Communicating Effectively in Times of Crisis and Uncertainty

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

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.

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.

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.

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.

An Illustration of Communicating in Times of Crisis and Uncertainty

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

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

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.

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.

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.

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.

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.

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.

Crisis Communications is a Process

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.

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.

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.

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

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.

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.

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.

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.

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).

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.

Implement the Six Proven Steps to Delivering Effective First Messages

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.”

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).”

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.”

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.”

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).

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 and our Web site is

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.

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.

Anticipating the Questions

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.

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.

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?

Start Practice Scenario

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

Setting the Stage Oak County has a population of 1 million people residing within one city and several surrounding rural towns. It is economically diverse with a mix of industrial and farming operations. Oak County is a distribution hub for the entire southwest region of the state. It is an educational hub for the region, with an old, prestigious school of agriculture and several community colleges.

DAY 1: Tuesday – 9:00 a.m. Oak County Hospital Oak County Hospital reports a patient with a positive blood test for Q-fever to the Oak County Public Health Department. The 24 year old male patient’s symptoms included fever, migraine-like headache, non- productive cough, muscle and chest pain. Q-fever was suspected because the individual works in a dairy plant—Purity Brands.

DAY 3: Thursday – 1:00 p.m. Purity Brands Dairy Plant An investigation reveals that 8 other individuals at the Purity Brands Dairy Plant, where milk from multiple dairies is pasteurized, bottled, and distributed, have also had Q-fever symptoms. None of the individuals symptoms are as severe as the 24 year old male patient. A total of 15 people work at the plant. The milk is distributed statewide.

Additional Information About Q-Fever Q-Fever is transmitted via infected animals’ urine, milk, feces and birth products. People become infected when they inhale contaminated droplets or dust. High temperature pasteurization kills the organism that causes Q-Fever.

Additional Information About Q-Fever Only about one-half of all people infected show signs of clinical illness. It is difficult to test for an accurate diagnosis. Symptoms: high fevers (up to ° F), severe headache, weakness, muscle pain, confusion, sore throat, chills, sweats, non-productive cough, nausea, vomiting, diarrhea, abdominal pain, and chest pain. Fever usually lasts for 1 to 2 weeks. Q-Fever is treated with the antibiotic, Doxycycline.

Additional Information About Q-Fever A small number of people develop Q-Fever Fatigue Syndrome which can last for years. Chronic Q-Fever, Endocarditis, is more difficult to treat and surgery may be needed to remove damaged heart valves. Although rare, complications may involve the liver, heart and bones. Only 1 to 2 percent of people with acute Q-Fever die.

DAY 3: Thursday – 2:00 p.m. Purity Brands Dairy Plant The additional 8 dairy workers are given blood tests to confirm the diagnosis and are treated with antibiotics. The likely route of infection is through an aerosolized bacteria that workers breathed in as it entered the plant.

Review the Facts What is currently known? –9 individuals are sick with an illness that resembles Q-fever. One illness is confirmed. –The 9 ill people are taking antibiotics and are being monitored closely. –All 9 individuals work at the same dairy plant. –Dairy plants and farms are associated with Q-fever. –Milk products are pasteurized at the plant. Pasteurization kills infectious agent in milk and no milk leaves the plant without being pasteurized.

Review the Facts What is currently unknown? –If the 8 additional illnesses are caused by Q- fever or if it is another disease. –If any infected milk has left the plant.

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? –Purity Brands employees –Hospital staff

DAYS 4 and 5: Friday & Saturday Local Hospitals Over the next few days, hospitals across the state begin to experience a rise in emergency room visits from people with severe flu like symptoms.

DAY 6: Sunday – 9:00 a.m. Purity Brands Dairy Plant The State Department of Agriculture investigation does not find any cows with Q-fever at local dairy farms. Pasteurization controls at the plant were found to have been disabled. Thousands of people in the state were likely exposed to Q-fever. State Agriculture Department contacts the Food and Drug Administration (FDA). The FDA issues a recall for Purity Brands without informing the Oak County Public Health Department first.

DAY 6: Sunday – 11:00 a.m. Patients Search World Wide Web Self published “Blog” Web sites proclaim Q-Fever victim input : –“I have been unable to work for 10 years.” –“No one knows how to treat Q fever. I have been left without treatment or support.” –“Q Fever could be developed for use in biological warfare and is considered a potential terrorist threat.”

DAY 6: Sunday – 1:00 p.m. Media Calls Local news reporters begin paging the Public Information Officer of the Oak County Public Health Department as they have been contacted by patients with Q- Fever.

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?

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.

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

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.

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

Sharing Your Group Results Sample First Message:

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

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.

Share Your Group Results Sample questions: Is it safe to drink our milk? What have you found that will affect us? What caused this problem? What is being done to help the victims? Who is in charge?

Intentional Milk Mayhem The investigating federal agencies report that no other dairy plants in the state appear to have any problems with pasteurization control. Thus, the milk at the plant did not come from a local dairy. The milk supply was intentionally contaminated with Q-fever.

Intentional Milk Mayhem The FBI announces they have in custody a professor from the agricultural school in connection with the milk tampering. The professor had been in the plant, researching infection control measures. He said he wanted to “see if he could do it” and purposefully used a generally non- lethal pathogen.

Next Steps

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.

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?

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?

Yes - If You Understand that Crisis Communications is a Process

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

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.

Thank You

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

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 Covello, V.T. (n.d.). Risk and crisis communications: 77 questions commonly asked by journalists in a crisis. Retrieved March 10, 2006 from Northwest Center for Public Health Practice (NWCPHP). (2005). Emergency risk communications course for public health professionals. Retrieved March 10, 2006 from 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.