1. Communicating Effectively in Times of Crisis and Uncertainty

2. Getting Started Presenter –(insert name and credentials) Participants –Your Name –Your Organization –Your Role

3. Presentation Objectives Today you will learn: –Why communicating EARLY in a crisis is so important. –Core skills for communicating quickly and effectively during a crisis. –New ways of thinking about your role as a communicator.

4. Communication: Whose Job Is It? In the event of a public health crisis, who becomes a “spokesperson?” –Public Health Professionals –Government Officials/Representatives –First Responders –Medical Professionals –Others? What is the likelihood that YOU will be a spokesperson during a time of crisis? –It is likely.

5. Communication: Why Is It Critical? Why is it critical to communicate with the public during times of crisis and uncertainty? Effective communication can limit injury, suffering and death.

6. Communication: How Is It Critical? How does effective communication limit injury, suffering and death? –It builds public trust and cooperation. –It supports response and recovery efforts. –It informs response partners. –It reduces rumors and misinformation. –It discourages social stigmatization. –It aids the care of the sick. –It bolsters individuals and communities to rebound from traumatic events.

7. An Illustration of Communicating in Times of Crisis and Uncertainty

8. A Killer Without A Name Where: In the Southwest region of the United States. When: May through November 1993. Who: Mostly healthy, young, rural Native American residents. What: 48 cases of rapidly progressing respiratory disease causing 27 deaths. Why and How: Currently Unknown.

9. A Killer Without A Name What did those who were sick have in common? –Healthy –Young –Rural residents –Native American Which commonality do you think received the most attention? –Native American

10. A Killer Without A Name An investigation was launched. Information about the 27 deaths began to spread across the region. A well-coordinated crisis communications effort got off to a late start, allowing for a number of negative public responses.

11. A Killer Without A Name Public Response: –A medical center reports an increase of 800 patients a day of “worried well.” –Native American men and women are perceived as “carriers of death.” –Native American owned businesses are boycotted by Native Americans and others.

12. A Killer Without A Name Public Response: –Rumors multiply that the government is spreading a biological killer to “wipe out undesirables” causing additional mistrust of government. –Reporters hound Native American individuals, asking intrusive and intimate questions, disregarding confidentiality. –Native American beliefs against speaking the names of the dead and conducting autopsies are ignored and haunt the living.

13. A Killer Without A Name WHY and HOW were people getting sick and dying? –Hantavirus. –Caused by an unusual increase in the population of deer mice and the increased contact of the mice with humans. This information was taken from the book: Virus Hunter: Thirty Years of Battling Hot Viruses Around the World by C.J. Peters, 1997.

14. A Killer Without A Name How could local health officials have reduced fear and cultural insensitivity by what they did before and during the event? –Before: Built relationships with tribal leaders and members. –Before: Built relationships with media. –During: Spoke earlier rather than later, delivering first, then frequent messages through news conferences.

16. Speak First – Speak Well Understand that crisis communication is a process. Understand that FIRST MESSAGE DELIVERY is a critical point in that process. Understand that there is a right - and a wrong - way to deliver first messages. Understand that the right message at the right time can save lives and limit suffering.

17. Crisis Communications is a Process

18. When Crisis Occurs What happens in a crisis? –Crisis events can happen instantly. –Crisis can also creep slowly into communities. –Crisis events create a demand for information before all facts are known. –During a crisis, people take in, process, and act on information differently.

19. Health Crises Are Different What makes health crises challenging and especially scary to the public? –Diseases and contamination may be silent and invisible. –Illnesses are discovered over time (while the public continues to be exposed). –There are many uncertainties, investigations and delays before a solution is found. –Experts may disagree on disease control efforts.

21. First Messages Matter Why is it so important that you speak early during a time of a health crisis? –The public judges YOUR emergency preparedness by how quickly you release information. –The public takes action and makes choices based on the first messages they hear. –You demonstrate that someone is in charge and taking action. –It buys time for interagency coordination to take place.

22. First Messages Matter Speed Equals AuthorityIn other words, Speed Equals Authority –Someone is in charge. –A system is in place. –A response is underway.

23. What if We Speak Late? What are the consequences of communicating late? –It allows time for bystanders and unofficial professionals to characterize the emergency and offer unofficial opinion. –It forces the media to report rumors and inaccuracies. –It creates public confusion and anxiety.

24. Why Do Some Organizations Hold Back? Most commonly, organizations withhold information for fear that people will panic. –The reality is that most people cope creatively with crisis and DO NOT engage in extreme behavior, especially if they believe they are being told the truth. –Be sure not to confuse fear and anxiety with panic. –Know that there will always be “fighters and fleers” who take unnecessary actions.

25. Why Do Some Public Health Organizations Hold Back? It is a natural response for Public Health agencies to: –Want ALL the information before talking with the public. –Have coordinated with ALL response partners before offering a statement. Since 9/11, the CDC recommends communicating with the public right away to show that a response is underway.

26. First Messages Matter Remember, developing and communicating first messages DOES NOT mean having all the answers. It DOES mean showing that someone is in charge, and that a response is underway.

28. What Are People Looking For? Why does the public want information quickly in a crisis? –To help them make more informed decisions about their well-being. –To know how to protect themselves and their loved ones. –To help them preserve or recover their well- being and normalcy. –To get involved in emergency response efforts (for some people).

29. So, Be First to Speak The goals of delivering first messages are: –To provide a caring and compassionate response. –To spread credible information rapidly. –To reduce or manage personal risk. –To set reasonable public expectations. –To emphasize the need to comply with public health measures for containing the spread of the disease.

30. Implement the Six Proven Steps to Delivering Effective First Messages

31. Six Steps to Delivering First Messages 1.Express empathy. –Show your ability to understand what another person is feeling. People are better able to listen to difficult information from a caring person. –Provide an expression of empathy in the first 30 seconds. –Example: “I know you are concerned and I know you want as much information as possible.”

32. Six Steps to Delivering First Messages 2.Share what you know – only the confirmed facts. –Who, What, When, Where, Why and How. –It is not necessary to have every answer to move ahead with delivering your first message. –Example: “This is an evolving emergency. I want to tell you what we can confirm right now. At (time), a (brief description of what happened).”

33. Six Steps to Delivering First Messages 3.State what you don’t know. –Acknowledge that there are unanswered questions. –Example: “At this point, we do not know the number of (persons ill or exposed, injured, deaths, etc.) but we will tell you when we know.”

34. Six Steps to Delivering First Messages 4.Describe the process and plans to fill in knowledge gaps. –Explain the first steps being taken to respond to the crisis. –Describe what people can expect next. –Example: “We are working with local health care providers and emergency response partners to care for the victims.”

35. Six Steps to Delivering First Messages 5.State your agency’s commitment to helping people through the crisis. –Let people know that your agency is there for the long haul. –State when they will be hearing from you again. –Example: “We are committed to keeping you informed and will be back with a statement in two hours” (Be sure to follow through).

36. Six Steps to Delivering First Messages 6.Guide people to where they can get more information. –Provide a web site address and a hotline or resource number. –Again, state when you will be back in touch with them. –Example: “Please check our hotline number and web site for up-to-date information. The hotline number is 555.555.5555 and our Web site is www.healthdept.com.”www.healthdept.com

37. Recap: Six Proven Steps to Delivering Effective First Messages 1.Express empathy. 2.Share what you know – only confirmed facts. 3.State what you don’t know. 4.Describe the process and plans to fill in knowledge gaps. 5.State your agency’s commitment to helping people through the crisis. 6.Guide people to where they can get more information.

38. Keep This in Mind What is important to remember when developing first messages? –During a crisis, a person’s ability to listen to and understand information goes down. –Use simple words and phrases. –People forget 80% or more of the information they hear. –People remember the first and last things that are said.

39. Anticipating the Questions

40. Why is it critical to anticipate the questions AFTER first messages are delivered? –Speeds up the process of communicating with the public. –Allows the response to be proactive, not reactive. –Helps focus the incident commander and response partners on the public’s concerns. –Prepares you and your partners to deliver consistent Key Messages to the public. –Media reporters will be doing the same thing.

41. Anticipating the Questions What are the questions that are likely to be asked as a crisis unfolds? –Anticipate questions from the people that are directly affected by the crisis. –Anticipate questions from the general public. –Anticipate questions from the media.

42. Anticipating the Questions Are my family and I safe? What have you found that will affect us? What can I do to protect us? Who (what) caused this problem? What is being done to help the victims? Is it controllable? Is there catastrophic potential? Is the affect or outcome uncertain?

43. Start Practice Scenario

44. The following slides represent a realistic public health crisis event and you are charged with developing first messages for the public.

45. Setting the Stage Brookfield is a city of 100,000 in a large semi-rural farming region. Brookfield is the region’s healthcare, business, transportation and communications hub. The community has a trauma hospital, several four-year colleges, and an airport.

46. Setting the Stage Methamphetamine abuse is a problem in the Brookfield area. About ten people each year are admitted to the hospital with symptoms of Methamphetamine overdose. There are hundreds of users in the community and many people are jailed each year for using and making Methamphetamine.

47. DAY 1: Saturday - 12:45 a.m. Brookfield Hospital Three 20 year olds are brought to Brookfield Hospital ER by ambulance with symptoms of drug overdose. One person was given CPR in the field and has been put on a ventilator. The other two collapse in the ER. All three people die by 3:00 a.m. Blood tests show evidence of Methamphetamine intoxication.

48. DAY 3: Monday - 2:00 p.m. Children’s Corner Childcare Center Emergency Response Services respond to a childcare center to evaluate 5 toddlers with apparent respiratory problems. Children were spontaneously wheezing and coughing. No odors or harsh cleaning products were detected. The childcare center has good air circulation. The children recovered and were not transported to the hospital.

49. DAY 3: Monday – 6:00 p.m. Brookfield Hospital Four young adults are brought to Brookfield Hospital ER with Methamphetamine overdose, including elevated blood pressure, high body temperature and profuse sweating. All four are being monitored in the hospital. Two are on ventilators and the others are very ill as well.

50. DAY 5: Wednesday – 11:30 a.m. Children’s Corner Childcare Center Emergency Response Services are called back to the childcare center, where 8 children in the infant and toddler rooms are exhibiting respiratory problems. Two children are transported to the hospital. Routine toxics screens show that the blood of one 3 year old child tests positive for Methamphetamine. The other child’s test is negative, but is having breathing problems, probably from inhaling a strong caustic.

51. DAY 5: Wednesday – 2:00 p.m. Children’s Corner Childcare Center Children’s Corner staff request that the Brookfield Public Health Department assess the indoor air quality of the childcare center. The Public Health inspector notes signs of a Methamphetamine lab in the house next door to the childcare center. (Lots of trash bags, chemical bottles, tanks, and blacked out windows.) The inspector reports the house to the police.

52. Review the Facts What is currently known by Public Health? –Paramedics have responded twice in three days to a daycare to evaluate a total of 13 toddlers with apparent respiratory problems. –2 children are transported to the hospital. –One 3 year old tests positive for Methamphetamine. –Methamphetamine production and use are a problem in the community. –A potential Methamphetamine lab has been identified. –Police have been notified.

53. Review the Facts What is currently known by others? (Public Health may or may not be aware of the following facts because Methamphetamine overdose is not reported to Public Health by hospitals or law enforcement.) –7 people have shown up at the hospital over the last 5 days for Methamphetamine use. –3 people have died and 4 are still hospitalized and are seriously ill. –The ER normally sees about 10 people a year for Methamphetamine.

54. Review the Facts What is currently unknown? –Whether the apparent increase in hospitalizations is coincidence or evidence of a bad batch of Methamphetamine?

55. Additional Information Methamphetamine oil becomes airborne and saturates carpets, walls and other surfaces. Anyone living where Methamphetamine is cooked will get it in their blood from environmental contamination. Risks to the people living in the house where Methamphetamine is being cooked include injury from explosion, skin and lung irritation, respiratory distress, neurological symptoms, mucus membrane irritation, and effects from toxicity of the drug itself.

56. Additional Information Methamphetamine takes only a few hours to “cook,” and the process is relatively simple (but dangerous) to carry out. Methamphetamine cooking materials are extremely flammable and many labs are discovered when there is a fire or explosion. For every pound of Methamphetamine manufactured, 5-6 pounds of toxic waste are produced. Environmental contamination to drinking water and soil is possible when materials are disposed of improperly.

57. DAY 5: Wednesday – 5:00 p.m. Children’s Corner Childcare Center Public Health inspectors do an initial assessment of the suspected Methamphetamine lab, and post a “Do Not Enter” sign on the house. The childcare operator tells parents about the hospital visits and the suspected Methamphetamine lab.

58. DAY 6: Thursday – 10:00 a.m. Investigation A police/public health investigation reveals a Methamphetamine lab operation next door to the childcare center. Anhydrous ammonia, used in Methamphetamine cooking, probably wafted in the air, sickening the children. The 3 year old Methamphetamine positive boy lived in the home and attended the childcare center.

59. Could the Word Get Out? Although you have not made any public announcements, could the word get out? –Yes! How could the word get out? –Emergency response service workers –Children’s Corner staff –Children’s Corner neighbors –Parents of children that attend Children’s Corner

60. DAY 6: Thursday – 12:00 p.m. Investigation Continues There is evidence that the abandoned well in the backyard of the house was used as a dump for the toxic Methamphetamine cooking chemicals. The homes in the neighborhood are on private or community wells. It is possible that drinking water in the neighborhood may have been contaminated.

61. DAY 6: Thursday – 12:00 p.m. Brookfield Health Department Reporters from the television stations and local newspapers begin calling to ask what is going on. They are demanding to know if the water is safe to drink. Neighbors state they detect the taste of solvents in their water. Promotional news spots feature hysterical neighbors with their children.

62. Communicating With the Media What is the best way to handle the media during a crisis? Do you … a)respond to reporters on a one-on-one, first- come-first-served basis OR, b)issue a news release OR, c)hold a news conference?

63. Communicating With the Media The best way to handle the media during this crisis is to … c)Hold a news conference. –This is fast-breaking news, the public will want to know what’s happening and who’s in charge. –Talking to reporters individually could lead to inconsistency of information given to the public. –After the news conference, send a news release to your full media list with all of the same information that was presented at the news conference.

64. Break into groups of 4 to 6 people, develop your first messages using the six proven steps.

65. Deliver An Effective First Message 1.Express empathy. 2.Share what you know – only confirmed facts. 3.State what you don’t know. 4.Describe the process and plans to fill in knowledge gaps. 5.State your agency’s commitment to helping people through the crisis. 6.Guide people to where they can get more information.

66. Report to the large group the first messages your group developed.

67. Sharing Your Group Results Sample First Message:

68. In your groups of 4 to 6 people, develop a list of questions you would expect the media and the public to ask.

69. Anticipate the Questions What are the questions that are likely to be asked as a crisis unfolds? –Anticipate questions from the people that are directly impacted by the crisis. –Anticipate questions from the general public. –Anticipate questions from the media.

70. Share Your Group Results Sample questions: Will there be delayed effects on the children? What will be done to clean up the lab? What can we expect next? How did this happen?

71. Community Scourge Continues Lab results from neighborhood drinking water wells come back positive for Methamphetamine. At least 5 homes have been affected by contamination and people in the homes have been drinking water contaminated by solvents and other chemicals. Police and Public Health officials continue to respond.

72. Next Steps

74. Common Communication Errors What is important for a spokesperson to avoid when delivering first messages? –Speculating about future facts. –Using technical jargon and scientific terms (this includes acronyms). –Discussing emergency response costs. –Offering reassurance for reassurance sake alone.

75. Common Communication Errors Using HUMOR is also important to avoid when delivering first messages. –What You Say: “If I were a cow, I’d be mad, too.” –What They Hear: You don’t take this seriously. If you don’t take it seriously, why should I? You don’t really care about me or my safety. I could get sick from this, how can you joke about it?

76. Common Communication Errors Saying “No Comment” is counteractive when delivering first messages. –What You Say: “No Comment.” –What They Hear: You don’t care. You don’t know. The government is hiding information from us. What are we paying you for?

78. Yes - If You Understand that Crisis Communications is a Process

79. 1.Express empathy. 2.Share what you know – only confirmed facts. 3.State what you don’t know. 4.Describe the process and plans to fill in knowledge gaps. 5.State your agency’s commitment to helping people through the crisis. 6.Guide people to where they can get more information. Yes - If You Understand the Six Proven Steps to Delivering Effective First Messages

80. Yes - If You Know Your Strengths and Limits Stick to the rules. Practice. Seek input and feedback. Be comfortable with the unknown. Observe others. Continue to train.

81. Thank You

82. The Communicating Effectively in Times of Crisis and Uncertainty Training Series was created by the Public Health – Seattle & King County Advanced Practice Center with the help of the Advanced Practice Center National Risk Communications Advisory Council. Funding was provided by the National Association of County & City Health Officials. The project lead for developing Speak First: Communicating Effectively in Times of Crisis and Uncertainty was Jo Ellen Warner, Emergency Risk Communications Specialist at Public Health – Seattle & King County. Special thanks go to the Advanced Practice Center - Risk Communications Advisory Council and the project staff Hilary Karasz- Dominguez, Andrea S. Cohen, Wendy Roark, and Carina Elsenboss. Source: Public Health – Seattle & King County Advanced Practice Center

83. Bibliography Centers for Disease Control and Prevention and U.S. Department of Health and Human Services (2003). Crisis and Emergency Risk Communications Course: For Leaders By Leaders. Retrieved April 10, 2006 from http://www.cdd.gov/communication/emergency/leaders.pdf. http://www.cdd.gov/communication/emergency/leaders.pdf Covello, V.T. (n.d.). Risk and crisis communications: 77 questions commonly asked by journalists in a crisis. Retrieved March 10, 2006 from http://www.in.gov/isdh/bioterrorism/77_questions.htm. http://www.in.gov/isdh/bioterrorism/77_questions.htm Northwest Center for Public Health Practice (NWCPHP). (2005). Emergency risk communications course for public health professionals. Retrieved March 10, 2006 from http://www.nwcphp.org/training/courses-exercises/courses/risk-communication.http://www.nwcphp.org/training/courses-exercises/courses/risk-communication Peters, C.J. (1997). The Killer Without a Name. Virus Hunter: Thirty Years of Battling Hot Viruses Around the World (pp. 7-40). New York, NY: Anchor Books. University of Pittsburgh Medical Center. (2004). How to lead during bioattacks with the public’s trust and help: A manual for mayors, governors, and top health officials. Baltimore, MD: University of Pittsburgh Medical Center, Center for Biosecurity. U.S. Department of Health and Human Services. (2002). Communicating in a crisis: Risk communication guidelines for public officials. Washington, DC: Department of Health and Human Services. U.S. Department of Health and Human Services. (2003). Emergency risk communication CDCynergy. Washington, DC: Department of Health and Human Services.