mistaken information again if they do not realize that a
correction was made.

Ask that a letter to the editor or guest editorial be printed: If an important message
concerning the issue reported is needed, a letter to the editor may be the right choice. Letters
to the editor are widely read, and publications are usually quite willing to print opposing views.
Keep in mind that the message must be concise or your opportunity to correct an error could be
lost in editing. Make the strongest points early and keep the letter brief and to the point. Editors
who are rushing to meet a deadline cut from the bottom up. Be sure to seek approval from
subject matter experts within your organization before sending your letter. Coordinate with your
public affairs office.
4. Know whom to contact.

Media outlets have a chain of command. Starting at the top is not usually the best approach. Follow the
chain of command when contacting the media to respond to an article or broadcast piece.
Talk to the reporter first: Always give the reporter the first opportunity to respond to
concerns. Perhaps the reporter is frustrated because an editor changed a piece without his or
her knowledge. Perhaps the producer who put together the nightly news teaser misunderstood
the reporters message or sensationalized an originally balanced report. Let the reporter have an
opportunity to respond and explain. Know the reporters position before taking any action.
If the reporter cant be convinced: Ask to speak to the news editor or producer. Keep
moving up the chain until satisfied or until convinced that satisfaction is unlikely.
If you have doubts about the integrity of the media: If the reporter or media outlet that
presented the negative or inaccurate report is known to lack journalistic integrity, consider
going to another media outlet. Of course, go to them with a great story idea, not just a complaint
about the other media outlet.
Consider reaching your public through alternative outlets: If all else fails in efforts to
set the record straight with the offending media outlet, redouble your efforts to get messages to
the public through other means, such as the following:
yy Use the Web, which makes direct communication much easier.
yy Set up a public forum.
yy Invite partners to write letters or make phone calls.
yy Offer articles for community newsletters.
yy Work to establish contacts in competing media outlets.

5. Know what you want to communicate.
When you decide to counter a questionable news article, you must thoughtfully develop the message
you want to send. Know the audience and the message the audience should receive:
Develop messages and have them screened by advisors and subject matter experts. Remember,
your organization should speak with one voice to maintain credibility. Confer with interested
parties within your organization to avoid cross purposes with colleagues who have a different
perspective or additional information.
Make sure to frame the message in a positive way. If appropriate, include a call to action.
Focus on the audience, which is the public, and the purpose, which is to promote public health.
Keep anger at your critics or the media out of the message. The media are neither the message
nor the audience.
Convincing a reporter or producer to air a message requires being prepared to communicate that
message without delay.
6. Have a plan before you need it.

If an objection is to be effectively heard, express it as soon as possible. Know the important issues
within the organization and the basic arguments of critics. Prepare messages on the various issues
ahead of time, especially when an issue is controversial. Draft letters to the editor that could be altered
slightly and submitted within hours of the appearance of the offending piece. Consider releasing articles
on these issues before reporters have the opportunity to run inaccurate or negative stories.
Put the media on notice that you are paying attention: The media has a stake in
responding to the need for correct information. They need to know that their actions are being
watched and their stories are carefully read. Maintain regular contact and call reporters to
praise good stories. Remember to build relationships with the media at every opportunity. They
are a critical link to the public because they can facilitate your efforts to promote public health.
Let the media know that youre a potential source for the future: Dont just ask for an
immediate airing on the subject; invite reporters to call for interviews in the future. Make sure of
availability and give credible and constructive interviews. Develop internal sources of interview
candidates that you can offer to the media when issues surface. Be willing to deal with tough
subjects. Dont minimize the arguments of your critics. Remember to focus on getting your
message to your audience.

Monitoring the Media for Public Response to Crisis Management
When CDCs Joint Information Center was activated to respond to the 2009 H1N1 crisis, the
communicators immediately began gathering information from the media to determine what
was being said. This helped them create health messages for the media and through CDC
online channels, such as their website, Twitter, and Facebook pages.
Once the initial messages were disseminated, CDC conducted daily media monitoring of
print, TV, blogs, Twitter, and other Internet sites to determine if the information was being
reported accurately. When information didnt always include what they thought the public
needed to know, they held additional media events that reinforced accurate information.
Because of the length of the H1N1 crisis, CDC also had to monitor the media to make sure
to keep H1N1 in the public eye. They also monitored media outlets to make sure the public
had the most up-to-date information concerning at-risk populations, vaccines, school
closing procedures, and preventative measures.
Conclusion
Disasters are media events. Despite changes in the media and the fact that social media continue to
expand, print, television, and radio serve a pivotal role during disasters. The media typically serve two
broad functions:
They monitor and inform the public of risks.
They serve a watchdog function for public agencies and government.
Although working with the media during a crisis is almost always very challenging, some strategies and
techniques can enhance the flow of accurate and timely information. In addition, it is important not to
develop an adversarial relationship with journalists. Instead, recognize that reporters are professionals
who have an important role to play during a crisis.

References
1. U.S. Government Accountability Office. Media ownership: economic factors influence the number of media
outlets in local markets, while ownership by minorities and women appears limited and is difficult to assess.
GAO-08-383 [online]. 2008 Mar. [cited 2012 Jun]. Available from URL: http://www.gao.gov/new.items/d08383.
pdf.
2. Mitchell RK, Agle BR, Wood DJ. Toward a theory of stakeholder identification and salience: defining the
principle of who and what really counts. Acad Manage Rev 1997;22(4):8536.
3. Federal Emergency Management Agency. Integrated Public Alert and Warning System (IPAWS) [online].
2012. [cited 2012 Jul]. Available from: http://www.fema.gov/emergency/ipaws/.
4. American Red Cross. More Americans using social media and technology in emergencies. New American Red
Cross survey finds high expectations on response organizations [online press release]. Washington, DC; 2011
Aug 24. [cited 2012 Jun]. Available from URL: http://www.redcross.org/portal/site/en/menuitem.94aae335470
e233f6cf911df43181aa0/?vgnextoid=7a82d1efe68f1310VgnVCM10000089f0870aRCRD.
5. American Red Cross. Social media in disasters and emergencies. Online survey of 1,046 respondents and
telephone survey of 1,011 respondents [online]. 2011. [cited 2012 Jun]. Available from URL: http://www.
redcross.org/www-files/Documents/pdf/SocialMediainDisasters.pdf.
6. Tucker C. Social media, texting play new role in response to disasters: preparedness, communication
targeted. Nations Health [online] 2011 May/Jun [cited 2012 Jun];41(4):118. Available from URL:
http://thenationshealth.aphapublications.org/content/41/4/1.2.full.
7. Vergano D. At Japanese nuclear plant, a battle to contain radiation. USA Today [online] 2011 Mar 15 [cited
2012 Jun]. Available from URL: http://www.usatoday.com/news/world/2011-03-15-1Aquake15_ST_N.htm.
8. The Poynter Institute [Internet]. St. Petersburg (FL): Northwestern University; c2010 [cited 2012 Jun].
Available from URL: http://about.poynter.org/.
9. Dart Center for Journalism & Trauma. Tragedies & journalists: a guide for more effective coverage [online].
New York (NY): Columbia University Graduate School of Journalism; 2003 [cited 2012 Jun]. Available from
URL: http://dartcenter.org/files/en_tnj_0.pdf.
10. PSA Research. Public Service Advertising Research Center. Myths and frequently asked questions about
PSAs [online]. [cited 2012 Jun]. Available from URL: http://www.psaresearch.com/faq.html.
11. World Health Organization. Implementation of the international health regulations (2005). Report of the
review committee on the functioning of the international health regulations (2005) in relation to Pandemic
(H1N1) 2009. External criticisms, pp. 11819 [online]. 2011 May 5. [cited 2012 Jun]. Available from URL:
http://apps.who.int/gb/ebwha/pdf_files/WHA64/A64_10-en.pdf.
12. Dill RK, Wu HD. Coverage of Katrina in local, regional, national newspapers. Newsp Res J 2009 Apr
15;30(1):620.
13. Fischer, HW. Response to disaster: fact versus fiction & its perpetuation: the sociology of disaster. 2nd ed.
Lanham (MD): University Press of America; 1998.

14. Barnes MD, Hanson CL, Novilla LM, Meacham AT, McIntyre E, Erickson BC. Analysis of media agenda setting
during and after Hurricane Katrina: implications for emergency preparedness, disaster response, and disaster
policy. Am J Public Health [online] 2008 Apr [cited 2012 Jun];98(4):60410. Available from URL: http://www.
ncbi.nlm.nih.gov/pmc/articles/PMC2376984/.
15. Ahern J, Galea S, Resnick H, Kilpatrick D, Bucuvalas M, Gold J, et al. Television images and psychological
symptoms after the September 11 terrorist attacks. Psychiatry 2002 Winter; 65(4):289300.
16. CDC. Emergency preparedness and response. Specific hazards. Radiation emergencies [online]. [cited 2012
Jun]. Available from URL: http://emergency.cdc.gov/radiation/.
17. U.S. Department of Health and Human Services [Internet]. Washington, DC [cited 2012 Jun]. Health
information privacy. Available from URL: http://www.hhs.gov/ocr/privacy/hipaa/understanding/index.html.
18. Yale DR, Carothers AJ. The publicity handbook: the inside scoop from more than 100 journalists and PR pros
on how to get great publicity coverage: in print, on-line, and on the air. New York (NY): McGraw-Hill; 2001.
Resources
Braud GD. Dont talk to the media until 29 secrets you need to know. USA: Diversified Media; 2010.
CDC. 2009 H1N1 flu [online]. 2010 Aug. [cited 2012 Jun]. Available from URL: http://www.cdc.gov/h1n1flu/.
Tompkins, A. 5 tips for covering disaster preparedness [online]. 2011 Mar 4. [cited 2012 Jun]. Available
from URL: http://www.poynter.org/latest-news/als-morning-meeting/105194/5-tips-for-covering-disaster-
preparedness/.

Chapter 7:
Stakeholder and Partner Communication
2014 EDITION

Chapter 7:
Stakeholder and Partner
Communication
This chapter reviews the following topics regarding stakeholders:
Common interests and challenges
Responding to your stakeholders and partners
Crisis coordination and crisis collaboration
Working with communities
Stakeholder and Partner Communication and Community Relations during an

Emergency or Crisis
Stakeholders are people or organizations with a special connection to your agency, the issue, or the
emergency.1 Perhaps they have long-term supportive relationships with your agency and are considered
partners as well. Sometimes they emerge within the context of
the specific event. Sometimes they are near and directly affected,
and sometimes they are remote and the crisis only impacts
A stakeholder has a strong interest in
them indirectly. Take the time to understand your stakeholders
interests by anticipating and viewing any incident from their how the event is managed and how
perspective. They will be most interested in how the incident various organizations respond.
will affect their activities, well-being, family, friends, property,
and future.
Common Interests and Challenges
Expectations
Stakeholders expect action from agencies. It might be as simple as information released through the
media or a website, or as complex as in-person meetings with key organization officials. Throughout this
chapter, advocates, adversaries, and those who are ambivalent will be discussed:
Advocates: You want to maintain and enhance their loyalty and support. Where appropriate, it
may also be helpful to influence advocates to take some action.
Adversaries: Discourage them from getting involved. It may also be possible to shift
adversaries to an ambivalent position or, in some cases, shift them to be advocates.
Ambivalents: They tend to stay on the sidelines or provide tacit support. In many cases
during a crisis, maintaining large percentages of stakeholders in an ambivalent position
may be all that is possible.
213
In crisis and emergency risk communication (CERC) planning, the first step when responding to
stakeholders is to identify them. Stakeholders may vary according to the emergency, but your core
stakeholders will be interested in every public health emergency involving the organization and will
expect some form of response from your organization. Build positive relationships with stakeholders
before an event occurs. This will increase your reservoir of goodwill and help improve the effectiveness
of the response.
A good reputation, a track record of effective response, and a history of responsible conduct will build
a reservoir of goodwill for your organization. This will make your organization seem more credible and
help ensure that your messages are received positively.
Stakeholders are persons, groups, or organizations that may be affected by the event, your organization,
or both. They include the following:
People directly affected by a crisis and their family members
The medical community, including all who care for the sick and injured
People whose livelihoods are affected by the crisis (They are more remote stakeholders.)
People who have visited the crisis location (They are also more remote stakeholders.)
Communities and cultural groups that may occasionally be associated with a disease outbreak,
sometimes unfairly
Organizations, community groups, and supply chains
Stakeholder relationships are usually extensive and may take careful consideration to fully
understand. Its best to think of everyone as a stakeholder, while recognizing that some have
greater stakes than others.
Potential Stakeholders
The list of potential stakeholders includes the following:
Employees
Families
Retirees
First responder community
Board members
External advisors
The organizations clients
Individuals and agencies who provide funding
214 Chapter 7 Stakeholder and Partner Communication

Local residents
Business and community leaders
Community groups, such as schools and faith-based organizations
Nongovernmental organizations (NGOs)
Cultural groups and organizations
Elected officials
Consumer action groups
Business communities
Union or labor organizations
Competitors
Legal advocates
The media
Some of these stakeholders may not be supporters of your

organization. It is important to identify those stakeholders who
may be unsupportive or critical and be prepared to respond to
them appropriately. Your response to stakeholders will depend in I think one thing you need to
part on whether they are advocates, adversaries, or ambivalent. understand about NGOs , faith-based
Ask the following questions to anticipate stakeholder reactions: organizations, not for profits that
are working in these communities;
What type of relationship do they have with your
number 1 they are close to the
organization?
people, they have institutionalized
Do they have an affinity with your organization? relationships with them. They
How have similar groups reacted in the past when this understand the community and they
type of crisis has occurred? can translate the needs of the people
and reconcile that with the resources
Why expend energy on stakeholders during an emergency? They that are available. So if you can
are key audiences and sources of critical resources. A retailer make the delivery end of the service
may be able to deliver resources such as bottled water quickly
through an NGO or faith-based
and efficiently. Coordination with stakeholders is necessary for
an effective response. The effort to connect with stakeholders organization, youre going to get a
secures critical information you need. They represent points of far better response.
view that are vital to understanding how various groups perceive
your organizations response efforts. Involving stakeholders gives
RADM Thad Allen, Retired,
them a chance to tell you what they feel you need to know. It Former Commandant,
also ensures that everyone is aware that their involvement is United States Coast Guard
welcomed and valued.
Chapter 7 Stakeholder and Partner Communication 215

An emergency or crisis may also be an opportunity to strengthen stakeholder relationships as they
see your organization in action. An effective response will enhance credibility. Dont forget to consider
existing stakeholder controversies or concerns and how the ongoing relationship will affect their
attitude during the incident.
A common challenge with certain stakeholder communication is their expectation to be treated

differently than the average group. This is especially true when a group has been harmed or
experienced loss.
Communicating with Stakeholders

The following are common mistakes2 any organization can make in communicating with
stakeholders during a crisis:
1. Inadequate accessibility: There is a tendency during a crisis to focus internally, circle

the wagons, and engage in internal decision making. This may make your organization seem
inaccessible and its response efforts seem not transparent.
2. Lack of plain language: Retreating into jargon is a natural response and officials use it in
high-stress situations. It may frustrate stakeholders who simply need to understand.
3. Lack of empathy in the response: Stakeholders need to know that response officials
understand at a very human level what stakeholders are experiencing.
4. Problems with timeliness: Are you providing information too little or too late? Time is
always critical in a response, and the natural tendency to wait to get all the facts before issuing
a response can make matters worse.
5. Paternalistic attitudes and coming across as arrogant: Do you value your stakeholders
or do you express a we know whats best for you attitude? In a crisis, stakeholders often feel
disenfranchised and powerless. They may be particularly sensitive to responses they see as
arrogant.
6. Lack of opportunity for input into decisions: Those who have been most affected by a
crisis want a voice in key decisions. The opportunity for input can help offset feelings of being
powerless.
Key internal and external stakeholders require timely and accurate information that meets their
specific needs. They must have opportunities to be heard and offer input. Several helpful strategies
are listed below:
Make sure appropriate messages are tailored to your specific stakeholder audiences.
Use audience assessment tools and worksheets, such as the stakeholder reaction worksheet
at the end of this chapter. They will help you sort through audience needs, values, issues, and
preferred means of communication.

Consider the relationships you have with specific stakeholders. Some stakeholders are
dependent on you. Some may have the ability to directly influence how you conduct your public
health business.
Focus on a set of concerns and reactions common to various stakeholder groups. Address these
universal issues.
Certain communication strategies may help minimize negative reactions. Focus on factors
that inspire trust:
Express empathy.
Show competence in core areas of expertise.
Encourage stakeholder feedback and information exchange.
Be honest and sincere in your communication and actions
Establish a long-term commitment through a steady visible presence.
Trust may be assessed and given swiftly during the early stages of a crisis. However, that trust may
quickly erode if information is inaccurate, inconsistent, or overly optimistic.
To maintain good relationships with your stakeholders, do the following:
Do not underestimate risk: Your organization might estimate the risk to be lower than it
actually is, and you might wind up having to say it is more serious than we thought. This
underestimation may damage your organizations trustworthiness and credibility. On the other
hand, your organizations reputation may be less damaged if you overestimate the degree of risk.
People prefer to hear the incident is much less serious than we thought.
Pay attention to organizational process: When possible, involve the affected community in
action planning.
Explain your organizations procedures with care: Be prepared to describe the
organizations mission, tools, and methods used to provide service.
Describe the desired outcome: Explain to your stakeholders what factors make a successful
response effort. This will include desirable outcomes, such as fewer deaths, decreased infection
rates, and establishing systems to detect secondary outbreaks. Be open with your stakeholders
to help clarify issues.
Promise what you can deliver, then follow through on commitments: Under the
pressure of scrutiny and the desire to fix or mitigate problems, you may be tempted to
guarantee outcomes. Public commitments can create serious problems and should only be made
after very careful consideration. Make every effort to get back to your stakeholders to ensure
them that you have kept your promises.

Remain forthcoming with information: Focus on building trust and providing good
technical information. After identifying key stakeholders, determine their interests. Provide
information that meets the needs of the people involved.
Consider your method of communication and its impact on trust: Ask yourself, if it is
possible to satisfy stakeholders needs with mass e-mails or faxed messages, or is it necessary to
make phone calls or hold special meetings to ensure continued understanding and support?
Coordinate your messages with other responding organizations before reaching out to stakeholders.
You need to make sure that messages are consistent and that it is possible to accomplish key goals.
Stakeholders may also be stakeholders of other responding organizations. Power struggles or visible
confusion among organizations will reduce the credibility of all the players and frustrate stakeholders.
The following tips are not needed for all stakeholders, but if used will help you maintain good
two-way communication:
Designate stakeholder-specific meetings.
Create specific Web pages for partners and key stakeholder groups.
Provide quick updates through microblogs, e-mails, and text alerts.
Designate stakeholder liaisons.
Hold telephone calls that include management or management representatives.
Provide information releases on the background of the organization and the incident.
Provide periodic updates relevant to stakeholder interests.
Assessing Stakeholder Reactions

Part of stakeholder communication strategy involves identifying and describing the advocates,
adversaries, and those who are ambivalent. Know your audience:
Identify what they want to learn and their likely reactions.
Project the full impact, the political or financial effect of their reactions.
Identify stakeholders whose reactions will have the greatest impact if the crisis escalates.
Forecast the involvement and response of top management.
Develop a management strategy for likely reactions by key stakeholders.

Responding to Your Stakeholders
In your CERC plan, include the goals for communicating with advocates, adversaries, and ambivalent
stakeholders. First understand the relationship of the stakeholder to the organization and the event.
Understand the general goals of the stakeholder group, such as what they want to achieve and what
outcome they desire.
In thinking through your CERC plan, consider how actions, decisions, and messages will be perceived
by various stakeholder groups. What might shift their views? For example, during the 2009 H1N1
influenza pandemic, CDC originally posted guidance for schools that advised they close if they had a
suspected or actual case of H1N1 flu. This guidance was provided to lessen the risk of spreading the
virus into their communities.
However, more information became available suggesting a lower risk of severe illness and death from
H1N1. In addition, communities provided feedback saying that closing schools placed a burden on
parents and their employers. Parents had to arrange child care or stay at home with their children. In
response to this new information, CDC changed its recommendation 6 days after the first notice.
Stakeholders reactions, and whether they are advocates, adversaries, or ambivalents, will vary
based on several factors:
The level of disruption they experience and the specific nature of the disruption
Past history of interaction and the reservoir of goodwill
The level and form of impact (short term or long term, minimal or severe)
The level to which stakeholders depend on your agency and vice versa
Perception of common goals, interests, and values
Perception that your organization and stakeholders are all in the event together and share a
common fate
When designing message strategies, consider the following:
Address common concerns and reactions.
Identify strategies that minimize negative reactions.
Engage in confidence-building actions and communication.
Fulfill commitments to develop trust.
Offer consistent themes and messages.
Use pre-emptive and proactive communication to address emerging or anticipated issues.
Consider plans to provide advance notice to important audiences.
Prioritize stakeholders according to the type of emergency.

Partnership Development
A partner may be defined as anyone with a role in aiding in the crisis response. Almost all crises require
partners and close coordination among partners for an effective response. Most crises are too large or
diverse for any one agency to manage alone.
Partner relationships should be developed in advance of the crisis. One of the best methods of building
partnerships is to start with informal relationships through community, social, and professional
networks. A number of networks have been developed to bridge the divides within public health,
including local emergency planning committees (also known as LEPCs), liaison groups, and joint
exercises. Strong, collegial relationships can be invaluable when emergency coordination is required.
Base partnerships on a common purpose of serving the community, on mutual needs, and shared
understanding of what is necessary during a crisis.
Each potential partner should play a specific role during a crisis. This role should be determined and
agreed upon before a crisis situation occurs or, if necessary, in the first few hours of a crisis. It is helpful
to assess what each partner brings to the table, including strengths, weaknesses, and unique abilities.
Your partner organizations will most likely choose a representative. That person should be someone who
will execute the partners role and has the authority to make decisions and speak on their organizations
behalf. Usually this person is not the head of the organization, but typically will keep his or her
leadership informed.
The following are tips for developing partnerships:
Design plans for building relationships before the crisis.
Look for opportunities to interact with the partner organizations.
Create a partner contact sheet with every available phone number (work, home, cell), e-mail
address, and website address. Obtain permission to contact the people by any means necessary
during an emergency.
Draft a plan for partner communication during a crisis upon which all partners agree.
This plan should outline methods such as using e-mail and text alerts, twice-daily faxes,
and conference calls.

Reality Check
Despite every good intention to allow partners a preview of a press statement or press
release, it may be impossible to do so. With some time-sensitive issues, it is important to
consider the increased possibility of leaks. You may choose not to share.
If you cannot give partners a preview, consider doing one of the following:
Tell partners to expect a release on a subject.
Ensure that they get the release and any supporting documents at the same
time as the media.
Coordinating with Partners

Crises almost always require a joint effort between multiple agencies and organizations working
together. Coordination is one of the most important challenges to effective partnerships in an
emergency. One definition of crisis coordination is mutually agreed upon cooperation about how
to carry out particular tasks.3 An example of a method for crisis coordination is a memorandum of
understanding (MOU) that crisis response partners create to predefine their roles and responsibilities
during a crisis.
A common problem with crisis coordination is the Robinson Crusoe Syndrome. This is when partners
focus on their own tasks, and work independently in response to a crisis instead of focusing on the
bigger picture and how their tasks fit into the overall response.4
Three perspectives regarding disaster response coordination have been described. These are the
bureaucratic perspective, the structural perspective, and the network perspective (see Table 71).
1. Bureaucratic method: This is a top-down system, such as the National Incident

Management System (NIMS). Coordination is achieved through highly centralized systems
where decisions and activities are determined at the top and flow down to lower levels. As
described in Chapter 4, NIMS is a standardized, universal on-scene, all-hazards incident
management approach that is scalable and can be applied to all incidents. The NIMS approach is
required when federal dollars are being used in a response.
2. Structural systems: These describe specific areas of expertise or domains. Each agency may
have a specific area of expertise they bring to the incident. Each agency works within their
specific area or response. For example, police deal with issues of public safety, public health
officials focus on health-related issues, and the Red Cross focuses on providing shelter and
immediate support for victims. Because each agency knows its domains of activity in advance, it
is able to respond more quickly with little direction.

3. Networked coordination: This uses a system of linked and integrated agencies where
information is shared. Networked coordination requires ongoing communication and
interoperability between communication systems. As information about various activities flows
between agencies, ongoing decisions can be made about which agency is doing what, where, and
with what success. Networks may emerge around a disaster as needs and conditions become
clear. Sometimes, networks are spontaneous and can incorporate many community groups and
organizations involved in the response.
Table 71. Summary of Three Perspectives of Disaster Response Coordination
Coordination Philosophy Example

Perspective
Bureaucratic yy Command-and-control response to chaos Incident Command System (ICS)
in disasters
FEMA/Christopher Mardorf
Photo courtesy of
yy Top-down and centralized
yy Rigid, universal, hierarchical structure
Structural yy Disaster response is a blend of elements of Response to the attacks of

structure (domains and tasks) and agency September 11, 2001
(resources and activities)
FEMA/Andrea Booher
Photo Courtesy of
yy A range of different organizational forms
created on continuum from formal
organizing to collective behavior.5
Networked yy Networks of organizations are CDCs JIC

formed to respond to a particular disaster
based on needs and situation. Two types:
1. Emergent multi-organizational
networks6
2. Joint information centers,
or JICs
yy Network structures are flexible and fluid to

determine the most successful strategies
and organizations necessary.

Differences Between Crisis Coordination and Crisis Collaboration
Crisis coordination and crisis collaboration are different. Understanding the distinction between the two
is important. Failure to understand this distinction sometimes becomes a source of conflict. Different
organizations have assigned different meanings to the word coordination. Sometimes they refer to
coordination when they are really talking about collaboration.
There are at least three ways the term coordination can be used by disaster response groups:3
1. Coordination can be as simple as informing others about what an organization will be doing in
response to a crisis. Often, this is effective, but can create the impression that one group or
agency is going it alone.
2. Coordination may also be seen as centralizing decision making within a particular agency or with
key officials. In such cases, managers control the response, and coordination is a function of a
centralized authority.
3. Coordination may be seen as based on mutually agreed upon cooperation that is sometimes
negotiated. Participating groups reach an agreement on how to carry out crisis response tasks.
In these cases, groups and agencies share authority.
When partners come together to respond to a disaster, they may become easily frustrated with one
another because they feel other partners are not coordinating with them. They may be really looking for
some form of collaboration. These are different:
Crisis coordination: This implies a minimal level of involvement between organizations to

achieve synchronized crisis response and mitigation.
Crisis collaboration: The term crisis collaboration suggests a deeper alliance where each
values the others interdependence, and promotes equal input of participants in shared decision
making.7 Collaboration is based on shared goals of effective crisis response and mitigation,
shared values, and usually a longer history of interaction.
Differences in meanings of coordination among partners can be a source of conflict and tension. This
can result in problems concerning the following:
Information sharing Decision making
Resource sharing Trust
In pre-crisis planning meetings with response organizations, discuss and clarify the goals of a crisis
response. Also be sure to determine what crisis collaboration and coordination mean. This will lessen
potential conflicts, lead to more effective communication with stakeholders, and enhance the ability of
response organizations to create consistent messages.

Working with Communities
Community Partnerships
Community leaders and institutions, such as schools,
community organizations, religious groups, and major employers When your whole community is in
can be valuable partners in supporting public health strategies, crisis, things really do change. People
distributing information, and countering rumors surrounding step up.
an event.
Leng Caloh, Interactive Strategies
These partners may be familiar, trusted, and influential with Manager, KPBS San Diego
the target audience. Community partners may be more
likely than the media alone to motivate the public to take
recommended actions. Partners can reach groups of people in
settings with which they are familiar. In addition, many public health strategies,
such as social distancing and vaccination, require the support of institutions.
Establishing these partnerships requires ongoing interaction and mutual trust. In pre-event planning,
make an effort to reach out to these groups:
Use MOUs to engage partners as information distributors during a public health emergency.
Supply partners with background information before or soon after an emergency occurs.
Work with them to determine the best role for your partner organization or institution to take
and the best way to reach their target population.
Develop fast and reliable channels of communication that provide information directly to these
community leaders so they will have facts ready when their constituents begin to ask questions.
Invite partners to tour emergency facilities.
Include them in training drills and exercises.
Brief community partners on such issues as the strategic national stockpile, available state and
local assets, social media strategies, public health emergency laws, and response strategies.
Consensus Building
Controversies will inevitably develop around a crisis. These often require engaging stakeholders and
partners in building consensus. Controversies should not be negotiated through the media. Instead,
engage a neutral third party to speak for the diverse group and help resolve differences. Neutral parties
can do the following:
Speak to the media on behalf of all involved.
Facilitate a face-to-face meeting.

Express both consistent and inconsistent points of view held by the entire group in an effort to
find and build consensus.
Engage the public in community forums, create task forces or advisory groups, and practice
effective listening.
Convening a Community Forum

A community forum is a meeting, sometimes open to the public and media, and other times limited
to invited participants. In these meetings, people who have particular experiences or insights share
their knowledge and perspectives. These meetings can help build positive stakeholder relations by
doing the following:
Sharing information Demonstrating openness
Seeking input Building consensus
In addition to the strategies presented for managing public meetings in Chapter 5, community forums
may benefit from a facilitator. A professional facilitator should be comfortable with the culture of the
community and perceived by all sides as neutral.
An assessment can determine which stakeholders or partners are associated with the issue.
Representatives from all elements of the community should be considered, not just those from a vocal
advocacy group. You should also consider inviting community leaders and participants with particular
subject matter expertise. Make sure someone takes careful notes.
In some cases, an online forum may be used. This system allows for discussions in real time or over an
extended period, and can include offsite participants. This technique also generates a transcript of the
conversation for your records.
Task Forces and Advisory Groups

Sometimes, it makes sense to have stakeholders and partners participate in deliberations through a
more structured, long-term process. Advisory groups or task forces, composed of carefully selected
representatives of stakeholder groups, can be an effective way to build consensus. Be sure to provide a
carefully developed charge or mission statement to the task force.
If you create a task force or advisory group, you have an obligation to take their suggestions and input
seriously. The group expects you to do so. The decision-making processes of these groups can be
facilitated using the following steps:
Define the problem or issue, including its scope.
Define the scope, or charge, for the advisory group.

Identify available options.
Present all known information about alternatives.
Analyze the costs and benefits, weaknesses and strengths, and pros and cons of each alternative.
Establish criteria for a solution, including the must versus want criteria.
Be able to express why one alternative was chosen over the others. The chosen alternative will
be such that the highest number of people will be helped with a minimum disruption to self-
reliance and community sovereignty.
Effective Listening
Active listening during a public meeting or community forum can help facilitate understanding of the
partners needs and demonstrate a commitment to the relationship. The first step in reaching consensus
on debated issues is to understand the various viewpoints. Asking questions can demonstrate interest
and prompt the audience to give you useful feedback. Although active listening is a skill requiring
practice, some keys for using active listening in public meetings include the following:
Manage the flow of conversation carefully by calling on people one at a time.
Listen for both intent (feeling) and content (facts).
Ask questions to make sure you understand and indicate your interest in what is being said.
Pay attention to who is speaking:
yy What are his or her qualifications on this subject?
yy Does this person have underlying motives?
yy Is this person speaking as a representative of other groups, such as a community leader or

member of an advocacy group?
Dealing with an Angry Public

Controversies will arise when risks are uncertain because science has not provided an answer or
brought stakeholders to a consensus. Add to this the need to make decisions under the enormous time
pressure of a crisis, and the uncertainty may seem unbearable to response officials and the public.
When science cannot lead to a clear path, decision makers must make choices about what is and is not
acceptable. In pressure-free environments, the public may turn to the courts to settle differences about
the amount of acceptable or perceived risk.
A crisis creates an imperfect environment for making wide-ranging decisions. Decisions about important
issues must be made in minutes, not months. The fallout can be harsh, especially after the crisis is
resolved and the decisions are reviewed with the power of hindsight.

The struggle of imposing some risk on individuals or suspending some civil liberties to protect the larger
community may be great. In such cases, empowering the public is even more important.
At the community level, empowerment may mean a face-to-face meeting with stakeholders. Building
community consensus is the best way to advance compliance with public safety requirements before
and during emergencies. Anything less might invite public mistrust of institutions or government
agencies responding to the crisis. Public forums can diffuse anger and help the community work toward
a mutually agreeable solution to a common problem.
Communication experts and psychologists point out that anger is a defensive response to pain or the
threat of pain.8,9 Three basic circumstances can give rise to anger:
When people have been hurt
When people feel threatened by risks not of their own making
When people sense their fundamental beliefs are being challenged
The intensity of that anger can be confounded by other factors. For example, when people feel
powerless, their anger may be more intense. When people feel that they have not been treated fairly or
with respect, they are likely to become angrier. If they have been manipulated, trivialized, ignored
or worse still, lied toanger and a sense of unfairness will build. However, bear in mind that public
displays of anger may be a form of manipulation by another party, especially in public settings. Some
will use anger to bully others into accepting certain demands.
Avoid defining anger as either rational or irrational. Such an assessment is judgmental,

counterproductive, and truly in the eye of the beholder. Dont label others as irrational because you may
then feel justified in dismissing them, which will only heighten their sense of injustice.
Allow the Audience to Participate in Finding Solutions

Lectures are generally an ineffective way to communicate about a risk. They generally do not help to
address a risk or crisis during a public meeting. A lecture as a one-way form of communication does
not engage the audience. Telling is easy; asking and listening is harder. Asking questions is a deliberate
action. It forces the process to slow down and forces everyone to stop and think before replying.
Instead of attempting to persuade individuals or community group to take an action, allow them to
persuade themselves through a self-discovery process. The key is to not give the solution but help your
audience discover the solution through the help of information.
How do you help an audience discover its own answers?
Ask the right questions. Offer the right information.
Receive feedback.

Using feedback as your tool, ask the audience questions that will create awareness about the situation.
Empower them to make a difficult choice. A person who comes up with his own answer, while
speaking with his own voice, will often take ownership of that idea. Its better for you to ask a leading
question than to make an interpretation. The right questions can help an audience make the necessary
connections. This strengthens the audiences tendency to take ownership for the insight.
For example, if an outbreak of a severe communicable disease occurs, emergency response officials
may be faced with the challenge of temporarily suspending civil rights to limit the spread of disease.
An extreme public health scenario would be to quarantine individuals or communities. A population
that understands the need to quarantine will be more likely to uphold the quarantine requirements
and support this decision.
Questions to Help People Persuade Themselves

To help people find solutions through self-persuasion, start with broad, open-ended questions,
such as the following:
What challenges have you (or your community) faced that required consensus building to solve
the problem?
How did it go?
What did you learn from those experiences?
Were there difficult choices to make?
Feedback from the audience is critical, not only to get information, but to demonstrate openness. Ask
questions to discover the explicit wants, needs, and desires of the audience:
What is most important to you (or your community) when faced with a problem to solve?
yy Is it consensus building?
yy Is it putting the greater good for the greater number first?
yy Is it avoiding conflict?
yy Is it that the solution is fair and equitably distributed?
yy Is it ensuring everyone has a voice and was heard?
yy Is it that reasonable alternatives be fully explored?

When issues and concerns are presented in broad, general terms that are hard to address, ask questions
that are more specific to the audience:
What are the ramifications to you (your family, your community, or the nation) when faced with
this current problem?
What consequences are you hoping to avoid?
What do you see as the worst outcome for you (or your community)?
What courses of action do you believe could lead to this outcome?
Questions that encourage audience members to state the benefits they would like to see result from a
course of action may promote understanding of anticipated outcomes:
What benefits would you (or your community) expect if this disease did not spread further?
Because you have brought up quarantine, what benefits would you (or your community) expect
if you accepted quarantine as a course of action to reduce spread of disease?
Understanding and expressing the benefits makes it easier to demonstrate how a strategy can
solve the problem. In addition, strategies may be refined once benefits are understood. Ask
questions about the benefits while looking for the right solution:
From what I understand, you are looking for a way to protect yourself (or your family or
community) from more illness or death. If I can explain how quarantine will meet those needs,
are you open to implementing it?
If you think quarantine would work in this effort, how do you see the quarantine being explained
to the entire community?
Allowing people to persuade themselves is not an easy process. Done poorly, it can seem condescending
or manipulative. It takes practice and empathy, but its worth the effort. It is the most effective way to
gain your audiences acceptance in thought and behavior.

De-escalating Conflict
Conflict is natural and to be expected during a crisis or emergency.10 It can also impede the ability of
stakeholders and partners to work effectively with agencies. You can de-escalate using the following
approaches:
Begin de-escalation by trying to agree on issues that may not be key to the conflict. Do not start
with the hot button issue, the one where people are not willing to concede.
Find the elements that bring some agreement among both groups. This can help as a strategy
and can help build trust.
Establish guidelines for interaction and make an effort to humanize each side for the other.
Look for common interests upon which to base a common dialogue.
Remain open to reason, and allow yourself to consider that you might be wrong.
Strive for fairness in the process, especially where a real or perceived lack of fairness or
injustice has occurred.
Work to get input from all stakeholders.
Try to agree on actions that will be taken, however small, such as having a subsequent meeting.
Give decision-makers and others with influence in the community open access to complete
scientific information.
Try to get as many yes responses as you can. If someone says, Your proposal is totally unrealistic, try
this response: Are you saying that you dont see how this proposal can respect citizens rights and stop
the spread of disease? When a person says yes, this transforms the relationship. Each question you
offer that allows a yes answer from the other side further reduces the tension.
Dont Say But. Say, Yes, and

Typically, people express their differences by prefacing their responses with but. The other group will
be more receptive if you first acknowledge their views with a yes, and then preface your view with an
and. For example, you might say, Yes, we want to protect peoples rights and we want to keep them
alive to enjoy those rights.

Conclusion
Stakeholders are people or organizations that have special connections to the agency, the issue,
affected members of the public, or the specific emergency. Partners are agencies and groups who will
be assisting in a response. Often, stakeholders and partners emerge within the context of the specific
response.
Communicating effectively with partners and stakeholders is critical to managing an emergency. Often,
this means careful coordination and collaboration as well as ongoing, two-way interaction, even in
circumstances where stakeholders are upset and angry.
Specific communication strategies may help manage some of the anger and concern that are natural
in these circumstances. They will create strong, manageable, long-term relationships among your
organization, your stakeholders, and your partners.

Worksheet 71. Stakeholder Reaction Assessment
Stakeholder group
Relationship to the agency
Relationship to the event
Nature of likely reaction: Advocate Adversary Ambivalent
Values:
Interests:
How central is this stakeholder group to the agency or the event?
Likely initial reaction?
Turning point(s) in their likely reaction?
What would cause a change in position?
Key messages:

Key contacts:
Opportunities for feedback and interaction:
Steps for using feedback:
Strategies to inform and involve stakeholders:
Information to provide:
Services and products to provide:
Contact updates:
Date, with whom, and how:

References
1. Mitchell RK, Agle BR, Wood DJ. Toward a theory of stakeholder identification and salience: defining the
principle of who and what really counts. Acad Manage Rev 1997;22(4):8536.
2. FEMA. Welcome to the Emergency Management Institute. Emergency management: understanding your role.
Training: the emergency manager [online]. 2012. [cited 2012 Jun]. Available from URL: http://training.fema.
gov/emiweb/downloads/is1_Unit2.pdf.
3. Quarantelli EL. Ten criteria for evaluating the management of community disasters. Disasters 1997;21(1):
3956.
4. Auf Der Heide E. Disaster response: principles of preparation and coordination [online]. 1989. [cited 2012
May]. Available from URL: http://coe-dmha.org/Media/Disaster_Response_Principals.pdf.
5. Kreps GA, Bosworth, SL. Disaster, organizing, and role enactment: a structural approach. Am J Sociol
1993;99(2):42863.
6. Drabek TE. Strategies for coordinating disaster responses. Boulder (CO): National Hazards Center,
University of Colorado; 2003. Monograph 61.
7. Keyton J, Stallworth V. On the verge of collaboration: Interaction processes versus group outcomes. In: Frey
LR, editor. Group communication in context: studies of bona fide groups. 2nd ed. Mahwah (NJ): Lawrence
Erlbaum Associates; 2003. p. 23562.
8. Quinn SC, Thomas T, Kumar S. The anthrax vaccine and research: reactions from postal workers and public
health professionals. Biosecur bioterror 2008;6(4):32133.
9. Izard CE. Translating emotion theory and research into preventive interventions. Psychol Bull
2002;128(5):796824. doi: 10.1037/0033-2909.128.5.796.
10. Zicherman N, Khan A, Street A, Heyer H, Chevreau O. Applying conflict sensitivity in emergency response:
current practice and ways forward [online]. London: Humanitarian Practice Network, Overseas Development
Institute; 2011 [cited 2012 Jun]. Available from URL: http://www.odihpn.org/hpn-resources/hpn-network-
papers/applying-conflict-sensitivity-emergency-response-current-practice-ways-forward.

Resources
Izard CE. Emotion theory and research: highlights, unanswered questions, and emerging issues. Annu Rev
Psychol [online] 2009 [cited 2012 June];60:125. doi:10.1146/annurev.psych.60.110707.163539. Available from
URL: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2723854/pdf/nihms92055.pdf.
Leeds D. The 7 powers of questions: secrets to successful communication in life and at work. 1st ed. New
York (NY): Berkley Publishing Group; 2000.
Quinn SC, Thomas T, McAllister C. Postal workers perspectives on communication during the anthrax attack.
Biosecur bioterror [online] 2005 [cited 2012 Jun]; 3(3):20715.
Reynolds BJ. When the facts are just not enough: credibly communicating about risk is riskier when emotions
World Health Organization. Risk reduction and emergency preparedness: WHO six-year strategy for the
health sector and community capacity development [online]. 2007. [cited 2012 June]. Available from URL:
http://www.who.int/hac/techguidance/preparedness/emergency_preparedness_eng.pdf.

Notes:

Chapter 8:
Other Communication Channels
2014 EDITION

Chapter 8:
Other Communication Channels
The following topics are addressed in this chapter:
Communication channel attributes
Channel characteristics and features
Applying specific communication tools
Selecting and Using Communication Channels during a Public Health Emergency

There are major communication issues beyond working with the media that must be addressed in
preparation for crises. At the community, state, and national levels, the public expects access to the
government during an emergency.
Effective ways to provide access includes the Web, e-mail, social media, and toll-free information
telephone lines. As the public health crisis evolves beyond the first 24 to 48 hours, the demand
increases for information outside traditional media channels, such as radio, TV, newspaper, and websites
that provide news.1 Choosing the right communication channels to reach your target audiences is
crucial to the publics health and safety. The public information official must select the right delivery
methods for a particular set of circumstances.
Communication Channel Attributes
Channels of Communication during a Crisis

A channel of communication is simply the way a message is carried. In a crisis, messages are delivered
in many ways. Message delivery might be low-tech, such as handwritten flyers or messages painted on
buildings during floods. Message delivery may also be high-tech, such as two-way Internet channels
used with social media.
Selecting the appropriate channels and methods for communication is important for reaching your
target audiences. This is especially important with health risk communication, where participants can
quickly feel excluded if they do not believe they are getting adequate information in a timely manner.
More and more, audiences are fragmented, turning to specialized and localized outlets for news and
information. In addition, different channels of communication have different strengths. Newspapers are
excellent for reporting detailed investigations and in-depth news. Television delivers information very
237
quickly and can present the visual elements of the story. Some channels are more interactive and even
personal, such as telephone or call-in talk radio. Television, radio, telephones, and the Internet may
have a wider reach but require working infrastructure, which may be damaged during emergencies such
as in a hurricane, flood, or tornado.
The Demographics
According to a 2010 Pew Center study, about 92% of Americans use multiple channels of
communication for news, and 59% use both online and offline news sources. Unlike offline
news consumers, most of the online news readers use only a handful of favorite sites, and 35%
use a single news site.2
News today is often described as portable, personalized, and participatory:
About 33% of mobile device owners get news on their devices.2
About 28% of Internet users have created personalized news options.2
About 37% of Internet users report that they have created or reacted to a story online.2
Internet news users are younger, more affluent, and better educated.3 Poorer and older audiences, those
most vulnerable during a crisis, are less likely to receive their news from the Internet.2,4
For many minority audiences, specialized news sources are particularly important. More than
3,000 ethnic media organizations operate in the United States, serving an audience of 57 million.5
Many of these organizations are small foreign-language outlets, newspapers, cable news shows,
or local radio programs.2
Channels can be classified in the following ways:
Face to face, such as health-care professional to patient, organizations staff member to state
partner organization, and organizations staff member to individuals in the community
Group delivery, such as communicating to a small group and participating in
smaller public meetings
Public communication, such as public presentations to larger meetings
Organizational communication by response stakeholders and partners, via organizational

messages, web pages, and publications
Mass media, such as radio, television, newspaper, and direct mail
Social media, such as Twitter, Facebook, and YouTube
Community, such as employers, schools, malls, health groups, and local government agencies
Word of mouth
238 Chapter 8 Other Communication Channels

Your communication strategy should use a combination of any or all of these to reach a broad audience.
During a crisis, use as many channels as possible. It is important to ensure the widest distribution of
messages. In these cases, it is important to have close coordination and overall consistency of messages
between channels. While messages will need to be adapted to the selected communication channel,
consistency is key.
Channel Characteristics and Features
Multiple Options Available

During a disaster, television and radio are most widely used because they are the most immediate
channels of communication,6 but online channels are also used:
Radio reports are nearly real time as people call in with reports of news.
Many radio and TV stations have very close community connections, and are able to serve the
needs of the community during a crisis.
Social media channels are increasingly important. In many cases, the first news of a crisis will
probably be shared via Twitter or Facebook.
YouTube videos made with cell phone cameras can also be expected for many crises. (Social
media will be discussed more fully in Chapter 9.)
As people try to connect with friends and family, word of mouth becomes an important form of crisis
communication. They want to learn what others are doing in response to the crisis. Crises have a
powerful emotional impact on people, and they often want to share the experience with friends and
family as well as confirm that others are safe.
Crisis, in many cases, become news stories. One study of the September 11, 2001, attacks found that
by noon that day, 99% of the respondents had heard of the attacks and approximately 91% turned to
the media for more information. Most of them used television. The average viewer watched 8 hours of
television coverage the day of the attacks. Word of mouth, television, and radio were the most common
channels for learning about the attacks.7
Chapter 8 Other Communication Channels 239

KPBS Radio and the 2007 San Diego Wildfires8
In October 2007, a series of wildfires in the San Diego region burned more than 800 square
miles, destroyed 2,200 homes, and caused the evacuation of millions of people. The local
public radio station, KPBS, had covered such crises before, such as the 2000 wildfires
and the 2001 shooting at a local high school. KPBS became the primary news source
for the community thanks to its forward-thinking crisis-coverage plan and use of online
technologies.
Along with 80 hours of continuous live coverage, KPBS used an interactive Google map,
cell phone alerts using Twitter, and Flickr photos to chart the fires paths and to update
information about relief centers and evacuation routes. The information came from the
stations reporters, emergency authorities news releases, and residents call-in reports.
The radio station and its online website soon became the definitive wildfire news source,
receiving more than 132,000 visits per day.8
Other organizations recognized the radio stations coverage and stepped in to help. When
KPBS servers got overloaded, Google offered to host its Google map and increase its
bandwidth. When the stations radio tower was consumed by the fire, it still streamed their
broadcast online and a local FM radio station agreed to switch over and carry KPBS news
feed.
A study of those residents affected by the wildfires showed the impact of KPBS coverage.
One citizen commented, I used KPBS Twitter page and their excellent Google map overlay.
Listened to KPBS via an Internet stream when their radio transmitter burned.9 People felt
that KPBS was a timely and accurate source of local information and appreciated its use of
social media and online streaming broadcasts when other traditional news formats became
compromised. KPBS cutting-edge coverage and close ties with the community made the
station a credible and trustworthy news source for the public.
Questions to Ask When Selecting Channels

Which channels are most likely to reach your target audience?
Which channels are most appropriate for the health-risk problems, issues, and messages?
Which channels will be most accessible given the specific event?
Which channels will the target audience find credible?
Which channels will deliver the message in the appropriate time frame?

Which channels fit the programs purpose? (Are you trying to inform, influence, allay fears, sway
attitudes, or change behaviors?)
Which channels should be used and how many channels are feasible, considering
the schedule and budget?
Telephone Call Centers during an Emergency

The telephone can help your organization keep in touch with audiences during a crisis and allow for
transparency and feedback.10 Typically, a crisis response will include some form of toll-free hotline to a
call center where the public can call with questions. Consider the following when planning for toll-free
number services:
Decide between rapid expansion of an existing phone number or a new toll-free number
generated specifically for the emergency.
Make sure the service is expandable in terms of number of calls managed per hour or day and
the hours of operation.
Make sure the toll-free number is answered by trained people who reassure callers, provide
requested information, and can refer callers as needed.
Make precleared materials on multiple subjects easily accessible during an emergency.
yy Confirm that your materials are specific to the emergency and the community.
yy Make certain they are easy to read and understand. Use plain language.
yy Have them available in multiple languages based on community needs.
yy Field test them during your pre-crisis phase for word choices, readability, cultural
sensitivity, and other preferences.
Establish standards of performance and evaluation, such as customer satisfaction, response

capacity, and accuracy.
Call managers must be able to quickly integrate new information into their responses
during an emergency.
E-mail Services
Many organizations include a public e-mail response option.10 Consider the following in advance:
At the start of the e-mail response service, publicly state how long it might take for members
of the public to get a response to an e-mail. Response time frames such as 2 hours, 24 hours, or
within the same week are helpful.

Provide a way that is faster than the standard e-mail response service for the public to reach the
organization if the need is more urgent.
Advise people to contact their health-care providers or 9-1-1 for a personal medical emergency.
Social Media
Social media channels are increasingly important. The first news of a crisis may be reported through
them. For example, within one week of the 2010 Haiti earthquake, more than one in 10 Americans,
including 24% of those younger than 30, say they received or shared information about the Haiti
earthquake through Facebook, Twitter, or other social networking sites.2
Social media may provide opportunities to reach members of the public. Even though social media are
increasingly used by organizations during an emergency, the public uses these channels on a much
greater scale to seek and share information just after the event. People who join and use Twitter during
a crisis or disaster are more likely to adopt long-term use of the technology.11 This approach is useful in
communicating the most up-to-date information to the public during a crisis.
Applying Specific Communication Tools
Making Your Selection

The tools you use will depend on your audience and the situation:
What channels are available (after a fire, tornado, power outages, etc.)?
How does your audience prefer to receive information?
How do you wish to provide the information using your available channels?
What are your overall goals under the present situation?
Following are tools that may be useful during an emergency. They include briefings, community
mailings, exhibits, flyers, newsletters, open houses, presentations, public meetings, focus groups, and
personal telephone contacts.
Briefings
A briefing is a session with many state and local officials, media representatives, and community
leaders.10 Briefings help to inform them of response-related developments at the site, such as results
of studies or actions that should be taken to protect health. You can use a briefing to introduce your
organization and explain its role and work process. Briefings are not usually open to the general public
in the manner of an open house.

Conducting briefings:
Schedule briefings in a small public room, in a neutral location, such as a hotel meeting room or
a conference room.
Prepare a fact sheet or question-and-answer sheet.
Present a short, official statement about the agencys findings, health concerns, or recent
developments.
Use simple language. Avoid jargon, acronyms, and overly technical terms.
Answer questions about the statement.
Work with other organizations to coordinate briefing plans.
Benefits of briefings:
Briefings allow state and local officials, the media, and community leaders to ask questions about
any activity before the public release of information.
Briefings prepare officials and citizen leaders to answer questions from their constituents when
the information becomes public.
Briefings allow for the exchange of information and concerns.
Limitations of briefings:
Although briefings can be effective, they may become the only means of communicating with
site-specific communities. Make sure they are followed by activities to inform the general public,
such as small group or public meetings.
Be aware of negative feelings or bad publicity after briefings as a result of leaving people out
who believe they should have been invited. Be sure not to exclude such persons or convey the
perception of favoritism.
Community Mailings
A community mailing is a way to send information to key contacts, and concerned or involved members
of the community. Mailings disseminate information easily, in writing. They are particularly useful when
there are updates for the community.10 However, many crises disrupt local mail service and can delay
or impede mailings. As electronic forms of communication have grown, traditional mail delivery has
become less popular and less expected.12
If the updates are straightforward, not controversial, and easy to understand, the mailing can stand on
its own. However, if the updates are more complicated and require discussion or further explanation,
the mailing should be made in conjunction with a public meeting or small group meetings. The
community mailing can announce upcoming meetings and provide advance information or serve
as a follow-up for people who did not attend previous meetings.

Developing a community mailing:
Compile your mailing list, which should include the following:
yy State and local officials, who can be identified by checking with city, county, or parish officials
yy Community leaders, who can be identified by checking with the local chamber of commerce
and other officials
yy Leaders from faith-based organizations (FBOs), businesses, nonprofits, schools, civic groups,
and nongovernmental organizations (NGOs)
yy Local residents of the site area, who can be identified by checking with the city clerk
for assistance
yy Community members who have signed up to receive information
When creating mailing materials, do the following:
yy Provide a cover letter that introduces you, briefly explains the purpose of the mailing, and
provides contact information for comments or questions.
yy Include a fact sheet, newsletter, report, or other documents as well as suggestions about
where to get additional information.
yy Keep materials simple, focused, and encourage plain language. Plain language (also
called plain English) is communication your audience can understand the first time
they read or hear it.13
Benefits of a community mailing:
May require less planning time than a meeting
Allows for coverage of an entire geographic area, such as every household in a specific
postal zip code
Limitations of a community mailing:
It is not as quick as electronic methods of delivering information
Mailings allow no interaction or opportunity for community members to ask questions.
Residents may not read the mailing.
Mailings are only an option if mail service is available.
Large mailings may present logistics concerns and cost challenges.

Exhibits
Exhibits are visual displays such as maps, charts, diagrams, or photographs and can help illustrate
issues and proposed actions.10 Effective exhibits can make technical information accessible and
understandable. Exhibits can be used during any phase of site work and can be installed in locations
where there is high traffic or where specific target audiences may be reached.
Creating an exhibit:
Identify the target audience, such as the following:
yy The general public
yy Concerned residents
yy Media representatives
yy Public officials
yy Community leaders
Include specific messages, such as the following:
yy Descriptions of a specific health risk
yy Remedies and actions to protect community health
yy Processes or methods, such as how to file forms or claims
yy Historical background information related to the issue
yy Community relations activities.
Decide where it will be placed, preferably in a highly visible location, such as an evacuation
center, public library, convention hall, or shopping center. This is especially applicable when
residents are your target audience.
Set up a temporary exhibit at a public meeting if a segment of concerned community members is
the target audience.
Design it according to the message to be transmitted and include photos or illustrations. Use
text sparingly. A bulletin board could suffice, if appropriate.
If possible, staff the exhibit with someone to answer questions, guide people through
complicated issues, and gain feedback.

Benefits of an exhibit:
Stimulates public, partner, and stakeholder interest and understanding
Creates visual impact and leaves a lasting impression
Provides a physical presence for an agency
Limitations of an exhibit:
If not staffed, will be a one-way communication tool that does not provide an opportunity for
community feedback
May become obsolete if circumstances change
May be damaged or changed
Takes time and can be expensive to produce
Flyers
A flyer is a brief statement, usually one page, sharing current or proposed activities, announcing or
clarifying some activity, or seeking or presenting some specific information.10 Flyers are appropriate
whenever new information is available. They also can be produced and distributed quickly in response
to emerging information and can be an effective on-site tool.
Flyers can be useful for the following:
Introducing your organization and explaining its role
Explaining specific health risks and guiding community members in precautionary health actions
Announcing new findings or information
Reaching audiences at public meetings or community gatherings
Disseminating information when other channels are not available
Flyers contain the following types of information:
Explanation of the triggering event that caused a health-risk situation
Timetable for some proposed actions
Description of health concerns or problems
Description of recommended health actions
Description of public participation opportunities
Name, address, and phone number of contact person who can provide additional
information on request

Create flyers following these guidelines:
Select a simple, one-page format.
Be clear and concise.
Avoid jargon, acronyms, or highly technical language.
Clearly identify the agency.
Include the date the flyer was released.
Include contact information for additional assistance.
Benefits of flyers:
They briefly summarize key facts, issues, and actions.
They provide background for information discussed during a meeting.
They can be produced very quickly.
They are low-tech and flexible.
Limitations of flyers:
They are a one-way communication tool.
They require careful writing and balance between the need to make technical information easy
to understand and the need to deliver an accurate message.
Your organization must have physical access to deliver them.
They will require clearance.
Newsletters
A newsletter is a paper or electronic publication informing community members about activities,
findings, health precautions, and other information.10
Newsletters are generally assumed to be ongoing communication tools. There is an expectation of more
than one issue. You may need to structure them to include several articles on a related topic.
Newsletters topic areas may include the following:
Overview of the agency and background of its involvement at the site or in this event
An open letter from the director or agency head
Plans for your organizations onsite work and findings, if available
Health guidelines, if applicable

A description of upcoming activities and previous organization activities that have taken
place in the community
Frequently asked questions and answers
Contact information for the organization, as well as resources for additional information
Timelines of key events
Consider the following in your newsletter design:
Add dates and edition numbers to your newsletters.
Use simple, easy-to-understand language with headlines, boxes, lines, type variations, and other
effects to make the newsletter attractive and easy to follow.
Establish a page limit.
Use two colors if resources allow.
Electronic newsletters can include links to other sites and sources of information.
Distribute the newsletter to the mailing list. You can also distribute it at public or small group meetings.
If there is a central gathering place in the community, ask to leave copies there for community members.
Place newsletters on your website.
Benefits of a newsletter:
Explains activities and findings to the community
Serves as a written document that community members can keep and refer to later
Allows for multiple messages on a related topics
Allows community organizations to become a central point for disseminating information
Limitations of a newsletter:
Can cause problems if community members do not understand or are angered by the messages
Does not give community members the opportunity to ask questions or provide feedback
(Always include contact information in your newsletter so people have a way to ask questions.)
Creates the expectation of ongoing communication
Printed newsletters may be expensive and difficult to disseminate.

Open Houses and Availability Sessions
An open house or availability session is an informal meeting where community members can speak
with agency staff one on one, in a more relaxed informal manner.10 It is most appropriate when key
milestones or major decisions have been reached.
Conducting an open house or availability session:
Determine community interest in the site before planning an open house.
Select a date, time, and location for the open house. To encourage attendance, choose evening
hours or weekends at an easily accessible building familiar to residents, such as a public library
or local meeting room.
Anticipate the number of attendees and plan accordingly. Consider holding two open houses
to enable staff to greet and talk with each attendee. One staff member per 15 to 20 attendees
generally fosters an informal atmosphere for conversation and helps avoid the condition of
speaking to a crowd.
Publicize the open house at least 2 weeks before the event. Send announcements to
newspapers, television stations, radio stations, residents on the mailing list, and any interested
community organizations that publish newsletters.
Create exhibits and fact sheets to provide background information. This enables residents to ask
more informed questions during the open house.
Include personnel that are prepared to discuss technical information in an
easy-to-understand manner.
Benefits of an open house:
Allows for one-on-one interaction and feedback.
Creates the image of accessibility and transparency.
Helps build trust and establishes a rapport between community members and agency staff.
Limitations of an open house:
It requires extra staff time for planning and conducting an open house.
Turnout may not justify the effort.
Physical location may not be adequate.

Presentations
A presentation can be a speech to a community organization, civic or faith-based groups, businesses,
nonprofit organizations, ethnic groups, schools, or similar local audiences.10 Presentations often focus
on such major milestones as accomplishments, research findings, or health recommendations. They may
also serve as a way to create community interest and commitment.
Developing a presentation:
Organize the presentation according to your goals and the information you have.
Describe the issue and how it affects the audience.
Talk about what the organization is doing to address the situation.
Discuss how residents can assist and obtain additional information.
Select materials to support the presentation, such as slides, graphics, and exhibits to hold the
audiences interest.
Conduct a trial presentation in front of colleagues and rehearse the presentation several times.
Benefits of a presentation:
Offers the audience a chance to ask questions allowing the agency to gauge community concerns
Reaches many people simultaneously, reducing individual inquiries
Provides an opportunity to inform and persuade
Limitations of a presentation:
Requires presentation skills
If poorly presented, distorts your audiences view of the situation
Can only address individual community concerns during a question-and-answer period following
the rehearsed presentation, which could try peoples patience
Presenter may face difficult or argumentative questions from community members

Public Meetings
A public meeting is generally a larger assembly, open to the public, where experts present information
and answer questions, and community members ask questions and offer comments.10
Arranging a public meeting:
Develop an agenda with the involvement of residents and other interested groups.
Hold the meeting in a public space, with a comfortable setting that is easily accessible, well lit,
and has adequate parking and seating, especially for people with disabilities.
Be sensitive to special needs of your audience:
yy Consider hiring translators for people who do not speak English.
yy Use sign language for hearing-impaired participants, if possible.
Announce the meeting through local media outlets two weeks in advance if possible. Distribute
flyers to community members and groups interested in attending. Announce the meeting
through social media. Explain that the meeting is not a formal public hearing but, rather, a place
to exchange information and comments.
Follow up with members of the media closer to the
meeting time to encourage attendance. Send a media There were town hall meetings in
alert, which contains brief information about the meeting communities along the coast and
date, time, and topic. Consider making phone calls to key we put together news releases. We
contacts.
put together talking points for our
Conducting the meeting: administrators and medical directors
yy State the purpose of the meeting then outline the who worked in those communities.
agenda and the procedures for making statements. So they could speak on behalf of the
state and on behalf of DHH to assure
yy Present preliminary findings and proposed courses
the people that we had their best
of action.
interest at heart, that we were doing
yy Distribute materials, including fact sheets and other everything we could to show them
materials, for participants to take home or read ahead. that everything was fine and if there
yy Prepare a transcript of the meeting, make the were any problems we would let them
transcript publicly available, and announce how know that there were health issues.
it can be obtained.
Ken Pastorick,
yy Have a finite time for the meeting. Public Information Officer,
yy Allow time for comments. Include a question-and- Louisiana Department of
answer session. Meetings should last from 1 to 3 hours. Health and Hospitals

yy Consider audio or videotaping the meeting so you can refer to it to refresh your memory on
community concerns, if necessary.
yy Consider posting video on the website.
Benefits of a public meeting:
Creates an image of openness and transparency
Provides an opportunity for community members to hear from others
Allows the audience to express concerns and your agency to present information and respond
Limitations of public meetings:
They require skill in managing discussions.
Public meetings can intensify conflicts rather than resolve controversies. If public meetings have
failed in the past, use an alternative method, such as small group meetings or a formal public
hearing, to transmit information and obtain feedback.
Consider that your available facilities may not be favorable for holding public meetings.
Small Group or Focus Group Meetings

Small group meetings allow for more interaction between members.10 At a small group meeting, for
example, agency personnel share information with interested community members, stakeholders,
partners, and state and local officials. It is especially useful for informing and keeping in touch with
community concerns, answering questions, and clearing up any misconceptions or misunderstandings.
Small groups can also be used to test messages before they are released to the general public.
Preparing for a small group meeting:
Identify interested residents, key contacts, leaders from all sectors, and officials.
Contact each resident, group, or local organization directly affected by site activities.
Offer to discuss public health issues at a convenient time.
Limit attendance to between 5 to 20 people. If more community members and officials are
interested, schedule additional small meetings.
Decide whether to invite the media. Media presence may intimidate your participants.
You may want to hold a similar meeting for media only.
Select a meeting place conducive to two-way interaction. Place chairs in a circle or other
informal arrangement.

Select a date and time that allows for maximum participation. Make sure that the date and time
do not conflict with other public meetings, holidays, or other special occasions.
Conducting a small group meeting:
Ask, but do not insist, that people provide contact information so you have a record of who
attended.
Begin with an overview of current and future activities and findings.
Encourage participation.
Distribute fact sheets and other written information for attendees to take home.
Follow up on major concerns. Stay in touch with the group and contact newly formed groups.
Benefits of a small group meeting:
Allows two-way interaction with the participants
Provides a method for acquiring direct feedback
Enables participants to engage in consensus building
Limitations of a small group meeting:
They require a day or more of staff time to reach only a few participants.
It may be perceived by community groups as an effort to limit attendance or a tactic to prevent

large groups from exerting influence. If this happens, hold additional small group meetings with
organizations that express concern about being left out of the process.
Irate groups or individuals may accuse your organizations staff of giving different information
to different groups. Avoid criticism by inviting a cross section of community representatives to
each small group meeting and by keeping a record. The record may be written, audio, or video.
Personal Telephone Contacts

Personal telephone contacts with state officials, local officials, and concerned community members can
be used to build important relationships. Personally informing them of your organizations activities,
finding out who is involved, and gathering information about the event can be helpful in building trust.
After an initial contact is made, follow-up calls can inform these individuals and monitor the extent of
community concerns.14
Make calls periodically to inform key contacts of any major findings and the progress of activities.
Telephone contacts help you understand community concerns and gather information for your
organization.

When making telephone contacts, know exactly what information
to request, such as additional references, site specifics, or I think that interoperable
background information, and tailor questions accordingly.
communications is the greatest single
Information to solicit from these contacts might include:
challenge to managing catastrophic
Background on the problem and recovery process incidents in the United States of
America. And unless we improve
Recent government activities
and continue to improve in that area,
Nature and extent of citizen involvement we will continue to struggle in the
Names, addresses, and telephone numbers of other immediate response to catastrophic
possible contacts incidences.
Always test your messages with a small group before public Col. Terry Ebbert, USMC Retired,
release to ensure that the meaning is clear. Former Director,
Homeland Security,
Conclusion City of New Orleans
Selecting the right communication channels is necessary for

effectively delivering your message, and thus is crucial for public
health and safety. The public information official must select the
right delivery methods for a particular set of circumstances. This choice should be strategic and based
on your audiences needs, message you need to convey, available resources, nature and scope of the
event, and goals of your organization.
In addition, some communication channels have a particular utility in a crisis situation and some
crises may limit the viability of some channels. Most crises will require multiple channels to reach
all of your audiences.
As a crisis develops over time, the mixture of channels may change. Regardless of which channels are
selected, it is important to coordinate content so messages remain consistent.

References
1. CDCynergy. Choosing the right communication channel. Introduction [online]. 2003. [cited 2012 Jun].
Available from URL: http://www.orau.gov/cdcynergy/erc/Content/activeinformation/essential_principles/EP-
channels.htm.
2. Pew Research Center. Pew Internet & American Life Project. Understanding the participatory news
consumer [online press release]. Washington, D.C.; 2010 Mar 1. [cited 2012 Jun]. Available from URL: http://
www.pewinternet.org/Press-Releases/2010/Online-News.aspx.
3. Pew Research Center Publications. Audience segments in a changing news environment: key news audiences
now blend online and traditional sources [online]. 2008 Aug 17. [cited 2012 Jul]. Available from URL: http://
pewresearch.org/pubs/928/key-news-audiences-now-blend-online-and-traditional-sources.
4. Narcisse D. Commentary from the Center for Working-Class Studies at Youngstown State University.
Disconnected, disenfranchised, and poor: addressing digital inequality in America [online]. 2010 Nov 8.
[cited 2012 Jul.]. Available from URL: http://workingclassstudies.wordpress.com/2010/11/08/disconnected-
disenfranchised-and-poor-addressing-digital-inequality-in-america/.
5. NewAmericaMedia.com [Internet]. San Francisco: Pacific News Service; 2010 [cited 2012 Jun]. Available from
URL: http://newamericamedia.org/about/.
6. American Red Cross. Social media in disasters and emergencies. Online survey of 1,058 respondents
representative of the US population aged 18 and older [online slide set]. 2010 Aug 5. [cited 2012 Jun].
Available from URL: http://www.redcross.org/www-files/Documents/pdf/other/SocialMediaSlideDeck.pdf.
7. Rogers EM. Diffusion of news of the September 11 terrorist attacks. In: Noll AM, editor. Crisis
communications: lessons from September 11. Lanham (MD): Rowman & Littlefield; 2004, p. 1730.
8. Egner J. Ahead of the flames: crisis planning, web tools assist KPBS reporting. Current [online] 2007 Nov 5
[cited 2012 Jun]. Available from URL: http://www.current.org/web/web0720fire.shtml.
9. Sutton J, Palen L, Shklovski I. Backchannels on the front lines: emergent uses of social media in the 2007
Southern California wildfires. In: Fiedrich F, Van de Walle B, editors. Proceedings of the 5th International
Information Systems for Crisis Response and Management (ISCRAM) Conference [online]; 2008 May 57;
Washington, D.C. p. 62432. Session 7; Track 3. [cited 2012 Jun]. Available from URL: http://www.iscramlive.
org/portal/node/2236%3Cbr%20/%3E.
10. The Center for Biopreparedness Education, Creighton University Medical Center and University of Nebraska
Medical Center. Crisis communication planning workbook. Event response matrix [online]. [cited 2012 Jun].
Available from URL: http://www.preped.org/resources/crisiscommunication-workbook.pdf.
11. Hughes AL, Palen L. Twitter adoption and use in mass convergence and emergency events. In: Landgren J,
Jul S, editors. Proceedings of the 6th International Information Systems for Crisis Response and Management
(ISCRAM) Conference; 2009 May 1013; Gothenburg, Sweden.
12. The Federal Financial Institutions Examination Council. Lessons learned from Hurricane Katrina: preparing
your institution for a catastrophic event. What about the mail? [online]. 2011 Feb 2. [cited 2012 Jul]. Available
from URL: http://www.ffiec.gov/katrina_lessons.htm.

13. Plainlanguage.gov. Improving communication from the federal government to the public. [online]. [cited 2012
Jun]. Available from URL: http://www.plainlanguage.gov/whatisPL/index.cfm.
14. Managing organizational support for community engagement. In: CTSA Consortium Community Engagement
Key Function Committee Task Force. Principles of community engagement. 2nd ed. U.S. Department of
Health and Human Services, National Institutes of Health [online]. 2011 Jun. p. 91105. [cited 2012 Jun].
Available from URL: http://www.atsdr.cdc.gov/communityengagement/pdf/PCE_Report_508_FINAL.pdf.
Resources
Chess C, Hance BJ. Communicating with the public. Piscataway (NJ): Rutgers University Press; 1987.
Hyer RN, Covello VT. Effective media communication during public health emergencies. A WHO handbook
[online]. Geneva (Switzerland): World Health Organization; 2005. [cited 2012 June]. Available from URL:
http://www.who.int/csr/resources/publications/WHO%20MEDIA%20HANDBOOK. pdf
Pew Research Center for the People & the Press. Haiti dominates publics consciousness: nearly half have
donated or plan to give [online]. 2010 Jan 20. [cited 2012 June]. Available from URL: http://people-press.org/
report/580/haiti-earthquake.
U.S. Environmental Protection Agency. Tipsheets. Adapted from community relations in superfund: a
handbook. Washington (DC): U.S. Environmental Protection Agency; 1992.

Chapter 9:
CERC, Social Media, and
2014 EDITION Mobile Media Devices

Chapter 9:
CERC, Social Media, and Mobile
Media Devices
This chapter will discuss the following topics:
Social medias relationship with mainstream media
Social media forums, attributes, and users
Working with social media before and during a crisis
Writing for social media during a crisis
Keeping up with social media during a crisis
Mobile media and its role during a crisis
Responding to social media regarding serious errors, myths, and misperceptions
Understanding the Use of Social Media in Crisis and

Emergency Risk Communication (CERC)
Disasters can become media events. Today, they can also become social media events. Major public
health emergencies will cause those who use social media to immediately become involved, especially if
the events are exotic, catastrophic, or the first of their kind. For example, if a public health emergency
involves terrorist activity, social media forums will likely engage at higher levels. User-generated content
will often be the first publicly provided material. For example, some users will provide large amounts
of content through narratives and related videos on YouTube,
pictures on Flickr, and posts to Twitter and Facebook. This
information can be picked up and repeated by mainstream The social web is creating a
media outlets. fundamental shift in disaster
responseone that will ask
Social media use has grown quickly, constantly changing and emergency managers, government
evolving. Users develop new applications and social media
agencies, and aid organizations to
companies, such as Google and Facebook, are continuously
innovating. Today, audiences are more segmented, yet many mix time-honored expertise with
people rely on social media as their first source of news.1 real-time input from the public
Social and new media outlets include, but are not limited to We need to work together to better
the following groups: respond to that shift.
Social networks Podcasts Gail McGovern,

Blogs Forums President,
American Red Cross
Microblogs Photo and video sharing
257
Responders to a public health emergency may think of social media as a distraction from serious efforts
to respond to the event. For them, the distraction may seem uncontrollable, unmanageable, and full
of misinformation (intentional or not). Many feel that social media have questionable credibility and
reliability. Many see social media as little more than an annoyance.
In reality, social media are now a constant presence, like traditional media. Today, social media sources
play a critical role in informing and, in some cases, misinforming the public during any crisis or
emergency. Traditional media outlets routinely use social media sources for content. Social media users,
by co-creating audio, picture, video, and multimedia information about public health event crises and
emergencies, drive some of the Web-based and traditional media content.
No one source of information can be expected to reach everyone. At the same time, its impossible to
maintain a dialogue on every social media platform and with all social media content generators and
distributors. Added to this challenge is the expanding number and types of social media sites that are
integrated into public health conversations, especially when it comes to crises and emergencies.
Social Medias Relationship with Mainstream Media
What Is Social Media?

Social media can be defined as interactive online media that make it easy for users to participate
and contribute content. Social media combine a wide range of online tools that enable interactive
communication. Social media allow users to interact, engage in dialogue, and create and share
experiences. Interaction might include the following:
Sharing of opinions
Participating in polls
Giving personal recommendations or ratings
Social media involve two-way communication. They allow users to share what they have on their minds
and promote communication among like-minded people. According to one of the most published writers
on the subject, Brian Solis, Social Media is much more than user-generated content. Its driven by
people in the communities where they communicate and congregate. They create, share, and discover
new content without our help right now. Theyre creating online cultures across online networks and
using the social tools that we learn about each and every day to stay connected.2
In a crisis, interactions might range from sharing photos of the public health emergency, to sharing
information with follow-up discussions on social network sites. For example, these interactions may
augment how a virtual community can be better protected during an outbreak or crisis or to encourage
donations in response to an emergency. This level and kind of online interaction is what makes social
media different.
258 Chapter 9 CERC, Social Media, and Mobile Media Devices

Web 1.0 is used for pushing content in one direction, such as traditional organizations static
websites.
Web 2.0 is different. It is used for two-way information sharing, such as the following:
yy Social interaction
yy Relationship sharing and community building
yy Discussing and interpreting news and information
yy Creating and sharing information and emotions with people on a local and global scale
Technological Advances
Technological advances have transformed how crisis managers view, interact with, and disseminate
information to affected communities in a crisis situation. Crisis and emergency risk communicators
must consider how to make the most effective use of new communication technologies in response to
public health disasters facing individuals, organizations, communities, and society. New communication
technologies have transformed simple text messaging services into multimedia messaging services. For
example, a person can take a picture or record video on a smart phone, type in commentary, and send
that content directly to another persons phone, or to an Internet service. Users may also use services
that allow them to directly stream live video from their smart phones to the Internet.
Converged Media
Mainstream media outlets are connecting with social media.3 For example, a majority of the content
on Twitter comes from the mainstream media, either through media posts or through user reposts.
Therefore, social media and mainstream media are increasingly converging.
During a crisis, if the response agencies and organizations are not engaged, the media will find other
sources via social media to comment on the crisis. Thus, when it comes to being accessible to the media,
not engaging with social media can have the same effect as not returning a reporters call. Using social
media in CERC also means changing the definition of media contacts to include backpack journalists,
bloggers, and other key online influencers.4
Mainstream media organizations are increasingly using social media as a way to generate content. They
may monitor social media, such as Facebook pages or Twitter feeds, for information. They may solicit
news tips, pictures, or video. Today many federal agencies use Twitter and Facebook accounts as a way
to provide timely information, including updates for the media.
Chapter 9 CERC, Social Media, and Mobile Media Devices 259

Organizations evaluating social media should consider the following:
Advantages of Using Social Media:
yy Provides immediate information
yy Can create rapid connections and build relationships with the public
yy Helps build and maintain dynamic relationships with the media
yy Helps dispel rumors by immediately providing accurate information
yy Incorporates website links where media outlets and the public can obtain more detailed
information
yy Works in support of a broader communication strategy
Examples to help conceptualize these advantages:
yy Text-based 9-1-1 system
yy Twitter-like feeds to report emergency department waiting times
yy Photo sharing of disaster sites capturing progress and recovery efforts
yy Mobile applications to provide new preparedness tools
yy Interactive mapping
Disadvantages of Using Social Media:
yy Some people mistrust social media. They may also not know how to use them.
yy Personnel and technology are required to maintain and monitor social media services.
yy Continual monitoring and following up are needed to update information and dispel rumors.
yy Social media are limited in terms of how much information can be included.
yy Some audiences do not use social media.
yy Some people may post to create controversy, to start online fights, or to advocate their side of
an issue or event.

Social Media Forums, Attributes, and Users
Social Media Forums

A 2010 survey of the U. S. population over age 18, conducted by the American Red Cross, showed that
nearly three out of four participate in at least one online community or social network, with Facebook
being the most popular (58%), followed by YouTube (31%), MySpace (24%), and Twitter (15%).5
According to the survey, one in six has used social media to get information about an emergency,
including Facebook (14%), mobile apps (7%), Twitter (6%), text alerts from local governments (6%),
and Flickr (2%). However, television news (66%) and radio (43%) continued to be the main source for
emergency information during an event.5
The survey also showed approximately half of the respondents would sign up for the following:
E-mails
Text alerts
Applications to receive emergency communication, including the following:
yy Location of food and water (53%)
yy Evacuation routes (52%)
yy Shelter locations (50%)
yy Road closures (50%)
yy Location of medical services (50%)
yy How to keep yourself safe during an emergency (48%)5
About half of those who use social media also said they would repost emergency information on their
sites. More than half would send a text message to a responsible agency if someone they knew needed
help. Nearly half would use social media to let loved ones know they are safe. More than two-thirds
agree that response agencies should regularly monitor and respond to postings on their websites. Three
out of four would expect help to arrive in an hour.5
An ever-growing list of social media forums is available. One of the challenges of social media is the
accelerated pace of change as well as evolving technology, with new social media platforms coming
online daily. It is important for public health communicators to understand todays technology:6,7
Stay informed about new social media platforms.
Be aware of who is using what types of social media regarding the crisis event.

Use new social media platforms that are deemed important by CERC communicators and those
who bear risk during a public health event.
Recognize where the largest audiences reside and put resources where they exist.
The following are the major social media categories with direct implications for public health emergency
communicators (as of the writing of this book):
Social Networks: These are individual websites where people sign in as members. They allow
users to share content with friends or organizations for various reasons:
yy Develop friendships yy Advance a career
yy Build emotional support yy Purchase products or services
Websites such as Facebook and MySpace allow users to create personal profile pages, add friends, meet
new people, comment on the activities of others, join groups with similar interests, and participate in
online discussions.
Specialized social networks are also used. For example, LinkedIn, a business-related site, can be used
for professional networking.
Blogs: Blogs are well-known forms of social media. These are online journals that provide
a platform for individuals and organizations to write and share content where readers can
comment on the content as well as share that information with others. Popular websites for
blogging are Blogger and WordPress.
Microblogs: These are social media sites that allow people to share limited amounts of
information through posts, often with links to additional information. One good example of a
microblog is Twitter, which allows sharing of bite-sized (140 character) content. Microblogs play
an increasingly important role during public health emergencies, much like forums and content
communities.
Wikis: Wikis are Web pages where people work together as a community to create and edit
content. For example, Wikipedia, is an online encyclopedia that allows participants to add
content or edit the information provided in articles. Wikis are also used by government and
other organizations to manage projects, conduct research, and brainstorm.
Podcasts: These are a series of digital media files that are released periodically. They are often
distributed through a subscription-based service, but many are also available for free online.
They can include both audio and video, or multimedia formats.
Forums: Internet forums are online discussion groups focused on particular interests and
topics. They have diverse topics of interest available for discussions. They can be powerful and
popular elements of online communities during a public health emergency.
Content Communities: Members use content communities to share photos, videos, and other
multimedia content. These platforms are organized around specific content that people create,

share, and discuss. Some examples of online content communities include YouTube and Flickr.
The visual nature of these sites can play a positive or negative role in communication during a
public health emergency.
Aggregators: These are social media tools that collect content from different sites into one
site. Their content includes news stories, blogs, and any other specific information available
on the Web. The information they provide is frequently ranked by popularity and can include
comments from users. Examples of aggregators include Google Reader and Magnify.net, a video
aggregator.
Social Bookmarking: Users share and rate online content through social bookmarking sites.
Online bookmark management services are generally organized by subject matter. The full
resources themselves arent shared, merely bookmarks (links) that help to reference where they
can be found. Examples of social bookmarking sites include Delicious and Digg.
Crowdsourcing Content: Crowdsourcing is the act of outsourcing a task traditionally
performed by an employee or contractor to an undefined, large group of people or community
through an open call. Crowdsourcing social media sites have been used successfully in response
to emergencies:
yy Managing traffic following natural disasters
yy Tracking food radiation contamination following the 2011 Japanese earthquake and tsunami
Livecasting: This encompasses Internet radio and other applications that are streamed
through a live broadcast to your social network or audience.
Virtual Worlds: Computer-generated worlds, such as Second Life, allow users to interact with
one another inside a virtual community.
Multi-User Online Games (MOGs): A number of online communities of gamers provide
virtual worlds in which users play together and socialize. They share information and
experiences with other players around the world.
RSS (Really Simple Syndication): This type of Web content is constantly being created
and updated. RSS automatically feeds current content from key websites to subscribers as it is
published.
Digital Mapping: Data from many disasters such as fires, floods, and even disease outbreaks
are compiled and turned into real-time, interactive visual images or digital maps (See Figure
91). Google Maps and Ushahidi8 are examples of mapping programs used by the public.
Programs such as ETEAM and WebEOC also use digital mapping to improve coordination and
share information among crisis response organizations. These also support situational awareness
for your emergency operations center or EOC.
Pinterest:9 This is a content sharing service that allows members to pin images, videos, and
other objects to their pinboard. It also includes standard social networking features.

Figure 91. Google Map of 2011 Minot, North Dakota, Flooding
(Otis & James, 2011)
Google Attribution for Figure 91 (http://maps.google.com/maps/ms?ie=UTF8&source=embed&t=h&oe=

UTF8&msa=0&msid=210936661488428171865.0004a488925fb9508a017)
(Shortened URL: http://tinyurl.com/3svvd74)
The above digital map provides locations for critical resources that could be used by people affected
by the flood. Certain locations are marked with icons, which indicate that more information is available
about access to this location and the resources available there. Examples of icons and resource
information are listed below:
Minot Auditorium/Evacuation Center

The Minot Auditorium will be made available to evacuees as needed.
MSU Dome Evacuee Shelter

The MSU Dome is still accepting and housing any evacuees.
Temporary Re-Entry Zone

From the Minot Flood Emergency Operations Center: Residents living on the East side of 1st
Street NE and the North side of 7th Ave NE are allowed back to their homes during the hours
of 8 am to 8 pm, beginning today.

Broadway Partially Open
6.29.2011: Broadway will be open for North/South traffic between the hours of 7AM-10AM and
4PM-7PM. No entrance into evacuation zones is permitted, and the road will only be operated
as a two-lane for the time being.
KXMC Live Camera

CLICK HERE for a live camera view of the Souris River at the Broadway bridge.
Jim Hill RV Parking

The Jim Hill Middle School parking lot has been opened up for RV parking - they have about 80
spots open for parking. There are no services available (electricity/water/sewer.)
EVAC ZONE 1
6.22.2011: SIRENS HAVE SOUNDED/AREAS MUST BE EVACUATED IMMEDIATELY/
MANDATORY EVACUATION IS IN EFFECT.
EVAC ZONE 2
6.22.2011: SIRENS HAVE SOUNDED/AREAS MUST BE EVACUATED IMMEDIATELY/
MANDATORY EVACUATION IS IN EFFECT.
Social Media Attributes

Social media are a collection of online communication platforms that share five major characteristics or
attributes, including participation, openness, conversation, communities, and connectedness.10 Other
attributes include reach, accessibility, usability, immediacy,
permanence, and education and entertainment. These attributes
create unique communication opportunities when compared to
There are two great advantages
older media channels:
for using social media for
Participation: Anyone who has access to the Web can emergency communications and
share information and provide commentary and feedback those two advantages revolve
on a crisis through dialogue and information push or by around speed, its really fast and
creating and altering content. its direct.
Openness: An opportunity for transparency concerning
Ali Khan, M.D., M.P.H.,
management of the crisis and crisis communication is
at the core of social media. Most social media platforms
Director,
are built on community discussions that require posting Office of Public Health
content and providing feedback. Preparedness and Response,
CDC
Conversation: CERC is reliant on both information
push, such as for a product recall or boil water notice,

and two-way communication. It is also a give and take of information and perspectives, such as
community discussions about risks of environmental contaminants.
Communities: During a crisis, single-issue groups and groups with similar interests can arise
quickly. These groups may have already gathered in chat rooms and on discussion boards,
Facebook, and Twitter. They may be more engaged during a crisis. Social media enables the
creation of communities that are temporary in nature until the crisis event is over. However,
these communities may continue into the crisis resolution, follow-up, remediation, and
compensation stages.
Connectedness: Social media involve sharing content with people and organizations known or
unknown. Participants often provide and use links to other content for information or emotional
support. During crises, those bearing the risk have used social media as an emotional outlet,
especially when the crisis isolated them from friends and family.
Additional Attributes
Reach: While social media do not reach everyone, a diverse range of the public, including
minority communities and older people, increasingly uses it.11 A digital divide remains in the
sense that some people will be more connected than others. Therefore, communicators must
also use traditional forms of crisis and risk communication to make sure they reach the widest
possible audience. Social media do not replace other forms of communication; they enhance the
overall package of communication tools.
Accessibility: Social media are accessible through many handheld devices. This means that
information will be more accessible to a large number of users. A disaster may disrupt service
and accessibility. If electricity is not available, but cell towers are still working, handheld devices
may enable people to continue using social media channels.
Usability: Social media are increasingly user-friendly, allowing users to quickly and easily view
and generate content.
Immediacy: One of the most important attributes of social media is the speed with which
information can be distributed.12,13,14 In fact, many crises and disasters are likely to be reported
first via social media.
Permanence: A record of an event can be maintained through social media postings. This
information, which may be in the form of text, audio, images, or multimedia, can be used to
assess additional risks during the crisis event. It may also be used for crisis resolution, follow-up,
fixing the problem, and compensation.
Education and Entertainment: Social media are used for both education and entertainment.
Many elements of social media can be used to more dynamically engage the public information

process. At the same time, much of social media dialogue and sharing is about entertainment
and can help engage audiences. An appreciation for the complex nature of social media is
important when communicating during public health emergencies.
Social Media Users

Social media users are diverse and can be put into five categories.15 Each category of users has
implications for public health communication during an emergency:
Lurkers: These are users on the outside looking in. They observe the community and look at
content, but do not comment or contribute. While these users are not engaged in social media,
they may look to gather information about the crisis. This way they experience the crisis, but
are not directly responding to the event.
Novices: Novices are just beginning to get engaged in the social media community. They
are more active observers and create a limited amount of content. They may post photos or
participate in a few threads of conversation. During a crisis, novices are likely to get more
involved in creating and sharing content.
Insiders: These users are consistently engaged in dialogue and content creation. They interact
with other members and make an effort to comment, rate, and use materials from other
organizations and people. During a crisis, insiders will seek risk information from social media.
They expect response organizations to be engaged with social media and provide information
quickly and accurately.
Leaders: Leaders are users who are recognized as veteran participants. They will cross-
link information, often comment on newly posted material, and correct misinformation or
misbehavior as needed. During a crisis, leaders are followed as sources of information for
traditional media as well as those bearing the crisis. Leaders are also more likely to self-correct
misinformation about the crisis.
Elders: These are users who have stopped using social media for a variety of reasons. They may
have a problem with time or have acquired other interests. During a crisis they might re-engage
in various capacities as needed.
When you engage with social media users, keep two other unique characteristics in mind:
Social media users bypass traditional media and other information gatekeepers by posting their
thoughts, images, and multimedia messages directly. However, this does not mean that social
media users are not consumers of traditional media.
Social media users also use traditional media by posting and reposting media content and linking
RSS feeds.
Communicating with social media users is quite different from providing press updates and press
conferences with traditional media personnel. For most social media users, the creation and

dissemination of content is not their job. There is little to no formal training or an apprentice period for
social media users.
The technology, and application of the new technology, is constantly evolving at a pace that makes it
very difficult to keep up with changes. Health communicators are challenged to do the following:
Learn how to use it and use it routinely prior to an event.
Understand who is using it and why.
Know the proper formal and informal protocol for sharing information and engaging in dialogue.
Working with Social Media Before and During a Crisis

Before a Crisis
Social media have changed how crisis and risk information is handled prior to, during, and after a public
health emergency. This information may be in the form of text, audio, visual, or multimedia. Social
media have affected every step in the process of handling crisis information, including how it is created,
manipulated, processed, shared, and disseminated.
Developing relationships with audiences before a crisis occurs builds trust. Using social media before
a crisis can also help promote preparedness and educate audiences about risks. Organizations need to
be regular users of social media before a crisis. Establish your social media relationships early. If not,
social media users will go to other sources and groups with whom they already have relationships for
information.
Following are some best practices for using social media for risk communication before a crisis:16
Determine social media engagement as part of the organizations risk and crisis management
policies and approaches. Every crisis communication plan should have a section for
communicating with stakeholders and working with the media. Social media can be used to
communicate directly with stakeholders and the media at the same time. More importantly,
social media provides a built-in channel for stakeholders to communicate directly with
organizations. Incorporating social media into the plan ensures that social media tools will be
analyzed and tested before the crisis. It also requires regular updating of the communication
plan as social media evolves.
Incorporate social media tools into environmental scanning procedures to listen to audience
concerns. One important use of social media is the opportunity it provides, if used well, to listen
to the concerns of the public and others who may be bearing risks. When users create and
manage their own content, external and internal social media monitoring becomes even more
critical. In addition, tracking issues through social media and reporting the results to the crisis
management team can increase the potential that a crisis will be addressed sooner. It will also
demonstrate to the team why social media needs to be embraced in the crisis response.

Use social media in daily communication activities. Individuals may have information that is
crucial to handling the crisis. However, they probably will not share that information if they
do not trust the organization or know where to find it online. Do not wait until you are in the
middle of a crisis to try using social media. To build partnerships and build trust, the discussion
with members of the public should already be taking place. Internally, using social media like
Wikis on day-to-day projects can streamline communication within the organization and increase
efficiency.
Follow and share messages with credible sources. Collaborating with trustworthy and supportive
sources can enhance the credibility of the organization and increase its reach. By cross posting
and retweeting messages among partner organizations, a coalition of credible sources is
established and more individuals are reached through shared networks.
Preparedness 101: CDCs Zombie Apocalypse Venture

When CDC was looking for a way to draw new attention to emergency preparedness
messages, they used zombies to provide a witty yet educational guide for their Public Health
Matters blog. Using existing resources and social media savvy, CDCs Office of Public Health
Preparedness and Response harnessed the power of popular culture and created a viral
campaign that caught national and international attention.
Buzz started to grow about the blog and it went viral two days after @CDCemergency
tweeted, Prepared for a #zombie apocalypse? If so, ur prepared for any emergency. Learn
more: CDC Public Health Matters blog http://go.usa.gov/jRH.
The blog, which usually receives around 3,000 visitors a month, was overwhelmed with users
and crashed 48 hours after 30,000 readers rushed to see what had caused all the commotion.
Within one week, the blog post received over 2 million page views. Comments about the blog
on CDCs Emergency Preparedness and Response page (on Facebook) sparked discussions
about what people are doing to prepare. In some cases users sought advice from other users.
Catherine Jamal, Lead for the Emergency Web and Social Media Team, summed up the
experience of using social media for risk communication by stating the following: It was
exciting to make a campaign that was directly tailored to what users told us they were
interested in, and then have that campaign resonate with all of our target audiencesthe
general public, public health professionals, health-care providers, emergency responders,
and even the media. Sharing the message of general preparedness via social media channels
like Twitter, Facebook, widgets, and badges enabled us to reach people of all ages around
the world in about a day.

During a Crisis
While social media are important before a crisis occurs, the You have to figure out what it is
immediacy of social media is a particularly important feature
you are trying to do, what is the
during a crisis. Public health emergency managers and
communicators are challenged with the demand for delivering mission, the effects youre trying to
accurate information rapidly. It must be done in a manner that achieve, and what enhances your
can be altered and shared through diverse social media channels. ability to do that. For the majority
of the population and the complex
The various forums discussed earlier can be expected to play problems were dealing with today,
a role during a crisis. The most immediate forms, such as
it takes you to social media.
microblogging (Twitter) and social media (Facebook), will be
prevalent in the earliest stages. For example, within one week RADM Thad Allen, Retired,
of the 2010 earthquake in Haiti, more than one in 10 Americans Former Commandant,
(13%)including 24% of those younger than 30say that
United States Coast Guard
theyve gotten or shared information about the Haiti earthquake
through Facebook, Twitter, or another social networking site.17
Social media should also be accessible during a crisis from a
multitude of digital handheld devices.
These highly mobile communication devices have created additional access to social media and are
particularly useful for transmitting hazard and risk warnings to those members of the public who
principally rely on these devices for news and communication. The rapidly evolving Commercial Mobile
Alert System (CMAS) communicates alerts and warnings to handheld devices.18 Later in this chapter
mobile media are discussed in more detail.
With social media, everyone has the potential to be watchdogs, citizen journalists, photo journalists, and
caring or nosy neighbors who can constantly survey the world around them and share what they find
online. Stakeholders on the ground of a crisis event are generally the ones with first-hand knowledge.
They become key sources of information and facilitators of a broader understanding of the event. They
may do the following:
Provide information that is critical for situational awareness
Distribute information
Create content and visuals
Assist in connecting people and information via social media
They may not intend to help CERC communicators but the information they provide inherently does.

Some best practices for using social media during crisis events are described below. These can be
helpful in determining a social media strategy for an organization:12
Join the conversation, help manage rumors by responding to misinformation, and

determine the best channels to reach segmented audiences: Health communicators
can do more with social media than track issues. It is essential that they interact with their
audience to address misinformation and establish the organization as a credible source.
Responding to posts demonstrates that the organization cares what stakeholders think. It also
demonstrates that the organization is engaged and able to address their concerns. Reaching
specific audiences with a key message is a foundation of targeted communication. However, in
CERC, communicators often resort to the standard mass media push to reach everyone at once.
Health communicators must still consider how messages will be interpreted and who will not
be reached. After all, those who face the greatest risks are often those with the least access to
information. Determining the best communication channels for specific audiences online or in
the community should be incorporated in communication plans.
Check all information for accuracy and respond honestly to questions: Inaccurate
information that is shared and retweeted, or passed on through other social media outlets,
not only makes the organization look bad, it can also look bad for the user who passes on the
information. It is easier simply to skip over a post you do not want to address than it is to
ignore a pointed question from the media. However, the public, like the media, will turn to
other sources if the organization stonewalls on key issues. If you do not know the answer to a
question, it is better to communicate the uncertainty of the situation and explain what you are
doing to find out the answer than to answer incorrectly or not answer at all.
Recognize that the media are already using social media: The crisis will likely be
discussed through social media, and traditional media will be part of that discussion. If the
organization is not engaged, the media will find other sources through social media to comment
on the crisis. Thus, when it comes to being accessible to the media, not engaging in social media
can have the same effect as not returning a reporters call.
Remember social media is interpersonal communication: Social media allow for
human interaction and some degree of emotional support, and have been shown to be important
to stakeholders dealing with crises.19 If communicators use social media to send out messages
that come across as generic marketing blurbs, these messages will be seen as cold, callous,
and impersonal. They will not encourage the relationship building and mending needed in a
crisis. Organizations should be ready to pull messages, such as advertisements or campaigns,
in case of a crisis. It took 2 days after September 11, 2001, for advertisers in Times Square to
change their billboards to messages of sorrow, charity, or patriotism. Two days is a lifetime
online, especially as it relates to social media. Incorporating and responding to emotional
appeals are ideal uses of social media, but organizations have to be ready to move to that
message exchange instantly.

Use social media as the primary tool for updates: Organizations often promise to
follow up with the media and public as soon as they have new information, but then wait to
release that information until a press release can be drafted, refined, cleared, and sent out.
Generally, its posted to the organizations website after the release. Sometimes, organizations
will wait until the next scheduled press conference to provide their updated information;
this allows them to have a spokesperson deliver the information while also displaying the
appropriate emotions. Using social media allows organizations to keep their promise of providing
timely updates to the media and public.
Organizations have another option: They can use social media for updates in the crisis
response and recovery. This allows them to humanize the response and continue to be a reliable
source without requiring all the exact details and time needed to fill a press release or hold
another press conference.
Ask for help and provide direction: Giving people something meaningful to do in response
to a crisis helps them make sense of the situation. As a partner in the crisis response, the public
can provide essential information, especially if they are directly affected by the event. By
providing that information, social media users are taking action. When an organization requests
useful information via social media, it helps both the organization and the stakeholders who
respond in managing the crisis. If there are actions individuals can take to reduce risks or assist
in the recovery efforts, social media are an ideal forum for reaching stakeholders with the
directions needed. Even more, by simply forwarding, cross-posting, or retweeting the directions,
users are taking action.
Web 2.0 is not a solution to all communication problems: Social media remains a
channel or tool with its technological advancements, rapid access to information, large numbers
of users, low cost, and ease of use. The power to communicate remains with the behaviors
of the communicating organization and the content they produce, not in the technology. The
real value in communicating through social media comes from the quality of the content being
disseminated. That content needs to explain the actions of the organization while demonstrating
compassion and empathy for those affected. Thus, using social media is not a best practice
in CERC. Social media are a tool that can assist practitioners in following best practices.
Reality Check
During a public health emergency, community information is often difficult to gather. Social
media are a great way to scan and monitor the environment, getting glimpses and anecdotal
evidence about how a community is responding to the crisis.
Gain insight into areas of misinformation.

Understand emotional response issues for first responders.
Gather an informal impression about what risk bearers are thinking, perceiving,
feeling, and sharing.

Writing for Social Media during a Crisis
Unlike working with journalists, there is not a generally agreed upon writing standard for social media.
The pressure is to move the process along at the accelerated pace of the online world.
The publics belief that an emergency response was effective is related to how much access
to information they had during the crisis. The fundamental challenge is have speed and accuracy.
Both are crucial:
If information is accurate and released after the public has moved on to another issue,
it has little value.
If information is out fast, but inaccurate, its a mistake. The best-case scenario is to admit errors
and move on. The worst case scenario is that the inaccuracy causes harm to the public and
damages your organizations credibility.
When writing for social media, keep the following points in mind:
Provide adequate scientific expertise: During a public health emergency or any event
involving technology, most social media users will not have the scientific background to quickly
grasp new information or the nuances of that information:
yy Prepare to fill in the blanks without talking down to your audience.
yy Do not assume that everyone knows technical jargon.
yy Engage in dialogue with social media users.
yy Start with the basics regarding new information.
yy Bring reporters along in their understanding of technical issues. Reporters will appreciate not
being made to feel stupid, and their reports will be more accurate.
yy Link to other credible Web resources.
yy Explain points from using plain language as social media are a user-driven medium.
yy Engage your technical experts with social media early.
Provide messages of self-efficacy: Social media are about dialogue, participation,

connectedness, and other social attributes. It relies on people to engage in communication
and take responsibility for both communication and action during a public health emergency.
For example, when an F5 tornado devastated the town of Joplin, Missouri, in 2011, FEMA
immediately posted messages on their blog, Twitter, and Facebook pages.20 They also created
a video featuring FEMA Administrator Craig Fugate communicating to the public how they can
help tornado survivors as well as how to keep safe during a tornado.21

Use social media to provide emotional support:
yy Communicate with compassion, concern, and empathy.
yy Be present but understand that some of the dialogue can be frustrating.
yy Prepare for emotionally charged reactions to the crisis event and how the situation
is being managed.
Establish trust with social media users:
yy Identify yourself and your organization if you are providing information in chat rooms,
posting videos on YouTube, or making comments on Facebook groups that have been set up
specifically for the crisis event.
yy Communicate with honesty, candor, and openness.
You are not necessarily able to control what messages are being sent:
yy Be prepared for all types of messages about your brand, partners, stakeholders, and
audiences.
yy Have a strategy about when and how to respond.
The public is increasingly diverse in terms of which medium they are using to
get information: This is a huge barrier for public information officers and public relations
professionals seeking to manage a crisis.
Use social media to listen to the public:
yy Listen to concerns and understand the audience.
yy By engaging in social media dialogues, you can address rumors early and correct
misinformation more easily and quickly.
Collaborate and coordinate with credible sources: Feel free to repost or retweet
effective messages from credible sources such as other public health, emergency management,
or disaster relief agencies, or even influential bloggers who are supporting your organization.
Partner with the public via social media:
yy Stay transparent by providing enough information for people to know what is happening.
yy Update your social media profiles regularly.
yy Include information on how the situation is being handled and how decisions are being made.
yy Include information on decisions about how to communicate with the public during the crisis

Accuracy is always important but so is speed of response: Concerns about accuracy
may be why some emergency managers avoid social media. While this may be problematic
at times in both traditional and social media, anecdotal evidence during a crisis suggests
that social media are generally accurate because they are self-correcting. People who are
experiencing the crisis or public health emergency will often correct misinformation, provide
more timely information than emergency managers have, and provide more detail than officially
provided. In this manner, the advice to accept uncertainty and ambiguity is ever more necessary
in social media.
The core principles of crisis and emergency risk communication, Be First, Be Right, Be Credible,
apply to social media. Throughout this manual, it has been emphasized that effective CERC means being
quick, accurate, consistent, and crediblebeing the first and best source for information. Social media
are one of the tools to help you achieve these goals.
Using Social Media during the H1N1 and the Seasonal Flu Outbreak
During the 20092010 H1N1 and seasonal flu outbreak, CDC and the U.S. Department of
Health and Human Services worked together to create social media tools that provided
the public and partners with credible, science-based information. A comprehensive set of
tools was developed and utilized to encourage participation and achieve the overall goal
of communicating key messages to influence health decisions.
By using multiple formats to disseminate messages, users had the option to participate
based on their knowledge, level of access, and engagement with social media. A variety
of tools was made available to partners to ease their sharing and promotion of H1N1 and
seasonal flu information. Tools with portable content, such as widgets and online video,
allowed users to share messages and become health advocates.
The CDC Facebook page was used to share H1N1 and seasonal flu updates and provide
social media tools, such as the following:
Badges and widgets, for users to download and share
Links to CDC.gov for additional information
Posted blogs from CDC subject matter experts
Promotions about CDCs text messaging campaign
By using Facebook to share H1N1 and seasonal flu information, CDC reached a younger
audience than they reach with their main website, www.CDC.gov.6

Providing Links to Other Key Information Sources
Social media can be used to link directly to other credible sources of information about a disaster or
crisis. This allows users to select the kind and amount of information they want.
Advantages of providing links within social media posts:
Links can be used to direct readers to information presented using other methods,
yy Video, audio, or both yy Telephone news conferences or webcasts
yy Text from press releases yy Satellite media tours
yy Commercial press release services yy E-mail distribution and broadcast faxes
yy Website content yy Websites, video streaming, and webinars
yy Press conferences or media opportunities
The linked content can provide additional information, include background information that may
help provide context for the social media post.
Links give traditional media organizations both tangible and electronic items to use.
Providing links allows for the simultaneous release of paper and electronic (e-mail and
Web) forms.
Links can be disseminated through multiple social media channels, directing readers to go to
a single source for the content. This ensures consistent information is distributed to all social
media users. It also makes it easy for mainstream media outlets to get the right information.
This method provides a historical record.
Disadvantages of providing links from social media posts:
Releases take considerable time to write, and information may be changing while a release is
being written. Communicators must be willing to update releases to provide the most current
and accurate information. This means they must also communicate the uncertainty of the
information they are providing.
Releases may be difficult to clear through all layers of official command.
Reporters and social media users will expect more information in that same form; be prepared
to consistently release information this way.
If the release is not organized through your command post or joint information center,
competing press releases can and will occur. This is especially true if press releases cover
information that spans response areas. This is particularly problematic if there is lack of clarity
about who is responsible for collecting and releasing what information.

As discussed here and in earlier chapters, mainstream or traditional media functions differently during
a crisis. This same statement can apply to social media. During an unfolding emergency, the behavior of
social media users will be mixed and varied. During the early stages or phases of a crisis you can expect
the following:
Diminished information verification: Tentative information, sometimes incorrect, will be

posted without the usual practice of confirmation from multiple sources. Social media, however,
tend to be self-correcting as users fix content errors.
Diminished adversarial role: Reporters will want
to help by providing important messages. Most media Reporters will want to help by
outlets contribute in their way to public health and providing important messages.
safety. Mainstream media may even see themselves in
partnership with response officials in the early stages. Media professionals are generally
Media professionals are generally more likely to adopt more likely to adopt an independent
an independent stance as the event progresses. With
stance as the event progresses.
social media, the users are the content providers,
and us versus them is less of an issue.
For major crises, expect the national media to
dominate: Most people will get their news from the national media. Ideally, local media will
likely feed information to the national media, coordinating their coverage. Messages meant for
local audiences will compete for airtime with national coverage. Social media increasingly offset
traditional media dominance and are a mainstream national media resource. Social media are a
direct source of local news and can help provide important information and updates to people
affected by the event.
Person-on-the-street interviews: These interviews are common. Today, the use of cell
phones and cameras is routine during the first moments of a crisis. Social media users are often
the first to report and provide visual content of a crisis situation, often via handheld devices.
During a crisis, social media allow everyone to serve as a reporter. Every cell phone becomes a
photojournalists camera. Pictures, videos, and tweets can be posted almost instantaneously.
Media interviewing media: Reporters interviewing other media personnel will be
commonplace during the first moments of an event. Until official news sources are available,
the media will use informal sources to fill time. This will include significant content from social
media. Layperson and citizen journalist reports and content will be common. This will include
advice, updates, requests, and status reports. Some of these reports will come from people who
are directly affected by the crisis.
Information that cannot be easily found might as well not be published: Structured
hierarchies and predetermined groupings for sorting information are standard within many
organizations. However, social media users dont think along those lines. User-defined tags, and
Google-inspired index-driven searches are the design patterns for social media. For example,
if you only communicated or tagged your 2009 pandemic flu prevention information as H1N1,

you would have missed your key audiences. Social media people were mostly searching for
swine flu on Facebook and Twitter.22
Employees want information first: Internal audiences are important and should generally
be targeted as one of the first to receive information. Doing so helps ensure collaboration is
occurring and that employees have the ability to be on the same page.
Keeping Up with Social Media during a Crisis
How to Keep Up
One key concern about social media during a crisis is how to keep up with and process all the
messages. Its a legitimate concern but one that isnt unique to social media. Crisis management and
communication has and will always be about processing and communicating information quickly. The
difference is that the conversation is now even more immediate and disseminated more widely. Make
sure that you do the following:
Dont miss vital information being shared via social media.
Enhance situational awareness of the event.
Respond in a timely manner to those bearing the risk if they ask direct questions through social
media platforms.
Two things can you help manage these concerns:
One option is to outsource computer processing or geospatial monitoring to collect, categorize,

sort, and analyze social media content for quick feedback during a crisis.
A second option is to outsource social media crisis communication specialists to assist in
managing the social media dialogue during and after a crisis. Such an option does relinquish
control over messages and should be approached carefully.
Using Social Media for Internal Organizational Communication

One group that is sometimes overlooked is your internal audience. Social media can have a significant
impact on internal communication in organizations and agencies during a crisis. Using social media for
internal communication are an excellent strategy for organizations involved in public health disasters.
When implementing your internal social media strategy during a health disaster, the following factors
are important:
Have a social media policy that defines the types of boundaries your agency may require for
maintaining confidential information.
The culture of your organization may need to adapt to allow for the proper use of social media.
Create only those social media services that will benefit the agency, stakeholders, and partners.

These challenging tasks might best be initiated through conversations with key managers and
communication professionals. Also review and use the Social Media Communications Strategy
Worksheet located at the end of this chapter.
Some questions to ask when using social media internally include the following:
Would people in your organization be more effective if they could communicate more quickly
and accurately with each other?
Would your organization, and the people working and volunteering for you, be more productive
if they were able to work in a more collaborative environment?
Could the environment of your organization be improved by using a communication tool that
brings about quick communication and collaboration?
If you answered yes to any of these questions, consider using social media inside your organization
before, during, and after a crisis event.
The following suggestions can help integrate social media into your current internal websites and move
your organizations approach from using Web 1.0 to Web 2.0. This will be especially helpful in managing
a public health emergency:
Planning is fundamental and essential for success: Create a vision and a plan that is
based on a thorough assessment of employees or members needs and expectations, as well as
those of management.
Leadership must set the tone: Senior management must lead by example and spearhead
the dialogue, by establishing the culture of social media use within your organization. Sanitized
organizational speak from communication specialists posing as executive voices does not
work. It runs the risk of hurting trust among employees or members who want honest, direct,
and simple messages.
Policies and training are necessary: What can and cant be done needs to be
defined. Anonymous postings should not be allowed. Everyone needs to take ownership
of their contributions.
Everything is about conversation and dialogue: Co-creating content for solutions to
challenges is important. Everyone can and should participate. Actively encourage employee and
member comments and contributions to blogs and wikis.
Social media content has to be relevant and up-to-date: A blog that is updated
once a month isnt serving a purpose. Dont start a social media site and just leave it,
hoping it will take off.

Mobile Media and Its Role during a Crisis
Mobile Devices
Web 2.0 offers an excellent opportunity to use mobile handheld communication devices for transmitting
hazard and risk warnings to the public. These devices include the following:
Mobile phones
Smartphones
Personal digital assistants (PDAs)
Wireless tablets
Mobile collaboration devices that extend the capability of video conferencing in real time over
secure networks
In the past, mobile devices were designed for news and personal communication. Today, these devices
are used for many CERC functions, including the following:
Information sharing
Real-time coverage of events
Dissemination of crisis information to family and friends
Location and safety updates of family members and other loved ones
Directions away from disaster areas
Using Mobile Devices

Community members who experienced the 2007 southern California wildfires
sought information using mobile phones to contact friends and family, including by
using the following:
Information portals and websites Photo sharing sites, such as Flickr

advertised in traditional media and Picasa
Individual blogs Microblogs, like Twitter
Web forums
Residents used mobile technology devices to fill the information void and get details that
werent available in traditional media.12 They also used it to inform themselves and each
other about their safety. The benefit of mobile devices is that they are small, smart, and
portable. People will stay connected, as long as channels are available.

The mobile telephone, once only used to communicate by voice with others, has evolved into a
powerful communication tool. This includes smart phones that come with a wide variety of applications,
commonly referred to as apps. These apps can empower responders and the public to perform a
number of tasks, while staying mobile:
Communicate by voice with others Take notes on site
Take photographs Send press releases in the form of text

messages to the media, stakeholders,
Make videos
partners, or the public
Send text messages
Manage location-based applications and
Perform powerful computing functions systems through the global positioning
system (GPS)
Organize tasks
GPS technology is a satellite-based navigation system that allows users to identify their geographic
locations. These devices are rapidly becoming more popular.
Mobile phones offer a number of pathways for effective communication. Traditional one-to-one verbal
communication has been augmented with other variations. In one-to-many communication, a sender can
broadcast information directly to a large segment of the population or to a large stakeholder group. The
information can be disseminated in various forms, such as photos, videos, short message service (SMS)
text messages, and short press releases.
In many-to-many communication, the mobile device is used to connect groups of people using mobile
wireless Internet capabilities including social networking sites like Facebook, Twitter, and foursquare.23
The latter is particularly well-suited to the mobile device, because it combines location-based features
such as geographical information with social-networking capabilities. The foursquare app, like many
social media systems, raises questions about privacy.
Handheld devices provide a number of advantages to professionals in a disaster or crisis situation,

including the ability to maintain continuous communication and to better manage the flow of
information. Continuous connectivity, however, often creates information overload and creates the
expectation of always being in touch. One of the primary benefits for public health communicators and
emergency managers is access to on-the-ground information from those affected by the crisis, including
the following:
Location of casualties Overcrowded health facilities
Blocked access points Sources of food contamination
Along with these advantages, however, come risks that must be anticipated and managed. Technologies
allow the entire online community to obtain information that can potentially create problems for those
tasked with managing a crisis. For example, officials might experience impromptu reporting in which

bystanders use their phones to record video or take photos of emergency personnel who may not appear
to be acting professionally. Under the stress of a crisis, the immediacy of digital communication might
result in false information being communicated to stakeholders.
In addition, social media users can take advantage of these technologies to create and disseminate
their own influence, decentralizing the dissemination of information, and reducing official control. For
example, following a school shooting at Virginia Tech University on April 16, 2007, the school could
not officially release the names of dead and injured students to the media until all relatives had been
notified. However, students were sharing this information through social media because people wanted
to know if their friends and family were safe.24
Mobile devices do more than enhancing the communication individuals have with their personal
contacts. The technology also forges mobile connectivity with an entire online virtual community. With
mobile devices, users can do the following:
Receive information through their devices.
Create their own content or forward content immediately to others while in the field.
Contribute directly to the media by providing eyewitness perspectives through video, photos,
or texted accounts of an event.
Bypass the professional reporters on the scene and providing unfiltered views of what is
happening in the world.
Reality Check
A Morgan Stanley analyst suggested that the world is currently in the midst of the fifth
major technology cycle of the past half-century, predicting that within the next five years
more users will connect to the Internet over their mobile devices than on desktop PCs.25
Mobile Devices Used in Disasters

Globally, mobile devices have become more affordable and integrated into everyday life. This has
changed the way people communicate with each other in a disaster situation. For example, people
in a disaster zone can communicate more quickly over the mobile network, including searching for
loved ones. Journalists can literally walk around as a mobile television or radio studio covering the
event. Analyses of disaster situations occurring since 2000 illustrate the opportunities and challenges
of using mobile devices in a crisis. Mobile technologies have played a prominent role in several crises
and disasters:

Southeast Asia tsunami catastrophe in 2004: Photo sharing capabilities and features
were used to document events and to provide dramatic visual eyewitness accounts, including a
poignant and frightening video of an incoming wave taken from the abandoned camera of one of
the victims.15 This disaster also saw the initiation of the use of mobile technologies to solicit and
receive donations for relief efforts.
2005 London subway terrorist attack: Mobile devices played key communication roles
during these terrorist attacks in the London subways. Despite some challenges, mobile devices
were useful tools for coordinating the dissemination of information during this event to affected
populations. In this particular case, the initial use of mobile devices was to communicate
information in the form of text followed by visual information. Mobile devices were soon used to
forward pictures of the impact of the bombings on train stations to the London community, the
media, and the rest of the world.
Virginia Tech shootings of 2007 and Northern Illinois University (NIU) shootings of
2008: Shootings occurring on university campuses, including Virginia Tech and NIU, provided
further insight into the impact of mobile media use on disasters. People were beginning to use
mobile media more extensively to communicate with others and give real-time accounts on
what was going on during these traumatic events.15 Researchers analyzed online communication
that occurred during the Virginia Tech and NIU shootings and found that people used virtual
communities (e.g., social networking sites) to interact with others, seek information regarding
the crisis, share experiences, form online relationships with others, and build community
and awareness of the tragic events.24 In the aftermath of these shootings, many colleges and
universities instituted cellular phone services to communicate safety alerts to students,
faculty, and staff.
Mumbai terrorist attacks of 2008: Mobile phones also played a significant role in the
Mumbai terrorist attacks in 2008 by raising awareness through eyewitness accounts. On
November 27, 2008, a series of coordinated terrorist attacks across the city of Mumbai hit
several hotels, a cafe, train station, and a Jewish center. Several people were killed. What was
unique in this particular case was the fact that the traditional news media were obtaining most
of their information from sources on the ground in Mumbai. Citizen journalists were reporting
events during the 60-hour terrorist ordeal using tweets, Flickr pictures, and videos posted on
YouTube from their mobile devices for the world to see.26
Haiti earthquake of 2010: Following the earthquake, mobile devices allowed people from all
over the world to donate to relief efforts using text messages. This type of fundraising effort,
first seen following the 2004 tsunami disaster in Southeast Asia, increased the awareness of the
power of nonprofit organizations as a communication channel in a disaster situation. The Haiti
earthquake disaster highlighted the use of SMS text messages to communicate first response aid
to individuals needing immediate medical attention or who were trapped under buildings and
other fallen structures. Mobile phones were used to communicate first aid information and to
provide information about where to go for shelter, food, water, and other health assistance.
Some of the messages that were being sent via these mobile devices included information

yy An offering of medical care: Hospital Sacre-Coeur in Milot says it has capacity for
patients and asks people to make their own way there
yy An announcement concerning search and rescue: Though the government says the
search and rescue phase is over, SAR teams are still available. If you know someone is trapped
call + 870 764 130 944, e-mail haiti.opc@gmail.com, or contact MINUSTAH
Response personnel also sent general advisories on other issues of relevance.27,28 The growing
prevalence of mobile phone ownership and use, even in very poor countries like Haiti, makes
rescue efforts possible that would have been unthinkable in 2000.
Japanese earthquake and tsunami of 2011: Social media use in response to the disasters
that hit Japan in 2011 highlighted the growing importance and evolution of social media and
mobile device use during a crisis event. In addition to uses described in the previous crisis
events, crowdsourcing websites were used for monitoring traffic patterns out of affected regions
and for tracking radiation contamination of food in the affected region and beyond. In addition,
Googles Crisis Response site was one of the most visited social media sites used for sharing
information on the crisis. It provided access to the companys Person Finder search program,
which helps people reconnect after a disaster, using both personal descriptions and photos.
People could post if they had been identified as missing as well as search for missing friends
and family. They could make donations to multiple agencies. They could connect with missing
persons phone lines and emergency voicemail message boards. They could also receive alerts
and statuses from world health agencies, Japanese utility companies, government agencies
services, and real-time updates of RSS feeds.
People use social media tools often through mobile devices during a crisis. These tools can help
determine the whereabouts and well-being of their friends and family, process information in real time,
and serve as a way to post corrections when users conclude that information is not accurate.
Opportunities
Mobile devices provide many opportunities for more effective communication in disaster situations.29
With their immediacy and nearly universal prevalence, mobile technologies allow rapid and proactive
disaster relief responses. Professionals operating in disasters have greatly improved remote access to
information, along with the ability to communicate with their home base or others onsite.
Valuable Resource for the Community: Mobile communication channels also serve as a
valuable resource for the community. They do the following:
yy Provide information
yy Contribute to a sense of normal life
yy Afford many ways to be occupied until the situation returns to normal
yy Help to reduce fear and anxiety by allowing people the means to quickly obtain the
information they need

Prior to the advent of mobile devices, people experienced uncertainty and anxiety in addition to
the challenges resulting from a particular disaster.
Along with CDC, FEMA emphasizes the importance of communicating with the public through
mobile devices. FEMA created a mobile version of their website so it is easier to navigate from
smartphones and other handheld devices allowing the public to receive localized information
during a disaster.21
In 2011, FEMA, along with the Federal Communications Commission and the cellular
industry, launched PLAN (CMAS), so emergency managers can provide location-based alerts
and warnings directly to a persons cell phone.11 Some people call this a reverse 9-1-1
system because users dont have to sign up for the service and there is no cost to receiving
the messages.
Community self-efficacy: Mobile devices have empowered people to establish connections with
others during a disaster situation while obtaining access to the information and knowledge they
must take action for themselves. Stakeholders can collaborate and assist each other, enhancing
their personal sense of control, and further reducing the load on official emergency responders.
The use of mobile technology has the potential to facilitate two-way communication between
responders and large groups of people affected by a disaster or crisis. The combination of mobile
telecommunications devices and the Internet has the potential to provide higher capacity and
more effective service. Together, they can create interactive communication mechanisms that
can enable just-in-time messages and encourage collaboration among large numbers of residents
and responders.
Web 2.0 media have provided increased access to emergency response information. They have
also increased the ability of those facing risks to share information. Social media help build
networks among groups related to a crisis. This form of communication also allows participants
to witness debates, participate in chat rooms, and access other sources for more information
and expert opinions.
Challenges
In spite of the many advantages provided by social media and their use on mobile devices in an
emergency, the history of responses to disasters in the era of new technologies demonstrates that this
is a rapidly changing landscape requiring constant analysis and proactive planning. Recognizing the
challenges to planners, responders, and victims posed by the use of mobile media during a disaster or
crisis will allow crisis managers to anticipate problems and maximize performance:19
Lack of Training: Although personal use of mobile media is quite common, leading to
relatively high levels of competence, emergency planners should not assume that all personnel
have the knowledge and training to use the technology appropriately during a disaster situation.
Training is needed for those using one-to-many or many-to-many features of mobile technology.

Otherwise, these beneficial features could be misused or underused. All personnel working on
the disaster scene, such as team leaders and dispatchers, should be equally skilled in the use
of this technology. This will make the users of the devices interchangeable in the field. Training
should also minimize the likelihood that unskilled users will consume available bandwidth and
other wireless resources, which might be stretched very thin during an emergency. Responders
cannot control the wireless resources used by victims. However informative messages
suggesting ways victims should use their technology might be helpful.
Investment of Time: A social media strategy requires considerable human resources
for managing and updating. Staff requirements must include creating, managing, and
monitoring the various forms of social media. The skill set necessary to use social media
effectively can be daunting.
Resilient Infrastructure: A sound and resilient infrastructure for mobile devices supports all
new features, allowing for the exchange of photos, videos, and data among responders on the
disaster scene, as well as with others in relevant organizations. The information that is shared
on these devices should be duplicated in both online and offline platforms. A critical aspect of a
resilient mobile infrastructure is the need to make security a top priority.
People With Limited Access: CERC professionals and emergency managers should
remember that not everyone in the population will have access to a mobile device.
Additionally, having access does not mean its regularly used. While many senior citizens
own cell phones, they are not as frequent users as others. Alternate means for reaching these
individuals must be included in any crisis plan. Efforts are being made to ensure a broader
reach for these technologies.
Information Overload: Among the challenges facing victims of a disaster is the risk of
information overload caused by the extensive coverage available in both traditional and
mobile media.
Responding to Social Media Regarding Serious Errors,

Myths, and Misperceptions
The media have a good record of getting facts correct during crises. Unfortunately, social media-
generated content sometimes gets basic facts wrong, reports rumors, or perpetuates false information.
Blog posts, tweets, and Facebook status updates are in most cases unfiltered and have included
inaccurate and conflicting information. These mistakes may not only harm the public, they can
undermine the credibility of your organization. While media rumors, myths, and errors in press reports
are usually self-correcting, the correction sometimes does not happen fast enough.
Mobile communication allows stakeholders to communicate with each other while bypassing
gatekeepers in agencies and traditional media. Todays stakeholder groups expect to be informed rather
than controlled or commanded. This raises significant challenges. Individuals supplying official messages
must be completely transparent, operating with a 24/7 mentality, and recognizing their role in the
international digital business community.

The perception of reduced official control of information due to mobile devices and social media raises
the following problems for your organization, especially during a disaster:
Stakeholders might receive false information regarding the situation.
Information sent from mobile devices can spread virally in seconds.
Disseminating rumors or false information during a disaster can be catastrophic.
Mistakes or inappropriate behaviors from responders can be communicated widely and

instantaneously to a world audience.
News stories can spread incredibly fast and negative online comments can fan the flames, which
can damage your organizations reputation.
Suggestions for Using Mobile Devices for Social Media

The primary issue facing emergency managers and communicators is a gap between expectations
for the performance of social media and new mobile technologies on one side, and the needs and
expectations of those impacted by the disaster on the other side. These challenges must be considered
based on previous disasters and risks.
Taking full advantage of the opportunities provided by mobile devices while avoiding the potential
pitfalls requires careful, thoughtful analysis long before any disaster emerges. Emergency managers and
responders must be proactive instead of reactive to take full advantage of the immediacy provided by
mobile media:
Establish crisis communication plans that plan for the use of mobile devices.
Conduct research on potential audiences that use mobile devices to access trusted
sources of information.
Information supplied by emergency managers and first responders should be consistent. It should
provide people with what they need to know to reduce uncertainty and receive necessary help, without
producing overload. Emergency managers must build a mobile communications and online community.
In this community, stakeholders can engage with others and obtain contact information for media
outlets and other crisis communication representatives. Empowering stakeholders in a crisis situation
can work to everyones advantage.

Conclusion
For health communicators seeking ways to educate the public about risk, risk management, health,
safety, and for those cases where information must be disseminated quickly about a crisis, social media
are invaluable tools. They are so widely used that any effective communication plan must include a
social media strategy.
Technology is a tool and not always the answer, but social media create new, flexible, timely, and
interactive channels of communication that convey information about risks and crises. Use of mobile
devices allows communicators to take social media with them. While social media and traditional media
are converging, there are unique considerations in using this form of communication.
The basic principles of CERC, including the need to be right, be first, and be credible, still apply.
Through social media it is possible to add be interactive. The interactive nature of social media has
shifted the traditional emphasis of CERC from the sender (the management agency or organization) to
the receiver (those experiencing the crisis or risk). In fact, in many cases, the receiver has become the
sender.

Worksheet 91: Social Media Communications Strategy Worksheet
Use this worksheet to help you strategize about your audience, and the potential social media tools and
channels you may want to use for your campaign or communication activity.
1. Determine your target audience.
a. Describe the person(s) you want to reach with your communication; be as specific as possible.
b. More than one audience may be listed. Include a primary and secondary (influencers) audience
if appropriate. (Examples: mothers of children younger than two years old living in Atlanta,
pediatricians practicing in Nevada)
I.
II.
III.
2. Determine your objective(s).
a. What do you want to achieve through your social media outreach and communication? This
could include something you want your target audience to do as a direct result of experiencing
the communication.
b. Objectives may include (but are not limited to) the following:
a. Provide information
b. Highlight a campaign
c. Encourage a health behavior
d. Reinforce health messages
e. Encourage interaction
f. Obtain feedback/exchange ideas
g. Collaborate with partners (Example: Increase awareness of immunization campaign.)
I.
II.
III.

c. Restate your objectives in SMART terms:
Specific: Explain, in concrete, detailed, and well-defined terms, what exactly you are going
to do for whom?
Measurable: Your objectives should be quantifiable, with the source of measurement

identified.
Attainable/Achievable: Can the objective be achieved in the proposed time frame with the
resources available?
Relevant/Realistic: Is the objective directly related to the overarching communication goal

from your communication plan?
Time-bound: have deadlines been set?
(Example: By December 2012 (time-bound), there will be a 5% increase (measureable) in

recognition of the immunization campaign name (specific), as measured through surveying,
by moms of children under two in the Metro Atlanta area (specific).
Additional information on writing SMART objectives can be found at http://www.cdc.gov/

healthyyouth/evaluation/pdf/brief3b.pdf and http://www.cdc.gov/phcommunities/resourcekit/
evaluate/smart_objectives.html
3. Define audience communication needs.
People access information in various ways, at different times of the day, and for different reasons:
a. If possible, define your audience needs by using market research and other data. You can use
the following resources:
a. Organize Content Based on Audience Needs from Webcontent.gov: http://www.usa.gov/

webcontent/managing_content/organizing/audience_viewpoint.shtml
b. Pew Internet and American Life Project: http://www.pewinternet.org/
c. CDC eHealth Data Briefs: http://www.cdc.gov/socialmedia/Data/Briefs/index.html
b. Describe your audiences and their health information needs.
I.
II.
III.

4. Integrate your communication goals with your overall objectives.
a. Describe how your social media objectives support your organizations mission and overall
communication plan.
b. How does it support other online or offline components? What events, either national, state, or
local, present communication opportunities?
I.
II.
III.
5. Develop key messages.
Develop the key messages based on the target audience and objectives identified. (Example: for moms
of young children to encourage late season flu vaccination, Its not too late to vaccinate.)
I.
II.
III.
6. Determine resources and capacity.
Determine who in your organization will be responsible for implementation and the number of hours
they can allocate for content creation and maintenance.
I.
II.
III.
7. Identify social media tools.
Determine what tools will effectively reach your target audience. Match the needs of the target
audience with the tools that best support your objectives and resources. (Example: Because Facebook
has a large population of young women who have children, is free, and requires minimal technical
expertise, it may be a good tool for a mom-centered program while only requiring a small amount of
funding for social media activities.)
I.
II.
III.

8. Define Activities.
Based on all of the elements above, list the specific activities you will undertake to reach your
communication goals and objectives. (Example: Develop and promote Facebook fan page for diabetes
education program.)
I.
II.
III.
9. Identify your key partners and their roles and responsibilities.
10. Define Success for Evaluation.
What are your measures of success? Your measures of success may be different depending on your goals
and objectives.
I.
II.
III.
11. Evaluate.
Create an evaluation plan; see the Social Media Evaluation Plan for more information.
I.
II.
III.

References
1. American Red Cross. More Americans using social media and technology in emergencies [online press
release]. Washington, DC; 2011 Aug 24. [cited 2012 Jun]. Available from URL: http://www.redcross.org/portal/
site/en/menuitem.94aae335470e233f6cf911df43181aa0/?vgnextoid=7a82d1efe68f1310VgnVCM10000089f087
0aRCRD.
2. Solis B. Cultural voyeurism and social media: the essential guide to social media [online]. 2008 Mar 17. [cited
2012 Jun]. Available from URL: http://www.briansolis.com/2008/03/cultural-voyeurism-and-social-media/.
3. Pew Research Center Publications. Project for Excellence in Journalism and the George Washington
Universitys School of Media and Public Affairs. How mainstream media outlets use Twitter: content
analysis shows an evolving relationship [online]. 2011 Nov 14. [cited 2012 Jun]. Available from URL: http://
pewresearch.org/pubs/2130/twitter-news-organizations.
4. Stevens J. Backpack journalism is here to stay. Online Journalism Review [online] 2002 Apr. [cited 2012 Jun].
Available from URL: http://www.ojr.org/ojr/workplace/1017771575.php.
5. American Red Cross. Social media in disasters and emergencies. Online survey of 1,058 respondents
representative of the US population aged 18 and older [online slide set]. 2010 Aug 5. [cited 2012 Jun].
Available from URL: http://www.redcross.org/www-files/Documents/pdf/other/SocialMediaSlideDeck.pdf.
6. CDC, Office of the Associate Director for Communication. The health communicators social media toolkit
[online]. 2011 July. [cited 2012 Jun]. Available from URL: http://www.cdc.gov/socialmedia/Tools/guidelines/
pdf/SocialMediaToolkit_BM.pdf.
7. Park H, Rodgers S, Stemmie J. Health organizations use of Facebook for health advertising and promotion.
Journal of Interactive Advertising [online] 2011 Fall. [cited 2012 Jun];12(1). Available from URL: http://jiad.
org/article153.
8. Ushahidi.com [Internet]. Florida: Ushahidi; 2012 [cited 2012 Jun]. Available from URL: http://ushahidi.com/.
9. Pinterest.com [Internet]. 2012. [cited 2012 Jun]. Available from URL: http://pinterest.com/.
10. Voit L. Participation, openness, conversation, community, connectednessyes, thats what social
media is all about [online]. 2011 Oct 6. [cited 2012 Jun]. Available from URL: http://www.isnare.
com/?aid=595202&ca=Marketing.
11. Rainie L, Purcell K, Goulet LS, Hampton KN. Social networking sites and our lives [online]. 2011 June 16.
[cited 2012 Jun]. Available from URL: http://pewresearch.org/pubs/2025/social-impact-social-networking-
sites-technology-facebook-twitter-linkedin-myspace.
12. Mazmanian A. Of hurricanes and hashtags: disaster relief in the social-media age. National Journal [online].
2012 Jun 3. [cited 2012 Jun]. Available from URL: http://www.nationaljournal.com/tech/of-hurricanes-and-
hashtags-disaster-relief-in-the-social-media-age-20120603.
13. Thomas D. Italian cruise ship disaster shows reach of social media. 2012 Jan 25 [cited 2012 Jun]. In: Social
Media Today Blog [Internet]. Social Media Today LLC. 2012. Available from URL: http://socialmediatoday.com/
davidalanthomas/430550/italian-cruise-ship-disaster-shows-reach-social-media.
14. Lyn TE. Lies E, editor. Japan doctors used Twitter to save patient lives after quake. Reuters, U.S. edition.
[online]. 2011 May 13. [cited 2012 Jun]. Available from URL: http://www.reuters.com/article/2011/05/13/uk-
japan-quake-twitter-idUSLNE74C01U20110513.

15. Safko L, Brake DK. The social media bible: tactics, tools, and strategies for business success. Hoboken (NJ):
John Wiley & Sons, Inc.; 2009.
16. Veil S, Buehner T, Palenchar MJ. A work-in-process literature review: incorporating social media in risk
and crisis communication. Journal of Contingencies and Crisis Management [online] 2011 Jun [cited 2012
Jun];19(2):110122. Available from URL: http://onlinelibrary.wiley.com/doi/10.1111/j.1468-5973.2011.00639.x/
pdf.
17. Pew Research Center for the People & the Press. Haiti dominates publics consciousness: nearly half have
donated or plan to give [online]. 2010 Jan 20. [cited 2012 June]. Available from URL: http://people-press.org/
report/580/haiti-earthquake.
18. Penn, D. Emergency alerts delivered to your phone: what our new PLAN means to you. 2011 May 13 [cited
2012 Jun]. In: FEMA Blog [Internet]. Washington: FEMA. 2011. Available from URL: http://blog.fema.
gov/2011/05/emergency-alerts-delivered-to-your.html.
19. Sutton J, Palen L, Shklovski I. Backchannels on the front lines: emergent uses of social media in the 2007
Southern California wildfires. In: Fiedrich F, Van de Walle B, editors. Proceedings of the 5th International
Information Systems for Crisis Response and Management (ISCRAM) Conference [online]; 2008 May 5-7;
Washington, D.C. p. 62432. Session 7; Track 3. [cited 2012 Jun]. Available from URL: http://www.iscramlive.
org/portal/node/2236%3Cbr%20/%3E.
20. Public Affairs. Photos 5: supporting efforts for Southern U.S. tornadoes and flooding. 2011 May 1 [cited
2012 Jun]. In: FEMA Blog [Internet]. Washington: FEMA. 2011. Available from URL: http://blog.fema.
gov/2011_05_01_archive.html.
21. U.S. Department of Homeland Security. Written statement of Craig Fugate, Administrator, Federal
Emergency Management Agency, before the Senate Committee on Homeland Security and Governmental
Affairs, Subcommittee on Disaster Recovery and Intergovernmental Affairs: Understanding the power of
social media as a communication tool in the aftermath of disasters. [online]. 2011 May 5. [cited 2012 Jun].
Available from URL: http://www.dhs.gov/ynews/testimony/testimony_1304533264361.shtm.
22. Parr B. What Twitter and Facebooks 2009 trends tell us about ourselves. Mashable social media. [online].
2009 Dec 27. [cited 2012 Jun]. Available from URL http://mashable.com/2009/12/27/twitter-facebook-2009/.
23. foursquare.com [Internet]. New York and San Francisco: foursquare; 2012 [cited 2012 Jun]. Available from
URL https://foursquare.com/about/new.
24. Palen L, Vieweg S. The emergence of online widescale interaction in unexpected events: assistance, alliance
and retreat. Proceedings of the 2008 ACM Conference on Computer Supported Cooperative Work (CSCW);
2008 Nov 8-12; San Diego, CA. New York: Association for Computing Machinery; 2008. p. 117126.
25. Ingram, M. Mary Meeker: mobile internet will soon overtake fixed Internet [online]. 2010 Apr 12. [cited 2012
Jun]. Available from URL: http://gigaom.com/2010/04/12/mary-meeker-mobile-internet-will-soon-overtake-
fixed-internet/.
26. Coyle D, Meier P. New technologies in emergencies and conflicts report: the role of information and social
networks [online]. 2010. [cited 2012 Jun]. Available from URL: http://www.unfoundation.org/news-and-media/
publications-and-speeches/new-technologies-emergencies-conflicts.html.
27. Emergency Information Service. Information in a crisis text messages beamed to earthquake survivors in
Haiti. The Guardian [online] 2010 Jun 18 [cited 2012 Jun]. Available from URL: http://www.guardian.co.uk/
activate/information-in-a-crisis.

28. Shinn W. Social media saves lives in Haiti. Coast Guard News [online] 2010 Feb 2 [cited 2012 Jun]. Available
from URL: http://coastguardnews.com/social-media-saves-lives-in-haiti/2010/02/02/.
29. Palenchar MJ. Social media and mobile technologies implemented in risk communication practices and
disasters: counter improvised explosive devices. Presented at: U.S. Department of Homeland Securitys
Effective Risk Communications for the IED Threat Working Conference; 2010 Sep, Williamsburg, VA.
Resources
Bonabeau E, Stephenson WD. Expecting the unexpected: the need for a networked terrorism and disaster
response strategy. Homeland Security Affairs [online] 2007 Feb [cited 2012 Jun];3(1). Available from URL:
http://www.hsaj.org/?fullarticle=3.1.3.
CDC [Internet]. Emergency preparedness and response. Social media. [cited 2012 Jun 28]. Available from
URL: http://emergency.cdc.gov/socialmedia/.
CDC [Internet]. Social media at CDC. [updated 2012 Apr 13; cited 2012 Jun 28]. Available from URL: http://
www.cdc.gov/SocialMedia/.
CDC [Internet]. Social media at CDC. CDC social media tools, guidelines & best practices. [cited 2012 Jun 28].
Available from URL: http://www.cdc.gov/SocialMedia/Tools/guidelines/.
Coombs WT. Ongoing crisis communication: Planning, managing, and responding. 3rd ed. Thousand Oaks
(CA): Sage Publications; 2012.
Driessen S. Social media: is social media killing the intranet? [online]. 2011 Jan 11. [cited 2012 Jun]. Available
from URL: http://www.quora.com/Social-Media/Is-social-media-killing-the-intranet.
Facebook. [Internet]. Palo Alto: 2012 [cited 2012 Jun 28]. Create a page. Available from URL: http://www.
facebook.com/pages/create.php.
Federal Emergency Management Agency [Internet]. Washington, DC. [cited 2012 Jun 28]. Social media tools:
our Internet presence. Available from URL: http://www.fema.gov/help/social_media.shtm.
Federal Emergency Management Agency [Internet]. Washington, DC. [cited 2012 Jun 28]. Privacy policy:
Internet and social media Internet. Available from URL: http://www.fema.gov/help/privacy.shtm.
Otis & James Photography. 2011 Minot flood map [online]. 2011 Dec 8. [cited 2012 Jun 28]. Available from
URL: http://maps.google.com/maps/ms?hl=en&gl=us&ie=UTF8&oe=UTF8&msa=0&msid=2109366614884281
71865.0004a488925fb9508a017.
Twitter help center. [Internet]. San Francisco: Twitter, Inc.; 2012 [cited 2012 Jun 28]. Welcome! How can we
help you? Twitter basics. Available from URL: http://support.twitter.com/.

Notes:

Chapter 10:
Terrorism and Bioterrorism
2014 EDITION Communication Challenges

Chapter 10:
Terrorism and Bioterrorism
Communication Challenges
In this chapter, the following topics are addressed:
Chemical, biological, radiological, nuclear, or explosive (CBRNE) events

Communication challenges
Bioterrorism versus emerging infectious diseases and hoaxes
Psychological responses to terrorism
The Strategic National Stockpile (SNS) and emergencies
This chapter discusses two phrases that are commonly used in responses to terrorism
and bioterrorism events:1
Crisis Management: Within the context of terrorism, this phrase refers to activities that involve
identifying, obtaining, and planning the use of resources that a response organization may need to
anticipate, prevent, or resolve an act of terrorism, or the threat of an act of terrorism.
Consequence management: Within the context of terrorism, consequence management refers

to activities that a response organization might take to protect the health and safety of the public,
restore necessary government services, and provide emergency relief to affected people, governments,
and businesses.
Crisis management is mostly handled by law enforcement agencies, such as the Federal Bureau of
Investigation (FBI). Consequence management is primarily controlled by state and local governments,
with assistance from federal government agencies, such as the Federal Emergency Management Agency
(FEMA), as required.
Communicators Face New Challenges

Most approaches to emergency management and response support an all-hazards approach to
terrorismthe intentional use of violence, threats, and intimidation for political aims. Terrorists have
become increasingly sophisticated in their forms of attacks.2 This chapter describes many of the unique
challenges that terrorism creates for communicators.
One of governments primary responsibilities is to protect its citizens. Given the relative
sophistication of terrorists, this reality amounts to one of the most challenging priorities facing
governments. Terrorism is a potential threat to national security and social stability. It is also a violent
criminal act. Since the attacks of September 11, 2001, terrorism has become a more prominent national
priority. The nature of the threat and the uncertainty associated with terrorism create particular
challenges for communicators.
297
Chemical, Biological, Radiological, Nuclear, or
Explosive (CBRNE) Events
Terrorist Events are Real

Terrorism is not new. Its been around as long as people have been willing to use violence as a political
weapon. Title 22 of the United States Code, Section 2656f(d), defines terrorism as the premeditated,
politically motivated violence perpetrated against noncombatant targets by subnational groups or
clandestine agents, usually intended to influence an audience.3
The types of terrorist attacks discussed in this section are rare and usually relatively limited in
scope. For example, in 1984, a small religious cult in The Dalles, Oregon, led by self-professed guru
the Bhagwan Shree Rajneesh, tried to influence the outcome of a local election by infecting the local
population with Salmonella.4
The organism was spread through restaurant salad bars, grocery produce, and doorknobs. Although no
one was killed, about 750 people became ill.4 This was the first known bioterrorism attack during the
20th century in the U.S.
On September 11, 2001, several thousand people died from the air attacks on the World Trade Center,
the Pentagon, and on the plane near Shanksville, Pennsylvania. Thousands more, including first
responders, area residents, and workers, were exposed to potentially dangerous chemicals in the
dust and ash clouds in Manhattan. Even more suffered issues of stress, including posttraumatic stress
disorder (PTSD) and other mental health challenges.5 The attacks on the World Trade Center and the
Pentagon demonstrated todays role of public health workers in terrorist attacks.
Later in 2001, the well-known anthrax attacks took place.6 This involved the intentional contamination
of letters with this dangerous bacterium. Seventeen people were infected and five of them died. The
attacks also created widespread social and economic disruption. The attacks demonstrated to the
public how an infectious disease could be used in a terrorist attack. Public health professionals became
central to the response. Since that time, CDC has paid even closer attention to reports involving viruses,
bacteria, and toxins that might be used by terrorists to cause harm.
The bioterrorism agents that have the potential to create widespread harm to the publics health are
ranked by categories. Category A biological diseases are those most likely to cause illness and death and
are included in the following list:7
Anthrax (Bacillus anthracis) Smallpox (Variola major)
Botulism (Clostridium botulinum toxin) Tularemia (Francisella tularensis)
Plague (Yersinia pestis) Hemorrhagic fever due to Ebola virus or

Marburg virus
298 Chapter 10 Terrorism and Bioterrorism Communication Challenges

In addition to these agents, a large number of chemical, radiological, nuclear, or material substances
could be used in a terrorist attack. Attacks with these agents are generally referred to as chemical,
biological, radiological, nuclear, or explosive (CBRNE)8 events.
According to the Department of Homeland Security (DHS),9 a biological attack is the intentional
release of a pathogen (disease-causing agent) or biotoxin (poisonous substance produced by a living
organism) against humans, plants, or animals. These attacks can cause the following:
Illness Societal disruption
Death Economic damage
Fear
In addition, attacks on agriculture would primarily cause the following:
Economic damage
Social disruption
Possible human casualties
With biological attacks, it is important to distinguish between agents that may spread from person to
person, such as smallpox virus, and those agents that do not spread from person to person, such as
anthrax bacteria.
DHS defines a chemical attack10 as the spreading of toxic chemicals with the intent to do harm. The
variety of chemicals that could be used to do harm is quite large and includes the following:
Chemical weapons
Toxic industrial and commercial chemicals
Toxins of biological origin, such as ricin
The severity of chemical attacks may vary based on the level of exposure, the form of the chemical, and
the health of the people exposed.
A radiological attack,11 according to DHS, is the spreading of radioactive material with the intent to
do harm. Radioactive materials are common and widely used in medicine, industry, and research.
Like chemical attacks, radiological events are complex and must take into account many factors in
determining risk. A radiological attack, such as a dirty bomb, is not considered a nuclear attack. A dirty
bomb uses conventional explosives to disperse radioactive material.
Chapter 10 Terrorism and Bioterrorism Communication Challenges 299

DHS describes a nuclear attack12 as the use of a device that produces a nuclear explosion. A nuclear
explosion would produce devastating waves of heat, light, air pressure, and radiation, followed by the
production and release of radioactive material. Fallout from a nuclear explosion can expose people at
great distances to radiation and radioactive material.
Attacks such as these are rare, but their potential health effects and other consequences would be
severe. They would cause direct harm to the public. They would also create serious social disruption,
psychological trauma, and a wide range of economic impacts.
Attacks with explosives, including improvised explosive devices (IEDs), are used to destroy,
incapacitate, harass, or create a distraction. IEDs are homemade explosive devices. The term IED
became commonly used during the Iraq War that began in 2003.13
Explosive devices can come in many forms. They can be as small as a pipe bomb, or much larger and
capable of causing significant damage and death, such as the one used in the 1996 Oklahoma City
bombing.12 Explosives can be made from commonly available chemicals and materials.14
Category B attacks are serious, but not as serious as Category A. Category B agents are the second
highest priority:7
They are moderately easy to spread.
They result in moderate illness rates and low death rates.
They require specific enhancements of CDCs laboratory capacity and

enhanced disease monitoring.7
Traits of a Terrorist Attack

Terrorism is a criminal act and this influences the response. The goal of terrorism reaches beyond the
immediate victims and seeks to influence wider public opinion. Terrorists try to commit criminal acts
of violence to draw attention to issues, causes, and ideologies. Attacks are in part publicity events.
They are likely to focus on targets with larger symbolic meaning and shock value, or are planned to
create widespread disruption. Terrorists often target transportation, communication, food production,
or economic institutions. Terrorist acts are also designed to undermine faith and trust in institutions,
including government.
An attack involving a chemical, radiological, or biological agent could serve terrorists by producing
widespread public fear and social disruption. Although not as dramatic or visual as a major explosion,
a chemical, biological, or radiological event would likely create significant public anxiety because the
effects would not immediately be evident.

Law Enforcement and Public Health in Terrorist Events
The focus on criminal investigations and prosecution is a relatively new concept for public health
professionals when responding to a public health crisis. It is important that public health communicators
understand the challenges they face in releasing information in response to a terrorist event. First and
foremost, the FBI must have final authority over the release of information about the incident. The
Department of Justice (DOJ) and the FBI are committed to ensuring that all health-related information
addressing a terrorist or suspected terrorist incident will be immediately released to protect the
publics health and safety. In a disease outbreak, however, some points normally considered background
information, such as descriptions of where a suspicious outbreak first occurred, may have to be withheld
by public health officials to protect the integrity of the criminal investigation.
The response to a terrorist threat or incident within the U.S. will entail a highly coordinated,
multiagency local, state, and federal response. The primary agencies that provide the core federal
response are the following:
Department of Homeland Security (DHS)

DHS Federal Emergency Management Agency (FEMA)
Department of Justices (DOJ) FBI
Department of Defense (DOD)
Department of Energy (DOE)
Department of Health and Human Services (HHS)
Environmental Protection Agency (EPA)
A number of policies and procedures are in place to clarify roles. The National Response
Framework (NRF) replaced the National Response Plan in 2008.15 NRF provides an approach for
the U.S. in conducting all-hazards response. The National Incident Management System (NIMS)16
provides a template to coordinate the efforts of governments, NGOs, and the private sector
in response to any incident.
Coordination of agencies responding to a crisis is challenging, particularly when there are multiple
interests as noted below:
The U.S. Attorney General has the lead and responsibility for criminal investigations of
terrorist acts and threats.
The Secretary of DHS is the principal federal official for domestic incident management.
The FBI serves as the primary investigating agency under DOJ.
HHS serves as a support agency to the FBI for technical operations and to FEMA for
consequence management.
FEMA, under the direction of DHS, is the lead agency for managing the event aftermath.

The federal government also recognizes the critical role and considerable responsibility of state and
local authorities who are charged with managing their own local and regional emergencies and disasters.
HHS provides technical personnel and supporting equipment to the lead federal agency during all
aspects of a terrorist incident. HHS can also provide regulatory follow-up when an incident involves a
product regulated by the Food and Drug Administration (FDA).
HHS assistance support includes the following:
Threat assessment
Epidemiology investigations
Technical advice and assistance for the FBI:
yy Identification of agents used yy Onsite safety and protection activities
yy Sample collection yy Medical management planning
yy Sample analysis
Operational support to FEMA:
yy Mass immunization yy Contingency medical records
yy Mass prophylaxis (preventive treatment) yy Patient tracking
yy Mass fatality management yy Patient evacuation
yy Pharmaceutical support yy Definitive medical care provided through

operations through SNS the National Disaster Medical System
CDCs Strategic National Stockpile

CDCs Strategic National Stockpile, commonly referred to as SNS, has large quantities of
medicine and medical supplies to protect the American public if there is a public health
emergency severe enough to cause local supplies to run out. Examples of such emergencies
could include a terrorist attack, flu outbreak, or earthquake.
Once federal and local authorities agree that SNS is needed, medicines will be delivered
to health officials in the U.S. in time for them to be effective. Each state or territory has
plans to receive and distribute SNS medicine and medical supplies to local communities as
quickly as possible.17

Communication Challenges
How a Terrorism Incident Is Different From Other Crises

Chemical, biological, radiological, nuclear, or explosive substances used in a terrorist attack are CBRNE
events.8 Weapons of mass destruction (WMDs) use CBRNE elements to produce:
Mass casualties
Extensive damage to property
Widespread social and economic disruption
WMD incidents are different from other types of incidents in several ways.18 These must be considered
when planning a communication response. First responders will need to be able to identify aspects of
the incident, such as signs and symptoms exhibited by victims, and report them accurately. This will
be key to maximizing the use of local resources and for triggering a federal response. Consider the
following differences between WMD events and other public health events:
There will likely be a stronger public reaction to WMD incidents than to other types of incidents.
The thought of exposure to CBRNE events evoke fear in most people. Uncertainty also makes
the publics response more severe.
The interest and uncertainty will mean that information will flow very quickly through social
media. Public information officers (PIOs) will need to engage with social media to keep up.
The situation may not be recognized until there are multiple victims or casualties:
yy Most chemical and biological agents are not detectable by methods used for
explosives and firearms.
yy Many agents can be carried in containers that resemble everyday items.
Multiple events might occur. One event may be carried out in an attempt to influence
another events outcome.
Responders are at a higher risk of becoming casualties:
yy Chemical and biological agents are not readily identifiable.
yy Responders may be contaminated before knowing an agent is involved.
yy First responders might be targets for secondary releases or explosions.
The location of the incident will be treated as a crime scene:
yy Preservation and collection of evidence is critical.

yy On-scene actions must be coordinated between response organizations to minimize conflicts
with law enforcement authorities who will view the incident as a crime scene and other
responders who view it as a hazardous material problem or a disaster scene.
Critical facilities and large geographic areas may be contaminated:
yy Victims can unknowingly carry an agent to public transportation facilities, businesses,

residences, doctors offices, walk-in medical clinics, or emergency rooms because they dont
realize they are contaminated.
yy First responders may unknowingly carry the agent to fire or precinct stations, hospitals, or to
the locations of subsequent calls.
Time works against responders. The incident can expand geometrically and very quickly,
affecting mutual aid jurisdictions.
Airborne agents flow with the air current and may spread via ventilation systems, carrying
the agents far from the initial source. In addition, the effects of some chemicals and biological
agents worsen over time.
Support facilities such as utility stations and 9-1-1 centers, along with critical infrastructures,
are at risk as targets.
Specialized state and local response capabilities may be overwhelmed.
Reality Check
Its easy to see why a terrorism event can cause such strong emotional responses among
the public. These events:
Are outside of the control of the individual
Are catastrophic or unfairly distributed
Originate from a mistrusted source
Are manmade
Usually appear exotic or unfamiliar
The uncertainty of the event may further increase fear and require CERC concepts
for management.

Terrorism and Public Information
Releasing information about a terrorist event will be complicated by the ongoing criminal investigation.
At the same time, social media can be expected to provide a great deal of information, correct and
incorrect, very quickly. Speed of response will be particularly
important as a media strategy.
There are a number of things that
The DHS Secretary and the Attorney General (through have triggered the activation of
the FBI) will be responsible for coordinating information
a JIC in the past, but I think the
dissemination to the White House, Congress, and other
federal, state, and local government officials. In fulfilling
most important was clearly when
this responsibility, the FBI, as the lead law enforcement an agency is aware that there is a
federal agency, ensures that the release of public information threat to public health and there is
is coordinated between crisis-management and consequence- a responsibility to ensure that the
management response entities. A national joint information public is aware of what is going on,
center (JIC) under NIMS will serve as a focal point for what the risk is, and what to do to
coordination and dissemination of public and media information.
protect themselves.
A state-level JIC will likely follow the same protocols.14
Dr. Marsha Vanderford,
Because of the high uncertainty and concern that comes with
Associate Director for
a CBRNE terrorism event, communicators will have to contend
Communication,
with an intense need for information. A carefully coordinated
communication plan is particularly critical. Coordination of Center for Global Health, CDC
communication will occur through the JIC. In all cases, JICs
should include federal response agencies as well as state and
local PIOs.
Coordinating with State and Local Response Agencies16

Throughout the management of the terrorist incident, crisis-management and consequence-
management entities will operate at the same time. They do this to ensure that the work of multiple
response agencies is coordinated. They also work to produce a time-phased deployment of specialized
federal resources that is tailored to the incident.
It is critical that all participating federal, state, and local agencies and organizations coordinate their
activities to avoid chaos.
Once an incident has occurred, local government emergency response organizations will report to
the incident scene and communicate appropriate notifications to local, state, and federal authorities.
Control of the incident scene will be established by local response authorities such as a senior fire
or law enforcement official. Command and control of the incident scene is the responsibility of the
Incident Commander or Unified Command. Operational control of assets at the scene is retained by the
designated officials representing agencies or organizations (local, state, or federal) providing the assets.
These officials manage tactical operations at the scene in coordination with the unit commanders as

directed by agency counterparts at field-level operational centers. Field-level centers are not always
used; assets may be managed from the emergency operations center in some cases.
Traits of Biological Terrorist Events

Traditional tools used by public health officials, such as infectious disease reporting systems, would
likely be the first to detect an infectious agent released to cause harm. At that point, the role of public
health personnel is to detect, investigate, and work with responders to reduce the public health impact
of a bioterrorist event. This is most important with biological agents, which, after a silent release, may
first present as unidentified illnesses.
The delay from a silent release would likely occur between the time a biological agent is released in
a public place and the onset of illness. Doctors or emergency department workers may be the first to
identify initial casualties. By then, the terrorist(s) may be far away. With some infectious diseases, only
a short window of opportunity exists between the time the first cases are identified and the time the
second wave of the population becomes ill. During that brief period, public health officials must do the
following:
Determine that an attack has occurred.
Identify the organism.
Develop strategies to prevent more casualties.
Strategies for managing the illness will involve effective communication with the public as well as a
variety of public health partners.
Early detection and response are crucial and require some level of knowledge among medical
professionals about possible biological terrorist agents. They must possess bioterrorism knowledge as
they are in the best position to report suspicious illnesses. Early detection also requires access to a
communication system between medical professionals and public health officials.
Preparing Public Health Agencies for Biological Attacks

Some epidemiologists are trained to detect and respond to biological attacks. The goal is to rapidly
identify the organism involved which allows for a faster response. Increased laboratory capacity,
well-trained lab workers, and needed supplies also help to speed diagnoses. In addition, the
implementation of secure, reliable, and swift communication channels assists with early detection
alerts and a quick response.
Many medical providers and public health officials have received additional training to become
familiar with disease signs and symptoms rarely or never seen in the U.S. that could be used as
biological weapons. The nation has stockpiled drugs, medical supplies, and vaccines within the
SNS program. Such items could be needed to supplement local supplies depleted by a large-scale
biological or chemical event.

Bioterrorism Versus Emerging Infectious
Diseases and Hoaxes
Recognizing and Responding to Outbreaks

The intentional release of a biological organism could mimic a naturally occurring outbreak.18
Recognition of and response to an undeclared use of an infectious disease agent by a terrorist
will be much more difficult to detect than an announced biological release, a chemical release,
or terrorist bombing.
Health investigators may not immediately know that an infectious disease outbreak is the result of an
intentional release of germs. CDC has long recognized that selected illnesses and symptoms may result
from nature or from bioterrorism.18 Examples include:
Encephalitis
Hemorrhagic mediastinitis
Pneumonia with abnormal liver function tests
Papulopustular rash, such as smallpox rash
Hemorrhagic fever
Descending paralysis
Nausea, vomiting, and diarrhea
The following list summarizes some characteristics of a disease outbreak that suggest the possibility of
intentional use of an infectious agent:18
Outbreak of a rare disease
Outbreak of a disease in an area that normally does not experience the disease
Occurrence of a seasonal disease at an inappropriate time of year
Unusual age distribution of people involved in the outbreak
Unusual epidemiologic features of an outbreak (e.g., a typical pathogen transmitted solely by

food ingestion now found to be transmitted from person to person)
Unusual clinical symptoms not typically seen with a known pathogen (especially
respiratory symptoms)

In the last 40 years, CDC has been involved in the discovery of several emerging infectious diseases,
either in the U.S. or around the world. Many past outbreaks, now known to be only nature at work,
could have been initially mistaken for terrorism. These include the following:18
Legionnaires disease outbreak, Philadelphia, 1976: This outbreak was characterized by

a severe pneumonia of unknown origin. The discovery of the cause of the pneumonia took many
months.
Hantavirus pulmonary syndrome, Southwestern U.S., 1993: This outbreak of severe
pneumonia of unknown origin affected healthy young adults. This virus had never before been
recognized in the U.S.
Foodborne cryptosporidiosis, Minnesota, 1995: Investigators determined that a
common organism previously associated with drinking contaminated recreational water,
exposure to animals, or person-to-person contact was associated with contaminated
chicken salad in this outbreak.
Antibiotic-resistant strain of plague, Madagascar, 1995: This outbreak could have been
attributed to genetic engineering for bioterrorism purposes, but it was found to be a naturally
occurring strain.
Ebola virus infection, Zaire, 1995: Researchers found this virus to be a 99% genetic match
to the Ebola virus that caused the 1976 outbreak. This was unusual because most viruses mutate
over time, causing a greater gap in genetic matching to strains from previous outbreaks. This
finding raised the possibility of intentional reintroduction from a strain kept in a laboratory.
Nipah virus encephalitis, Malaysia, Singapore, and Bangladesh, 19992003: Nipah
virus is considered to be an agent with the potential to be used in bioterrorism. It was first
identified in 1999 following a naturally occurring outbreak in Malaysia and Singapore. It re-
emerged in Bangladesh in 2001 and 2003.19
H1N1 influenza pandemic, Worldwide, 20092010: This pandemic first attracted
attention as an outbreak of influenza-like illness in Mexico in March and April 2009.20 It
developed into a worldwide pandemic. The influenza virus that caused this pandemic had
characteristics of multiple other influenza viruses. This led to discussions, including online
discussions, of possible bioterrorism.21
Whether epidemics result from terrorism or natural factors, the public health community must detect
and quickly investigate outbreaks in the U.S. and worldwide. New disease agents could simply be nature
at work. The past illustrates that it is best to be cautious and not prematurely assume that bioterrorism
is the cause of an emerging infectious disease outbreak.

Reality Check
An outbreak could unfold such that an early and reasonable assumption of bioterrorism
will be made simultaneously by the media, the public, and official responders. This
happened with the anthrax letters in 2001.
In the anthrax response, some suggested early on that the anthrax death of a National
Inquirer employee was likely from natural causes, not from bioterrorism, because he was
an avid fisherman with plenty of outdoors exposure.
In a potential bioterrorism response, there is no room for assumptions:
Nothing is officially bioterrorism until a designated official, usually law

enforcement says it is.
The FBI should publicly announce what is or is not deemed a bioterrorist act.
Over-reassurance can impede the governments credibility.
Identifying Bioterrorism
In fall 1999, West Nile virus first appeared in the western hemisphere.22 It debuted in the media capital
of the world, New York City. Since then, West Nile virus spread throughout the U.S., Canada, Mexico,
the Caribbean, and Central America.
West Nile virus notoriety has rivaled such deadly diseases as plague, Ebola, and hantavirus. Perhaps,
it was because this exotic disease arrived in local neighborhoods and communities. In addition, the
disease killed birds. Every dead bird was an additional reminder of the outbreak. Unfortunately, for
public health communicators, the number of questions about when, where, and how it would strike,
was much greater than the available answers at the time.
New York City public health and medical professionals had well-developed plans and training for
responding to emerging diseases and bioterrorism. Some experts believe that these preparations
enabled them to recognize that the initial cluster of illnesses was unusual and bring it to the attention
of public health officials more quickly. Infectious disease experts are taught, When you hear hoof
beats think horses, not zebras. This describes a medical philosophy of considering the most obvious
explanations first, before moving on to less likely explanations. When monitoring the publics health
for both an emerging infectious disease and a potential bioterrorist act, epidemiologists must think
horses and zebras. This means they must be sure to consider all explanations, not just the obvious ones.
That distinction is important in early responses to disease outbreaks regardless of whether the virus is
supplied by nature or by people.

Although public health was considering all explanations, some in the media theorized that this was a
case of domestic bioterrorism. A New Yorker magazine article released in October 1999 about West
Nile virus, after the first wave of questions about the new virus had been answered, might have led to
a potential media frenzy.23 The article asked if West Nile virus could be a case of bioterrorism. The day
the articles advance news release went to national media, the CDC issued a statement reassuring New
Yorkers that as awful as West Nile was, it still looked like nature at work. Working closely with CDC,
local media officials minimized the plausibility of bioterrorism theories. Within 24 hours of the CDC
statement, the media frenzy faded.
These communication approaches are helpful:
Policy on commenting about potential bioterrorism aspects of an outbreak investigation should

be made in advance and be included in your CERC planning.
Spokespersons should not mention bioterrorism as a possibility unless there are compelling
reasons to do so. Mentioning bioterrorism is likely to feed speculation.
If media asks, organizations can respond by saying, There is no reason to suspect that this is
anything other than a natural outbreak.
By stating officially to the media that West Nile virus was believed to be nothing more than nature
at work, the CDC set a challenging precedent. For example, what if, in the course of the next outbreak,
early suspicions about bioterrorism are raised? Should those suspicions be confirmed? CDC experts
can name many disease outbreaks with characteristics that could have been believed at first to be the
work of terrorists.
CDC uses the following general format in responding to media speculation about bioterrorism during the
early stages of an ongoing infectious disease outbreak investigation:
Were all understandably concerned about the uncertainty surrounding this

outbreak and we wish we could easily answer that question today. For the
sake of those who are ill or may become ill, our medical epidemiologists
(professional disease detectives) are going to first try to answer the following
critical questions:
1. Who is becoming ill?

2. What organism is causing the illness?
3. How should it be treated?
4. How can it be controlled to stop it from spreading?
A question that disease investigators routinely ask is: Could this outbreak
have been caused intentionally? [Your organization name] must keep an open
mind as data in this investigation are collected and analyzed.

With public safety in mind, we should not speculate on the organisms route
of introduction until we have enough data to formulate a theory. We must
consider the possibility that we may never have the data to answer this
important question, based on epidemiology alone.
Any specific questions about the FBIs involvement in this outbreak

investigation should be referred to them. However, the FBI and [your
organization] have a strong partnership in the investigation of unusual
disease outbreaks and have worked comfortably together in past
parallel investigations.
All messages should be coordinated carefully with other response agencies. This is
particularly important when considering the potentially sensitive questions surrounding
a possible bioterrorism event.
CDC Media Strategy during a Possible Undeclared

Bioterrorism Event
During all infectious disease outbreak investigations, CDC will not comment to the media
about the possibility of an outbreak being a bioterrorist event; nor will it comment on the
FBIs participation in an investigation unless first confirmed by the FBI to the media.
CDC will inform the media that all disease outbreak investigations routinely include
questions about the possibility of an intentional act and that it is CDCs policy not to
speculate about this possibility during an outbreak investigation. All media will be
referred to the FBI while an investigation is ongoing for comment about the possibility of
bioterrorism.
CDC will provide factual information as requested. CDC will not release information
about an ongoing investigation unless first coordinated with the affected state; however,
CDC can confirm that it has been invited by the state to assist in an investigation.
CDC can release information about a multistate investigation after the state health
departments (health officer and information officer) are notified.
CDC will not speculate to media or the public about the possibility of a bioterrorist act,
nor will it respond to alarming scenario questions of a general nature during a suspected
event. During an infectious disease outbreak investigation, CDC will defer to the FBI any
speculation about whether an event may be a bioterrorist event.

Preparing for a Hoax
Hoaxes are false claims that, at least momentarily, appear credible. When these false claims reach the
public, they can considerably disrupt daily activity and cause lasting economic harm. For example,
during the anthrax attacks of 2001, many perpetrators sent benign white powder substances in letters
with notes claiming the substance was anthrax. These hoaxes caused momentary fear as recipients
waited for verification that the contents were actually harmless.
The power of hoaxes is in the uncertainty they create. Agencies often have a good idea that the
claims are false. The difficulty is that if they are incorrect in assuming a hoax is false, the result could
be disastrous. Imagine if a school ignored a bomb threat only to have a major explosion in a highly
populated area of the school. Thus, agencies are typically forced to dedicate considerable time and
resources to investigating hoaxes.
The Internet and social media provide almost limitless opportunities to spread hoaxes. DHS maintains
an Internet website to label and debunk hoaxes as soon as they are identified.24 The management of
hoaxes requires an effective and rapid social media strategy.
Agencies face a paradox when responding to hoaxes. They are forced to make a serious response to
all claims. Agencies need to be open and honest about the fact that they cannot, beyond a shadow
of doubt, deny the authenticity of a suspected hoax without taking appropriate precautions and
completing a thorough investigation. As such, hoaxes can drain valuable resources.
Key communication strategies during a confirmed hoax include:23
Attacking the source
Challenging the claims made in the hoax
Emphasizing that public safety remains the agencys primary value
Attacking the source involves stressing the harm caused by the hoax and revealing the misguided
motives of the perpetrators. Challenging claims occurs as the agency generates evidence to invalidate
the hoaxers allegations.
The value of public safety must remain of utmost importance throughout your agencys response. It is
possible to say, Although the accusation is not credible, our agency is responding in this way out of an
abundance of caution and concern for public safety.25

Foot and Mouth Hoax in New Zealand
New Zealands Ministry of Agriculture and Forestry (MAF) provided a model response to
a hoax in 2005.25 The Prime Minister received a letter claiming that a group had released
a vial of foot and mouth disease virus on Waiheke Island. Had the claim been true, the
financial impact would have been colossal for New Zealand and its farmers. The MAF was
open and honest in its communication.
The agency shared its anger toward the perpetrators with farmers and reporters. Animals
were tested and the feasibility of infecting the cattle in the precise manner described in the
threatening letter was subjected to rigorous scientific debate.
The MAF assured farmers that the agency was taking steps to protect both the livestock
and the reputation of New Zealands farmers. New Zealanders waited anxiously for six
days as information was gathered. In the interim, the hoaxers sent a follow-up letter
with outlandish claims that were deemed scientifically impossible. This letter, along with
negative test results and scientific discussion, enabled the MAF to declare the event a hoax
within a week.
The MAFs patient and thorough response allowed the agency to maintain the confidence
of New Zealands citizens and the international marketplace. New Zealands farmers saw no
lasting impact of the event on consumption and exportation of their product.
Psychological Responses to Terrorism

The public will likely have a stronger public reaction and risk perception following terrorist incidents
than other types of crisis events. This is due to the intentionality and uncertainty that accompanies
such events. The intense media coverage of international terrorist attacks and frequent government
warnings of future attacks cause some people to continue to experience anxiety and fear.
A review of several research studies on the medical and

psychological effects following the September 11, 2001, attacks The intense media coverage of
concluded the following:5 international terrorist attacks and
frequent government warnings of
The likelihood of developing PTSD after the attacks was
future attacks cause some people
influenced by direct exposure, knowing someone who
perished in the attacks, number of hours of watching
to continue to experience anxiety
television, and prior mental illness. and fear.

People who are anxious about potential future attacks are more likely to change their
behaviors. One year after the attacks, some people had become more anxious and exhibited
such behavioral changes as avoidance of crowds, avoidance of ying, and increased watching of
programs related to world politics in general. People who were depressed were more likely to
increase their consumption of alcohol, cigarettes, and marijuana.
Trauma also has the potential to bring out the best character strengths in some people.
Examples include gratitude, hope, kindness, leadership, love, spirituality, and teamwork. This
reaction held true both immediately following the attacks and 10 months later.
People may first seek support from family and friends rather than health professionals. Both
immediately and in the months following the attacks, the majority reported that they did not
seek help from counseling services but rather found support by talking to family and friends.
There are different gender responses to terrorist attacks. Women reported more psychological
distress, but more positive coping mechanisms than men.
Responders need to be taken care of, too. Mental health professionals, social workers,
and medical professionals assisting victims of the attacks and disaster workers at Ground
Zero experienced increased levels of emotional exhaustion, anxiety, depression, and
psychological distress.
The Strategic National Stockpile (SNS) and Emergencies
The SNS Program17

In anticipation of a natural or manmade infectious disease outbreak, CDCs SNS maintains large
quantities of medicine and medical supplies. This stockpile is composed of multiple, comprehensive
collections of supplies stored in strategic locations around the U.S. to ensure rapid delivery. It is
maintained to protect the public if there is a public health emergency, such as a terrorist attack,
widespread flu outbreak, or natural disaster that is severe enough to cause local supplies to run out.
Should federal and local authorities agree that SNS is required, SNS staff will ship drugs, vaccines,
medical supplies, and medical equipment to states and local communities. The first of these supplies will
arrive within 12 hours of the federal decision to deploy. Other shipments will continue to be delivered
for as long as needed. SNS experts can assist states, territories, and communities with receiving,
storing, staging, distributing, and dispensing SNS materials. Emergency communication plans support
SNS staff deployments and are part of every regional, state, territory, or local areas SNS plans.
SNS supplies typically will arrive by air or ground in two shipment phases:
The first phase is called a 12-hour push package. The 12-hour refers to the packages transit
time: 12 hours or less after the federal decision to deploy. The word push is used because a
state need only ask for helpnot for specific itemsand the SNS will push or ship everything

a state needs in response to a broad range of threats in the early hours of an event. The 12-hour
push takes place when people are critically ill or dying from an ill-defined threat.
Second-phase shipments will normally begin within 2436 hours after a state identifies a threat.
Shipments contain large quantities of specific items designed to deal with a defined threat.
Second-phase shipments are referred to as vendor-managed inventory or VMI. This is because
major pharmaceutical vendors store second-phase pharmaceuticals until they are shipped.
The 12-hour push package includes large quantities of supplies that states and communities will need
to respond to such nerve agents as sarin and biological agents such as anthrax, plague, and tularemia.
The package will enable state and local authorities to immediately treat thousands of symptomatic
individuals and protect hundreds of thousands more who may have been exposed.
CDC scientists work closely with the intelligence community to assess the probability of various
biological and chemical threats. Once the scientists identify the threats, they create protocols for
therapeutic treatment and preventive medication. The protocols determine which drugs and other
supplies are in the SNS. Because threat assessments, treatment protocols, and other factors change
over time, the items in the 12-hour push packages are also subject to change.
SNS Communication Concerns

Crisis communication plans should include special consideration of SNS issues. During a large-scale
emergency, public fear and anxiety could impair the ability of agencies to distribute and dispense
disease-preventing medicines to those who need it. An effective public information plan, designed to
inform and reassure the public, will earn public confidence and cooperation.
Your pre-crisis planning is critical and should be consistent with principles described in previous
chapters. Plans should take the following into account:
Audience characteristics
Audience needs
Channels of communication, including using public health partners and stakeholders to

distribute messages
Carefully coordinate all messages and integrate the SNS communication plan into the larger SNS plan.
SNS will be deployed only in the case of a significant threat to the public health. The act of deployment
will signal that the event is very serious and will generate a requirement for communication. Therefore,
in your plan, you should consider specific communication channels, partnerships, and staffing pools
that support public information release, reproduction, and dissemination. Also consider volunteers or
contracted professionals to assist with the following:

Public information campaigns
Printing needs and distribution of printed materials
Onsite public information
Onsite interpretation for people who do not speak English
Resources for the hearing impaired
A state or communitys SNS program will require careful coordination and planning regarding logistics
and the medical needs of various audiences. You will need simple and accessible messages to inform
the public. Storage location of all informational material, including electronic versions, should also be
considered. Methods for reproducing and passing out information must be there, as well.
In your planning, consider the following:
Use Emergency Use Authorization (EUA) information sheets. They are required by the FDA and
must be provided along with any medication that is dispensed off label during an emergency.
For example, antibiotics expected to be dispensed during an anthrax attack are medically safe
for such use, but may not be specifically licensed for it. Current versions of EUA information
sheets are available for state and local SNS planners.
Incident-specific messages for people who are potentially exposed will need to say where they
should go for preventive medications if they are well. These messages should also say where
people who are potentially exposed need to go if they are sick. The messages need to make clear
which people should go to dispensing sites.
Include information about who should seek preventive treatment at a dispensing site, often
called a point of dispensing or POD, and who should seek symptomatic treatment at a treatment
center. Provide directions to and information about PODs. Also include information and
directions for treatment centers. For both, be sure to include the following:
yy Hours of operation
yy Access to each site (the best way and an alternative route)
yy Driving and parking instructions
Include information about the best modes of transportation to get to the dispensing site, such as
walking, public transportation, or driving. If you list public transportation, include information
on bus departure locations and schedules.
Include threat-specific information about the nature of the disease and appropriate
preventive medications.
Disseminate information through multiple communication channels.

Establish 24-hour hotlines in coordination with other agencies. It may help provide reassurance
and updates to the public. By doing so, you will lessen the time they spend in clinics asking
questions. The hotline can include separate lines for physicians, those seen in a clinic, and
the general public.
Include plans for communicating with patients and their caregivers in clinics, using items such
as flyers, posters, and other printed material.
When developing communications materials, make sure you include important information in
the languages spoken in your community. This includes medical forms and paperwork, television
and radio public information announcements, scripts, and videotapes that dispensing sites use
to issue preventive medications to the public.
Use frequently asked questions (FAQ) sheets for threat-specific diseases. These can be
found on CDCs Emergency Preparedness and Response website at http://emergency.cdc.gov/
bioterrorism/factsheets.asp.
Make sure the public knows what medical history and related information to bring
when seeking assistance:
yy Form(s) of identification
yy Information they must present when picking up medications for family members
yy For children: required weight, age, and health information; drug allergies; and current
medications
yy For adults: health information, drug allergies, and current medications
If members of the public must be given medications, make sure they are also given information
about those drugs:
Explain the reasons for using specific drugs or changing drug regimens. The cultural and ethnic
sensitivity of this information is important. You need to make sure some groups do not think
others are getting preferential treatment because they may receive different drugs. The reasons
for using specific drugs will affect the quantities of those drugs that are provided to dispensing
PODs or treatment locations. Your explanation will make a difference in how the public accepts
these medications.
Provide information about the importance of taking the medication. Stress the importance of
taking all of a prescribed course of drug treatment. For example, someone who has potentially
been exposed to anthrax needs to take the whole 60-day course of this antibiotic. This
information affects the demand for SNS resources and minimizes the likelihood of additional
people becoming symptomatic.
Be aware of the danger of overmedicating. Focus on dispelling the false notion that if two
doses per day are good, four or six must be better. Reduce the demand for SNS supplies by
discouraging individuals from acquiring drugs from multiple dispensing sites. A secondary goal
is to minimize the possibility that some individuals will take more of a drug than is safe.

Reality Check
In fall 2001, health authorities put at-risk anthrax individuals in one area on ciprofloxacin.
This antibiotic is effective, but causes adverse reactions in some people.
Later, the determination was made that doxycycline was also effective, and
authorities put subsequent at-risk individuals on doxycycline to eliminate drug
reaction problems arising and to reduce cost.
In their rush to protect everyone, authorities failed to adequately explain their
reasons for changing the medication.
The ensuing outcry forced public health officials to spend valuable time dealing
with public complaints rather than protecting the public.
Medication compliance is a well-known problem and will be especially challenging during an emergency
if the following are true:
The treatment period is long
The prescribed drugs cause unpleasant side effects
Outbreaks stop before the public finishes their required medications
After the anthrax attacks in fall 2001, CDC surveyed those who received preventive drugs. Despite
initial counseling and strong local appeals that encouraged people to finish the 60-day course of
treatment, CDC found that only 45% adhered to the required time plan. Reasons for sporadic or
discontinued use included the following:
Side effects of the medication
A perception they were no longer at risk for anthrax

Conclusion
The all-hazards approach is most appropriate for emergency management and response.
However, terrorism involving CBRNE agents will create unique challenges. Many programs and much
effort have been directed toward preparing and developing response capabilities. These include new
surveillance and monitoring systems, new training, and expanded programs such as SNS. Bioterrorism
creates unique challenges for public health, including an enhanced need for CERC within the context of
a criminal investigation.
Human-caused outbreaks versus the natural origins of disease, along with the possibility of a hoax,
create additional uncertainty for everyone. While rare, and usually of limited scope, bioterrorism
is a real and significant danger. Careful CERC planning and preparation, in collaboration with your
organizations stakeholders and partners are required to address these threats.

Checklist 101. Strategic National Stockpile Communication Needs Assessment
Checklist 101. Strategic National Stockpile
Communication Needs Assessment
As a state or local public health communicator, you should contact the project area official managing
SNS planning under the cooperative agreement to coordinate health communications needs.
Pre-event Planning
Do you have FAQ sheets for threat-specific diseases (found on CDCs Emergency Preparedness
and Response website at http://emergency.cdc.gov/bioterrorism/factsheets.asp)?
Do you have threat-specific information about the nature of the disease and appropriate
preventive medications?
Have you considered how to provide disease and drug information prepared in the multiple
languages spoken by your community?
Are processes in place to create incident-specific messages for people who are potentially
exposed? These messages will need to say where they should go for preventive medications
if they are well. These messages should also say where people who are potentially exposed
need to go if they are sick. The messages need to make clear which people should go to
dispensing sites.
Are processes in place to ensure that PIOs know which dispensing and treatment locations
are active?
Are media, public health partners, and other stakeholders awarebefore an eventof the need
to disseminate SNS-related information and messages?
Your plan should include the following:
Assurance for dissemination of information through multiple communication channels

Plans for communicating with patients in the clinic (flyers, posters, printed material, etc.)
Establishment of 24-hour hotlines in coordination with other agencies, which can include
separate lines for physicians, those seen in the clinic, and the general public.
Plans to use multiple languages in the information your organization hands out. You need to
consider the languages spoken by ethnic populations within your community. This includes
medical forms and paperwork, television and radio public information announcements, scripts,
and videotapes that dispensing sites use to issue preventive medications to the public.
Storage location(s) of all informational material (including electronic versions).

Methods for reproducing and disseminating informational materials during an emergency.

Specific communication channels, partnerships, and staffing pools that support public
information release, reproduction, and dissemination. This includes possible volunteers or
contracted professionals to assist with public information campaigns, printing needs, onsite
public information, onsite interpretation for people who do not speak English, and resources for
the hearing impaired.
To determine how much SNS-related information you will need to provide to site locations,
consider the following:
Is the agent contagious?

Who should be concerned about exposure?
Who should seek preventive treatment at dispensing sites and who should seek symptomatic
treatment at treatment centers?
Directions to and information about dispensing and treatment locations.

When will the dispensing operation start and what hours will it be open?
Where is the nearest dispensing site?
What is the best way to get to each dispensing site and an alternative route?
Where is there parking at each dispensing site?
What is the best way to get to the dispensing site (e.g., walk, use public transportation,
drive)? In the case of public transportation, do you have bus departure locations and
schedules?
What is the dispensing process?

What form(s) of identification are needed?
What information must someone present when picking up medications for family members?
For children: required weight, age, and health information; drug allergies; and current
medications. For adults: health information, drug allergies, and current medications.

Information about the Drugs the Public Must Take
The information should include the following:
Reason(s) for using specific drugs or changing drug regimens. Remember that cultural
sensitivities of this information are important to ensure that some groups do not think others
are getting preferential treatment because they receive different drugs. The reasons for using
specific drugs will affect the quantities of those drugs that are provided to dispensing PODs
or treatment locations. Your explanation will make a difference in how the public accepts
these medications.
The importance of taking the medication. Stress the importance of taking all of a prescribed
course of drug treatment. For example, someone who has potentially been exposed to anthrax
needs to take the whole 60-day course of this antibiotic.
Messages about the importance of medication compliance, especially if the treatment regimen is
long, the prescribed drugs cause unpleasant side effects, or the outbreak stops before the public
finishes the required medications.
Messages to warn patients of the danger of overmedicating. Focus on dispelling the erroneous
notion that if two doses per day are good, four or six must be better. Reduce the demand for
SNS supplies by discouraging individuals from acquiring drugs from multiple dispensing sites or
taking more of a drug than is safe.

References
1. Federal Emergency Management Agency (FEMA). R&R: response and recovery. Terrorism incident annex
[online]. 1999 Jun 3. [cited 2012 Jun.] Available from URL: http://www.au.af.mil/au/awc/awcgate/frp/frpterr.htm.
2. Central Intelligence Agency. CIA & the war on terrorism. Terrorism-related excerpts from the National
Intelligence Councils Global trends 2015: a dialogue about the future with nongovernment experts
[online]. 2011 Dec 30 [cited 2012 Jun]. Available from URL: https://www.cia.gov/news-information/cia-the-
war-on-terrorism/terrorism-related-excerpts-from-global-trends-2015-a-dialogue-about-the-future-with-
nongovernment-experts.html.
3. U.S. Department of State. Legislative requirements and key terms [online]. 2011 Jun 23. [cited 2012 Jun].
Available from URL: http://www.state.gov/documents/organization/65464.pdf.
4. CDC. Forensic epidemiology: case study III salmonellosis in Oregon [online]. [cited 2012 Jun]. Available
from URL: http://www.cdc.gov/phlp/docs/FE15.pdf.
5. Mardikian J. Mental health consequences of September 11: a five-year review of the behavioral sciences
literature. Behavioral & Social Sciences Librarian 2008;27(3):158210.
6. Federal Bureau of Investigation (FBI). Famous cases & criminals. Amerithrax or anthrax investigation
[online]. [cited 2012 Jun]. Available from URL: http://www.fbi.gov/about-us/history/famous-cases/anthrax-
amerithrax/amerithrax-investigation.
7. CDC. Emergency preparedness and response. Bioterrorism agents/diseases [online]. [cited 2012 Jun].
Available from URL: http://emergency.cdc.gov/agent/agentlist-category.asp.
8. National Science and Technology Council (NSTC), Committee on Homeland and National Security,
Subcommittee on Standards (SOS). A national strategy for CBRNE standards [online]. 2011 May. [cited
2012 Jul]. Available from URL: http://www.whitehouse.gov/sites/default/files/microsites/ostp/chns_cbrne_
standards_final_24_aug_11.pdf.
9. U.S. Department of Homeland Security (DHS). Biological attack: what it is [online]. 2011 Jul 15. [cited 2012
Jun]. Available from URL: https://www.dhs.gov/files/publications/gc_1245181954420.shtm.
10. U.S. Department of Homeland Security (DHS). Chemical attack: what it is [online]. 2011 Jul 15. [cited 2012
Jun]. Available from URL: https://www.dhs.gov/files/publications/gc_1243880711334.shtm.
11. U.S. Department of Homeland Security (DHS). Radiological attack: what it is [online]. 2011 Jul 13. [cited
2012 Jun]. Available from URL: https://www.dhs.gov/files/publications/gc_1245337032502.shtm.
12. U.S. Department of Homeland Security (DHS). Nuclear attack: what it is [online]. 2011 Jul 20 [cited 2012
Jun]. Available from URL: http://www.dhs.gov/files/publications/gc_1252522849927.shtm.
13. U.S. Department of Homeland Security (DHS). IED attack: what it is [online]. 2011 Jul 20 [cited 2012 Jun].
Available from URL: https://www.dhs.gov/files/publications/gc_1252695582972.shtm.
14. U.S. Department of Homeland Security (DHS). Bomb making materials awareness program [online]. 2010 Mar
31 [cited 2012 Jun]. Available from URL: http://www.dhs.gov/files/programs/gc_1259938444548.shtm.
15. Federal Emergency Management Agency (FEMA). National Response Framework (NRF) [online]. 2008 Jan.
[cited 2012 Jul]. Available from URL: http://www.fema.gov/pdf/emergency/nrf/nrf-core.pdf.

16. Federal Emergency Management Agency (FEMA). About the National Incident Management System (NIMS)
[online]. 2008 Dec. [cited 2012 Jul]. Available from URL: http://www.fema.gov/pdf/emergency/nims/NIMS_
core.pdf.
17. CDC. Office of Public Health Preparedness and Response. Strategic National Stockpile (SNS) [online]. 2012
Mar 8 [cited 2012 Jul] Available from URL: http://www.cdc.gov/phpr/stockpile/stockpile.htm.
18. CDCynergy. Biological attacks: communication challenges [online]. [cited 2012 Jul]. Available from URL:
http://www.orau.gov/cdcynergy/erc/Content/activeinformation/essential_principles/EP-bt.htm.
19. Hsu VP, Hossain MJ, Parashar UD, Ali MM, Ksiazek TG, Kuzmin I, et al. Nipah virus encephalitis reemergence,
Bangladesh. Emerg Infect Dis [serial online] 2004 Dec [cited 2012 Jul];10(12). Available from URL: http://
wwwnc.cdc.gov/eid/article/10/12/04-0701.htm.
20. CDC. Outbreak of swine-origin influenza A (H1N1) virus infectionMexico, MarchApril 2009. MMWR
2009;58(17):46770. Available from URL: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5817a5.htm.
21. Le Page M, editor. Is swine flu a bioterrorist virus? New Scientist [online]. 2009 Apr 27. [cited Jul 2009]. Available
from URL: http://www.newscientist.com/blogs/shortsharpscience/2009/04/is-swine-flu-a-bioterrorist-vi.html.
22. Kramer LD, Bernard KA. West Nile virus in the western hemisphere. Curr Opin Infect Dis. 2001
Oct;14(5):51925.
23. Preston R. West Nile mystery. New Yorker Magazine [online]. 1999 Oct 18 & 25:90108 [cited 2012 Jul].
Available from URL: http://www.newyorker.com/archive/1999/10/18/1999_10_18_090_TNY_LIBRY_000019339.
24. U.S. Department of Homeland Security (DHS). Internet hoaxes. Identifying hoaxes and urban
legends [online]. 2011 Nov 7. [cited 2012 Jul]. Available from URL: http://www.dhs.gov/xcitizens/
general_1165337828628.shtm.
25. Sellnow T, Littlefield R, Vidoloff K, Webb E. The interacting arguments of risk communication in response to
terrorist hoaxes. Argumentation and Advocacy, 2009;45(3):135 (Document ID: 1948264041).

Resources
American Medical Association. BioterrorismFAQs [online]. [cited 2012 Jul]. Available from URL:
http://www.ama-assn.org/resources/doc/cphpdr/bioterrorism_faqs.pdf.
CDC. Communicating in the first hours: initial communication with the public during a potential terrorism event
[online]. 2007 May 14. [cited 2012 July]. Available from URL: http://emergency.cdc.gov/firsthours/index.asp.
CDC. Emergency preparedness and response. Bioterrorism training and education [online]. [cited 2012 Jul].
Available from URL: http://emergency.cdc.gov/bioterrorism/training.asp.
CDC. Emergency preparedness and response. Preparation and planning for bioterrorism emergencies
[online]. 2012 Mar 23. [cited 2012 Jul]. Available from URL: http://emergency.cdc.gov/bioterrorism/prep.asp.
Chandler D, Landrigan I. Bioterrorism: a journalists guide to covering bioterrorism. 2nd ed [online]. New York
(NY): Radio and Television News Directors Foundation (RTNDF); 2004. [cited 2012 Jul]. Available from URL:
http://www.rtdna.org/media/pdfs/bestpractices/newsandterror/bioterrorism/bioguide.pdf.
Federal Emergency Management Agency (FEMA). National Response Framework (NRF) resource center
[online]. [cited 2012 Jul]. Available from URL: http://www.fema.gov/emergency/nrf/.
Mitchell CS, editor. Worker training in a new era: responding to new threats. Report of Johns Hopkins
Education and Research Center for Occupational Health and Safety Conference [online]; 2002 Oct 2627;
Baltimore, MD. Cincinnati: National Institute of Occupational Safety and Health (NIOSH) and Johns Hopkins
Bloomberg School of Public Health [cited 2012 Jul]. Available from URL: http://www.cdc.gov/niosh/docs/2004-
173/pdfs/2004-173.pdf.
National Institutes of Health (NIH), National Institute of Allergy and Infectious Diseases. Biodefense and
related programs [online]. 2011 Oct 27. [cited 2012 Jul]. Available from URL: http://www.niaid.nih.gov/topics/
biodefenserelated/Pages/default.aspx.
National Institutes of Health (NIH), U.S. National Library of Medicine. MedlinePlus. Biodefense and
bioterrorism [online]. 2012 May 3. [cited 2012 Jul]. Available from URL: http://www.nlm.nih.gov/medlineplus/
biodefenseandbioterrorism.html.
U.S. Department of Health and Human Services (HHS). Public health emergency. Medical countermeasures
[online]. [cited 2012 Jul]. Available from URL: https://www.medicalcountermeasures.gov/home.aspx.
U.S. Department of Homeland Security (DHS). Proposed guidance for protecting responders health during
the first week following a wide-area anthrax attack [online]. 2011 Sep 14. [cited 2012 Jul]. Available from
URL: http://www.dhs.gov/files/laws/gc_1256758853114.shtm.
U.S. Food and Drug Administration (FDA). Emergency preparedness and response: counterterrorism
and emerging threats [online]. 2012 Jun 18. [cited 2012 Jul]. Available from URL: http://www.fda.gov/
EmergencyPreparedness/Counterterrorism/default.htm.

Notes:

Notes:

Notes:

Chapter 11:
Human Resources for CERC
2014 EDITION

Chapter 11:
Human Resources for CERC
In this chapter, the following topics are discussed:
Working with responders from varied backgrounds

Appropriate staffing and preparation to maintain the well-being of communicators
Emotional health issues for those responding to a crisis
Emotional health issues for families of deployed emergency response workers
Crises, disasters, and emergencies require diverse resources for the right preparation and response.
This includes human resources. Disasters bring many people together with different training,
experiences, and backgrounds. These events can create stress that complicates human resource
management.1
Working with Responders from Varied Backgrounds2

A crisis or disaster brings people together who might not normally interact.This includes people with
diverse backgrounds, training, and perspectives:
Politicians, who may have little formal training for

When you do hiring, you can hire
emergency responses and may need to interact with
professional emergency management personnel for skill, but you also want to hire
for aptitude, and I definitely looked
Volunteers, who may be participating in a number
for aptitude and learning new
of activities, such as assisting evacuees, collecting
information, and dispensing food and water
things, aptitude and technology,
and a desire to play around,
Public health professionals, who may be working side by
experiment and see what you can
side with law enforcement officials
do with new things.
Professional leadership, who may be representing
businesses, nonprofits, faith-based organizations, and Leng Caloh,
many communities Interactive Strategies Manager,
KPBS San Diego
While the people involved in a crisis response usually share
common goals, they often have varied training, backgrounds,
expectations, and experiences.3 This at times can create
conflicts and make coordination challenging. A crisis is always a complex work environment, with huge
pressures and stress, and long work hours. In many cases, the event will take place in a remote location.
Participants are making decisions and taking actions that affect the lives and well-being of others.
Even when you are focused on those who have been personally affected by the crisis, its necessary
to ensure an effective response for all who are involved. Therefore, the well-being of your responders
requires special attention.4,5,6
329
Appropriate Staffing and Preparation to Maintain
the Well-Being of Communicators
Public information officers (PIOs) and other CERC communicators are responders who interact with
other first responders. Like other responders, they are often extremely committed and think of others
before themselves. While it is this generous outlook that calls them to this work, it is imperative that
they, and those managing them, be encouraged to pay close attention to their physical and emotional
well-being throughout the crisis. The strength and resilience of responders is the engine behind a
successful response and recovery.
PIOs and CERC professionals are often placed in particularly stressful situations as they face media,
people directly affected by the event, politicians, and other responder groups. Communication
professionals need to pay close attention to their preparation, as well as their physical and emotional
needs, as each crisis evolves. This chapter discusses important steps to ensure that they can function at
an optimum level as they respond to the event.
First Responder Stress

Public health officials and CERC professionals are first responders and are likely to experience unique
levels and types of stress. In addition, they may be asked to develop messages to help manage the
stress that other responders experience. These kinds of problems range from acute or short-term stress
reactions to the long-term effects of post-traumatic stress disorder (PTSD).
Traditional first responders, such as police, fire, and EMS workers, are trained to deal with the daily
stress of performing their jobs. Nevertheless, their proximity to death, severe trauma, and perceived
threat to themselves and their families can increase their level of stress and present new challenges
including methods for coping. According to one study of first responders, Firefighters and other
emergency responders follow the principle: Risk a life to save a life.7 During a terrorist attack, this
response may be even more intense. The threat and horror of the event, the intensity of the work,
the long hours and duration, and the uncertainly can all contribute to unusually high levels of stress.
Communication personnel may not receive the type of instruction they need to be ready for first-
responder stress as part of their routine training.
Health-care professionals and trade workers also experience increased stress as they are called to assist
the victims in the aftermath of a crisis. For example, following the attacks on September 11, 2001,
mental health professionals, social workers, and medical professionals assisting victims and disaster
workers at Ground Zero experienced the following:
Increased levels of emotional exhaustion
Anxiety and depression
Psychological distress8
330 Chapter 11 Human Resources for Crisis Communication

One study documented the stress associated with the terrorist attack: Over 100 cases of
psychological stress among construction and trades personnel were treated during the first nine
weeks at the World Trade Center. The consensus is that many more experienced such stress,
but did not seek treatment.6
Since 2001, public health officials and CERC professionals have been recognized as first responders for
crises and emergencies because they have to deal with the intense pressure from the media and general
public to provide information immediately and accurately throughout the duration of the crisis.9
Responders have the added stress of their homes being damaged or lost, and family, friends, and
pets possibly missing or dead. They often struggle between their duty to their work and their duty to
family and friends. If concerns for keeping responders safe during crisis response arent addressed by
employers prior to a crisis, one can expect higher rates of the following:7,10
Distraction Absenteeism
Poor decision making Refusal to come to work
Disaster TraumaPost-Traumatic Stress Disorder

Post-traumatic Stress Disorder is an anxiety disorder that people can develop after experiencing
an emergency or disaster. Everyone who experiences a disaster, including responders, is at risk of
experiencing stress symptoms, which could lead to PTSD, other anxiety disorders, or depression.
Disaster responders are vulnerable to getting PTSD, as they may not be able to stop thinking about what
they saw or experienced for months after the event. It is important to remember that not everyone who
lives through a disaster gets PTSD. With any type of disaster, it is likely that people will report sadness,
anxiety, stress, and fear, but they usually do not develop PTSD.11
According to the National Institute of Mental Health,11 PTSD symptoms can include:
Re-experiencing: flashbacks or bad dreams
Avoidance: emotional numbness, staying away from the location that is a reminder
Hyperarousal: being easily startled, on edge, or having difficulty sleeping
Risk factors for PTSD include:
Surviving a dangerous event or trauma
Little or no social support following the event
Dealing with additional stressors post-event, such as the loss of a family member
History of mental illness
Witnessing people get killed or injured
Being injured
Chapter 11 Human Resources for Crisis Communication 331

It is important to pay close attention to your physical and emotional well-being throughout a crisis.
Even the most experienced response workers can be psychologically and emotionally affected by a
disaster response. The strength and resilience of responders is the engine behind a successful response
and recovery, so it is vital that you manage your stress as much as possible.
As a communicator, you should also be aware of the risk factors and symptoms of PTSD when
developing your messages. When discussing the disaster, take care to express sensitivity and empathy
to the intense feelings your audience may be experiencing. Consider adding messages that let people
know where psychological support and resources are available.
Pre-crisis Planning for Human Resources12,13

The following is a list of pre-crisis activities that can be useful to include in human resources planning:
Provide job training: The following is a human resource communication checklist when considering
team training:
Train communicators for designated emergency response tasks.
Ask the following questions during training exercises:
yy Are phone numbers, including cell phone numbers, and e-mail addresses up-to-date
in your plan?
yy Does your team respond within an appropriate timeframe after they are alerted?
yy Are backup personnel ready if primary responders are away or out of reach?
yy Can an early skeletal staff produce, get authorization for, and then release an initial news
statement within 2 hours of obtaining information?
yy Are the initial steps such as verification, notification, clearance, and coordination
executed properly?
yy Is equipment adequate, including personal protective equipment?
yy Will personnel pulled in from other departments or agencies have sufficient access to your
organizations computer files and network?
Refresh training routinely. At a minimum that training should include a review and update of
the crisis communication plan as well as a discussion of roles. Create training drills routinely
(possibly unannounced) to see how effectively your crisis communication operations can get up
and running. They are also good ways to bring people with diverse backgrounds together.
In addition to tabletop exercises and drills, technological advances in communication are
reshaping crisis communication. Social media, with its rapid development, has created a new
training need. Communicators must take the required time to regularly upgrade their skills in
these and other areas.

Training has the added benefit of reducing uncertainty and enhancing confidence. Public health
professionals will be more confident when they can say, I have trained for this and I know the
people with whom I will be working.
Provide training in stress management: PIOs and other communicators will experience major
time constraints and must balance competing interests of multiple stakeholders. They may be asked
to make and implement decisions that affect the health and well-being of others. They may face angry
constituents and respond to emotionally challenging questions. During a crisis, they will function under
conditions of very high uncertainty, which also adds to stress.
Techniques and skills that reduce and manage stress can be very helpful for first responders, including
crisis communicators. Although these techniques and skills cannot eliminate stress, they can help
reduce its impact. It will be important to help communicators and others managing a response
understand, anticipate, and prepare for the stress. Some stress relief techniques include the following:
Exercise Relaxation
Meditation Development of support systems
Not every technique will work for every person. Individuals need to learn what works best for them. It
is important to recognize that stress from different sources adds up to greater total stress. Managing
stress in ones personal life will reduce the overall stress that might be experienced during a disaster.
Stress Management Techniques to Consider

Individual stress management training consists of learning to control and even turn off the
bodys fight-or-flight response. The body has another counter-balancing reaction to stress
described by Dr. Herbert Benson called the relaxation response, which returns breathing,
heart rate, and minds back to a relaxed state.14 You can learn to turn on this relaxation
response, by learning various methods of relaxation training.
Relaxation can be achieved through many kinds of meditation: Tai chi, yoga, and the technique
of progressive relaxation or biofeedback training are some well-known methods. Other stress
management techniques include journal writing, aerobic fitness, muscle strength training, and
maintaining proper nutrition.
Talking to close friends or coworkers and receiving feedback is a form of emotional release
that can allow people to work through feelings and make sense of the experience. Social
support can aid the process of putting a traumatic experience into context so that it no longer
exerts an overly powerful influence on ones life. If symptoms persist over time, social support
may not be enough and a referral to a psychological professional should occur to see if the
person needs therapy or professional aid.

Acknowledge levels of experience: Develop a system for assessing expertise so team members
can be promoted as they gain more skills and experience in responding during an emergency. For
example, the American Red Cross ranks responders, from technician to specialist to coordinator, and
then assistant officer and officer.8 The American Red Cross offers different tracks depending on level
of emergency response experience and if they are volunteers, staff, or subject matter experts (SMEs)
such as mental health workers, social workers, or nurses. Informal and formal performance reviews of
members also help to give important feedback as well as develop leaders. Not everyone with specialized
skills wants to lead, but their level of emergency response expertise should be recognized.
The Federal Emergency Management Agency (FEMA) offers training options for PIOs. These include
basic and advanced PIO courses. Their courses range from a classroom-oriented National Incident
Management System (NIMS) training, to more scenario-driven National Response Framework
Integrated Emergency Management courses. Topics address the full range of PIO responsibilities in
disaster response. FEMA also provides an extensive PIO position checklist.15
Because PIOs are considered part of the incident command staff during crisis response, the National
Public Health Information Coalition and the Department of Homeland Security strongly recommend
they complete the NIMS core courses, as well as other PIO-specific courses. One study shows that
public health PIO job responsibilities are multi-layered assignments and can include:16
Media relations
Health campaigns
Internal and external communication
Emergency preparedness and risk communication knowledge
Staff supervision
Web development
Maintain a registry of communication professionals: During a large-scale event, more trained

communication professionals may be required as surge staff. This added capacity can be achieved
through mutual aid agreements between hospitals, public health agencies, and other organizations.
Others within the agency may also volunteer to be trained. Identify your organizations current staff skill
set, especially for those who volunteer at headquarters or are deployed as part of an emergency public
health response:
Reach out regularly to find new volunteers within your organization and add those names to
your database.
Register communicators by specialty areas, types of experience, and level of experience.
You should also register their willingness to work in the headquarters, be deployed to a joint
information center (JIC), work in evacuation centers, or be sent to remote locations.

Verify that contact information is current.
Make sure all of the volunteers supervisors are willing to lend those staffers during the
emergency response.
Ask people to recommit annually, to ensure the database accurately represents your
organizations staff.
The more available responders you have on your list, the more likely your operation can be maintained
and ready to meet your organizations demands. Building and maintaining a communicators list will give
you an assessment of the current staff inventory if and when you need it.
Divide your registry according to the types of jobs identified in your organizations crisis communication
plan. For example, if your plan indicates that your website or 24-hour phone operations support will
come from another organization, theres no need to keep those assignments active on your registry.
It is important to clarify agency policy regarding the positions that non-paid, trained volunteers
are permitted to occupy during an emergency. Indicate on the registry who is eligible to serve in
supervisory or leadership positions during an emergency response. Establish criteria for management or
leadership positions to make this determination.
Determining Staffing Levels

As an initial step in crisis response, your organization will need to make decisions about communication
operations. This includes decisions about daily hours of operation, the number of operational days per
week, and, at some point, the expected duration of the response. Initially, the nature of the event and
its scope and scale will not be well understood. As the crisis unfolds, you will need to reassess your
staffing needs. Risk assessment tools can help make these decisions.17
Stagger work shifts to ensure continuity in operations and clear

situational awareness. An uninformed team may come to the
JIC fresh and have little knowledge about the state of events. When I was out there, there was a
You dont want your entire communication staff to be replaced couple days when I worked 22 hours
at once, or the entire staff will be uninformed. Staggering team in a 24-hour day. But you become
rotationsat various times in the operational daywill provide less effective if you dont get some
more continuity. For example, 12-hour shifts can be staggered so decent rest.
that some are working 7:00 a.m. to 7:00 p.m., others come in at
4:00 p.m. and work until 4:00 a.m., and still others are arriving at Mayor Dennis Walaker,
noon and working until midnight. Fargo, North Dakota
Leaders also need relief. They often have a hard time

disengaging; nevertheless, a well-trained and experienced staff
can help leaders feel like they can take necessary breaks. It is the duty of everyone involved to take
occasional breaks to help ensure they are functioning at the high level required in an emergency.9

The American Red Cross has deployed millions of volunteers domestically and around the world
for more than 130 years.18 They produced the following guidelines for establishing staff schedules
during a crisis:
Initial phase:
yy Managers should aim to keep the number of hours that each person works per day under 12,
with a limit of 16.
yy Keep deployments to a field location limited to periods of 3 weeks or less.
yy If the emergency is very intense, do not allow personnel to work more than 710 days without
taking a day off.
Maintenance phase:
yy If the emergency is less intense, managers should normally direct staff to take one 24-hour
period off after 7 days of work. They should also be directed to take 2 days off within a 3-week
period. Typically, an assignment is for 3 weeks.
yy If someone continues to be physically and mentally fit after a 3-week assignment, managers
may extend an assignment for another 3 weeks. With further reassessment, the assignment
may again be extended by 3 weeks, so the total maximum assignment time is 9 weeks.
yy If volunteers are deployed far from home, expect that they will return home for a brief stay
before redeploying for each of the 3-week assignments.
Resolution phase:19
yy Encourage a visit to a mental health counselor before volunteers return home or to their
normal jobs.
yy There is potential value in offering a voluntary debriefing to participants, as it can help

responders process their deployment experience and transition back to daily routines.
yy Provide support and educational materials to family members of persons deployed to a crisis
away from their home.20
Assessing Individual Capacity in Public and Media Response

During a crisis, some personnel may develop a superhero mentality and try to accomplish too much. The
result may be burnout and mistakes.
A motivated worker who is taking repetitive information calls from the public may manage 3040
repetitive calls requesting information per hour, if he or she is working from a script and does not have
to perform any analysis.12 However, no one should be expected to do an 8-hour shift of this type of call
response. A 6-hour shift with breaks is a reasonable guideline. If calls require reassurance, referral, or
recommendation, this time should be reduced.

Reality Check
If the information requires regular updating or substantial script changes, consider
the following:
Dont expect your telephone response workers to master the new

information immediately.
Plan for fewer calls to be managed in a day.
This frontline work is incredibly intense and those responding directly to the public, no
matter the job, must be monitored for emotional well-being and given needed support.
Media response needs: Press assistants who triage media calls can usually manage at least twice
as many calls as media information officers who provide more in-depth assistance. The work of a
press assistant can range from taking a message (not always an easy task) to directing the media
representative to an alternate source. The people answering these calls provide your organizations first
impression. To keep this flowing smoothly, do the following:
Make sure you assign enough people to this task.
Secure enough incoming phone lines. If you dont, your press assistants will likely endure many
complaints.
Create a frequently asked questions (FAQ) fact sheet containing known information that can be
given to reporters by fax, Web, and e-mail, when possible.
Ensure that the FAQ and other informational documents are updated by a certain time each day. Notify
the media when they can expect to see new or updated documents on the Web. This will reduce the
amount of human power needed to get through the emergency operation.
For communicators, a tough day of media calls on a single but complex subject could mean between
40 and 50 calls for one press officer. PIOs have been known to manage 100 calls in a day, although
that would be rare. Quantity must be tempered by quality. Someone working with issues and not just
providing information wont be able to field as many calls. Someone acting as a spokesperson for the
agency, doing interviews, will field even fewer calls.
Spokesperson assignments: If the media interest is intense or enduring, as expected in a crisis,

spokesperson work schedules should also be rotated with overlapping shifts. Fatigue creates mistakes
and mistakes by spokespersons can become very problematic. If possible, arrange interviews when
spokespersons are most fresh, not when they are tired, such as at the end of a shift. Reduce inevitable
stress with lots of support from the PIO, such as talking points and debriefs.

Top leaders should provide no more than four TV interviews in a day, along with two or three shorter
telephone interviews.21 That pace cannot be sustained day after day. An organization director or hands-
on leader of the response cant afford to do continuous interviews. While providing access to top leaders
helps foster the perception of openness and responsiveness, top leaders should be saved for important
moments when the public expects to hear from a policymaker or decision maker. If possible, substitute
lower-level organization leaders or SMEs for more routine interview requests. Overexposure of the
director may lead to accusations of grandstanding or perceived power struggles.
A spokesperson or SME solely working to provide media and public information response can do six or
more short on-camera interviews, interspersed with print and radio interviews, each day. The media
would love unlimited access to exclusive in-person interviews. Use your staff wisely and save your
human resources for when theyre really needed.
Emotional Health Issues for Those Responding to a Crisis

22
According to the American Red Cross, those who respond to a crisis have the potential to become
affected by it as they work long, intensive hours, often under poor conditions. In some cases, responders
may face physical dangers. For those deployed away from home, personal support systems are left
behind. Supervisory styles vary from person to person, and administrative organization and regulations
often must change with little warning, adding additional stress.
Many people who willingly respond to a crisis are dedicated individuals who also tend to be perfectionists.
As such, they are at risk of pushing themselves too hard and of not being satisfied with what they have
accomplished. They often fail to recognize what has been accomplished and seek to do more.
Frustration is common, and ones usual coping mechanism and sense of humor is often stretched
beyond its limits. Workers become exhausted and easily angered. The anger of others, such as workers,
people directly affected by the event, and media personnel, sometimes becomes difficult to handle and
may be experienced as a personal attack on the worker rather than as a normal response to exhaustion
and stress. Survivor guilt may also emerge as workers see what others have lost.
Coping
First responders and crisis PIOs need to understand that if the crisis has a strong, negative impact
on them, they may be unable to perform their response duties. During a crisis, when many people are
experiencing harm and loss, it may be hard to look past the harm to an individual job. It may also be
hard to disengage from the crisis, particularly in an era of 24/7/365 connectivity and handheld devices.
Few people have experienced mass death or destruction. One study of stress among World Trade Center
responders noted that stress was significantly compounded because many of the victims recovered
were horribly mangled, and in many cases only parts of bodies were recovered.7 Responders to the
1995 Oklahoma City bombing dealt with child victims, a truly devastating task for even seasoned

professionals. Deployed responders need to understand and appreciate the intensity of these
experiences and talk with others about their emotions.7,23
Supervisors should encourage employees to openly discuss their needs and the challenges they are
facing. Without these candid conversations, it is impossible to address these needs. Employees need to
be encouraged to take time and use stress management techniques such as the following:
Personal coping
Take these actions:
yy Recognize that emotions will be high in this abnormal setting and talk about it.
yy Eat nutritious food (e.g., fruit versus donuts, peanuts versus chips).
yy Take mental breaks.
yy Avoid lots of caffeine or alcohol.
yy Leave when your shift is over.
yy Exercise.
Individual Approaches for Stress Prevention and Management1
yy Manage your workload:
Set task priority levels with realistic work plans.
Recognize that not having enough to do or waiting is an expected part of

any disaster response.
yy Balance your lifestyle:
Eat nutritious food, stay hydrated, and avoid excessive caffeine, alcohol, and tobacco.
Get adequate sleep and rest, especially on longer assignments.
Get physical exercise.
Maintain contact and connection with primary social supports.
yy Use stress reduction strategies:
Reduce physical tension by using familiar personal strategies (e.g., take deep breaths,
do some gentle stretching, meditate, wash your face and hands, and practice progressive
relaxation).
Pace yourself between low- and high-stress activities.

Use time off to decompress and recharge batteries (e.g., get a good meal, watch TV,
exercise, read a novel, listen to music, take a bath, or talk to family).
Talk about emotions and reactions with coworkers during appropriate times.
Maintain self-awareness:
yy Recognize and heed early warning signs for stress reactions.
yy Accept that one may not be able to self-assess problematic stress reactions.
yy Recognize that over-identification with or feeling overwhelmed by victims and families grief
and trauma may signal a need for support and consultation.
yy Understand the differences between professional helping relationships and friendships to help
maintain appropriate roles and boundaries.
yy Examine personal prejudices and cultural stereotypes.
yy Recognize when ones own experience with trauma or ones personal history interferes with
effectiveness.
yy Be aware of personal vulnerabilities and emotional reactions, and the importance of team and
supervisor support.
Supervisor support
Take these actions:
yy Remind workers about the value of their effort.
yy Insist that scheduled meal breaks be taken.
yy Make nutritious foods and drinks available.
yy Expect high emotions and provide someone with whom workers can talk.
yy Respond to even timid requests for relief or reassignment.
yy Encourage exercise and personal grooming time.
yy Accept inoffensive silliness that some use to let off steam.
yy Despite what they say, insist that workers take time to sleep.
For Supervisors: Minimizing Stress During the Crisis24,25
yy Clearly define individual roles and re-evaluate if the situation changes.
yy Institute briefings at each shift change that cover the current status of the work environment,
safety procedures, and required safety equipment.

yy Partner inexperienced workers with experienced veterans. The buddy system is an effective
method to provide support, monitor stress, and reinforce safety procedures. Require outreach
personnel to enter the community in pairs.
yy Rotate workers from high-stress to lower-stress functions.
yy Initiate, encourage, and monitor work breaks, especially when casualties are involved. During
lengthy events, implement longer breaks and days off, and curtail weekend work as soon as
possible.
yy Establish respite areas that visually separate workers from the scene and the public. At longer
operations, establish an area where responders can shower, eat, change clothes, and sleep.
yy Implement flexible schedules for workers who are directly impacted by an event. This can help
workers balance home and job responsibilities.
yy Reduce noise as much as possible by providing earplugs, noise mufflers, or telephone

headsets.
yy Mitigate the effects of extreme temperatures through the use of protective clothing, proper
hydration, and frequent breaks.
yy Ensure that lighting is sufficient, adjustable, and in good working order.
yy Supply facemasks and respirators to lessen the impact of odors and tastes, and protect
workers breathing.
yy Provide security for staff at facilities or sites in dangerous areas, including escorts for workers
going to and from their vehicles.
yy Provide mobile phones for workers in dangerous environments. Ensure that personnel know
whom to call when problems arise.
Encouraging Mental Health and Rejuvenation

While managing the anthrax crisis, CDC offered a flexible schedule to their
communications staff to help prevent burnout. They created two staffs for their media
relations efforts and provided each team with alternating 4 days a week on and 3 days
off. This strategy was very successful in helping workers cope and perform at their
highest level.

Emotional Health Issues for Families of Deployed
Emergency Response Workers
While emergency workers may experience stress directly, their family members may also have
challenges. They may have a hard time understanding what their loved ones are experiencing. Family
members may be worried when workers have been deployed to disaster sites. They may not have the
means to cope with the situation. These strategies will help lessen the stress for family members:19,20,22,23
Provide family members with as much information as possible about the disaster and
deployment. Unfortunately, in the beginning of a response, your organization may not yet have
complete information on the event. Staff may not know the precise location where they will be
working, what exactly they will be doing, or how long they will be away from home. Make efforts
to update family members as often as possible. They are a key audience and communication
plans should include them.
As a second possible strategy, assign a specific liaison from your organization to family members.
Family members should understand that deployed staff usually work very long hours in very stressful
and emotional conditions. In many cases, they may be exposed to scenes of suffering, possible
destruction, and the strong emotions, anger, and loss that victims experience.
When a family member returns from a disaster scene, he or she may need time to adjust to the normal
pace of everyday life and may require additional rest before resuming previously normal responsibilities.
It is important for family members to be able to talk to one another about what happened and the
emotions that accompanied the work. Sometimes, deployed workers do not want to burden family with
these stories. They may be proud, frustrated, angry, sad, tearful, and happy all at the same time. It may
take some time to sort out these conflicting emotions and share them.
Returning deployed workers may also seem overly preoccupied with the disaster experiences and may
not seem to share in excitement, disappointment, or frustration about events at home. The disaster
experience tends to overshadow everyday events and puts them in a different perspective.
Often, emergency response workers return home with a conscious or unconscious need to reassure
themselves about the safety of their environment.24 Response workers often feel that they left
something undone or that they could have done more. Time, understanding, empathy, and support from
family are important to readjustment.

Conclusion
Human resources are critical to the effective management of any crisis event. First responders are
generally highly committed and skilled. Ongoing training is critical to ensure that responders are
performing at their most effective level. Registries of volunteers can help maintain surge capacity to
meet the expanding needs of a crisis. Crises and disasters are stressful events. That stress can take a
toll on first responders and their families. Anticipating and managing that stress is important. Without
effective management, stress will reduce the effectiveness of the first responder work force and possibly
cause responders to be added to the list of those affected by the event.

References
1. U.S. Department of Health and Human Services (HHS). A guide to managing stress in crisis response
professions. HHS Pub. No. SMA 4113. Rockville (MD): Center for Mental Health Services, Substance Abuse
and Mental Health Services Administration [online]. 2005. [cited 2012 Jul]. Available from URL: http://store.
samhsa.gov/shin/content//SMA05-4113/SMA05-4113.pdf.
2. Hearne SA, Segal LM, Earls MJ, Unruh PJ. Ready or not? Protecting the publics health in the age of
bioterrorism 2004 [online]. Washington (DC): Trust for Americas Health; 2004 Dec. [cited 2012 Jul]. Available
from URL: http://healthyamericans.org/reports/bioterror04/BioTerror04Report.pdf.
3. Miller B, Hsiao A, Ranji U, Salganicoff A. The state of public health preparedness [online]. 2008 Mar.
[cited 2012 Jul]. Available from URL: http://www.kaiseredu.org/Issue-Modules/The-State-of-Public-Health-
Preparedness/Background-Brief.aspx.
4. U.S. Department of Health and Human Services (HHS). Public health emergency response: a guide for
leaders and responders. Taking care of yourself and others. [online]. 2007 May. [cited 2012 Jul]. Available
from URL: http://www.phe.gov/emergency/communication/guides/leaders/Pages/default.aspx.
5. Agency for Toxic Substances & Disease Registry (ATSDR). Environmental Health and Medicine Education.
Surviving field stress for first responders [online course]. 2011 Jan 6. [cited 2012 Jul]. Available from URL:
http://www.atsdr.cdc.gov/emes/health_professionals/surviving_field_stress.html.
6. Fullerton CS, Ursano RJ, Wang L. Acute stress disorder, posttraumatic stress disorder, and depression in
disaster or rescue workers. Am J Psychiatry [online] 2004 Aug [cited 2012 Jul];161(8):13706. Available from
URL: http://ajp.psychiatryonline.org/article.aspx?articleid=176964.
7. Jackson BA, Peterson DJ, Bartis JT, LaTourrette T, Brahmakulam I, Houser A, et al. Protecting emergency
responders: lessons learned from terrorist attacks. Santa Monica (CA): RAND Corporation; 2002. CF-176-
OSTP.
8. Mardikian J. Mental health consequences of September 11: a five-year review of the behavioral sciences
literature. Behavioral & Social Sciences Librarian 2008;27(3):158210.
9. Barnett DJ, Balicer RD, Blodgett DW, Everly GS Jr, Omer SB, Parker CL, et al. Applying risk perception
theory to public health workforce preparedness training. J Public Health Manag Pract [online] 2005
Nov;Suppl:S337 [cited 2012 Jul]. Available from URL: http://www.hopkins-cepar.org/downloads/publications/
Applying_Perception.pdf.
10. Benedek DM, Fullerton C, Ursano RJ. First responders: mental health consequences of natural and human-
made disasters for public health and public safety workers. Annu Rev Public Health 2007;28:5568.
11. National Institute of Mental Health. Post-traumatic stress disorder. NIH Publication No. 08-6388. [online].
[cited 2014 May]. Available from URL: http://nimh.nih.gov/health/publications/post-traumatic-stress-disorder-
ptsd/complete-index.shtml.
12. CDCynergy. Human resources for crisis communication [online]. 2004. [cited 2012 Jul]. Available from URL:
http://www.orau.gov/cdcynergy/erc/Content/activeinformation/essential_principles/EP-hr_content.htm.
13. Council on Foundations. Disaster preparedness and recovery plan, version 1.1. Appendix B6: human
resources coordination checklist [online]. [cited 2012 Jul]. Available from URL: http://www.cof.org/files/
Documents/Community_Foundations/DisasterPlan/DisasterPlan.pdf.

14. Lazar SW, Bush G, Gollub RL, Fricchione GL, Khalsa G, Benson H. Functional brain mapping of the relaxation
response and meditation. Neuroreport 2000 May 15;11(7):15815.
15. Federal Emergency Management Agency (FEMA). Public information officer position checklist [online].
2012 Feb 10. [cited 2012 Jul]. Available from URL: http://training.fema.gov/EMIWeb/IS/ICSResource/assets/
PIO_PCL.pdf.
16. Golding L, Rubin D. Training for public information officers in communication to reduce health disparities: a
needs assessment. Health Promot Pract 2011 May;12(3):40613.
17. U.S. Environmental Protection Agency (EPA). Guidance & tools [online]. 2012 Jul 7. [cited 2012 Jul].
Available from URL: http://www.epa.gov/risk/guidance.htm.
18. American Red Cross. 2011 Annual Report [online]. [cited 2012 Jul]. Available from URL: http://www.redcross.
org/www-files/flash_files/AnnualReport/2011/AnnualReport.pdf.
19. American Red Cross. Connection. Updated guidance for providing post-deployment support to disaster
workers [online]. 2010 April 30 [cited 2012 Jul]. Available from URL: http://www.sccredcross.org/pdf/new%20
DMH%20post%20deploy.NationalARC2010-005%5b1%5d.pdf.
20. American Red Cross Disaster Services. Coping with disaster. For the families of disaster workers. Doc.
No. H20696B [online]. 2010 Feb. [cited 2012 Jul]. Available from URL: http://www.sccredcross.org/pdf/
FamiliesOfWorkersBrochure-3%5b1%5d.pdf.
21. Reynolds BJ. CDC. Crisis emergency risk communication: by leaders for leaders [online]. 2004. [cited 2012
May]. Available from URL: http://emergency.cdc.gov/erc/leaders.pdf.
22. American Red Cross. Taking care of your emotional health after a disaster [online]. [cited 2012 Jul]. Available
from URL: http://www.sccredcross.org/pdf/taking_care_of_your_emotional_healthdb[1].pdf.
23. McCarroll JE, Ursano RJ, Wright KM, Fullerton CS. Handling bodies after violent death: strategies for coping.
Am J Orthopsychiatry [online] 1993 Apr [cited 2012 Jul]; 63(2):20914. PubMed PMID: 8484426. Available
from URL: http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA264372
24. U.S. Department of Health and Human Services (HHS). Substance Abuse and Mental Health Services
Administration (SAMHSA). A post-deployment guide for families of emergency and disaster response
workers. Returning home after disaster relief work. Pub ID:NMH05-0220 [online]. 2005 Jan. [cited 2012 Jul].
Available from URL: http://store.samhsa.gov/shin/content//NMH05-0220/NMH05-0220.pdf.
25. U.S. Department of Labor. Occupational Safety & Health Administration (OSHA). Managing stress during
a crisis: a guide for supervisors. During a crisisat the scene [online]. [cited 2012 Jul]. Available from
URL: http://www.osha.gov/SLTC/emergencypreparedness/resilience_resources/support_documents/
supervisorintra/intradeployment_supervisors.html.

Resources
Burkle FM Jr. Acute-phase mental health consequences of disasters: implications for triage and emergency
medical services. Ann Emerg Med 1996 Aug;28(2):11928.
CDC. National Institute for Occupational Safety and Health (NIOSH). Emergency response resources:
disaster site management [online]. 2012 Jan 30. [cited 2012 Jul]. Available from URL: http://www.cdc.gov/
niosh/topics/emres/sitemgt.html
Federal Emergency Management Agency (FEMA). Designing a national emergency responder credentialing
system. Incident management (IM) working group. IM job title 7: Public information officer [online]. [cited
2012 Jul]. Available from URL: http://www.fema.gov/pdf/emergency/nims/im-job-titles.pdf
Federal Emergency Management Agency (FEMA). Emergency Management Institute. Advanced public
information officer [online course]. 2012 Mar 27. [cited 2012 Jul]. Available from URL:
http://www.training.fema.gov/emicourses/crsdetail.asp?cid=E388&ctype=R.
Foa EB. Trauma and women: course, predictors, and treatment. J Clin Psychiatry 1997;58 Suppl 9:258.
Review. PubMed PMID: 9329448.
International Association of Venue Managers, Inc. Shelter guidance aid and shelter staffing matrix October
2010 [online]. 2010 Oct 23. [cited 2012 Jul]. Available from URL: http://www.iavm.org/cvms/pdf/Sheltering_
Guidance_Aid_October_2010.pdf
North CS, Pfefferbaum B. Research on the mental health effects of terrorism. JAMA 2002 Aug 7;288(5):633
6. PubMed PMID: 12150676.
Sadock BJ, Sadock VA. Kaplan & Sadocks Synopsis of Psychiatry. 10th ed. Philadelphia (PA): Lippincott
Williams & Wilkins: 2007.
Sanders J. First responders: potential victims? Nellis Air Force Base news story [online]. 2012 Jun 5. [cited
2012 Jul]. Available from URL: http://www.nellis.af.mil/news/story.asp?id=123304868.

Notes:

Notes:

Chapter 12:
Understanding Roles of Federal, State,
2014 EDITION and Local Community Health Partners

Chapter 12:
Understanding Roles of
Federal, State, and Local
Community Health Partners
To help explore the interaction of multiple groups during a disaster, this chapter reviews the
roles and relationships of health partner organizations.
The Many Players and Partnerships in Emergency Response

Understanding the communication roles and responsibilities of the federal government and its
counterparts at the state and local levels can be challenging. Various stages of a crisis bring together
many players, agencies, organizations, and interagency partnerships. Each one is responsible for
different, and not necessarily distinct, components of emergencies.
Some of the key federal government agencies that may be involved1 include the following:
Department of Agriculture (USDA)
Department of Defense (DOD)
Department of Energy (DOE)
Department of Homeland Security (DHS), including the Federal Emergency Management

Agency (FEMA)
Department of Justice (DOJ)
Environmental Protection Agency (EPA)
Federal Bureau of Investigation (FBI)
Nuclear Regulatory Commission (NRC)
Within each agency, separate programs or departments may handle different areas of a crisis, including
the following:
Planning Coordination
Preparedness Communication
Training
On-the-scene assistance
Consequence management
349
In addition, nongovernmental organizations (NGOs) and faith-based organizations (FBOs) play a
critical role in most disaster responses. These agencies and groups often have distinct missions,
capabilities, and resources. Each may have a unique voice in the crisis and emergency risk
communication (CERC) process.
Change is a Core Factor

National, state, and local government administrations change. Threats change. New technologies are
developed and deployed. New or re-emerging incidents occur. The way incidents are handled and the
reactions to the way they are handled will vary. These and other factors lead to a constantly changing
environment of roles and responsibilities:
Most federal agencies will not be able to deploy assets during the first 48 hours following the
onset of an event.2,3
Local, state, and territorial emergency communication managers will be first to respond to an
emergency incident until federal assistance can be coordinated and deployed. This happens
because they are close to the scene.
The true first responders will be members of the community itself: friends, family,
and neighbors.4
Existing practice emphasizes the role of local response capacity and the private sector as opposed to
over-reliance on national, public assets.
Community-based Approaches to Emergencies

A basic principle of emergency management is that all disasters are local.2,5,6 They happen at a
specific place and the place is an important factor in the response. Local resources will be the first
deployed to an event. Other important local factors include:
History Values
Traditions Institutions
Most victims of a crisis, for example, are first helped by family, friends, neighbors, coworkers, or
even strangers as opposed to professional first responders.7 Most of the injured or sick will likely be
transported to medical facilities by private transportation. Initially, resources for a response, such as
bottled water and food, will come from private sector organizations within or near the community.
350 Chapter 12 Understanding Roles of Federal, State, and Local Community Health Partners
While federal and state resources and support will arrive, they will not be on the scene for at least
several hours and possibly much longer. People affected by a disaster should be prepared for a 72-hour
delay before federal or state help arrives.
Most government response agencies seek to stabilize the crisis situation so communities can assume
responsibilities. Long-term recovery and rebuilding most often become the primary responsibility of
local and state stakeholders and partners, with some assistance from federal groups.
The realization of what federal agencies can and cannot do has led to new approaches. One example is
community-based disaster preparedness (CBDP), which is increasingly used as a general framework for
promoting local-level capacity building.8
CBDP seeks to develop the knowledge, resources, and capabilities of local communities. This approach
builds on the abilities of NGOs, such as the American Red Cross, Salvation Army, and FBOs, as well as
private-sector organizations, local governments, and businesses. CBDP is based on the realization that
government agencies alone simply cannot achieve significant, sustainable risk reduction nor can they
provide the level of support necessary to respond to major events.9
FEMAs Whole Community Framework

FEMAs whole community approach recognizes that FEMA is not the nations complete
emergency management team. Instead, FEMA regards itself as part of a larger team. In
order to handle all phases successfully, from preparation through recovery, FEMA works
with the entire emergency management community.10
This whole community includes:
FEMA and other U.S. federal agencies
State, territorial, tribal, and local governments
NGOs and businesses
Individuals, families, and communities, who are the biggest assets in emergency
preparedness and response
Another approach to emergencies is community resilience.11 This approach suggests communities

may develop features and resources allowing them to reduce risks, respond more effectively, and
recover more quickly.
Chapter 12 Understanding Roles of Federal, State, and Local Community Health Partners 351
The National Strategy for Public Health and Medical Preparedness states: Where local civic leaders,
citizens, and families are educated regarding threats and are empowered to mitigate their own risk,
where they are practiced in responding to events, where they have social networks to fall back upon,
and where they have familiarity with local public health and medical systems, there will be community
resilience that will significantly attenuate the requirement for additional assistance.12
In a majority of cases, community members, family, friends, coworkers, neighbors, and even strangers
will provide initial medical aid. In the case of severe disease outbreaks or epidemics, volunteers can run
vaccination clinics, check in on home-bound neighbors and members of the community, and provide
support to home-bound patients.
CBDP approaches are diverse because they must be matched to local community conditions. They can
be facilitated through a number of activities. These activities should involve the community leaders,
institutions, businesses, partners, and stakeholders.
Community Preparedness
Communities, local organizations, and community health partners can do a great deal to enhance
preparedness, including developing plans and stockpiling resources such as water, food, and batteries.
Significant efforts have been directed toward encouraging preparedness through communication such
as the Ready.gov campaign.13 One of the first steps in building community preparedness is to collect
information about risks, resources, and response strategies:
Inventory of information about risks to the community:
yy Identify the risks a community is most likely to face.

yy Compile information about the geographic location, site-based risks, history of events, and
vulnerable populations. All of these may influence CBDP strategies.
yy Use this information to help in developing risk communication strategies.
Information and data about available community resources:
yy Inventory local resources, capacities, and expertise that might be needed in disaster response.
yy Use this inventory to help identify deficiencies and increase the speed with which community
resources can be deployed.
Strategies for risk reduction:
yy Make long-term plans to reduce risks, such as the following:
Develop flood mitigation strategies.
Build schools a safe distance from industrial sites.
Undertake fire reduction activities.
yy Communicate about risks with stakeholders and partners.
Communities that are connected via networks are more resilient.11 One of the most important
components of community preparedness is building integrated communication networks, both formal
and informal. Communities that have well-integrated networks are able to pass information more
quickly and with greater efficiency. These networks also can withstand technological disruptions by
passing information through alternative means. For example, word of mouth between trusted neighbors
can be used to pass information when radio and television broadcasting is disrupted.
Developing networks between community groups, FBOs, NGOs, institutions, and businesses, as
well as governmental agencies, can significantly bolster resilience.14 To help build, integrate, and
sustain your community networks, involve these groups in your CERC preparedness activities,
including the following:
Planning activities
Tabletop exercises and full-scale drills
After-action debriefs
Japans Disaster Prevention Day

Japan is known around the world as a leader in disaster preparedness. Every September
1 since 1960, Japan marks the anniversary of the Great Kanto earthquake of 1923 with
Disaster Prevention Day.
Like the U.S. and other countries, this helps government agencies and other response
partners practice using disaster response plans and communication warning systems such
as earthquake early warnings and the tsunami warning service.
Unlike the U.S., the Japanese government involves its citizens and businesses in their
nationwide drills. Disaster drills also include evacuation drills at schools. Public and
private organizations practice transporting stranded commuters from the office to home.15
In 2010, the disaster drill contained a scenario in which three massive and simultaneous
earthquakes struck a wide area in central Japan, involving 670,000 citizens in Tokyo and
34 prefectures around the country.16
Information learned at these drills has resulted in updates to response plans and building
codes, and investments in early warning systems. These drills have also created a
culture of preparedness and have kept people vigilant in realizing that the next big one
could come at any time. Although the 2011 earthquake and tsunami resulted in tens of
thousands of deaths, the public education program and annual drills most likely helped
save many thousands of lives.17
While local- and community-based strategies are critical, its important to understand and plan
for national and international organizations to be involved in your response. These could include
government agencies, NGOs, or FBOs. They will be among the primary groups you will be coordinating
and communicating with during an emergency response.
The environment in which you will be assigning roles and responsibilities while developing a
communication plan is constantly changing. The best CERC plans include adaptive strategies and
flexibility.18 Federal, state, county, territory, and city agencies all adapt to changing environments,
priorities, and budgets when it comes to CERC planning. While many organizations and agencies
provide recommendations, sample plans, training, and assistance, there is no prescribed best way
for departments of health to assign roles and responsibilities when generating communication plans.
However, there are recommendations and tools that can help facilitate your assignment decisions.
List of International Agencies, Federal Agencies,

NBOs, and FBOs
The remainder of this chapter is devoted to providing more details about federal and international roles
and responsibilities and related Internet resources you can use for developing CERC plans. Because
of changes in the structures and staffing of agencies and organizations, websites are provided, but not
detailed contact information. Use the following resources as the basis for preparing communication
plans, but supplement these resources by gathering additional contact information and information
about state-specific resources.
These agencies include international organizations, U.S. federal agencies, NGOs, and FBOs.
Table 121. Response Agencies (not an all-inclusive list)
Agencies
International Agencies 1. World Health Organization (WHO) http://www.who.int/en
2. Health Canada (HC) http://www.hc-sc.gc.ca
3. The Public Health Agency of Canada (PHAC) http://www.phac-aspc.gc.ca
Continued...
Agencies
U.S. Federal Agencies 1. Department of Homeland Security (DHS) http://www.dhs.gov
a. Federal Emergency Management Agency (FEMA) http://www.fema.gov
b. U.S. Coast Guard http://www.uscg.mil
c. U.S. Customs and Border Protection (CBP) http://www.cbp.gov
d. Transportation Security Administration (TSA) http://www.tsa.gov
2. Department of Health and Human Services (HHS) http://www.hhs.gov
a. Agency for Toxic Substances and Disease Registry (ATSDR)
http://www.atsdr.cdc.gov
b. Centers for Disease Control and Prevention (CDC) http://www.cdc.gov
3. Central Intelligence Agency (CIA) http://www.cia.gov
4. Department of Agriculture (USDA) http://www.usda.gov
5. Department of Defense (DOD) http://www.dod.gov
6. Department of Energy (DOE) http://www.energy.gov
7. Department of the Interior (DOI) http://www.doi.gov
8. Department of Justice (DOJ) http://www.justice.gov
9. Department of State (DOS) http://www.state.gov
10. Department of Transportation (DOT) http://www.dot.gov
11. Environmental Protection Agency (EPA) http://www.epa.gov
12. Nuclear Regulatory Commission (NRC) http://www.nrc.gov
13. U.S. National Response Team http://www.nrt.org
NGOs 1. American Red Cross http://www.redcross.org

2. Humane Society of the U.S. (HSUS) http://www.humanesociety.org
3. National Voluntary Organizations Active in Disasters (NVOAD)
http://www.nvoad.org
International Health Regulations
(http://www.who.int/ihr/en/index.html)
International Health Regulations apply when countries face a public health emergency of international
concern. These regulations provide a framework for affected nations to coordinate management of
these events. For participating countries, these regulations are legally binding. They improve the ability
of nations to do the following:
Detect public health threats
Assess the significance of public health threats
Notify other nations who may be affected by a public health threat
Respond to public health threats
Countries that participate are listed as States Parties to the International Health Regulations.19 When
countries do participate, they have 2 years to accomplish two goals:
Assessment of national capacity for public health surveillance and response
Development of national action plans for implementing and meeting the requirements of
these regulations
After these two goals are accomplished, participating countries have 3 years to meet specific
requirements described by the regulations. These requirements address the following:
National surveillance and response systems
Rules regarding designated airports, ports, and certain ground crossings
If needed, participating countries may have their deadlines extended by 2 years. For exceptional
circumstances, they may have their deadlines extended by up to an additional 2 years.
Federal Emergency Management Agency (FEMA)
(http://www.fema.gov)
FEMA is the federal agency charged with building and supporting the nations emergency management
system. FEMAs mission is to reduce the loss of life and property and protect communities nationwide
from all hazards, including natural disasters, acts of terrorism, and other manmade disasters. FEMA
leads and supports the nation in a risk-based, comprehensive emergency management system of
preparedness, protection, response, recovery, and mitigation.
FEMA tools and resources include the following:
National Response Framework (NRF)

(http://www.fema.gov/emergency/nrf/)
This framework presents the guiding principles for all response partners to prepare for and provide a
unified national response to disasters and emergencies. It applies for all disasters and emergencies, from
the smallest incident to the largest catastrophe. It establishes a comprehensive, national, all-hazards
approach to domestic incident response.
NRF, the Emergency Support Function (ESF) Annex #8

(http://www.fema.gov/pdf/emergency/nrf/nrf-esf-08.pdf)
For this component of NRF, FEMA works with HHS, the lead agency for ESF #8. This is the public
health and medical services component. It provides the mechanism for coordinated federal assistance to
supplement state, tribal, and local resources in response to the following:
A public health and/or medical disaster
A potential or actual incident requiring a coordinated federal response
A developing potential health or medical emergency
NRF, Public Affairs Support Annex

(http://www.fema.gov/pdf/emergency/nrf/nrf-support-pa.pdf)
According to FEMA, This Public Affairs Support Annex describes the interagency policies and
procedures used to rapidly mobilize federal assets to prepare and deliver coordinated and sustained
messages to the public in response to incidents requiring a coordinated federal response.
Excerpt from the NRF Public Affairs Support Annex
During an incident, federal, state, tribal, and local authorities share responsibility for
communicating information regarding the incident to the public. These actions are a
critical component of incident management and must be fully integrated with all other
operational actions to ensure the following objectives are met:
Delivery of incident preparedness, health, response, and recovery instructions

to those directly affected by the incident
Dissemination of incident information to the public, including special
needs populations
The Joint Information Center (JIC) structure provides a supporting mechanism to

develop, coordinate, and deliver messages. It supports the Incident Commander or
Unified Command and the associated elements of the Incident Command System.
A federal core group develops, coordinates, and delivers information and instructions
to the public related to:
Federal assistance to the incident- National preparations

affected area
Protective measures
Federal departmental/agency
Impact on nonaffected areas
response
Federal law enforcement activities
Assignments to this core group are determined by the DHS Office of Public Affairs
(OPA) in accordance with jurisdictional and statutory responsibilities, operational
tasks, areas of expertise and responsibility, and the nature and location of the incident.
NRF, Incident Annexes
(http://www.fema.gov/emergency/nrf/incidentannexes.htm
The Incident Annexes describe the concept of operations to address specific contingency or hazard
situations. They also address elements of an incident requiring specialized application of the framework.
Incident annexes include the following types of incidents:
Biological Mass evacuation
Catastrophic Nuclear or radiological
Food or agricultural Terrorism
National Preparedness Directorate (NPD)

(http://training.fema.gov/)
NPDs online course catalog provides searchable, integrated information about courses provided or
managed by FEMAs Center for Domestic Preparedness, the Emergency Management Institute, and the
National Training and Education Division.

(http://www.hhs.gov)
HHS is the U.S. governments principal agency for protecting the health of all Americans. The operating
divisions within HHS perform a wide variety of tasks including research, public health, food and drug
safety, and emergency preparedness and response. HHS is the primary agency for coordinating health,
medical, and health-related social services under the national response framework.
HHS provides the following tools and resources:
Office of the Assistant Secretary for Preparedness and Response (ASPR)

(http://www.phe.gov/about/pages/default.aspx)
This office was formerly known as the Office of Public Health Emergency Preparedness. ASPR was
created under the Pandemic and All Hazards Preparedness Act in the wake of Hurricane Katrina. ASPR
leads the nation in preventing, preparing for, and responding to the adverse health effects of public
health emergencies and disasters.
ASPR is focused on the following:
Preparedness planning and response
Building federal emergency medical operational capabilities
Countermeasures research, advance development, and procurement
Grants to strengthen the capabilities of hospitals and health-care systems in public health
emergencies or medical disasters.
The office provides federal support, including medical professionals, through ASPRs National Disaster
Medical System, to augment state and local capabilities during an emergency or disaster. Although
ESF #8 is part of DHS National Response Framework, HHS is the lead agency for ESF #8 under the
Pandemic and All Hazards Preparedness Act.20 The Secretary of Health and Human Services delegates
to ASPR the leadership role for all health and medical services support functions in a health emergency
or public health event.
HHS National Disaster Medical System (NDMS)

(http://www.phe.gov/preparedness/responders/ndms/Pages/default.aspx)
NDMS is a federally coordinated system that augments the nations emergency medical response
capability. The overall purpose of NDMS includes the following:
To supplement an integrated national medical response capability for assisting state and local
authorities in dealing with the medical impacts of major peacetime disasters
To provide support to the military and the Department of Veterans Affairs medical systems in
caring for casualties evacuated back to the U.S. from overseas armed conventional conflicts
ASPR Response Playbooks

(http://www.phe.gov/Preparedness/planning/playbooks/Pages/default.aspx)
These playbooks provide strategic guidance for ESF #8 responses. They outline key options and
recommended actions to support the HHS Secretary (or designee) in directing and coordinating the
response to disasters and public health emergencies.
They are written at a strategic level to highlight key decision points, actions, capabilities, and assets
that may be required to support an incident response. The playbooks contain a concept of operations
that outlines the phases of the response and identifies specific action steps for each phase. All federal
ESF #8 partners are included in identifying how the synchronized federal capabilities might be used to
support a state response. The playbooks primary focus is the following:
To enhance preparedness for response
To enhance the transition to recovery, including the following:
yy Alert yy Deployment
yy Activation yy Deactivation and demobilization of
federal ESF #8 resources
Agency for Toxic Substances and Disease Registry (ATSDR)

(http://www.atsdr.cdc.gov/)
ATSDR is an agency of the U.S. HHS. It serves the public by using the best science, taking responsive
public health actions, and providing trusted health information to prevent harmful exposures and
diseases related to toxic substances.
ATSDR is directed by congressional mandate to perform specific functions concerning the public health
effects of hazardous substances in the environment. These functions include the following:
Public health assessments of waste sites
Health consultations concerning specific hazardous substances
Health surveillance and registries
Response to emergency releases of hazardous substances
Applied research in support of public health assessments
Information development and dissemination
Education and training concerning hazardous substances
Centers for Disease Control and Prevention (CDC)

(http://www.cdc.gov)
CDC is recognized as the primary federal agency for protecting the health and safety of people, at home
and abroad. It provides credible information to enhance health decisions and promote health through
strong partnerships. CDC activities include the following:
Disease prevention and control
Environmental health
Health promotion and education
In addition, CDC serves as the national focal point for improving the health of Americans and supporting
specific global health efforts, such as aid to Haiti following the earthquake in 2010, assistance to Japan
following the tsunami in 2011, and global support for the eradication of polio.
CDC Tools and Resources include the following:
CDC Public Health Emergency Preparedness and Response website

(http://emergency.cdc.gov/)
This is an Internet resource that provides information addressing the following:
yy Public health emergencies
yy Training for specific emergencies and for public health officials
yy CDC contact information for emergencies
yy Other important information dealing with the public health aspects of emergency
preparedness and response
Funding, Guidance, and Technical Assistance to States, Localities, and Territories

(http://www.cdc.gov/phpr/coopagreement.htm)
All response to public health emergencies begins at the local level. Shortly after the terrorist attacks
on September 11, 2001, and the subsequent anthrax attacks, Congress appropriated funding to CDC
to support preparedness for emergencies at public health departments nationwide.
CDC plays a pivotal role in ensuring that state and local public health systems are prepared. This
is based on CDCs unique ability to respond to infectious, occupational, or environmental incidents
that affect the publics health.
CDCs Office of Public Health Preparedness and Response, Division of State and Local Readiness,
administers this funding through the Public Health Emergency Preparedness (PHEP) cooperative
agreement. Through the PHEP agreement, CDC helps public health departments strengthen their
abilities to respond to all types of public health incidents and build more resilient communities.
The CDC Interim Recommended Notification Procedures for Local and State Public
Health Department Leaders in the Event of a Bioterrorist Incident Public Health
Emergency Preparedness and Response
(http://emergency.cdc.gov/eMContact/Protocols.asp)
This is a Web resource that provides a flowchart of recommended notification procedures. It begins
with a local health official either learning of or suspecting a bioterrorist threat or incident.
Conclusion
All disasters are local. People must first rely on local community resources. Well-integrated local
communication networks are critical to creating resilient communities. A variety of response agencies
will likely be involved in any disasters or crises as communicators and response partners. The variety of
agencies and NGOs can be overwhelming and confusing. However, each brings unique resources and a
distinct voice to the response. Including these organizations in your CERC plan is one important key to
a successful response.
References
1. USA.gov. Disasters and emergencies [online]. 2012 Apr 26. [cited 2012 Jul]. Available from URL: http://www.
usa.gov/Citizen/Topics/PublicSafety/Disasters.shtml.
2. Federal Emergency Management Agency (FEMA). Are you ready? A message from Regional Administrator
MaryAnn Tierney [online]. 2012 Jan 6. [cited 2012 Jul]. Available from URL: http://www.fema.gov/about/
regions/regioniii/ready.shtm.
3. Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Health care at the crossroads:
strategies for creating and sustaining community-wide emergency preparedness systems [online]. 2003.
[cited 2012 Jul]. Available from URL: http://www.jointcommission.org/assets/1/18/emergency_preparedness.
pdf.
4. American Red Cross. More Americans using social media and technology in emergencies [online press
release]. Washington, DC; 2011 Aug 24. [cited 2012 Jun]. Available from URL: http://www.redcross.org/portal/
site/en/menuitem.94aae335470e233f6cf911df43181aa0/?vgnextoid=7a82d1efe68f1310VgnVCM10000089f087
0aRCRD.
5. Pittman E. Remember: all disasters are local, says FEMA deputy administrator. Emergency Management
[online]. 2011 Nov 22. [cited 2012 Jul]. Available from URL: http://www.emergencymgmt.com/disaster/
Remember-All-Disasters-Are-Local-Says-FEMA-Deputy-Administrator.html.
6. Singleton C. Johns Hopkins Bloomberg School of Public Health. Developing an emergency preparedness
plan: one local health departments approach [online course]. 2012. [cited 2012 July]. Available from URL:
http://www.jhsph.edu/research/centers-and-institutes/johns-hopkins-center-for-public-health-preparedness/
training/online/develop_health_dept_plan.html.
7. Auf der Heide E. Common misconceptions about disasters: panic, the disaster syndrome, and looting. In:
OLeary M, editor. The first 72 hours: a community approach to disaster preparedness. Lincoln: iUniverse
Publishing; 2004. p. 34080. Available from URL: http://www.atsdr.cdc.gov/emergency_response/common_
misconceptions.pdf.
8. Office of the Assistant Secretary of Defense for Nuclear, Chemical, and Biological Defense Programs.
Chemical and Biological Defense (OASD[NCB/CBD]) [online]. [cited 2012 Jul]. Available from URL: http://
www.acq.osd.mil/cp/.
9. Troy DA, Carson A, Vanderbeek J, Hutton A. Enhancing community-based disaster preparedness with
information technology. Disasters 2008 Mar;32(1):14965.
10. U.S. Department of Homeland Security (DHS). Statement of Craig Fugate, Administrator, Federal
Emergency Management Agency, before the U. S. House Transportation and Infrastructure Committee,
Subcommittee on Economic Development, Public Buildings, and Emergency Management on improving
the nations response to catastrophic disasters: how to minimize costs and streamline our emergency
management programs [online]. 2011 Mar 30. [cited 2012 Jul]. Available from URL: http://www.dhs.gov/
ynews/testimony/testimony_1301491494739.shtm.
11. Gurwitch RH, Pfefferbaum B, Montgomery JM, Klomp RW, Reissman DB. Terrorism and Disaster Center.
Building community resilience for children and families [online]. Oklahoma City (OK): Terrorism and Disaster
Center at the University of Oklahoma Health Sciences Center: 2007 [cited 2012 July]. Available from URL:
http://www.nctsnet.org/nctsn_assets/pdfs/edu_materials/BuildingCommunity_FINAL_02-12-07.pdf.
12. Bush GW. Homeland Security presidential directive 21 (HSPD-21): national strategy for public health and
medical preparedness [online press release]. Washington, DC; 2007 Oct 18. [cited 2012 Jul]. Available from
URL: http://www.fas.org/irp/offdocs/nspd/hspd-21.htm.
13. Ready.gov [Internet]. Be informed, make a plan, build a kit, get involved, business, kids [online]. 2012 Jun 11.
[cited 2012 July]. Available from URL: http://www.ready.gov/.
14. CDC Foundation. Meta-Leadership Summit Resource Center. An organizing guide for planning a meta-
leadership event in your community [online]. [cited 2012 Jul]. Available from URL: http://www.cdcfoundation.
org/meta-leadership.
15. Rauhala E. How Japan became a leader in disaster preparation. Time [online]. 2011 Mar 11. [cited 2012 Jul].
Available from URL: http://www.time.com/time/world/article/0,8599,2058390,00.html.
16. The Yomiuri Shimbun. Govt holds 1st triple-earthquake drill. Daily Yomiuri [online]. 2010 Sep 2. [cited 2012
Jul]. Available from URL: http://www.yomiuri.co.jp/dy/national/T100901006244.htm.
17. Glanz J, Onishi N. Japans strict building codes saved lives. The New York Times [online]. 2011 Mar
11. [cited 2012 May]. Available from URL: http://www.nytimes.com/2011/03/12/world/asia/12codes.
html?pagewanted=all.
18. Reynolds B. Crisis and emergency risk communication: pandemic influenza [online]. 2007. [cited 2012 Jul].
Available from URL: http://emergency.cdc.gov/cerc/pdf/CERC-PandemicFlu-OCT07.pdf.
19. World Health Organization (WHO). States parties to the international health regulations 2005 [online]. 2012.
[cited 2012 Jul]. Available from URL: http://www.who.int/ihr/legal_issues/states_parties/en/.
20. U.S. Department of Health & Human Services (HHS). Public Health Emergency.gov. Pandemic and All
Hazards Preparedness Act (PAHPA) [online]. 2010 Aug 11. [cited 2012 Jul] Available from URL: http://www.
phe.gov/preparedness/legal/pahpa/pages/default.aspx.
Resources
Nolte J. Enhancing interdisciplinary collaboration in primary health care in Canada. EICP Initiative
[online]. 2005 Apr. [cited 2012 Jul]. Available from URL: http://www.eicp.ca/en/resources/pdfs/enhancing-
interdisciplinary-collaboration-in-primary-health-care-in-canada.pdf.
Pfefferbaum BJ, Reissman DB, Pfefferbaum RL, Klomp RW, Gurwitch RH. Building resilience to mass trauma
events. In: Doll LS, Bonzo SE, Mercy JA, Sleet DA, Haas EN, editors. Handbook of injury and violence
prevention. Atlanta (GA): Springer Science+Business Media, LLC; 2007. p, 347358. DOI: 10.1007/978-0-387-
29457-5_19.
Reid M. Survivors perceptions of federal and non-governmental responses to Hurricane Katrina [online]. 2007
Apr. [cited 2012 Jul]. Available from URL: http://www.colorado.edu/hazards/awards/paper-competition/reid.pdf.
Williams JR, Edwards JC, Silenas R, Kang JE, Akins R. Study of disease surveillance policy issues across the
international borders of the United States [online]. 2006 Apr. [cited 2012 Jul]. Available from URL:
http://www.borderhealth.org/files/res_760.pdf.
World Health Organization (WHO). Working for health: an introduction to the World Health Organization.
Geneva, Switzerland: WHO; 2007. Available from URL: http://www.who.int/about/brochure_en.pdf.
Notes:
Notes:
Chapter 13:
Media and Public Health Law
2014 EDITION

Chapter 13:
Media and Public Health Law
The following chapter describes some of the most relevant laws and legal issues that relate to
crisis and emergency risk communication (CERC) during public health emergencies, including:
Freedom of speech and the press
Laws of defamation
Copyright law
The publics right to know
Freedom of Information Act
Health Insurance Portability and Accountability Act privacy regulations
Public health laws
Public health powers and liabilities
State public health emergency powers
Understanding the Legal Environment

During public health emergencies, it is essential for CERC communicators to be aware of the law
and comply with it. A multitude of legal requirements may apply to CERC activities, including laws
addressing access to information, privacy, and public health powers.
If you understand the content of relevant laws and how to apply them, you will be better able to make
good communication decisions. You will be more skilled at determining what information can and
cannot, and should and should not, be shared with the media and the public. You will also have a better
understanding of the legal basis for decisions your organization may makedecisions you may have to
explain to the public.
Freedom of Speech and the Press

The United States Constitution grants strong protections for freedom of speech and the press. The First
Amendment states: Congress shall make no law abridging the freedom of speech, or of the press ...1
Freedom of speech and freedom of the press have been recognized as fundamental rights, but they are
not absolute. Laws can constitutionally limit speech and press activities if they meet a compelling state
interest and are narrowly tailored to achieve that interest. There is no right to break the law to obtain or
disseminate news.
369
Espionage Law and the News Media
The Espionage Act of 1917 has been used to prosecute people who pass military secrets to other
countries. In 1985, the act was used for the first time to prosecute and convict a government employee
for disclosing information to the news media, rather than to agents of a foreign government.2,3 The
conviction was upheld on appeal. The Act is still being used in cases where government employees
divulged classified information to the media or to others who are not authorized for classified
information. In 2010, a government contract employee was indicted for releasing national defense
information to a reporter4 and, in the same year, charges were brought against several individuals in
relation to the WikiLeaks scandal.5 These developments could be seen as a warning to those who may be
tempted to leak classified information to reporters, no matter their motives.
Laws of Defamation
Knowledge of defamation law is important for those involved in any kind of public communication.6
Any communicator who feels compelled to report, in tangible form or in a broadcast, that an identifiable
person or business may be involved in illegal, unethical, immoral, or dishonest activity risks being sued
for defamation.7
Defamation
Defamation is communication that does the following:
Exposes an individual (or organization) to hatred or contempt
Lowers an individual in the esteem of others
Causes an individual to be shunned
Injures an individual in his business
Defamation has two forms:
Slander: This is spoken defamatory communication in the presence of others.

Slander is not published or broadcast.
Libel: This is published or broadcast defamatory communication.
The following conditions must be met before a statement is held legally libelous:
Publication: The defamatory statement must be published or broadcast.
Identification: The communication must identify a person, persons, or entity by

name or obvious suggestion.
Continued...
370 Chapter 13 Media and Public Health Law

Fault: The plaintiff has to prove that the defendant was negligent or reckless (i.e.,
that the defendant was at fault).
Falsity: The statement must be false. True statements cannot be considered libel. In
addition, the lie must be stated as fact.
Injury: The defamatory statement has to have potential to cause injury. Injury is
often assumed to have occurred if the statement insinuated a crime, a loathsome
disease, immorality, or caused harm to ones business or job performance.
Although any form of defamation is serious, libel is considered more serious than
slander because libel is:
Intentional: Libel is more intentional than slander because the forethought involved
in writing and editing precedes the deliberate act of publishing or broadcasting.
Widespread: Libel is more widespread than slander because it reaches a much
larger audience through publication or broadcast.
Permanent: Libel is more permanent than slander because printed publications,
broadcast audio recordings, and broadcast video recordings remain in existence,
unlike the spontaneously spoken word.
The common law permits victims of harmful words to sue their detractors and recover sums of money
for their loss of reputation. However, the First Amendment protects the media against libel actions
brought by public officials, even when the official has been the victim of a lie.
Officials cannot recover damages unless they can prove that the publisher knowingly published a lie or
showed reckless disregard for the truth.8 Private individuals may have difficulty recovering damages for
libel if the information revealed about them is a matter of public concern, a situation likely to be the
case during public health emergencies.
Retractions
One possible way to resolve an allegation of defamation is to publish a retraction. Laws vary by state,
but in many states retractions are a partial defense, provided the retraction appears with the same
prominence as the original. Some states have time limits for requesting and printing retractions. Other
states allow media outlets to run retractions to avoid paying certain damages.
Chapter 13 Media and Public Health Law 371

Defamation and the Internet
The development of the Internet, social media, and other technological advances expands the ability
to rapidly disseminate information online. The rapid spread of rumors and uncertain information could
lead to defamation allegations. While there is little precedent in this context, online statements could
constitute defamation. One court found that Internet service providers could not be held liable for
defamation based on posts hosted on the server.9
Defamation in Emergency Response

During emergency responses, anyone communicating information or reporting on events should
use caution to avoid engaging in defamation. For instance, statements warning the public about a
specific individual spreading an infectious disease or a business location that has been contaminated
by toxic substances could give rise to libel allegations. However, so long as the information revealed
is a matter of public concern, there will be a strong case against liability for libel. If feasible, anyone
communicating information that could give rise to a defamation claim should consult with an attorney
before releasing the information.
Copyright Law
Copyright allows a writer, composer, artist, or photographer to own, control, and profit from the
production of his or her work. Copyrighted material may not be republished without the copyright
owners permission. Often, you must pay to use the copyrighted work. Copyright law does not apply
to the following:
Facts Methods
Events Systems
Ideas Blank forms
Plans Titles
The fact that copyrighted materials are located online does not allow use of those materials without
the authors permission. Online materials retain their copyright protection. Users should assume that
materials found online through the Internet or other online services are copyrighted unless they are
clearly works of the U.S. government or otherwise noted to be in the public domain.
Works created by federal employees as part of their employment are considered works of the U.S.
government.6,10 Copyright protection is not available for these works in the U.S. The U.S. government
may receive and hold copyrights transferred to it by assignment, bequest, or otherwise.

Copyright Limitations: Fair Use
In general, the owner of the copyright has exclusive rights to the copyrighted work. However, the
act permits fair use for certain purposes such as teaching, scholarship, or research. Fair use
permits one author, composer, or artist to borrow limited amounts of material from another without
seeking permission.
Consider the following factors to determine what constitutes fair use:11
The purpose and character of the use, including whether such use is of a commercial
nature or is for nonprofit educational purposes
The amount and substantiality of the portion used in relation to the copyrighted work
as a whole
The effect of the use upon the potential market for or value of the copyrighted work
The nature of the copyrighted work, including whether the work is creative or factual
Examples of fair use by the government include the following:
Photocopying where copies are distributed to a discrete and limited audience within the
government, as opposed to copies that are sold or distributed broadly outside the government
Copying that is done spontaneously for the purpose of facilitating an immediate and
discrete objective, as opposed to the systematic archival copying of extensive materials
for possible future use
The Publics Right to Know

When releasing information, elected officials and civil servants must weigh the publics right to know
against the need for national security and individual privacy. Citizens expect government officials to be
transparent and accountable in their decisions. This is often referred to as a right to know about the
government activities.
The publics right to know generally is not recognized as a legal concept supported by the Constitution
or an Act of Congress. Instead, it is a concept designed to promote trust and support of the government
from those it governs.

Emergency Planning and Community Right-to-Know Act12
This is one example where the public does have a legal right to know. This act imposes
the following:
Legally mandated reporting standards on facilities involved with hazardous

chemicals.
Emergency preparedness requirements on state, local, and tribal governments to
plan for emergencies caused by the release of hazardous chemicals.
The public has the ability to access information regarding hazardous materials in their
communities and the emergency planning that is in place should any spill or misuse occur.
Similar reporting requirements exist in the Clean Air Act13 and Oil Pollution Act.14
Keeping certain sensitive information secret is of utmost importance to the defense and operation of
our government. The need to know concept is used to keep sensitive information in the hands of those
whose duties require its use and away from potential U.S. enemies.6
Finding the balance between what the public has a right to know and what is in the best interest of
national security can be difficult during an emergency. CDC has guidelines in place to help with these
difficult decisions.
CDC will make available timely and accurate informationthrough proactive news releases or in
response to specific requestsso that the public, Congress, and the news media may assess and
understand its scientifically-based health information and programs. CDC uses the following principles:
Final reports, information, and recommendations will be made fully and readily available.
Communication will be open, honest, and based on sound science, conveying accurate
information.
Information will not be withheld solely to protect CDC or the government from criticism or
embarrassment.
Information will be released consistent with the Freedom of Information Act (FOIA).15
Prevention messages will be based on supportable scientific data and sound behavioral and
communication research principles. At all times, health messages will remain scientifically valid
and accurate.

CDC will honor embargo agreements with standards of peer-reviewed periodicals in the
scientific and medical communities.
Targeted health messages will be sensitive to language and cultural differences and community
norms.
Public Record Laws

Open meeting laws now in effect in every state have been enacted in an effort to end the practice of
conducting public business behind closed doors. Statutes in all states give reporters and the public
access to most state and local records and to meetings of deliberative bodies, including city and county
councils, school boards, and the boards of trustees of state universities.16
Other kinds of records may or may not be freely available for public inspection. These include
the following:
Birth and death certificates Accident reports
Complaints filed with police Welfare rolls
Access depends on whether a law defines them as public records, or whether courts applying common
law, have defined them as such. These laws require legislative and administrative bodies to meet in
public. Closed meetings can be permitted only for limited purposes. Most such laws define a public
agency in broad enough terms to include any agency spending public funds.
Public records laws define a right of access for all persons, including journalists. The media are not
granted any additional right of access beyond that of the general public to government materials. Legal
precedent, however, supports the medias right to publish secret materials, if they can be obtained. For
example, even when state laws prevent release of names of juvenile offenders, the Supreme Court has
upheld that journalists can publish their names.
Freedom of Information Act (FOIA)15

A fundamental principle of democracy is that citizens be informed about their government. FOIA
ensures that the federal government provides the public with requested information to the maximum
extent possible. All records in a federal agencys possession that are not already in the public domain,
such as those available in the library or available from a clearinghouse, are subject to FOIA. The act
requires that federal agencies make the following information available for inspection and copying:
Decisions of administrative tribunals
Policy statements
Staff manuals of instruction affecting the public

The federal FOIA does not apply to state and local governments. Instead, state and local governments
are covered by their own freedom of information laws, which vary from state to state and city to city.
The federal FOIA also does not cover local branches of federal agencies.
FOIA cannot be used to obtain documentary information in the possession of the following persons
or organizations:
The President and his advisers
Congress, its committees, and the few agencies under its direct control, principally the Library
of Congress and the General Accounting Office
The federal judicial system
No forms are necessary to request information under FOIA. Seekers need only write a letter with as
much detail as possible about the records they want. Using FOIA to obtain a persons medical records is
more difficult, and executive agencies are exempt.
These types of records may be particularly of interest during a public health emergency.
To request records on a minor (a person less than 18 years of age), the consent form must be signed
by the minors parent or guardian. The relationship between the minor and the person signing must be
noted on the consent form.
Several types of information are exempt from FOIA requirements and can be withheld (in other
words, not disclosed). If you intend to withhold information, it must fall under at least one exemption.
Exemptions are categories of records that an agency is allowed to or must withhold from release.
Records withheld by CDC/Agency for Toxic Substances and Disease Registry usually fall into the
following exemption categories:
Records (including personnel, medical, and similar files) whose release would constitute a
clearly unwarranted invasion of privacy.17
Records containing confidential business information or inter- or intra-agency records of a
pre-decisional nature, which typically contain the opinions, conclusions, or recommendations
of the author(s) and are part of the decision-making or policy-making process of the agency
(Additionally, trade secrets and commercial or financial information obtained with the assurance
that it will be kept confidential are exempted from disclosure because they could cause
substantial competitive harm if disclosed. This information includes secret formulas, customer
lists, and sensitive financial information and potentially could encompass information about
pharmaceutical products in short supply during an emergency.)
Records whose release is prohibited by a law (other than FOIA).

A few additional FOIA exemptions18 that may be relevant during and emergency are listed below:
Materials properly classified under executive order to be kept secret in the

interest of national defense or foreign policy: This includes information that
could jeopardize national security. Documents properly classified as Top Secret, Secret, or
Confidential are not releasable. The designation For Official Use Only is not a national security
classification and cannot be used as the sole basis for withholding information.
Internal personnel rules and practices of an agency: Reports related solely to the
internal personnel rules and practices of an agency do not have to be released. This provision
is designed to relieve the government of the burden of maintaining routine material for public
inspection.
Certain agency memorandums and letters: Memorandums and letters within or between
agencies that would not ordinarily be available to outsiders except in connection with a lawsuit
are exempt.
Investigatory records compiled for law enforcement purposes: However, the law does
require disclosure of records if they do not do the following:
yy Interfere with an ongoing investigation yy Invade privacy
yy Identify confidential sources or methods yy Interfere with a fair trial

of gathering information
yy Endanger lives
Certain information regarding wells: Geological and geophysical information and data,
including maps, that concern wells are exempt.
In response to FOIA requests, agencies may delete information from documents they send to the seeker
if that information clearly would invade an individuals privacy. They must explain such deletions in
writing. The agency also may refuse to release information that it believes to be covered by one of the
exemptions. However, even when documents are withheld, the agency is required to describe them in a
general way and give its reasons for denying access to them. Such a report is called a Vaughn index.
Requests for information do not have to be justified. These requests must be decided upon within 10
working days. If the agency decides not to release information, the seeker is entitled to appeal to an
agency review officer, and the appeal must be granted or denied within 20 working days. If the law is
observed, the maximum delay is limited to 30 working days, or 6 weeks.
Because some agencies have been overwhelmed with large numbers of requests or requests for huge
volumes of documents, the law permits a 10-day extension. Agencies are permitted to charge fees
to recover direct costs, such as employee labor and copying costs required to fulfill the request. If a
request is deemed to be in the public interest, the agency can reduce, or even waive, its fee.

Privacy Act of 1974
The Federal Privacy Act of 1974 is designed to prevent disclosure by government agencies of personal
data about employees and others.19 It limits access to personal files collected by the government. Such
files are defined as those that link an individuals name with his education, financial transactions,
medical history, and criminal or employment history.
The Privacy Act offers guidelines for providing required information without sacrificing a persons right
to privacy. The following records concerning federal employees are a matter of public record and no
further authorization is necessary for disclosure:
Name and title of an individual
Grade classification or equivalent and annual rate of salary
Position description
Location of duty station, including room number and telephone number
Employee name in the case of accident or criminal charges, after next of kin has been notified
An individuals current city and state of residence, in general
Information on an individuals hospitalization or confinement while awaiting trial
In most circumstances, you may not release the following information:
Age or date of birth Race
Marital status and dependents Sex
Street address or phone number Legal proceedings
The Privacy Act normally protects such personal information as medical records, pay records, age, race,
sex, and family background. It is important to note, however, limitations of the Privacy Act:
The Privacy Act does not apply when FOIA requires the release of information, and its reach is
limited to federal information.
Information held by the private sector, state government, and local government is not covered
by the Privacy Act.
Twelve exceptions allow disclosure, including a broad provision authorizing disclosure for any
routine use compatible with the purpose for which the information was collected.20
In some cases, media representatives may insist on obtaining information protected or exempted by the
Privacy Act. In these cases, consultation with a lawyer prior to disclosure is advisable.

Sample Privacy Act Notification Statement
The Centers for Disease Control and Prevention, an agency of the Department of Health
and Human Services, is authorized to collect this information, including the Social Security
number (if applicable), under provisions of the Public Health Service Act, Section 30l (42
U.S.C. 241). Supplying the information is voluntary and there is no penalty for not providing
it. The data will be used to increase understanding of disease patterns, develop prevention
and control programs, and communicate new knowledge to the health community. Data
will become part of CDC Privacy Act System 09-20-0136, Epidemiologic Studies and
Surveillance of Disease Problems, and may be disclosed: to appropriate state or local public
health departments and cooperating medical authorities to deal with conditions of public
health significance; to private contractors assisting CDC in analyzing and refining records;
to researchers under certain limited circumstances to conduct further investigations;
to organizations to carry out audits and reviews on behalf of HHS; to the Department of
Justice for litigation purposes, and to a congressional office assisting individuals in obtaining
their records. An accounting of the disclosures that have been made by CDC will be made
available to the subject individual upon request. Except for these and other permissible
disclosures expressly authorized by the Privacy Act, no other disclosure may be made
without the subject individuals written consent.
In addition, the Privacy Act notification statement must appear on CDC forms which are
used by states, hospitals, or other third-party suppliers of individually identified data to CDC
if a full surname is present on the copy of the form that reaches CDC. The same prototype
can be used if the last sentence is modified to read: An accounting of such disclosures will
be made available to the subject individual upon request.
Health Insurance Portability and Accountability Act

(HIPAA) Privacy Regulations
The Privacy Rule established pursuant to the Health Insurance Portability and Accountability Act of
1996 imposes additional restrictions on disclosure of protected health information by covered entities:
Individually identifiable health information generally may not be disclosed without consent.
Covered entities are health-care providers, health plans, and health-care clearinghouses.
Most state and local health departments do not meet the criteria for a covered entity. However, to the
extent these agencies provide direct health-care services to individuals and keep individual medical
records in relation to these activities, the HIPAA Privacy Rule may apply to these records.

Even when the Privacy Rule applies, many exceptions to the consent requirement exist. For example,
several exceptions would permit sharing for public health emergency purposes, including allowances
to disclose without consent to comply with legally required disease-reporting obligations and to avert
serious threats to health or safety.17
Privacy: Legal and Practical Considerations

Nearly all states protect a right of privacy. The four kinds of invasion comprising the law of privacy
include the following:
Intrusion upon the individuals physical and mental solitude or seclusion: This
includes actions such as eavesdropping or entry without permission into anothers private space.
Public disclosure of private facts: A disclosure of private fact occurs when some medium
of communication disseminates personal information that the individual involved did not
want made public. The information must be of a nature that would be offensive to a person of
ordinary sensibilities. Truth is not an absolute defense against disclosure. If the facts at issue are
held to be newsworthy, or are taken from public record of a court or other governmental agency,
publication is not an invasion of privacy. Newsworthiness is information deemed to serve the
public interest.
False light: False light occurs if an individual is portrayed as something other than they
are to the point of embarrassment. Knowledge of falsity or reckless disregard for the truth
must be proven.
Appropriation: This involves the unauthorized use of one persons name or likeness to
benefit another.
Working with Sensitive Information

Public Information Officers (PIOs) often have access to sensitive information. As a liaison to the
press, PIOs must make decisions, in consultation with other emergency management officials, about
the release of such data. Usually, these issues are evaluated in the clearance process, as described in
Chapter 6. However, PIOs should consider the following before releasing information to the media:
Ability: Do you have the information on the subject? You must physically have the information
before you release it.
Competency: Are you qualified to discuss the topic with the news media? If you are not the
expert, find out who the expert is and arrange to have him or her brief the media.
Authority: Do you have the authority to discuss the issue? Its always advisable to stay in close
contact to your higher headquarters to coordinate your response and get its view of the big
picture.
Security: Is the information classified? The security limitation is most important because of
the need to safeguard classified and sensitive data. But remember that the designation For

Official Use Only is not a national security classification and cannot be used as the sole basis for
withholding information.
Accuracy: Is the information accurate? PIOs have an obligation to provide accurate, factual
information and to avoid speculation.
Propriety: Is the information appropriate to the situation? Ensure that information released
displays sensitivity and dignity. For example, do not release photographs of disease victims that
could hurt family members.
Policy: Do the policies of the agency permit release of this information?
Public Health Laws

A natural disaster is usually the
Sources of Authority legal purview of the local state
Public health law primarily exists at the state and local levels and local responders, so the local
of government, although federal law has an influence on public governments are the ones that have
health authority as well. The following sections describe these the authority to carry that out with
legal considerations:
support of the federal government
State and local public health powers after an emergency declaration.
Limitations on public health powers, including those RADM Thad Allen, Retired,
under federal law Former Commandant,
Relevant legal provisions and legal issues applicable to United States Coast Guard
public health emergencies
State Public Health Powers

State governments (and, by delegation, their various subdivisions) possess the authority to enact and
enforce public health laws under what is known as their police powers. This is a broad concept that
encompasses the functions historically undertaken by governments in regulating society.
Police powers do not come from the U.S. Constitution. They are inferred from those powers traditionally
possessed by governments and exercised to protect the health, safety, welfare, and general well-being
of the citizenry. Under the federalist system established by the U.S. Constitution, police powers are
not granted to the federal government. Instead they comprise a portion of the powers reserved for the
states under the 10th Amendment.
Police powers have been used to uphold a wide variety of actions by the states, many quite broad
in their reach and impact. Generally, such laws will be upheld if it can be shown that the laws are
reasonable attempts to protect and promote the publics health, safety, and general welfare and that

the laws are not arbitrary or impulsive attempts to accomplish such an end. These broad powers allow
public health officials to act to protect public health and well-being during emergencies.
Local Public Health Powers

Local health departments carry out activities under two types of authority:
Delegation of authority: State legislatures commonly empower local health departments

to carry out administrative functions of the state, such as the enforcement of the state public
health code.
Home rule authority: To avoid the need for specific authorization each time a new need
arises, most stateseither through legislation or by constitutional amendmenthave given local
governmental units the right of local self-governance. That means they have the right to make
decisions concerning their own welfare.
These two approaches are relevant because they control the extent to which local health departments
can act themselves to respond to public health threats.
In states that grant greater authority to local health departments, these local entities do not have to
await state-level authorizations before taking public health actions. General grants of authority can at
times serve as the basis for enacting ordinances in circumstances not specifically contemplated by the
state legislature. For example, courts upheld the authority of the mayor of San Francisco to declare a
public health emergency and authorize needle-exchange programs that were otherwise illegal under
state law. The state of California later passed legislation supporting this interpretation of state law.21
City councils commonly develop their own local public health ordinances or health codes. This
independent exercise of power is limited by the rule that localities may not assign responsibilities that
are in conflict with state laws and regulations to local health departments. Thus, public health law
is even more of a patchwork at the local level because health departments are responsible for local
public health ordinances, but must also deal with enforcement authority, responsibility, and limitations
established by state law.

Law and Public Health Agencies
Public health functions may be divided among a number of governmental departments, such
as health, environment, and registration. Public health authority is typically exercised by
boards of health and public health agencies at the state and local levels. The jurisdiction
and legal authority of these entities vary from state to state. The relationship between state
agencies and local public health departments within each state is itself varied and complex.
All 50 states; the District of Columbia; and the territories of Guam, Puerto Rico, American
Samoa, and the U.S. Virgin Islands have a state or territorial health agency. This section
refers to them as a state health agencies, for brevity. Each state health agency is directed
by a health commissioner or a secretary of health. Each state also has a chief state health
officer, who is the top public sector medical authority in the state. The same person may fill
both positions.
A state health agency is generally organized as one of the following:22
An independent agency directly responsible to the governor or a state board of

health (in 28 jurisdictions)
A division within a superagency (in 23 jurisdictions)
About 2,794 local health departments operate in the United States. They are structured in
one of the following ways:23
Centralized at the state level, with the state agency operating whatever local health
agency units exist within the state (in 28% of jurisdictions)
Autonomous units, with local health agencies operating completely independently of
the state health agency and receiving only consultation and advice from the state (in
37% of jurisdictions)
Hybrid structures, in which some programs are operated entirely by the state,
some programs are shared with the local health department, and some programs
have the state act merely as an adviser to the local health department (in 35% of
jurisdictions)22
These varying structures and relationships between state and local health agencies are
relevant for two reasons. First, these structural relationships dictate the scope of authority
and independence of the state and local health agencies to engage in public health
activities and to respond to public health emergencies. Second, these relationships allocate
responsibility for preparing for and responding to public health emergencies to the governing
entities in each jurisdiction.

Public Health Powers and Liabilities
Interaction among Levels of Government

The public health activities of the various levels of government are often interrelated and legal authority
for these activities may coexist. For example, a local health department may inspect local nursing
home facilities and make enforcement recommendations to a state agency, which has final enforcement
authority. At the same time, federal Medicare and Medicaid regulations may actually have the biggest
governmental influence on the operations of these same regulated facilities.
In many instances, the federal government has the legal authority to preempt an area of public health
regulation, denying regulatory authority to the states. Similarly, the states have authority to preempt all
areas of public health regulation from local governments, denying county and municipal governments
regulatory authority. The governmental level with highest authority has several options. It may do any
of the following:
Choose not to exercise its potential authority, leaving the lower levels of government the
decision to adopt the legislation it deems appropriate
Preempt the area, adopt legislation, and implement the program
Preempt the area by adopting legislation and delegating the programs implementation to a
lower government unit to run
Limitations on Public Health Powers

Although the courts have interpreted state police powers broadly, government authorities do have limits
placed on their powers. Limitations on state and federal powers are found in the following:
The U.S. Constitution
State constitutions
Federal and state laws
The U.S. Constitution grants the federal government specifically enumerated powers, reserving all
other powers to the states. The U.S. Constitution also describes a series of individual rights that must
be protected. If public health laws or actions infringe on constitutionally protected individual rights,
courts must balance between the collective needs of the community and the liberty of the individual. In
general, courts traditionally have been very reluctant to invalidate these public health laws, even for the
sake of protecting individual rights.

Reality Check
The United States Supreme Court has upheld numerous public health laws at the state
and local levels. The seminal 1905 decision in Jacobson v. Massachusetts, 197 U.S. 11
(1905), involved a challenge to a mandatory smallpox vaccination statute enacted by a local
government:
The Court applied the police powers broadly, finding that society can be governed
by certain laws for the common good and that competing individual rights are not
absolute.
Since the Supreme Court decided the Jacobson case in 1905, it has broadened its
recognition of individual rights.24
The Supreme Court first recognized the broad right to privacy more than half a
century after its Jacobson decision, and the recognition of that right has since been
important in several of its decisions on public health issues.25,26
Nevertheless, compulsory examination, treatment, and quarantine powers have long been
upheld by the nations courts as legitimate governmental requirements, despite their highly
intrusive nature. During public health emergencies, these powers are even more likely to be
upheld given the necessities of the situation.
Constitutional Rights
The U.S. Constitution protects the individual from certain types of restrictive action by the federal
government. Many public health laws have been challenged on the basis that they interfere with the civil
liberties guaranteed by the Constitution. For example, several provisions of the First Amendment to the
Constitutionrights to free exercise of religion, free speech, and free assemblymay be affected by
public health powers.
Freedom of religion: The First Amendment states that Congress shall make no law
prohibiting the free exercise [of religion].1 When conflict occurs between a legitimate, otherwise
valid law and a religious practice, the courts will look at the following:
yy The believers sincerity is reviewed, not the validity of the particular underlying
religious beliefs.
yy How central or essential the practice at issue is to the particular religion.
Where the court finds a real conflict between religious belief and an otherwise valid law, it must weigh
the competing social and individual interests.

Public health concerns have been deemed to outweigh individual interests in the area of compulsory
vaccination. As the U.S. Supreme Court stated, The right to practice religion freely does not include
liberty to expose the community to communicable disease 27 It should be noted, however, that
states sometimes choose to provide an exemption in their vaccination laws for persons whose religious
beliefs prohibit vaccination.
Freedom of speech: Laws may also be invalidated because they conflict with another section
of the First Amendment that protects the free communication of ideas: Congress shall make no
law abridging the freedom of speech, or of the press.1
Laws can conflict with free expression and communication either directly or indirectly:
yy A law making it a crime to publicly discuss the details of an emergency or disaster would
be intentionally aimed at restricting communication and likely would be barred by the
First Amendment.
yy A law aimed at something other than communication, but restricting communication as a

secondary or indirect effect might also be barred.
yy A law compelling the disclosure of information may also face scrutiny, because the freedom
of speech encompasses the freedom not to speak as well. For example, a law that requires
health workers to disclose the names and medical information about their patients as part of a
bioterrorism investigation could collide with their first amendment right of free speech, as well
as legal obligations found in privacy and confidentiality laws.
The importance of an investigation may be determined to outweigh these concerns and laws
such as these may be upheld.
Freedom of assembly: A third section of the First Amendment protects the right of the
people peaceably to assemble.1 This provision can give rise to challenges against social
distancing measuressuch as mass home quarantine, road closures, and bans on public
eventsthat may be used during a public health emergency.
Due process and equal protection: The Fifth and Fourteenth Amendments to the U.S.
Constitution protect individuals from being deprived by government of life, liberty, or property,
without due process of law.1
Due process of law requires the government to uphold both procedural and substantive
due process. Procedural due process demands that government provide fair procedures for
individuals subject to law, which typically include the following:
yy Notice yy Ability to cross-examine
yy Access to counsel yy Written opinion
yy A hearing by an impartial arbiter yy Option to appeal

In emergency circumstances, some of these robust procedural protections may be waived or
delayed by a court. Substantive due process, by comparison, requires the government to justify
government actions with sufficient reasons.
In an emergency context, due process rights are most relevant in circumstances where a
persons liberty is restricted or property taken to further a public health goal.
The Fourteenth Amendment states, no person shall be denied equal protection of the laws.1
Equal protection is an intricate concept that can be violated in two ways:
yy The government may deny equality if its rules or programs make distinctions between persons
who are actually similar in terms of any relevant criteria. For example, if a law restricted
governmental job eligibility based on sex rather that training and ability, it would be denying
equality in the application of law.
yy The government may deny equality if it fails to distinguish between persons who are actually
different in terms of relevant criteria. For example, a government program that provided free
smoke detectors to the public would violate equal protection rights of persons with disabilities
if it required them to appear personally at a government office to obtain one.
Equal protection does not require the same treatment in all instances. Government often
classifies people into groups and treats the groups differently. For example, state laws prohibit
alcohol and tobacco use for minors and some governments apply more stringent drivers license
requirements to persons over 75 years of age. And several states restrict the driving privileges of
persons suffering from certain medical conditions. Yet these distinctions have not been held to
be violations of equal protection.
Government can differentiate between individuals and groups, and deprive them of liberty or
property, if it has good reason to do so. Courts evaluate alleged violations of substantive due
process and equal protection by balancing government actions with individual rights under the
following three standards:
Strict scrutiny: The strict scrutiny standard applies when the law involves a suspect
classification, such as race, sex, or national origin. It also applies when the law affects a
fundamental right, such as interstate travel, voting, procreation, marriage, or free speech. The
strict scrutiny standard is very difficult to satisfy. Under this higher standard, the government
must show the following:
yy A compelling state interest in applying the law unequally
yy That the law is tailored narrowly to achieve that purpose
Intermediate scrutiny: The intermediate scrutiny standard applies when the law involves
discrimination based on sex or against illegitimate children.28,29 Under this higher standard, the
government must show the following:

yy An important state interest in applying the law unequally
yy The law is substantially related to achieving that purpose
Rational basis scrutiny: The rational basis standard applies in cases that do not involve a
suspect classification or a fundamental right. The standard is easily and routinely met. It
simply requires that government offer some plausible basis for a laws unequal application.
Taking of private property: The Fifth Amendment also provides that no private property
shall be taken for public use without just compensation. The Fifth Amendment prohibition
applies to two types of property:
yy Real property, defined as land, buildings, and other real estate
yy Personal property, defined as everything that is subject to ownership, that is not considered
real property
Many public health laws prohibit, ban, or otherwise regulate the possession or use of hazardous
agents, products, and real estate. The government does so to protect the publics health and
safety. Such laws may substantially interfere with use and enjoyment of property.
Property taken during a public health emergency may give rise to governmental liability for the
value of the property taken, or the government may avoid obligations to compensate people if
the property is taken to prevent harm or avert a public nuisance.
Public Health Officials Responsibilities and Liabilities

Public health authorities have broad legal authority giving them the power to institute a wide variety
of measures to protect the publics health and safety. Public health officials may have to consider the
following questions:
What does the law say about those responsibilities, and are they discretionary or mandatory?
Can an individual or organization be forced to act?
Can actions or failure to act be the source of legal jeopardy?
What happens if actions result in harm?
Can an individual or organization be sued for damages or threatened with criminal prosecution?

To be able to answer these questions, public health officials need to consider their responsibilities and
liabilities:
Responsibilities: State statutes that authorize public health officials to protect and enhance
the publics health and safety outline a variety of functions. These functions are classified as
either mandatory or discretionary:
yy Mandatory functions: These are duties that an agency must undertake by legislative
mandate. The statute leaves no room for an agency to determine whether to carry out the
function. Examples of mandatory functions include the following:
Statutory requirements to maintain vital records
Legal mandates to develop toxic air pollutant regulations
Ordinances requiring agencies to hold open or public meetings and to make other
information available to the public.
yy Discretionary functions: These are defined as duties involving the exercise of judgment or
discretion in connection with planning or policy-making. Discretionary activities may include
the following:
Decisions to create a waste disposal site
Management of natural resources
Planning inspection and social service policies
Allocating funds for inspection of nursing homes and day-care facilities
Health departments have a legal responsibility to carry out mandatory functions. However,
they are allowed considerable latitude in how and when to carry out discretionary functions.
Liabilities: Liability laws covering state and local health department agencies and employees
vary considerably across the country.
yy Liability of states and their political subdivisions: In most, if not all, states and
localities, government officials are, by statute, granted immunity from lawsuits arising from
the exercise of their governmental functions. Most state governments may be held liable
for negligence arising from the exercise of proprietary functions (services that must comply
with professional standards of care, such as medical services). State laws generally take of
two forms:
Overall immunity is granted to the state, subject to specified exceptions. In such states,
immunity is the general rule and the limited circumstances under which the state agrees to
be sued are specifically described.

Immunity is the exception. State statutes following this model confer immunity on a limited
basis as exceptions to a comprehensive scheme permitting lawsuits against the government.
In such states, the doctrine of sovereign immunity is abolished and immunities are restored
on a limited basis as deemed appropriate by state legislators.
yy Tort immunities: The rules for governmental tort immunities of counties and municipal
corporations usually take one of three forms, the first of which is the most common:
The state tort claims act governs the tort immunities of its counties and municipal
corporations.
The state tort claims act expressly excludes political subdivisions from coverage; more
limited immunities are usually provided to them under a separate tort claims act.
In a small minority of states, the rules governing immunity for counties and municipalities
remain defined by common law principles.
Regardless of the form they take, virtually all state tort claims acts do the following:
Retain immunity for essentially governmental functions
Waive immunity for negligence of governmental officers and employees acting within the
scope of their employment
Establish procedures for filing claims against the government
Limit the amount of damages that may be recovered
Authorize governmental entities to purchase liability insurance
yy Negligence: The term negligence means a failure to exercise reasonable care and caution.
The standard by which the legal system judges reasonable care is often expressed as that
which a prudent or careful person would do.
yy Liability for proprietary functions: Public health agencies are often involved in the
provision of clinical services through public health clinics, school health programs, and the
like. In such situations, the public health clinician has a legal responsibility to provide care
that meets the same high professional standards expected of private clinicians.
Failure to perform at this level of care and competency constitutes malpractice, that is,
negligent performance by a professional that results in harm to the patient or client. In
this situation, professionals who provide clinical services in health departments need
malpractice insurance protection, which is usually provided by the employer (in this case,
by the government).

yy Liability for governmental functions: What about the public health professionals
regulatory role? Certainly harm can result from the enforcement of public health laws. For
example, a hotel commandeered during an infectious disease outbreak to house quarantined
people will lose business during the event and afterward, perhaps running into the tens of
thousands of dollars. The owner of the hotel is unlikely to be able to sue successfully for
damages under tort law because virtually all states provide immunity from tort actions arising
out of the performance of essential governmental functions.
In most states, the general rule is that governmental entities are immune from suit for torts
committed by their officers and employees in performing basic governmental functions,
unless liability is specifically permitted by statute, or the function, even though essentially
governmental in nature, is official rather than discretionary. For the most part, the courts are
extremely reluctant to impede the important work of governmental agencies by expanding the
scope of their liability. For this reason, they often go to great lengths to define functions to fall
within the scope of a states immunity rules.
yy Liability of individual health officersqualified immunity: Injured persons who go to

the time and expense of bringing a lawsuit will often name not only a governmental entity as
a defendant but also the officers, agents, or employees who were involved in the incident. The
latter may be sued in their official capacity as well as personally.
As a general rule, when a government employee performs duties in good faith and in a
reasonable fashion, that employee is not personally liable for damages that may result from his
or her acts. Judges understand that if people are made too fearful of the legal consequences
of their actions, they will be timid and ineffectual in carrying out their dutiesnot a desirable
state of affairs. Thus, the courts have fashioned legal doctrines that afford public health
practitioners broad immunity from lawsuits.
This is qualified, not absolute, immunity. It only applies under circumstances where the
government employee is acting in good faith within the scope of his or her authority. The
principle would not hold in the following instances:
Gross and willful carelessness
Malicious, corrupt or criminal actions
Acts that went beyond the authority vested in the public health agency or the scope of
employment
Going beyond an agencys appropriate authority may seem less clear-cut. But in fact, this
problem would arise not from taking legitimate authority to excess, but rather from going
off into completely unauthorized or clearly invalid areas, such as attempting to require
participation in religious services by all nursing home residents.

yy Variations on the general rule: State statutes vary widely in the amount of protection
offered to individuals. In some jurisdictions health officials may be held liable for negligently
performing ministerial, as opposed to discretionary, acts. For example, health officials may be
personally liable for operating a motor vehicle in a negligent manner and for failing to follow
authorized protocols in providing health services.
yy Other sources of immunity from liability: Government employees and volunteers may be
protected from liability through other statutory provisions specifically designed to vaccinate
emergency responders and others acting for the public good.
The Volunteer Protection Act is a federal law enacted in 1996 that provides immunity for
volunteers for harm caused by acts or omissions only if they were acting within the scope
of their responsibility, properly licensed or certified, not receiving compensation, and not
engaged in willful, criminal or reckless misconduct or gross negligence.
The Public Readiness and Emergency Preparedness Act of 2005 provides liability protection
under federal and state law for manufacturers, administrators, and distributors of vaccines,
and other covered persons as defined by the act, who prescribe, administer, or dispense
countermeasures. Those protected under this act are provided immunity from claims of any
type of loss due to countermeasures used when a public health emergency has been declared.
At the state level, Good Samaritan statutes, found in every state, provide immunity to
individuals who attempt to rescue others in an emergency. The scope of these provisions
varies, with some states excluding health professionals from this sort of protection. Some
states have gone even further and have enacted specific immunity protections for volunteers
during public health emergencies. The Uniform Emergency Volunteer Health Practitioners
Act and the Emergency Management Assistance Compact provide templates for state laws
granting volunteer health professionals from other states immunity to incentivize them to help
without fear of liability and to create more uniformity and clarity in the protections that are
provided to emergency volunteers.
yy Other legal protections from discrimination during emergencies: Several other laws
provide important protections during public health emergencies, including the following:
Americans With Disabilities Act:30 The Americans With Disabilities Act (ADA), originally
passed in 1990 and amended in 2010, prohibits discrimination of persons with a disability
in employment, state and local government, public accommodations, commercial facilities,
transportation, and telecommunication. An individual with a disability is defined by the ADA
as a person who has a physical or mental impairment that substantially limits one or more
major life activities, a person who has a history or record of such impairment, or a person
who is perceived by others as having such impairment. The regulations cover activities of
the health department, whether provided directly or through contractual licensing or other
arrangement.

Under Title II of the ADA, which applies to state and local governments, public health
agencies must provide people with disabilities with an equal opportunity to utilize their
programs, services, and activities. To meet these requirements, state and local government
must meet certain architectural standards in the construction of new facilities. They are
also required to ensure access to older and existing structures; however, they are not
required to make changes that result in undue financial or administrative burdens. During
an emergency, local governments and public health agencies are required to adhere to Title
II in their response to the emergency, meaning that persons with disabilities are not to be
discriminated against and are to receive proper communication and accommodation to be
afforded the same safety and protection as persons without disabilities.
In 2011, Title II and Title III were amended to include requirements for service animals,
use of wheelchairs, use of power mobility devices, effective communication, and
examinations and courses. These requirements, like the 2010 amendments, came into
effect on March 15, 2012.
In developing emergency preparedness, response, and communication plans, persons

with disabilities may require certain accommodations to ensure they are receiving the
same information and the same opportunities for protection from the consequences of the
emergency. Key issues to be addressed will include the following:
Adequate planning for communication, notification, evacuation, transportation,

and sheltering
Access to medications and back-up power
Access to mobility devices or service animals
Access to information
Information on how to include protections and planning for individuals with disabilities may
be found at the ADA website, http://www.ada.gov/emergencyprepguide.htm, which offers a
comprehensive guide on emergency preparedness.31
One example of preparing for disabilities involves hearing impairments. If a communitys

warning system involves the use of sirens, other types of warnings should be adopted as well
to accommodate persons who cannot hear the sirens. Many of these issues can be managed
quite easily by formulating an emergency response plan that takes into consideration the
needs of persons with disabilities.

yy Civil Rights Act of 1964, Title VI: The Civil Rights Act of 196432,33 prohibits discrimination
based on race, color, or national origin. Section 601 of the act states:
No person in the United States shall, on the grounds of race, color, or national origin, be
excluded from participation in, be denied the benefits of, or be subjected to discrimination
under any program or activity receiving federal financial assistance.
Health departments have been challenged for discrimination based on national origin and
limited English proficiency. A complaint was filed with the U.S. Office of Civil Rights by an
Illinois resident on behalf of himself and other non- and limited-English-speaking persons,
alleging that an Illinois county health department discriminated against them based on
national origin. The complaint specifically alleged that the county denied or delayed their
receiving services, required them to provide their own interpreters, and treated them in
a discriminatory manner. As evidence of the latter, the complainants asserted that county
officials made negative comments, had a hostile attitude, and assigned them to Spanish-
speaking clinics.
As a result of the complaint, the Illinois county worked with the complainants and the U.S.
Office of Civil Rights to hire interpreters, conducted sensitivity training for its staff, and
reorganized delivery services to prevent segregation of Spanish-speaking persons. Similar
claims could arise under this Act based upon discrimination perpetrated during the planning
or implementation of a public health emergency response.
CDC has taken affirmative steps to ensure that emergency preparedness and other public
health materials are equally accessible to members of the population who do not speak
English fluently by producing materials in multiple languages. Additionally, materials
have been developed to target different education levels to provide accessible and
comprehensible materials for all members of the public.
State Public Health Emergency Powers

Individual states possess the principal legal powers to control epidemics consistent with those described
previously, but have had little experience using disease control laws in large-scale public health
emergencies. Existing laws were crafted, in many cases, to deal with the outbreaks typical of the early
20th century.
As part of a broad effort to strengthen the countrys preparedness for bioterrorism and other public
health emergencies, many states revised their public health laws to modernize or augment emergency
health powers. A number of states decided to adopt or modify the provisions contained in the Model
State Emergency Health Powers Act.34 According to the Center for Law and the Publics Health at
Georgetown and Johns Hopkins (which drafted the Model Act), as of July 15, 2006, 44 states and the
District of Columbia have introduced bills or resolutions based in whole or in part on the model law.35

This model law addressed a wide range of legal issues, including the following:
Reporting of disease cases Infectious waste disposal
Quarantine Control of health-care supplies
Vaccination Access to medical records
Protection of civil liberties Effective coordination with other state,

local, and federal agencies
Property issues
Restrictions on Personal Liberty

The most relevant, and controversial, of the emergency powers are provisions that authorize
restrictions on personal liberty (quarantine, isolation, travel restrictions, loss of privacy) and property
(decontamination, use of supplies and facilities, disposal of remains). Once a public health emergency
has been declared pursuant to the law, public health officials have increased authority to use their police
powers to rapidly respond to emerging circumstances to protect the publics health.36
Restrictions on personal liberty imposed by public health officials can include the following:
Quarantine and isolation

Travel and trade restrictions
Violations of privacy
Social distancing measures
Compulsory treatment
Quarantine and isolation powers, restrictions on movement of goods and people, and other compulsory
measures exist under federal and state laws.
At the federal level, the Public Health Service Act grants the U.S. Public Health Service responsibility
for preventing the introduction, transmission, and spread of communicable diseases from foreign
countries into the U.S.37 Under its delegated authority, the Division of Global Migration and Quarantine
is empowered to detain, medically examine, or conditionally release individuals and wildlife suspected
of carrying a communicable disease.
The list of diseases for which quarantine can be required is contained in an executive order of the
president and includes the following:38
Cholera Smallpox
Diphtheria Yellow fever
Infectious tuberculosis Viral hemorrhagic fevers such as

Marburg, Ebola, and Crimean-Congo
Plague
hemorrhagic fever
In 2005, an executive order was signed adding pandemic influenza to the list:39
For ships and airplanes destined for the U.S., the captain or commander of the vessel must report
recent deaths or illnesses among passengers on the vessel to federal authorities. The CDC Director may
require detention of a carrier until the measures necessary to prevent the introduction or spread of a
communicable disease have been completed.
The number of travelers and the speed of travel within and between nations have increased the
opportunities for disease to spread from one country or continent to another. The outbreak of Severe
Acute Respiratory Syndrome (SARS) during 20022003 posed a substantial challenge for national
and international systems designed to control the spread of communicable diseases.40 SARS emerged
initially from China, but rapidly spread to 29 countries over several months. As a new communicable
disease in human populations, initially there were no screening tests or treatments for SARS. Early
infections resulted in high rates of illness and death.
Because of the risk of this new epidemic and the uncertainty surrounding its cause, source, and method
of spread, many countries implemented quarantine and isolation for those exposed to or showing
symptoms of SARS. The World Health Organization (WHO) endorsed the use of quarantine and isolation
in these circumstances because of the following:
SARS was new and novel.
SARS was a pathogen that was highly able to cause disease.
SARS had no treatment or containment alternatives at the time.
Canada used primarily voluntary quarantine measures to address possible SARS exposures. China,
Taiwan, Hong Kong, and Singapore used more coercive mandatory quarantine orders that included
harsh penalties and enforcement tactics.
Isolation typically occurred in hospital settings while quarantine most often was applied in a persons
home. Many health-care workers treating infected patients were also subject to modified quarantine
orders, allowing them to travel to and from work but otherwise limiting contact with others. Social
distancing measures such as school and work closings were also implemented in some countries.35,38
While the U.S. was not significantly affected by the SARS epidemic, the lessons of this outbreak
primed later responses to pandemic influenza in 2009. Additionally, a new emerging infectious disease
like SARS would trigger the International Health Regulations, international standards for preventing
the spread of infectious diseases. These standards allow WHO to declare an infectious disease a
public health emergency of international concern and respond by providing assistance and making
recommendations to affected countries.41

U.S. federal law also permits the Director of the CDC to take measures to prevent spread of diseases,
when the Director determines that the measures taken by health authorities of any state or U.S.
possession are insufficient to prevent the spread of communicable diseases from one state to another.7,42
Measures may include the following:
Inspection Sanitation
Fumigation Pest extermination
Disinfection Destruction of animals or articles believed

to be sources of infection
A person who has a communicable disease during the period when the disease can be transmitted to
other people can be restricted from traveling from one state or possession to another without a permit
from the state or territorial health officer, or destination locality.
The person in charge of any conveyance, such as a bus, ship, or plane, that is engaged in interstate
traffic on which a case or suspected case of a communicable disease develops is required, as soon as
practicable, to notify the local health authority at the next port of call, station, or stop, and to take
measures to prevent the spread of the disease as the local health authority directs.
State laws authorize quarantine and isolation powers. Most often these powers are explicitly granted in
the state public health code, and courts have consistently upheld these powers as consistent with state
police powers. The scope of state quarantine and isolation measures varies:
Some states have broad powers that could be applied to any emerging infectious disease threat.
Other states have regulations targeted to specific conditions.
More targeted quarantine and isolation measures, such as those that only apply to specific disease
conditions, could cause problems. If new diseases emerge and threaten the publics health, it may not be
clear whether public health officials could use quarantine and isolation rules to respond.
Constitutional limitations on the use of these coercive powers apply as well. Quarantine and isolation
powers must comply with procedural and substantive due process provisions. Since deprivation of
liberty involves a fundamental right, the government must demonstrate that it has a compelling interest
and the power is being applied in a way that is narrowly tailored to achieve a public health goal.
Other uses of state police powers for community containment, such as social distancing, event
cancellation, and related strategies, also may raise constitutional concerns. These, however, are less
restrictive on liberties and therefore less likely to face strict scrutiny by a court.

Restrictions on Property
Public health emergency powers may permit a range of action by state and local governments to
restrict, secure, and manage property during an emergency response. Many situations might require
property management in a public health emergency. Examples include the following:
Decontamination of facilities
Acquisition of vaccines, medicines, or hospital beds
Use of private facilities for isolation, quarantine, or disposal of human remains
During the anthrax attacks in 2001, public health authorities had to close various public and private
facilities for decontamination. Consistent with legal fair safeguards, including compensation for taking
private property used for public purposes, clear legal authority is needed to manage property to contain
a serious health threat.43
Once a public health emergency has been declared, some states allow authorities to use and take
temporary control of certain private sector businesses and activities that are of critical importance to
epidemic control measures. Authorities may take control of landfills and other disposal facilities and
services to safely eliminate infectious waste. This could include bodily fluids, biopsy materials, syringes,
and other materials that may contain pathogens that otherwise pose a public health risk. Health-care
facilities and supplies may be procured or controlled to treat and care for patients and the general
public. Areas normally accessible to the public may be closed to prevent additional exposures.
Whenever health authorities take private property to use for public health purposes, constitutional law
requires that the property owner be provided just compensation. This means the state must pay private
owners for the use of their property.
For situations in which public health authorities must condemn or destroy private property posing
a danger to the public, such as equipment contaminated with anthrax spores or smallpox virus,
no compensation to the property owners is required. States, however, may choose to make a fair
compensation.
Under existing legal powers to abate public nuisances, authorities are able to condemn, remove, or
destroy any property that may harm the publics health. Other permissible property control measures
may include restricting certain commercial transactions and practices, such as price gouging, to address
problems arising from the scarcity of resources that often accompanies public health emergencies.
While property control measures may generate controversy, they were created to provide public
health authorities with important powers to more rapidly address an ongoing public health emergency.
Because the application of law varies in different states, it is advisable to consult with an attorney to
understand the applicable law in any particular jurisdiction.44

Modern Day Example of
Emergency Response and Communication: H1N1
Outbreaks of various flu strains have lead to some of the changes and modern-day use of the
public health powers discussed in this chapter. One of the first developments occurred in
2005 when an executive order was signed adding certain types of flu to the list of diseases
to be quarantined. The language in the executive order specifically states: Influenza caused
by novel or re-emergent influenza viruses that are causing, or have the potential to cause, a
pandemic.39
The major utilization of these powers, however, occurred during the 2009 H1N1 outbreak,
resulting in multiple states, the Food and Drug Administration, and the Department of Health
and Human Services declaring public health emergencies.45
Once the virus was discovered, CDC took immediate action in beginning to track the disease
and the possibility of its spread. After determining that the virus could spread between
humans, vaccine work began. On April 25, 2009, under the rules of the International Health
Regulations, the Director of WHO declared the outbreak a public health emergency of
international concern. On April 26, 2009, the U.S. also declared a nationwide public health
emergency.
WHO issued recommendations for the preventing the spread of, or contracting, this
influenza virus on April 27, 2009. The recommendation included staying home if exhibiting
symptoms of any kind to prevent spreading. WHO also advised taking antiviral medications
if recommended by a doctor. On April 29, WHO declared a pandemic was imminent and
requested countries implement their pandemic preparedness plans. The U.S. did so and CDC
continued to communicate with the public, schools, and health-care professionals to provide
information on how to deal with this particular flu strain.
Preventive measures were a key focus of pandemic response efforts, including developing
a vaccine and impeding the spreading of the disease through social distancing. A number of
local school districts, for example, closed schools and suspended group activities to attempt
to stop the spread of the disease.
The H1N1 example shows that in a modern day pandemic, international cooperation,
immediate and constant action, preparedness, and preventive measures are at the forefront
of handling this type of public health emergency. Communication between countries, public
health officials, local governments, health-care workers, schools, and the general public
remains integral in these types of circumstances. Utilizing emergency preparedness plans,
state emergency powers, and other relevant legal provisions may help contain the spread of
infection and mitigate the scope of harm when this type of disaster strikes.

Conclusion
This chapter outlined many of the important legal issues and requirements that may apply when using
CERC during public health emergencies. Laws will greatly influence your communication activities and
the actions of public health officials in emergency situations.
While this brief overview provides a general roadmap to relevant laws, its important to consult with
counsel during actual events to determine the specific legal obligations that must be followed.

References
1. U.S. National Archives & Records Administration. The Bill of Rights: a transcription [online]. [cited 2012 Jul].
Available from URL: http://www.archives.gov/exhibits/charters/bill_of_rights_transcript.html.
2. Gathering, transmitting or losing defense information, 18 USC sec 793 [online]. 2012. [cited 2012 Jul].
Available from URL: http://uscode.house.gov/download/pls/18C37.txt.
3. United States of America v Morison, 604 F Supp 655 [online]. District Court for the District of MD 1985.
[cited 2012 Jul]. Available from URL: http://frank.mtsu.edu/~lburriss/morison.html.
4. United States v Kim, CR-10-225, joint status report [online]. District Court for the District of Columbia, 2010.
[cited 2012 Jul]. Available from URL: http://www.fas.org/sgp/jud/kim/030211-status.pdf.
5. Calabresi M. WikiLeaks war on secrecy: truths consequences. Time Magazine World [online]. 2010 Dec 2.
[cited 2012 Jul]. Available from URL: http://www.time.com/time/magazine/article/0,9171,2034488,00.html?artI
d=2034488?contType=article?chn=world.
6. Holsinger RL. Media law. New York (NY): McGraw-Hill; 1991.
7. CDCynergy. Legal issues you should know [online]. [cited 2012 Jul]. Available from URL: http://www.orau.gov/
cdcynergy/erc/Content/activeinformation/essential_principles/EP-legal_content.htm.
8. New York Times Co v Sullivan, 376 US 254 [online]. 1964. [cited 2012 Jul]. Available from URL: http://scholar.
google.com/scholar_case?case=10183527771703896207&q=New+York+Times+Co.+v.+Sullivan,+376+U.S.+25
4+%281964%29.&hl=en&as_sdt=2,11&as_vis=1.
9. Zeran v America Online, Inc (AOL), 129 F.3d 327 [online]. 1997. [cited 2012 Jul]. Available from URL: http://
scholar.google.com/scholar_case?case=3112726467460676187&q=Zeran+v.+AOL,+129+F.3d+327+%281997%
29.&hl=en&as_sdt=2,11&as_vis=1.
10. USA.gov. Copyright and other rights pertaining to U.S. government works [online]. 2012 Apr 26. [cited 2012
Jul]. Available from URL: http://www.usa.gov/copyright.shtml.
11. The Library of Congress. U.S. Copyright Office. Copyright: fair use [online]. 2012 Jun. [cited 2012 Jul].
Available from URL: http://www.copyright.gov/fls/fl102.html.
12. U.S. Environmental Protection Agency (EPA). Emergency Planning and Community Right-To-Know Act
(EPCRA) [online]. 2012 Jul 16. [cited 2012 Jul]. Available from URL: http://www.epa.gov/oecaagct/lcra.html.
13. U.S. Environmental Protection Agency (EPA). Clean Air Act [online]. 2012 Jul 16. [cited 2012 Jul]. Available
from URL: http://www.epa.gov/air/caa/.
14. U.S. Environmental Protection Agency (EPA). Oil Pollution Act overview [online]. 2012 Jul 16. [cited 2012
Jul]. Available from URL: http://www.epa.gov/oem/content/lawsregs/opaover.htm.
15. U.S. Department of Justice. FOIA Resources. FOIA Statute [online]. [cited 2012 Jul]. Available from URL:
http://www.justice.gov/oip/foia-resources.html.
16. FOIAdvocates. Requests/Appeals/Litigation. State public record laws [online]. 2012. [cited 2012 Jul]. Available
from URL: http://www.foiadvocates.com/records.html.
17. U.S. Department of Health & Human Services (DHHS). Privacy Rule: HIPAA, 45 CFR 160;164 [online].
2002 Aug 14. [cited 2012 Jul]. Available from URL: http://www.hhs.gov/ocr/privacy/hipaa/administrative/
privacyrule/index.html.

18. U.S. Securities and Exchange Commission. Freedom of Information Act exemptions [online]. 1999 Dec 1.
[cited 2012 Jul]. Available from URL: http://www.sec.gov/foia/nfoia.htm.
19. U.S. Department of Justice. Privacy Act of 1974 [online]. 2011 Aug. [cited 2012 Jul]. Available from URL:
http://www.justice.gov/opcl/privacyact1974.htm.
20. Solove DJ, Rotenberg M, Schwartz PM. Privacy, information, and technology. 2nd ed. New York (NY): Aspen
Publishers; 2006.
21. Kaiser Family Foundation. Syringe exchange and AB 136: the dynamics of local consideration in six
California communities. Report [online]. 2002 Feb 25. [cited 2012 Jul]. Available from URL:
http://www.kff.org/hivaids/6018-index.cfm.
22. Association of State and Territorial Health Officials (ASTHO). State public health. Profile of state public
health, volume one, pg. 7 [online]. 2009. [cited 2012 Jul]. Available from URL:
http://www.astho.org/Research/Major-Publications/.
23. National Association of County & City Health Officials (NACCHO). The local health department workforce:
findings from the 2008 national profile of local health departments [online]. 2010 May. [cited 2012 Jul].
Available from URL: http://www.naccho.org/topics/infrastructure/profile/upload/NACCHO_WorkforceReport_
FINAL.pdf.
24. Jacobson v Massachusetts, 197 US 11 [online]. 1905. [cited 2012 Jul]. Available from URL: http://scholar.
google.com/scholar_case?case=16169198038706839183&q=Jacobson+v.+Massachusetts,+197+U.S.+11+1905
&hl=en&as_sdt=2,11&as_vis=1.
25. Griswold v Connecticut, 381 US 479 [online]. 1965. [cited 2012 Jul]. Available from URL: http://scholar.
google.com/scholar_case?case=12276922145000050979&q=Griswold+v.+Connecticut,+1965&hl=en&as_
sdt=2,11&as_vis=1.
26. Roe v Wade, 410 US 113 [online]. 1973. [cited 2012 Jul]. Available from URL: http://scholar.google.
com/scholar_case?case=12334123945835207673&q=Roe+v.+Wade,+410+U.S.+113+(1973&hl=en&as_
sdt=2,11&as_vis=1.
27. Prince v Massachusetts, 321 US 158 [online]. 1944. [cited 2012 Jul]. Available from URL:
http://caselaw.lp.findlaw.com/scripts/getcase.pl?court=us&vol=321&invol=158.
28. FindLaw for legal professionals. U.S. Constitution: Fourteenth Amendment. Section 1. rights guaranteed: the
new equal protection. Classifications meriting close scrutiny: illegitimacy [online]. [cited 2012 Jul]. Available
from URL: http://caselaw.lp.findlaw.com/data/constitution/amendment14/31.html.
29. Justia, Inc. US law: illegitimacy [online]. [cited 2012 Jul]. Available from URL:
http://law.justia.com/constitution/us/amendment-14/90-illegitimacy.html.
30. U.S. Department of Justice. Americans with Disabilities Act of 1990, as amended [online]. 2009 Mar 25. [cited
2012 Jul]. Available from URL: http://www.ada.gov/pubs/ada.htm.
31. U.S. Department of Justice. Americans with Disabilities Act. An ADA guide for local governments: making
community emergency preparedness and response programs accessible to people with disabilities [online].
2008 Oct 9. [cited 2012 Jul]. Available from URL: http://www.ada.gov/emergencyprepguide.htm.
32. U.S. Department of Labor. Office of the Assistant Secretary for Administration and Management. Title VI,
Civil Rights Act of 1964 [online]. [cited 2012 Jul]. Available from URL:
http://www.dol.gov/oasam/regs/statutes/titlevi.htm.

33. National Archives and Records Administration. Teaching with documents: the Civil Rights Act of 1964 and
the Equal Employment Opportunity Commission [online]. [cited 2012 Jul]. Available from URL:
http://www.archives.gov/education/lessons/civil-rights-act/.
34. Gostin LO, Sapsin JW, Teret SP, Burris S, Mair JS,Hodge JG, et al. The Model State Emergency Health Powers
Act. JAMA [online] 2002 Aug 7 [cited 2012 Jul];288(5):6228. Available from URL:
http://academic.udayton.edu/health/syllabi/bioterrorism/7ModelState/msehpa.pdf.
35. The Centers for Law & the Publics Health. A collaborative at Johns Hopkins and Georgetown Universities.
The Model State Emergency Health Powers Act (MSEHPA) [online]. 2010 Jan 27. [cited 2012 July]. Available
from URL: http://www.publichealthlaw.net/ModelLaws/MSEHPA.php.
36. Gostin LO. Public health law: power, duty, restraint. 2nd ed. Berkeley (CA): University of California Press;
2008.
37. U.S. Public Health Service. Public Health Service Act. Public Health Rep [online] 1944 JulAug [cited 2012
Jul];109(4):468. Available from URL: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1403520/?page=1.
38. Revised list of quarantinable communicable diseases [online]. Fed Regist 2003 Apr 9;68(68):17255. [cited
2012 Jul]. Available from URL: http://www.gpo.gov/fdsys/pkg/FR-2003-04-09/pdf/03-8832.pdf.
39. Amendment to Executive Order 13295 relating to certain influenza viruses and quarantinable communicable
diseases [online]. Fed Regist 2005 Apr 5;70(64):17299. [cited 2012 Jul]. Available from URL:
http://www.gpo.gov/fdsys/pkg/FR-2005-04-05/pdf/05-6907.pdf.
40. Rothstein MA, Alcalde MG, Elster NR, Majumder MA, Palmer LI, Stone TH, et al. Quarantine and isolation:
lessons learned from SARS. Louisville, KY: Institute for Bioethics, Health Policy and Law [online]. 2003 Nov.
[cited 2012 Jul]. Available from URL: http://www.iaclea.org/members/pdfs/SARS%20REPORT.Rothstein.pdf.
41. World Health Organization (WHO). International Health Regulations (IHR). Ten things you need to do to
implement the IHR. 1. Know the IHR; purpose, scope, principles and concepts [online]. [cited 2012 Jul].
Available from URL: http://www.who.int/ihr/about/10things/en/index.html#whatismeant.
42. McCormick E, Ransom MM, Kershner S, editors. Frequently asked questions about federal public health
emergency law. Based on the April 28, 2009, teleconference Federal public health emergency law:
implications for state & local preparedness and response and prepared by the Public Health Law Program,
Centers for Disease Control and Prevention. Atlanta (GA): CDC [online]. 2009 Sep. [cited 2012 Jul]. Available
from URL: http://www.naccho.org/topics/infrastructure/PHLaw/upload/Microsoft-Word-FINAL-Public-Health-
Emergency-Law-FAQ.pdf.
43. Hodge JG, Gostin LO. The Model Emergency Health Powers Act: why is it important now? NW Public Health
[online] 2002 FallWinter [cited Jul 2012] p. 167. Available from URL:
http://www.nwpublichealth.org/docs/nph/f2002/model_act_f2002.pdf.
44. Gable L, Hodge, JG. Public health law and biological terrorism. In: Lutwick LI, Lutwick SM, editors. Beyond
anthrax: the weaponization of infectious diseases. New York (NY): Humana Press; 2009. p. 23952.
45. CDC. The 2009 H1N1 pandemic: summary highlights, April 2009April 2010 [online]. 2010 Aug 3. [cited 2012
Jul]. Available from URL: http://www.cdc.gov/h1n1flu/cdcresponse.htm.

Resources
CDC. Public health law. Publications and resources [online]. 2012 Jul 7. [cited 2012 Jul]. Available from URL:
http://www.cdc.gov/phlp/publications/index.html.
Centers for Law & the Publics Health. A collaborative at Johns Hopkins and Georgetown Universities. News
and updates [online]. 2010 Jan 27. [cited 2012 Jul]. Available from URL: http://www.publichealthlaw.net/.
Price BR. Copyright in government publications: historical background, judicial interpretation, and legislative
clarification. Military Law Review [online] 1976;74:1965 [cited 2012 Jul]. Available from URL:
http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA392794&Location=U2&doc=GetTRDoc.pdf.
U.S. Department of Justice. What is FOIA? FOIA data at a glanceFY 2008 through FY 2011 [online]. [cited
2012 Jul]. Available from URL: http://www.foia.gov/.
White House. President Barack Obama. The executive branch [online]. [cited 2012 Jul]. Available from URL:
http://www.whitehouse.gov/our-government/executive-branch
CDC. Public health law. Publications and resources [online]. 2012 Jul 7. [cited 2012 Jul]. Available from URL:
http://www.cdc.gov/phlp/publications/index.html.

Acronyms
2014 EDITION

Acronyms
A
ADA Americans With Disabilities Act
AHRQ Agency for Healthcare Research and Quality (U.S. Department of Health and
Human Services)
AMA American Medical Association
APHL Association of Public Health Laboratories
ASH Assistant Secretary for Health
ASPR Assistant Secretary for Preparedness and Response (U.S. Department of Health and
Human Resources)
ATF Bureau of Alcohol, Tobacco, Firearms, and Explosives (U.S. Department of Justice)
ASTHO Association of State and Territorial Health Officers
ATSDR Agency for Toxic Substances and Disease Registry (U.S. Department of Health and
Human Services)
B
BIA Bureau of Indian Affairs (U.S. Department of the Interior)
C
CBDP Community-based disaster preparedness
CBP U.S. Customs and Border Protection (U.S. Department of Homeland Security)
CBRNE Chemical, biological, radiological, nuclear, and explosive
CDC U.S. Centers for Disease Control and Prevention (U.S. Department of Health and
Human Services)
CEPR Centre for Emergency Preparedness and Response (Public Health Agency of Canada)
CERCLA Comprehensive Environmental Response, Compensation, and Liability Act
CFBCI Center for Faith-Based and Community Initiatives (U.S. Department of Homeland
Security)
CFR Code of Federal Regulations
CHAMPUS Civilian Health and Medical Program of the Uniformed Services
CIA Central Intelligence Agency
405
CMAS Commercial Mobile Alert System
CMS Centers for Medicare and Medicaid Services (U.S. Department of Health and Human
Services)
CRS Catholic Relief Services
CSTE Council of State and Territorial Epidemiologists
D
DART National Disaster Animal Response Team (Humane Society of the United States)
DAS Deputy assistant secretary
DEO Division of Emergency Operations (U.S. Centers for Disease Control and Prevention)
DFO Disaster field office
DHHS U.S. Department of Health and Human Services
DHS U.S. Department of Homeland Security
DLA Defense Logistics Agency (U.S. Department of Defense)
DMAT Disaster Medical Assistance Team
DMORT Disaster Mortuary Response Team, National Disaster Medical System
DOC U.S. Department of Commerce
DOD U.S. Department of Defense
DOE U.S. Department of Energy
DOEd U.S. Department of Education
DOI U.S. Department of the Interior
DOJ U.S. Department of Justice
DOL U.S. Department of Labor
DOS U.S. Department of State
DOT U.S. Department of Transportation
DVA U.S. Department of Veterans Affairs
E
ECDC European Centre for Prevention and Disease Control
EEO Equal employment opportunity
EIDJ Emerging Infectious Disease Journal
EIS Epidemic Intelligence Service (U.S. Centers for Disease Control and Prevention)
EMS Emergency medical services
406 Acronyms
EO Executive order
EOC Emergency operations center
EPA U.S. Environmental Protection Agency
EPCRA Emergency Planning and Community Right-To-Know Act
ERC Emergency response coordinator
ERCG Emergency response coordination group
ERM Emergency Risk Management and Humanitarian Action (World Health Organization)
ERT Emergency response team
ESF Emergency support function
EUA Emergency use authorization
F
FAA Federal Aviation Administration (U.S. Department of Transportation)
FBI The Federal Bureau of Investigation (U.S. Department of Justice)
FBO Faith-based organization
FCC U.S. Federal Communications Commission
FCO Federal coordinating officer
FDA Food and Drug Administration (U.S. Department of Health and Human Services)
FECC Federal emergency communications coordinator
FEMA Federal Emergency Management Agency (U.S. Department of Homeland Security)
FHWA Federal Highway Administration (U.S. Department of Transportation)
FLSA Fair Labor Standards Act
FNEP Federal Nuclear Emergency Plan
FOIA Freedom of Information Act
FR Federal Register
FRA U.S. Federal Railroad Administration (U.S. Department of Transportation)
FRP Federal Response Plan
FTS Federal telecommunications systems
G
GAO General Accounting Office (U.S. Legislative Branch)
GAR Global Alert and Response (as in GAR System) (World Health Organization)
Acronyms 407
GPHIN Global Public Health Information Network (Public Health Agency of Canada)
GPO Government Printing Office (U.S. Legislative Branch)
GPS Global positioning system
GS General schedule
GSA U.S. General Services Administration
H
H1N1 2009 pandemic influenza A (H1N1)
H5N1 Influenza A (H5N1) (avian influenza)
HAN Health Alert Network (U.S. Centers for Disease Control and Prevention)
HHS U.S. Department of Health and Human Services
HIPAA Health Insurance Portability and Accountability Act
HSAB Health and safety advisory board
HSPD Homeland security presidential directive
HSUS Humane Society of the United States
HUD Department of Housing and Urban Development
HQ Headquarters
I
IAEA International Atomic Energy Agency
IAG Interagency agreement
IBC Institutional Biosafety Committee
ICS Incident command system
IED Improved explosive device
IG Office of the Inspector General (U.S. Department of Health and Human Services)
IHR International Health Regulations
IHS Indian Health Service
IOM Institute of Medicine (National Academy of Sciences)
IPAWS Integrated Public Alert Warning System (Federal Emergency Management Agency)
J
JCAHO Joint Commission on Accreditation of Healthcare Organizations
408 Acronyms
JHPHPP Johns Hopkins Public Health Preparedness Programs
JIC Joint information center
K
KRC Knowledge and Resource Centre on Health Communication (European Centre of Disease Prevention
and Control)
L
LWR Lutheran World Relief
M
MHPF Minority Health Professionals Foundation
MMWR Morbidity and Mortality Weekly Report
MOA Memorandum of agreement
MOU Memorandum of understanding
MSEHPA Model State Emergency Health Powers Act
MSPB U.S. Merit Systems Protection Board
MUPS Multiple unexplained physical symptoms
N
NACCHO National Association of County and City Health Officials
NALBOH National Association of Local Boards of Health
NAPHSIS National Association for Public Health Statistics and Information Systems
NARFE National Association of Retired Federal Employees
NAS National Academy of Sciences
NASA National Aeronautics and Space Administration
NCEH National Center for Environmental Health (U.S. Centers for Disease Control and Prevention)
NCHS National Center for Health Statistics (U.S. Centers for Disease Control and Prevention)
NCP National Contingency Plan
NDMS National Disaster Medical System
NECC National Emergency Coordination Center (U.S. Federal Emergency Management Agency)
NEIS National Earthquake Information Service
NEJM New England Journal of Medicine
Acronyms 409
NGO Nongovernmental organization
NIH National Institutes of Health
NIMS National Incident Management System
NIOSH National Institute of Occupational Safety and Health
NLM National Library of Medicine
NLTN National Laboratory Training Network
NNSA National Nuclear Safety Administration (U.S. Department of Energy)
NOAA National Oceanic and Atmospheric Administration (U.S. Department of Commerce)
NPD National Preparedness Directorate (U.S. Federal Emergency Management Agency)
NPHIC National Public Health Information Coalition
NRC Nuclear Regulatory Commission
NRDAR Natural Resource Damage Assessment and Restoration (NRDAR Program) (U.S. Department of
the Interior)
NRF National Response Framework
NRS National Response System
NRT U.S. National Response Team
NSB National Security Branch (U.S. Federal Bureau of Investigation)
NSF National Science Foundation
NSIR Office of Nuclear Security and Incident Response (Nuclear Regulatory Commission)
NVOAD National Voluntary Organizations Active in Disaster
NVPO National Vaccine Program Office (U.S. Department of Health and Human Services)
NWS National Weather Service
O
ODP Office for Domestic Preparedness (U.S. Department of Homeland Security)
OEC Office of Emergency Communications (U.S. Department of Homeland Security)
OEP Office of Emergency Preparedness (U.S. Department of Health and Human Services)
OET Office of Emergency Transportation (U.S. Department of Transportation)
OFDA Office of U.S. Foreign Disaster Assistance (U.S. Agency for International Development)
OSHA Occupational Safety and Health Administration (U.S. Department of Labor)
OSTP Office of Science and Technology Policy (U.S. presidential administration)
410 Acronyms
P
PAHO Pan American Health Organization
PAHPA Pandemic and All Hazards Preparedness Act
PDR Physicians Desk Reference
PHAC Public Health Agency of Canada
PHEP-NET Public Health Education and Promotion Network
PHS Public Health Service (U.S. Department of Health and Human Services)
PIO Public information officer
PL Public law
POD Point of dispensing
PSA Public service announcement
PTSD Post-traumatic stress disorder
R
RETCO Regional emergency transportation coordinator
RHA Regional health administrator (U.S. Department of Health and Human Services)
RSS Really simple syndication
S
S/CT Office of the Coordinator of Counterterrorism (U.S. Department of State)
SAMHSA Substance Abuse and Mental Health Services Administration (U.S. Department of Health and
Human Services)
SARS Severe acute respiratory syndrome
SMART Specific, measurable, attainable/achievable, relevant/realistic, and time-bound
SME Subject matter expert
SMS Short message service
SNS Strategic National Stockpile (U.S. Centers for Disease Control and Prevention)
SOP Standard operating procedure
T
TREAS U.S. Department of the Treasury
TSA Transportation Security Administration (U.S. Department of Homeland Security)
TVA Tennessee Valley Authority
Acronyms 411
U
UMCOR United Methodist Committee on Relief
UN United Nations
USACE U.S. Army Corps of Engineers
USAMRIID U.S. Army Medical Research Institute of Infectious Diseases
USC United States Code
USDA U.S. Department of Agriculture
USGS U.S. Geological Survey
USPHS U.S. Public Health Service
USPS U.S. Postal Service
W
WHO World Health Organization
WMD Weapon of mass destruction
412 Acronyms
Epidemiology Terms
2014 EDITION

Epidemiology Terms
Airborne infection: A mechanism of transmission of an infectious agent by particle, dust, or droplet

nuclei suspended in the air.
Antibody: Protein molecule formed by exposure to a foreign or extraneous substance, e.g., invading
microorganisms responsible for infection, or active immunization.
Antigen: A substance that is capable of inducing specific immune response. Introduction of an antigen
may be by the invasion of infectious organisms, immunization, inhalation, ingestion, etc.
Association: The degree of statistical dependence between two or more events or variables. Events
are said to be associated when they occur more frequently together than one would expect by chance.
Attack rate: Attack rate, or case rate, is a cumulative incident rate often used for particular groups,
observed for limited periods and under special circumstances, as in an epidemic. The secondary attack
rate expresses the number of cases among contacts occurring within the accepted incubation period
following exposure to a primary case, in relation to the total of exposed contacts; the denominator may
be restricted to susceptible contacts when determinable.
Behavioral epidemic: An epidemic originating in behavioral patterns (as opposed to invading

microorganisms or physical agents).
Biological plausibility: The criterion that an observed, causal association fits previously existing
biological or medical knowledge.
Carrier: A person or animal that harbors a specific infectious agent in the absence of discernible
clinical disease and serves as a potential source of infection.
Case: A person in the population identified as having the particular disease, health disorder, or
condition under investigation.
Case fatality rate: The proportion of persons contracting a disease who die of that disease.
Clustering: A closely grouped series of events or cases of a disease, or other health-related phenomena
with well-defined distribution patterns, in relation to time or place or both.
Cohort: The component of the population born during a particular period and identified by that period
so that its characteristics can be ascertained as it enters successive time and age periods.
413
Cohort study: The method of epidemiologic study in which subsets of a defined population can be
identified who are, have been, or may or may not be exposed in different degrees in the future, to the
probability of contracting a given disease.
Communicable disease: An illness due to a specific infectious agent or its toxic products that
is transmitted from an infected person, animal, or reservoir to a susceptible host, either directly or
indirectly.
Contact (of an infection): A person or animal that has been in physical association with an infected
person or animal, or contaminated environment, allowing the opportunity to acquire the infection.
Contact, direct: A mode of infection transmission between an infected host and susceptible host.
Contact, indirect: A mode of infection transmission involving fomites or vectors.
Contact, primary: Person(s) in direct contact or associated with a communicable disease case.
Contact, secondary: Person(s) in contact or associated with a primary contact.
Contagion: The transmission of infection by direct contact, droplet spread, or contaminated fomites.
Contagious: Transmitted by contact.
Contamination: The presence of an infectious agent on a body surface; also on clothes, bedding,
surgical instruments, or other inanimate articles or substances.
Death rate: A rate expressing the proportion of a population that dies of a disease.
Disease, preclinical: Disease with no signs or symptoms, because they have not yet developed.
Disease, subclinical: A condition in which disease is detectable by special tests but does not reveal
itself by signs or symptoms.
Disinfection: Killing of infectious agents outside of the body by direct exposure to chemical or
physical.
Dose response relationship: A relationship in which a change in amount, intensity, or duration of

exposure is associated with a changeeither an increase or decrease in risk.
Epidemic: The occurrence in a community or region of cases of an illness or other health-related

events clearly in excess of normal expectancy.
414 Epidemiology Terms

Epidemiologist: An investigator who studies the occurrence of disease or other health-related
condition or events in a defined population. Also known as a disease detective.
Epidemiology: The study of the distribution and determinants of health-related states and events in
populations, and the application of this study to the control of health problems.
Epizootic: An outbreak (epidemic) of disease in an animal population (often with the implication that
it may also affect human population).
Eradication (of disease): Termination of all transmission of infection by extermination of the

infectious agent through surveillance and containment.
False negative: Negative test result in a subject who possesses the attribute for which the test is
conducted.
False positive: Positive test result in a subject who does not possess the attribute for which the test is
conducted.
Fatality rate: The death rate observed in a designated series of persons affected by a simultaneous
event.
Fomites: Articles that convey infection to others because they have been contaminated by pathogenic
organisms. Examples include dishes, door handles, and toys.
Herd immunity: The immunity of a group or community. The resistance of a group to invasion and
spread of an infectious agent, based on the resistance to infection of a high proportion of individual
members of the group.
Host: A person or other living animal, including birds and arthropods, that affords subsistence to an
infectious agent under natural conditions.
Household interview study: Collection of information from a sample of a civilian noninstitutionalized

population by trained interviewers who go to the dwellings of the persons selected for interview.
Immunization: Protection of susceptible individuals from communicable disease by administration of

a living modified agent (as in measles), a suspension of killed organisms (as in whooping cough), or an
inactivated toxin (as in tetanus).
Incidence: The number of instances of illness during a given period in a specified population.
Incident rate: A measure of the rate at which new events occur in the population.

Incubation period: The time interval between invasion by an infectious agent and appearance of the
first sign or symptom of the disease in question.
Index case: The first case in a family or other defined group to come to the attention of the
investigator.
Infectiousness: A characteristic of the disease that concerns the relative ease with which it is
transmitted to other hosts.
Monitoring: The performance and analysis of routine measurements, aimed at detecting changes in the
environment or health status of populations.
Morbidity: Illness.
Norm: Can be defined as what is usual or what is desirable.
Nosocomial infection: An infection originating in a medical facility.
Notifiable disease: A disease that, by statutory requirements, must be reported to the public health
authority.
Numerator: The upper portion of a fraction used to calculate a rate or a ratio.
Occurrence: The frequency of a disease or other attribute or event in a population.
Outcomes: All of the possible results that may stem from exposure to a causal factor, or from
preventive or treatment interventions.
Outliers: Observations differing widely from the rest of the data, suggesting that these values come
from a different population.
Pandemic: An epidemic occurring over a very wide area and usually affecting a large proportion of the
population.
Parasite: An animal or vegetable organism that lives on or in another and derives its nourishment
therefrom.
Pathogen: Organism capable of causing disease.
Pathogenicity: The property of an organism that determines the extent to which overt disease is
produced in an infected population, or the power of an organism to produce disease.

Population-based: Pertaining to a general population defined by geopolitical boundaries.
Prevalence: The number of instances of a given disease or other condition in a given population at a
designated time.
Prevention: The goals of public health and medicine are to promote health, to preserve health, to
restore health when it is impaired, and to minimize suffering and distress.
Primary case: The individual who introduces the disease into the family or group under study.
Quantitative data: Data in numerical quantities, such as continuous measurements or counts.
Quarantine: The limitation of freedom of movement of well persons or animals exposed to a communicable
disease, for a period of time not longer than the longest usual incubation period of the disease.
Random: Occurs by chance.
Rate: Ratio whose essential characteristic is that time is an element of the denominator and in which
there is a distinct relationship between numerator and denominator.
Relative risk: The ratio of the risk of disease or death among the exposed to the risk among the
unexposed.
Reservoir: The natural habitat of the infectious agent.
Risk: A probability that an event will occur.
Risk factor: An attribute of exposure that is associated with an increased probability of a specified
outcome, such as the occurrence of a disease.
Sample: A selected subset of a population.
Screening: The use of tests or examinations to identify unrecognized disease.
Seroepidemiology: Epidemiologic study or activity based on the detection on serological testing of

characteristic change in the serum level of specific antibodies.
Statistical significance: Statistical methods allow an estimate to be made of the probability for the
observed or greater degree of association between independent and dependent variables under the null
hypothesis.

Surveillance: Ongoing scrutiny; generally, using methods distinguished by their practiceability,
uniformity, and, frequently, their rabidity, rather than by complete accuracy.
Surveillance of disease: The continuing scrutiny of all aspects of occurrence and spread of a disease
that is pertinent to initiate investigative or control measures.
Survey: An investigation in which information is systematically collected not using the experimental
method.
Transmission of infection: Transmission of infectious agents. Any mechanism by which an infectious

agent is spread through the environment or to another person.
Validity: Expression of the degree to which a measurement measures what it purports to measure.
Variable: Any quantity that varies. Any attribute or event that can have different values.
Virulence: The degree of pathogenicity.
Zoonosis: An infection or infectious disease transmissible under natural conditions from vertebrate
animals to man.

Notes:

Notes:

Index
2014 EDITION

Index
Active Listening 170, 226 Response website 362

Advisory Groups 225226 Chemical, Biological, Radiological, Nuclear, and
Agency for Toxic Substances and Disease Registry Explosive (CBRNE) 298319
(ATSDR) (see Centers for Disease Control and Civil Rights Act of 1964 394
Prevention) Clean Air Act and Oil Pollution Act 374
Aggregators 263 Clearance (Information) 99101, 107, 113, 124, 125,
American Red Cross 8, 76, 96, 116, 122, 261, 334, 336, 187, 195, 197, 198, 247
338, 351 Collaboration 223
Anger 28, 31, 32, 37, 41, 154, 169, 170, 206, 209, 227, Community Forum 225, 226
231, 248, 313, 338, 342 Community Mailings 243244
Appropriation 380 Commercial Mobile Alert System (CMAS) 178, 270, 285
Audiences 13, 29, 35, 38, 39, 4956, 59, 60, 63, 64, 68, Commercial Press Release Services 187188, 276
69, 75, 76, 77, 81, 94, 99, 101, 106, 114, 125, 126, 127, Communication Channels 49, 53, 237254, 271, 284
137, 139, 153, 160, 168, 173, 177, 178, 185, 193, 199, Attributes of 237239
206, 215, 216, 219, 237, 238, 241, 245, 246, 250, 254, E-mail 108, 114, 116, 186, 191, 218, 241242
257, 260, 262, 267, 268, 269, 271, 274, 277, 278, 287, Newspapers 237238
290, 316 Radio 53, 62, 74, 76, 160, 164167, 178, 202, 203,
Backgrounders 195, 198, 204 206, 238, 240
Bioterrorism/Biological Incident 17, 18, 137, 177, Social media (see Social Media)
297322, 386, 394 Television 37, 62, 153, 160, 164167, 178179, 199,
Blogs 114, 135, 205, 210, 257, 259, 262, 269, 273, 274, 237239, 353
275, 279, 280, 286 Telephone 241, 253254, 276, 281, 337
Briefings (see Press Briefings) Word of mouth 239, 353
Broadcast Fax 96, 137, 140, 145, 186, 191 Communication Lifecycle 914
BRoll 107, 135, 138, 142, 199200 Pre-crisis 10, 39, 60, 86, 332
Call Centers (see Telephone Call Centers) Initial 11, 40, 8789, 336
Centers for Disease Control and Prevention (CDC) Maintenance 12, 4142, 90, 336
4, 17, 22, 53, 64, 73, 7579, 81, 89, 98, 109, 110, 116, Resolution 13, 42, 91, 336
121, 122, 154, 157, 182, 184, 193, 195, 210, 219, 269, Evaluation 14, 91, 118, 126
275, 285, 290, 298, 300, 302, 307, 308, 310, 311, 315, Community Based Disaster Preparedness (CBDP)
317, 318, 341, 362, 361, 379, 394, 396, 397, 399 351352
Agency for Toxic Substances and Disease Registry Community Partnerships 224
(ATSDR) 361, 376 Community Forum 225226
Division of Emergency Operations 110 Community Resilience 85, 351352
Emergency Communication System 75 Conflict 22, 36, 54, 223, 230, 286, 385, 386
Health Alert Network 75, 87, 121 Content Communities 262263
Interim Recommended Notification Procedures for Consequence Management 297
Local and State Public Health Department Copyright 372373
Leaders in the Event of a Bioterrorist Incident Crisis
362 Communication, Defined 6
Public Health Emergency Preparedness and Characteristics of 6, 89
421
Psychological Effects 27, 313 Freedom of Religion 385
Coordination 223 Good Samaritan statute 392
Collaboration 223 Health Alert Network (HAN) (see Centers for Disease
Crisis and Emergency Risk Communication 12, 5, 7 Control and Prevention)
Defined 5 Health Insurance Portability and Accountability Act of
Life cycle 914 1996, 379
Role 1416 Hoax 307, 312313
Crisis Management 297 Incident Commander/Unified Command (IC/UC)
Credibility 2, 115 305
Crowdsourcing Content 263 Interviews 161168, 277
Department of Agriculture (USDA) 112, 349, 355 International Health Regulations (IHR) 356
Department of Defense (DoD) 301, 349, 355, 368369 Integrated Public Alert Warning System (IPAWS) 178
Department of Energy (DOE) 301, 349, 355 Intermediate Scrutiny 387
Department of Health and Human Services (HHS) Issues Management Communication 7
301302, 349, 355, 359362 Japans Disaster Prevention Day 353
Department of Homeland Security (DHS) 122, 299, 301, Joint Information Center (JIC), 86, 276, 305, 334, 358
305, 349, 355 Laws of Defamation 370372
Department of Justice (DOJ) 301, 349, 355 Liability 389392
Department of State 355 Memorandum of Understanding/Agreement (MOU/A)
Due Process 386 221, 377
Empathy 2, 158 Microblogs 114, 262, 280
Emergency Operations Center (EOC) 94, 110 Mobile
Emergency Use Authorization (EUA) 316 Device 280288
Emergency Medical Services 122 Media 280286
Environmental Protection Agency (EPA) 301, 349, 355 Phones 280282
Seven Cardinal Rules of Risk Communication 3438 MySpace 261, 262
Equal Protection 386388 Myths 205, 286
The Espionage Act of 1917 370 National Disaster Medical System 302, 360
Exhibits 245246 National Incident Management System (NIMS) 8, 99,
Facebook 114, 160, 193, 238, 242, 257, 261262, 105, 106, 221, 301, 334
Faith Based Organizations (FBO) 350, 354 National Response Framework 18, 301, 334, 357359
Fair Use 373 Emergency Support Function (ESF) 357
False Light 380 Public Affairs Support Annex 357358
Fax, Broadcast (see Broadcast Fax) Incident Annexes 359
Federal Bureau of Investigation (FBI) 122, 301, 305, National Preparedness Directorate (NPD) 359
311, 349 National Strategy for Public Health and Medical
Federal Emergency Management Administration Preparedness 352
(FEMA) 2, 8, 122, 297, 301302, 334, 349, 351, 355, Negligence 389, 390
357359 Newsletters 208, 247248
First Responder Stress 330 Nongovernmental organization (NGO) 62, 104, 179,
Flickr 114, 261, 280 215, 244, 350
Flyers 246247 Office of the Assistant Secretary for Preparedness and
Food and Drug Administration (FDA) 302 Response (ASPR) 359360
Foursquare 281 Open House 249
Freedom of Assembly 386 Personal Digital Assistant 280
Freedom of Speech 369, 386 Personal Telephone Contact 253254
Freedom of Information Act (FOIA) 375378 Pinterest 263
422 Index
Podcasts 257, 262 Small Group Meetings 243, 248, 252253
Posttraumatic Stress Disorder (PTSD) 27, 298, 313, Smart Phones 259, 281
330332 Social Bookmarking 263
Poynter Institute for Journalism 180181 Social Media 193, 242, 258279, 286
Presentations 6368, 204, 250 Advantages 193, 260
Press Briefing 162 Attributes 265267
Press Conference 103, 109, 113, 162, 188190, Disadvantages 194, 260
200205 Users 267
Press Release 186188, 195200, 221, 276, 281 Writing for 194
Privacy Act of 1974 378 Worksheet 289
Public Disclosure of Private Facts 380 Stakeholders 213219
Public Health Service Act 379, 395 Stakeholders and Partner Communication
Public Information Officer (PIO) 159, 274, 303, 330, 380 Advocates, adversaries, ambivalents 213
Public Meetings 168169, 225226, 243, 251253, 389 Coordinating with partners 221
Public Readiness and Emergency Preparedness Act of Stakeholder reaction assessment 218, 232
2005 392 Responding to your stakeholders 219
Public Record Laws 375 Partnership development 220
Publics Right to Know (see Right to Know) Strategic National Stockpile 302, 314, 320
Radio 53, 62, 74, 76, 93, 113, 114, 127, 135, 140, 145, Strict Scrutiny 387
160, 178179, 182, 197, 202, 206, 210, 237240, 249, Taking of Private Property 388
261, 263, 282, 317, 320, 338, 353 Task Forces 225226
Rational Basis Scrutiny 388 Terrorism 5, 297322
Really Simple Syndication (RSS) 107, 263, 267, 284 Telephone Call Centers 241
Red Cross (see American Red Cross) Tort 390391
Retraction 207, 371 Twitter 49, 96, 107, 111, 114, 160, 178, 193, 210,
Right to Know 373375 238239, 242, 257, 259, 261262, 266, 280
Risk Weapons of Mass Destruction (WMD) 303
Defined 7 Web 2.0 259, 272, 279
Characteristics of 7 Webcast 190, 276
Perception 3233 Wiki 262
Rumors 12, 13, 15, 23, 31, 49, 74, 88, 90, 94, 103, 104, World Health Organization (WHO) 354, 396
116, 120, 121, 124, 129, 183, 185, 192, 194, 205, 224, YouTube 114, 239, 257, 261
260, 271, 274, 286287, 372 Vaughn Index 377
Salvation Army 78, 122, 351 Volunteer Protection Act 392
Satellite Media Tours 186, 189190, 276 Zombie 269
Short Message Service (SMS) 281, 283
Index 423
Notes:
424 Index
For more information please contact
1600 Clifton Road NE, Atlanta, GA 30333
Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348
E-mail: cdcinfo@cdc.gov
Web: www.atsdr.cdc.gov
Publication date: August 2014

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Version 15.

CERC addresses a number of topics critical to successful public, partner,

CERC is the attempt by public health professionals to provide information

5 Defining Crisis and Emergency Risk Communication

9 The Communication Lifecycle

Chapter 2: Psychology of a Crisis

23 Mental States in a Crisis

ii Crisis and Emergency Risk Communication 2014 Edition

34 EPAs Seven Cardinal Rules of Risk Communication

Chapter 3: Messages and Audiences

63 Organizing Information for Emergency Response Presentations

Chapter 4: Crisis Communication Plans

92 A Seat at the Table for Communication

Crisis and Emergency Risk Communication 2014 Edition iii

115 Applying the Plan During the First 24 to 48 Hours

121 Applying the Crisis Plan Throughout the Response

Chapter 5: The Spokesperson

155 The Role of the Spokesperson in Crisis Communication

160 Working with the Media

168 Spokespersons in Public Meetings

171 Assessing Spokesperson Skills

iv Crisis and Emergency Risk Communication 2014 Edition

183 Giving Reporters What They Need

186 Getting Emergency Information to the Media

194 Writing for the Media during a Crisis

200 Meeting Media Needs Throughout an Emergency

205 Responding to Media Regarding Significant Errors, Myths, and Misperceptions

Crisis and Emergency Risk Communication 2014 Edition v

220 Partnership Development

224 Working with Communities

Chapter 8: Other Communication Channels

239 Channel Characteristics and Features

242 Applying Specific Communication Tools

vi Crisis and Emergency Risk Communication 2014 Edition

261 Social Media Forums, Attributes, and Users

268 Working with Social Media Before and During a Crisis

273 Writing for Social Media during a Crisis

278 Keeping Up with Social Media during a Crisis

280 Mobile Media and Its Role during a Crisis

Chapter 10: Terrorism and Bioterrorism Communication

303 Communication Challenges

Crisis and Emergency Risk Communication 2014 Edition vii

313 Psychological Responses to Terrorism

Chapter 11: Human Resources for CERC

338 Emotional Health Issues for Those Responding to a Crisis

Chapter 12: Understanding Roles of Federal, State, and Local

350 Community-based Approaches to Emergencies

354 List of International Agencies, Federal Agencies, NBOs, and FBOs

viii Crisis and Emergency Risk Communication 2014 Edition

359 Department of Health and Human Services (HHS)

Chapter 13: Media and Public Health Law

369 Freedom of Speech and the Press

370 Laws of Defamation

372 Copyright Law

373 The Publics Right to Know

375 Freedom of Information Act (FOIA)

381 Public Health Laws

384 Public Health Powers and Liabilities

Crisis and Emergency Risk Communication 2014 Edition ix

Locations near earthquake faults

Coastal hurricane areas

Regions subject to wildfires

Bacteria and viruses growing and rapidly spreading

Employing advanced tools, such as improvised explosive devices

Issues management communication

Crisis and emergency risk communication

Should I undergo a medical treatment?

What are the risks of living next to a nuclear power plant?

Do I elect to vaccinate a healthy baby against whooping cough?

Local public health agencies

State public health agencies Numerous after-action reports

Emergency medical services

Nongovernmental response organizations such as the American Red Cross

Monitor and recognize emerging risks.

Educate the general public about the risks.

Prepare the public for the possibility of an adverse event.

Increase self-efficacy by suggesting actions that reduce the likelihood of harm.

Provide warning messages regarding an imminent threat.

Develop consensus recommendations by experts and first responders.