Transcript Communications and Informatics - Northwest Center for Public

Preparing for and Responding to
Bioterrorism:
Information for the Public Health
Workforce
Northwest Center for Public Health Practice
University of Washington School of Public Health and Community Medicine
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Acknowledgements
This presentation, and the accompanying instructor’s manual,
were prepared by Jennifer Brennan Braden, MD, MPH, at the
Northwest Center for Public Health Practice in Seattle, WA, for the
purpose of educating public health employees in the general aspects of
bioterrorism preparedness and response. Instructors are encouraged
to freely use all or portions of the material for its intended purpose.
The following people and organizations provided information and/or
support in the development of this curriculum. A complete list of
resources can be found in the accompanying instructor’s guide.
Patrick O’Carroll, MD, MPH
Project Coordinator
Centers for Disease Control and Prevention
Judith Yarrow
Design and Editing
Health Policy and Analysis; University of WA
Washington State Department of Health
Jeff Duchin, MD
Jane Koehler, DVM, MPH
Communicable Disease Control,
Epidemiology and Immunization Section
Public Health - Seattle and King County
Ed Walker, MD; University of WA
Department of Psychiatry
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Communication and Informatics
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Communication and Informatics
Learning Objectives

Describe the Health Alert Network (HAN)
 Define
and describe its purpose and
functions in a BT response
 Identify
resources available for public health
through HAN
 Describe

public health participation in HAN
Identify factors influencing risk perception and
risk communication
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Communication and Informatics
Learning Objectives

Identify factors to plan for and issues to
consider when delivering high risk information to
the media and the public

Describe your communication roles and
responsibilities in a BT event or other public
health emergency
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Detecting and Responding to BT involves…
 Scanning data for suspect disease patterns
 Secure transmission of public health data
 Rapid communications within and beyond the
health care and public health sectors
 Management and maintenance of data systems
 Distribution of health alerts, treatment
guidelines, sampling protocols, public
announcements, etc.
 Communication of risk to various audiences
…all of which require competence in a new
discipline called INFORMATICS
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Public Health Informatics
 The systematic application of informatics and
computer science and technology to public
health
 Requires competence in:
The use of information per se
The use of information technology for one’s
own professional effectiveness
The management and development of
information systems for one’s health
agency
 Explicit list of target informatics competencies
for public health professionals is available at:
http://nwcphp.org/phi/comps
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Health Alert Network
Definition

A nationwide, integrated information and
communications system designed to:
 Ensure communications capacity at all local
and state health departments
 Ensure capacity to receive distance-learning
offerings from CDC, et al.
 Ensure capacity to broadcast and receive
health alerts at every level
More on HAN...
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Health Alert Network
How it Works

Links local health departments to one another
and to other organizations critical for
preparedness and response:
 Community
 Hospital
 State
first-responders
and private laboratories
health departments
 CDC
 Other
federal agencies
More on HAN...
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Health Alert Network

The “highway” for programs such as the
National Electronic Disease Surveillance
System (NEDSS) and the Epidemic Information
Exchange (Epi-X) project
More on HAN...
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Epidemic Information Exchange

A secure, moderated, Web-based exchange for
public health officials to…
Rapidly report and discuss disease outbreaks
and other public health events
 Create reports and track information
 Receive daily e-mails on new information in their
area(s) of interest
 Find contact information for key public health
officials
 Request assistance from CDC online
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The Flow of Health Information
Clinical care providers and
laboratories
NEDDS
Other reports
LHD
Local EOC
Media
Public
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Health alerts
Provider education
Other communication
SHD/PHL
Epi-X
Health Alerts
CDC
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Coordinating Information Activities
The Role of the EOC and JIC

Emergency Operations Center (EOC)
 The protected site from which state and local
civil government officials coordinate, monitor,
and direct emergency response activities
during an emergency

Joint Information Center (JIC)

A center established to coordinate the public
information activities on-scene
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Emergency Operations Center (EOC)

Maintained and activated by the state/local
emergency management department

In a health emergency (ESF 8), consists of
 State/local health officer
 Core health department technical staff
 Representatives from supporting government
and private agencies
 Public information officer
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The Flow of Information in an Emergency
Local and State Level
Clinical care providers and
Laboratories
Governor
SHD/PHL
LHD
State EOC
Local EOC
Media and
Public
State EMD
Local EMD
Other local
agencies
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Other state
agencies
Media and
Public
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Incorporation of a
Joint Information Center (JIC)
State EOC
Local EOC
JIC
FEMA
CDC
Other federal agencies
Media and
Public
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Risk Communication in
a Public Health Emergency
Effective risk communication can…
 Give community members a sense of control
 Help allay panic and social disruption, and
increase cooperation
 Dispel myths and rumors
 Increase trust in public health authorities and
their decisions
 Ineffective risk communication can…
 Do just the opposite!
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Communication With the Media
Disasters Are a Media Event

Drama, conflict, problems, rising and falling
action

Absence of media in disasters can create
enormous difficulties

Media (newspapers, TV, and radio) most
important sources for public to obtain
information
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Crisis: How News Media Operate

Media onslaught within minutes

Public curiosity feeds the media
frenzy

Instant experts and authorities
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24-hour news coverage

Pack journalism pressures
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Information Sought by Media

Casualty numbers, condition, treatment
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Property damage

Response and relief activities

Resulting effects (e.g., anxiety, stress)

Questions are predictable
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Media Different in Disasters

Diminished information verification

Diminished adversarial role

Domination by national versus local media

Command post perspective (official government
sources)

Difficulty with technical information
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Risk Communication
Models

Describe how risk information is processed,
risks perceived, and risk decisions made

Risk Perception Model

Mental Noise Model
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Negative Dominance Model

Trust Determination Model
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Factors Influencing Risk Perception

Whether the risk is perceived to be:
 Voluntary/imposed
 Controlled by individual/controlled by others
 Of clear benefit/little or no benefit
 Fairly distributed/unevenly distributed
 Natural/man-made
 From a trusted source/untrusted source
 Familiar/exotic
Source: Fischhoff et al. 1981
ATSDR - Health Risk Communication Primer
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Mental Noise

When people feel what they value is being
threatened,
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Resulting emotions  “mental noise”

Limits the amount and complexity of
information they are able to process at one
time
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Negative Dominance

In a high-concern
situation, people put a
greater emphasis on
losses than on gains
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Factors Influencing
Trust Determination

Third-party endorsements

Caring and empathy
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Dedication and commitment
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Competence and expertise

Honesty and openness
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Communicating With the Public
Crisis Communication Basics
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Give positive action messages
Repeat clear messages and be consistent
Give bias-free messages
Give guidance in threes, when possible
Correct misinformation
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Delivering The Message
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Listen to the public’s specific concerns
Be honest, open, and reassuring
Coordinate with other credible sources
Speak clearly and with compassion
Use plain words, no jargon
Humor may be inappropriate
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Prepare to Answer These Questions

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How are those who are
ill getting help?
Is this thing being
contained?
What can we expect?
Why did this happen?
Why wasn’t this
prevented?
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What else can go
wrong?
When were you notified
about this?
What does this
information/results
mean?
What bad things aren’t
you telling us?
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Planning for Calls From the Public

Do you expect calls from your
clients and stakeholders?
 What EOC hotline resources exist now?
 Identify people and equipment and provide
training now
 Consider recruiting volunteers and train them in
using risk communication principles
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Planning for the Release of
Information to the Public
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Develop information release policies

Identify a public information officer

Identify critical baseline information

Identify effective channels of communication
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Planning for the Release of
Information to the Public

Identify special populations, and means of
reaching
 Geographically isolated
 Without access to traditional channels of
communication (e.g., television, radio,
telephone)
 Limited understanding due to language,
health, or developmental barriers
 Different cultural groups
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Planning for Partner Relationships

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Identify and plan to update stakeholders
Join with partners to build shared trust
Clarify roles and release of information
Think about “new” partners in crises and how to
reach out to them (e.g., post office)
Think about alternates and delegate
responsibility—the CEO can’t talk to all
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Little Things Make Big Problems
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Do you know where your EOC is located?
Get telephone numbers NOW and update
Keep the team informed and stagger staffing
Identify resources and how to get more
Know your community and share your
knowledge with state and federal partners
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Internal Communication Issues
Roles and Responsibilities

Make sure each department knows what the
other is doing
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Clearly define communication roles and
responsibilities
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Critical baseline information

When to refer questions and to whom
Specify a call-down roster with 24 hr contact
information
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Internal Communication Issues
Technical
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Communication equipment
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Know how to use it
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Security of information exchange
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Redundant mechanisms
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Have more than one way to disseminate a
message, i.e., fax, e-mail, phone…
Periodically test and exercise systems
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If You Suspect or Have Been
Informed of an Emergency

Notify your supervisor, as outlined in your
agency emergency response plan

The local health officer, administrator, or division
head will
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Notify FBI and local law enforcement, if appropriate
Notify the state health department
Activate the emergency response plan, if appropriate
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Notification Procedures in a BT Event
Confirmed or Threatened
Local Health Officer is
informed of a bioterrorist
incident or threat
First:
Notify FBI
Notify local law
enforcement
Next:
Notify & involve State HD
and other response partners
State HD
Notifies CDC
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Modified from CDC
Notification Procedures in a BT Event
Suspected
Local health officer
suspects that cases of
illness may be due to a
bioterrorist incident
First:
Inform & involve State HD
HD notifies CDC
Conduct investigation
Is BT incident confirmed
or thought to be probable?
Yes
Notify FBI
Notify other pre-determined
response partners
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No
Continue investigation
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Modified from CDC
Summary of Key Points

The Health Alert Network is a system designed
to facilitate communication between public
health agencies and officials, and provide
secure transmission for laboratory and disease
reporting information.

Consistent and effective communication with the
media, other involved agencies, and the public
is an important element in the public health
response to an emergency.
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Summary of Key Points

Risk communication planning requires
anticipating how the risk, the message, and the
messenger will be perceived by those receiving
the message.

Risk communication messages should be
accurate, clear, positive, and succinct.

Communication roles and systems within an
agency should be periodically exercised and
updated.
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Resources
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Health Alert Network
http://www.phppo.cdc.gov/han
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Risk Communication – Vince Covello resources
http://healthlinks.washington.edu/nwcphp/covello.html

Risk Communication – ATSDR primer
http://www.atsdr.cdc.gov/HEC/primer.html
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