Mars Science Lab JIC Videoconference February 23-24, 2011 Communicating with the Public in a Radiological Emergency Presented by: John J. Lanza, MD, PhD, MPH, FAAP Florida Department of Health Chair, HPS Homeland Security Committee

Objectives Prevention is the best policy Proactive vs. reactive Lessons learned from previous emergencies Practical steps for public communication

In public health, prevention is the best way to keep (health) emergencies from happening. I think that it follows, in respect to communication with workers and the public, that providing information before something happens is better than trying to handle the stressed communications after it has occurred.

Proactive vs. Reactive In earlier radiological emergencies, governments and private businesses were mainly reactive to the incident rather than proactive. This philosophy lead to many problems that still haunt us today

Images Affecting the Public’s Perception Learning from past experiences

Three Mile Island Event (1979)

The TMI Experience There was NO significant off-site dose to the public, YET; 40 percent of the residents within a 15 mile radius of the power plant left without official advice to do so; a total of 145,000 people evacuated "spontaneously," that is, at their own initiative. Preparedness Planning For a Nuclear Crisis; A Citizen's Guide to Civil Defense and Self-Protection. U. S. Gov’t Printing Office. (Mar, 87)

Health Effects from TMI The Kemeny Commission Report concluded that "there will either be no case of cancer or the number of cases will be so small that it will never be possible to detect them. The same conclusion applies to the other possible health effects."

TMI Lessons Learned (Peter Sandman, 2004) Pay attention to communication Err on the alarming side Don’t lie, and don’t tell half truths Expect the media to be overreassuring too Keep it simple Pay attention to outrage Get the word out

TMI Lessons Learned (Peter Sandman, 2004) Pay attention to communication --Not just anyone can be a risk communicator --Risk communications skills are learnable Err on the alarming side (or lose credibility) --Better: “It's not as bad as we feared.” --Than: “It’s worse than we thought.”

TMI Lessons Learned (Peter Sandman, 2004) Don’t lie, and don’t tell half truths --Technically accurate, but misleading --People learn the other half truth --Met Ed lost credibility Expect the media to be over-reassuring too (happens in a crisis) % media coverage reassuring --People hear more (-) than (+) info (Covello: 3 goods balance 1 bad)

TMI Lessons Learned (Peter Sandman, 2004) Keep it simple --Need simple explanation of complex phenomena --Audiences less tolerant of complexity when upset --Experts speak more complexly when upset

TMI Lessons Learned (Peter Sandman, 2004) Pay attention to outrage --Mistrust of officials from Met Ed to NRC fed the fear --Expert disagreement over health effects of radiation --Control the fear: give people something to do

TMI Lessons Learned (Peter Sandman, 2004) Get the word out (+/-) --Usual: control of outflow of info --Info available from many sources --Don’t try?? --Speak with one voice and frequently --Need technical experts to assist those managing the crisis

Goiania and Chernobyl Lessons Learned Both accidents pointed out the need for timely information to be available to the media, the public, and to the response workers Eventually, led to development of stakeholder involvement concepts before an accident occurs

Communicating in a Crisis Is Different Public must feel empowered – to reduce fear and feelings of victimization Mental preparation reduces anxiety Taking action reduces anxiety Uncertainty must be addressed “When people are stressed and upset, they want to know that you care before they care what you know.” (Covello)

Five Communication Failures That Kill Operational Success 1. Mixed messages from multiple experts 2. Information released late 3. Paternalistic attitudes 4. Not countering rumors and myths in real-time 5. Public power struggles and confusion

How the Public Views Risk Risk viewed as… -voluntary -under one’s control -with clear benefits -distributed fairly -natural -statistical -from a trusted source -familiar -affecting adults … are more accepted than risk viewed as... -being imposed by others -controlled by others -little or no benefit -unfairly distributed -man-made -catastrophic -from an untrusted source -exotic -affecting children

Basic Concepts This role is not for everyone! Characteristics of a good spokesperson: -Communicates simply using easily-understood terms -Focus on immediate impact to the public -Able to convey empathy and caring -Demonstrates competence and expertise -Communicates honestly and openly -Shows commitment and dedication -Sensitive and responsive to concerns -Expresses optimism -Stays calm and collected -Exhibits positive body language -Responds quickly to public/media inquiry

Keep It Simple! Develop messages at sixth grade reading level -i.e., target message to a 12 year old Stay on message – repeat 3 times Avoid jargon and scientifically complex terms

Keep It Brief! Messages to the public should be: - Brief - Concise - Clear

Be Prepared! 95% of all questions and concerns of stakeholders are predictable Anticipate in advance Practice answers

What the Public Will Ask First Are my family and I safe? What have you found that may affect me? What can I do to protect myself and my family? Who caused this? Can you fix it?

What the Media Will Ask First What happened? Who is in charge? Has this been contained? Are victims being helped? What can we expect? What should we do? Why did this happen? Did you have forewarning?

The Don’ts! Don’t use “I” Don’t speculate Don’t make promises you can’t keep Don’t use jargon, technical terms, acronyms Don’t use negative words and phrases Don’t blame others Don’t discuss costs Don’t make jokes Don’t repeat negative allegations Don’t become defensive

“Give People Things to Do” Public must be educated before an incident about things to do– something on paper, Internet, etc. -Citizen Responder This prevents potential for panic Preparation is the key Pre-incident education - PI campaign Post-incident education—Joint Information Center, etc.

Contact Information John J. Lanza, MD, PhD, MPH, FAAP Florida Department of Health Escambia County Health Department