Public Information Management

In the chaos and craziness that ensues during or immediately after a disaster, whether it is a suspected contagious disease, an earthquake, or the explosion of a dirty bomb, there will be two constants: (1) the public will demand information about what is happening, and (2) the media will be at the scene trying to tell them. Ever since images from Vietnam broadcast live into the living rooms of millions of Americans, the public has come to see breaking news coverage not only as a given, but as their right. The thirst for information grows with every passing minute, fueled by the ever-increasing competition within the media for advertising, sponsorship, and viewers. All of this factors heavily into disaster response. Balancing emergency care for the sick or injured with the need to disseminate accurate public information is always a challenge. Emergency responders would never think of treating a patient without having the proper medical training. Training for disaster communication is also highly important; preparation is the key. Understanding what types of information the public and the media will want and need will help mitigate the effects of the disaster, win the confidence of the media, and reassure the public. Information presented in a clear and truthful manner within a reasonable amount of time will further its effectiveness.

Media history

The development of the printing press in the fifteenth century allowed inexpensively produced newspapers and books to spread information to large numbers of people. When Marconi sent a wireless message in 1896, radio came alive, allowing electronic communication during World War I. The newsreel brought edited pictures of World War II to moviegoers, albeit somewhat delayed. In the 1950s the “American dream” turned out to be a television as the centerpiece of every living room. By the 1960s, nearly all of America tuned in to watch the son of President John Fitzgerald Kennedy salute the flag-draped coffin of his father. Walter Cronkite became “the most trusted man in America.” And, of course, there was the Vietnam War. Television coverage has arguably changed the course of history by providing a window into the harsh realities of war that had never been seen before by most of America.

By the late twentieth century, new media outlets developed, offering 24-hour-a-day news coverage, as cable television proliferated America. A few years later, as a new millennium approached, the Internet and e-mail revolutionized communication, allowing information to travel rapidly right to the desktop. This, coupled with the competitive news business, created even more demand by both the public and the media for up-to-the-minute communication. This urgency for information has surpassed accuracy and even, in some cases, reason. In 1994, millions tuned in to watch a white Ford Bronco with O.J. Simpson inside drive down a freeway. And then there was September 11, 2001. The television images could not be edited to shelter viewers. They unfolded in real time, with real heartache. The world watched again and again with the hope of somehow hitting the pause button to allow the victims an additional moment or two of peaceful existence. Viewers tuned in for days, hoping to see people emerge alive from the burning rubble. News coverage was 24 hours a day for almost two weeks. Regular programming was preempted, and viewers struggled to come to terms with what had happened. As sad as it was, this horrific tragedy is a good example of what is expected of emergency response and public information.

In the past few years the era of “Social Media” have erupted as a popular means of communication. The public’s thirst for real-time data has never been stronger. Facebook, Twitter, Instagram, VK, Google, and YouTube are just a few of the popular sites used by millions of people globally. These sites were developed for communication among friends and families but have now morphed and have both pros and cons in the setting of disaster communications. The common operating picture for all of these sites is data sharing. We now live in an environment where crime scene photos and other emergency response scenes are being posted, blogged, shared, and transmitted before the first responders and other media personnel are on scene.

There are both pros and cons to social media ( Table 24-1 ). A big advantage includes being able to reach large numbers of people in a short time with a consistent message. However, for this to be effective, that message must come from a credible source. Many local municipalities and state governments have official accounts and release generally credible information. This is not to say that local citizens do not have good information to provide. During disasters citizens become the eyes and ears to real events before first responders. During Hurricane Sandy in New Jersey, there were Good Samaritans texting pictures of emergency situations to the Morris County Office of Emergency Management (OEM); for example, police officers and firefighters could not respond to people trapped in a car because of arcing wires on the vehicle. Local power authorities present in the emergency operation center at the time were able to identify the pole and shut off the power, while OEM personnel responded back with safety directions to the civilian. During the 2007 Virginia Tech massacre, the school was delayed in getting messages out, but social media was flooded with pictures and information from students. During the 2010 Deepwater Horizon oil spill in the Gulf of Mexico, community residents texted photos and locations of oil-soaked birds to the Louisiana Bucket Brigade, whose maps helped volunteers identify areas needing cleanup.

Table 24-1

Pros and Cons of Social Media

Able to disseminate messages to large number of people quickly Inaccurate data may be released by noncredible sources
Allows for the public to serve as “citizen soldiers” Not all people have smartphones or social media accounts
Reassuring to the public Lengthy periods of power outages may preclude charging of cell phones and access
Documents hazards and important information in near real time Cell data towers and/or cable lines may be inoperable
Helpful in rumor control Potential for unintentional release of sensitive data
Internet access may be available even in areas of power failure Not all information provided is accurate or helpful
Effective tool to raise relief funding Need dedicated personnel to update constantly
Another information gathering tool for TV, print, and radio media reporters Message size may be limited

Messages that are sent should relay the important facts and provide reassurance to the community at large, while not providing detail that may be harmful to emergency personnel operating at the scene. For example, if a terrorist group has several children held hostage at a school, it would be appropriate to communicate that 20 children have been rescued while 8 are still being held captive. It would not be advisable, however, to communicate that 20 children are being held safely with emergency and fire crews at the Kiddie Gym at 123 Main Street. This would give the opportunity for other members of the terrorist group who may be monitoring the media to potentially attack the gym.

Media and disasters

The medical management of disasters, both small and large, requires a multifaceted response to ensure timely evacuation, assessment, treatment, and recovery. This response, usually based on the Incident Command System (ICS), requires the appointment of an incident commander, a logistics chief, and others. One important and often overlooked component of the ICS and disaster management in general is an area defined as public information management. The ability to provide appropriate, timely information can significantly affect the disaster response.

The components of public information management include not only the release of information to prepare rescue workers and volunteers, but the dynamic ongoing release of information to the media and the incorporation of the media within the response mission. Effective interaction with the media can improve the accurate distribution of information that ultimately aids the response, while at the same time satisfying the needs of the media to “get the story.” This applies not only to hospitals or other institutions providing support in a disaster, but also to the rapid response elements (e.g., police, fire, and emergency medical services [EMS]) and to intermediate response organizations, such as the National Disaster Medical System’s disaster medical assistance teams, the U.S. Department of Health and Human Services’ Medical Reserve Corps, and the Federal Emergency Management Agency, to name a few.

During a disaster, potentially significant amounts of information should be communicated to the region affected to achieve a good response. This information provides the basis for management of the disaster as well as development of the public trust in the responsible agencies. For example, if a government frequently notifies the population of potential storms and their need to evacuate immediately, and subsequently, each storm causes insignificant damage, the population will learn to not trust the local government. If a category 5 hurricane then heads to this same region, the population may not heed requests to evacuate because they have been misled many times before and may not believe the local government or disaster coordinators. However, if the local government warns residents of only potentially dangerous storms and only requests evacuation for events that most likely will cause significant damage and injuries, while providing the details behind its decisions, the population will more likely respond to an evacuation request and, therefore, injuries and loss of life will be reduced. Obviously, the decision to warn or request evacuations is not just dependent on actual risks, but also on potential legal action or bad publicity should the disaster be worse than expected.

Further, immediately after an event, those who evacuated or had interests in the area will want to access the affected area to find family members, recover personal items, and assess the damage so that they may start to rebuild or repair. They will depend on information provided by functioning public communications systems. If this recovery action by those affected is not coordinated in a timely manner, people returning to the affected area can hamper appropriate response efforts and hinder response communications. For example, cellular phone towers may become overloaded with users and, therefore, important phone calls are not able to be placed. Providing reentry instructions contained in the evacuation order and subsequent evacuation instructions is the best strategy. Phone numbers, radio stations, websites, and other means to provide timely and accurate information to those returning to an evacuated area will reduce anxiety, potential traffic jams, and the overuse of the limited resources of response agencies that will have to divert their focus to communication with an uninformed population searching for information. Finally, information about sources of food, potable water, medical care, cash, shelters and housing, fuel, and available government assistance needs to be communicated to the residents returning to the affected area.

Effective management of information can help minimize property loss and reduce the chance of injuries, and even deaths, but also can improve the effectiveness of response teams. To do this, methods need to be developed to communicate information to the population from one reliable, consistent source. Disasters do not just include the typical natural occurrence (e.g., flooding, hurricane, tornado) or human-made acts (e.g., industrial accident or terrorism), but also include loss of infrastructure (e.g., computer information systems, power grids, potable water, sewers, job action). Even though a disaster may not result in any injuries or fatalities, the fact that “something went wrong” brings the problem into the public eye. In such cases, the news media become interested and so do the government and public. The handling of the incident by the “offending” corporation or entity (1) can provide for a good public relations (PR) review and minimize the PR effect of the disaster, or (2) if poor PR ensues, can make the disaster more significant and potentially harm the corporation.

Current practices

When a disaster strikes, media flood into the area. Be prepared to share your space. As word of the planes crashing into the two World Trade Center towers and the Pentagon spread, firefighters, police, and rescuers rushed to the scene. Not far behind were reporters, photographers, and camera crews. Tune into the local television station near where a hurricane is headed and undoubtedly reporters donning bright yellow rain slickers will be broadcasting from an evacuated beachfront while waves crash around them and lightning bolts light up the seas. Turn on the radio to hear broadcasters coughing out their report as the smoke of a nearby wildfire burns brush just steps away. Pick up a newspaper to learn how a reporter interviewed a family as they crouched in a storm cellar with a tornado blowing overhead. In a competitive media market, the emphasis is not always on providing the most accurate data but rather any data. In today’s social media market this is happening quicker than a press release can be developed and often leads to confusion among the public, and in some instances panic as a result of inaccurate or otherwise bad data. Castillo et al. observed that immediately after the 2010 earthquake in Chile, when information from official sources was scarce, several rumors posted and reposted on Twitter contributed to increase the sense of chaos and insecurity in the local population. Accepting media presence at events is important. Reporters will not go away, so it is best to help them find their way to a place that is close enough to the action to satisfy their needs, yet far enough away to prevent them from broadening the crisis by becoming a victim, or worse, placing emergency personnel at risk. When the media shift into crisis mode, they will broadcast whatever information they have in the order in which they receive it. Providing factual information to the media will allow one to effectively control the information instead of the information being in control. Reporters may or may not have time to verify the information, but they would rather report something than have nothing to report. If they have nothing to report, they probably will speculate. When the New York Post went to press with its July 6, 2004, headline, “Kerry’s Choice,” they declared Dick Gephardt as running mate to presidential candidate John Kerry. Kerry announced his choice of John Edwards for vice president that same morning. The debacle mirrored the infamous 1948 Chicago Daily Tribune headline, “Dewey Defeats Truman.” In the Gephardt case, the already tarnished reputation of the Post took a hit, and the Kerry campaign benefited from the exposure. Although a mistake by the media can hardly be deemed a crisis, it clearly illustrates the pressure that time and competition weigh on the media. In most instances, it is best to offer some information, even a small amount, to the media, as long as it is correct.

Provide the media with factual information as soon as possible; even small or minor details or known truths can be helpful. The first source often becomes the most credible. Also, remember to demonstrate empathy when providing information. In the immediate aftermath of the destruction of the World Trade Center towers, New York City Mayor Rudy Giuliani spoke to the people of New York and the nation. He provided very little new information, but he told what he knew and demonstrated empathy—that he was grieving, too. “The number of casualties,” he said, “will be more than any of us can bear.” This was not an unknown fact, and it most certainly was not a new piece of information. Giuliani had never been known for his compassion, and his behavior after the World Trade Center disaster was a turning point in his career, making him arguably the most popular mayor in the city’s history.

Be honest. The truth almost always comes out anyway. There are numerous instances throughout history in which an initially dishonest action was forgiven by the public after the truth was told. If one shares inaccurate information and later the information is determined to be false, all credibility will be lost.

Time and space in the media are money. When a newspaper is put together, the first pieces to go in are the advertisements. Articles fill in the spaces around them. Space is at a premium. Select words wisely. Studies have shown that the average level of reading comprehension is at grade 6. If the message is targeted to a sixth-grader, the majority of the population will understand it; however, keep the audience in mind and adjust accordingly. For television, the rule of 27/9/3 is extremely helpful. Developed by Dr. Vincent Covello of the Center for Risk Communication, this rule suggests keeping messages to 27 words, 9 seconds, and 3 ideas or concepts for maximum comprehension.

Media may not always be a friend, but they do not have to be an enemy. The media have a job to do, just like those who respond to a disaster. The media may play an essential role in communicating to the public during a disaster situation by offering evacuation routes, safety tips, or other important advice. Keeping the media up-to-date in an emergency is essential and should not be overlooked. Failure to provide frequent updates may result in the media using any means to get closer to the scene to get the information firsthand or going to possibly less reliable sources. Make the media a friend, and let them relay the information you provide, as opposed to what someone else provides.

“Hope for the best but prepare for the worst” is a very applicable cliché concerning the need to have prepared public information systems in place before a disaster. Current practice for emergency preparation is to plan and drill response. This should always include testing the public information component.

Medical/Emergency Medical Services/Fire Models

Disasters occur frequently, ranging from bus accidents with 10 to 20 injured persons, to hazardous material events requiring local evacuation, to regional incidents such as hurricanes. In all of these cases, the local community or larger region enters a disaster mode when the resources needed are greater than one segment can provide. EMS must redirect ambulances and rescue vehicles, hospital emergency departments must prepare for casualties, and government provides resources for scene control and forensic investigation, with preservation of evidence balanced with response and recovery. All of this must occur while the daily standard delivery of health care and maintenance of law and order are maintained and the community infrastructure is preserved. The totality of the response is dependent on the size of the disaster and the numbers affected with the dynamic match of available resources, supplies, and the specific demands.

Many events happen simultaneously during the early stages of a disaster response: EMS, fire, and police personnel are dispatched to the event and use an incident management system. Bystanders render aid, or as the word spreads, people arrive who may be able to help, but more than likely, they are not suitable responders. Plans should be made for this convergent volunteerism because it cannot be avoided (this is explored in other chapters of this text). Local emergency management representatives should work with local media to prevent a situation in which the media take it upon themselves to call emergency responders for help before the responders get direction from their office. If the media are asked to communicate a call for help, specific emergency personnel, upon arrival to the disaster scene, can then be directed to a gathering place and then to their duty station. Management of volunteers can consume precious resources away from critical aspects of a timely response. By reporting certain types of information, the media can fulfill an important role in assisting health care providers travel to their workplace, ensuring that any response teams are directed to their prearranged muster stations, and helping in prevention of injuries to unnecessary volunteers. The media responding to an event must also be directed to a location that enables them to accurately report while being kept safe.

In addition, it must be recognized that each response unit from various government and nongovernment agencies will have differing perspectives, based on their interpretation of the dynamics of the event, guiding their management or role. Unfortunately, all these views can diverge and provide a confusing and inconsistent picture of events, simply because of each unit’s perspective and underlying knowledge base. Caution must follow because each unit or members of each unit may be approached separately by members of the media and innocently provide inconsistent information. This can lead to misperception and loss of public trust. Further, if such misperception is acted upon by members of the command and control system, this may lead to disruption of the disaster response. Such misinformation may be a direct consequence of the real-time reporting that often occurs around disaster scenes. With media at the scene reporting in real time but missing vital elements or reporting unsubstantiated information, decisions can be rendered that can interfere with the dynamic response and recovery or divert resources, triggered by political expediency or a microphone held in someone’s face under bright lights.

Effect of Media Reports

A new area of media interaction related to disaster medicine is how the public responds to news reports and images that have the potential to induce posttraumatic stress disorder (PTSD). It has been reported that there is increased incidence of PTSD with intense coverage of an event, especially one associated with many images. This was reported to be especially true with the pediatric population. The authors believe that intense exposure to significant events, such as the World Trade Center disaster, is associated with psychopathology.

Media Communication

Several studies have looked at the public’s response to uncertainty. These results can have implications for how the public will respond to media communications. One study found that a majority of respondents prefer ranges of risk estimates because they believe that these ranges make the government look more honest. However, about half just want to know whether an area is safe or unsafe. Finally, disagreement among scientists about risk, even if a majority has one opinion, tends to result in the public assuming the worst. The implications of this reinforce the need for one spokesperson for a disaster response. Other studies looking at risk communication have provided goals for risk communication that could also apply to disaster communication, especially before the event. These are building trust, raising awareness, education, agreement, and motivating action. Before a hurricane or another major disaster, the development of these goals will help foster action by the community. The media become the vehicle for the communication of these goals and need to work with the public information officer (PIO) and responsible organization to develop them.

Detroit Free Press Example

The media are also concerned with safety and minimizing interference with the relief effort. The Detroit Free Press requests that their reporters and photographers work as teams. These teams are allowed to do whatever is needed to get a story as long as they feel comfortable or safe, obviously a very large leeway for the reporter. The teams are expected to be as inconspicuous as possible and to identify themselves to responsible agencies, including the police, to reduce potential problems. Reporters and their editors want to publish information that they believe is accurate, is timely, and has been verified with multiple sources, if possible. They prefer to verify information with at least two, but preferably three, sources. In addition, they have deadlines that must be met. Finally, these teams are willing to help responsible agencies to disseminate information as long as they have access (T. Fladung, managing editor, Detroit Free Press , personal communication, 2004).

Lessons from Recent Disasters

Multiple disasters have occurred within the last 20 years that provide a glimpse into the do’s and don’ts of public information management. These events have stemmed from airplane and train disasters, earthquakes, and terrorist actions. In each case, lessons learned have improved disaster response and have shown the importance of public information management.

Tokyo Sarin Attack, 1995

On March 20, 1995, Tokyo experienced a nerve gas poisoning attack with sarin. The first patient from this attack arrived at the hospital before ambulances began delivering patients. Approximately 2.5 hours after the event, the first press conference was held at one hospital, and the first televised news announcement was made 3 hours after the attack. At this point, most patients had reported to a local medical facility. In addition, there was no initial report to the population from an official source until all patients had left the scene. In this case, the media notification and distribution of information from an official were late, but the information after the initial conference was consistent.

Oklahoma City Bombing, 1995

On April 19, 1995, a terrorist action caused an explosion that destroyed the Murrah Federal Building in Oklahoma City. The blast was felt by many in the local area and was reported by news networks very quickly. The local emergency departments (EDs) immediately became fully staffed; many medical personnel immediately offered their services to local EDs, and as the departments became staffed, personnel decided to go directly to the explosion site and provide freelance medical care and rescue efforts. In addition to the local response, the local media, without notification or request, directed those with medical training to go to the federal building to provide care. This resulted in more than 300 volunteers at the site. Even though volunteers provided evacuation assistance, the site was unsafe and the responders did not have protective gear; as a result, one volunteer died from falling debris.

Some of the lessons learned from this disaster included how to request that additional health care providers go to their respective facilities and how to prevent untrained and superfluous volunteers from converging on the scene. If the need for additional support arises at the incident location, the incident management commander can request this through emergency management channels. The media can then receive a specific request for specific volunteers to be directed to a gathering, muster, or staging area for credentialing, briefing, equipping, and transportation assignments. The receiving medical facilities can then, either by direct communication or preexisting disaster protocols, have their requests met through proper channels and be prepared for the additional health care professionals, limiting resources dedicated to incorporate them into the existing staff. The media should be informed early in a disaster of set expectations of their role, any boundaries placed on them, and how they could potentially hinder the response and recovery. This partnership should be communicated to the public to build public trust. In addition, if the incident management team does not want bystanders because of safety concerns, this should also be conveyed to the media so that they might communicate this information to the public.

Haiti Earthquake, 2010

The Haiti earthquake showed how media coverage can focus a world’s attention on a disaster, but when the “excitement” of the event dissipates and the media leave, the ongoing disaster can fall off the world’s radar screen. The earthquake in Haiti killed an estimated 300,000 people in 2010. The consequences of this devastating event continue to cause death and suffering today. Yet, it is rare to find any news coverage of the situation today at all. The media have moved on to newer and more dramatic events, leaving Haiti to find a way to remain relevant and continue to garner the world support it so desperately needs.

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Aug 25, 2019 | Posted by in EMERGENCY MEDICINE | Comments Off on Public Information Management
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