EMERGENCY COMMUNICATION
By Patricia Dionico, MPH
Part One: Introduction
Rescue crews continue to search across western North Carolina for scores of missing people following storms from Hurricane Helene's historic deluge that killed more than 200 people, destroying numerous towns and villages, and leaving thousands without power or drinkable water. The storm washed out hundreds of roads leaving residents in already isolated communities stranded amid widespread power outages and without cell phone access, Federal, state and local authorities across the region pushed further into the small rural communities surrounding Asheville, clearing roads as food, water and other aid was airdropped to residents in need. Citizen-led volunteer groups in the mountains of North Carolina have supplemented officials' disaster relief operations, delivering aid to stranded communities on-foot and by helicopter and mule trains.
But it seems that the suffering just multiplies: standing water provides ample opportunities for aedes Aegypti and other disease carrying insect vectors to breed. Contaminated water is likely to contribute greatly to illness and suffering. Before hurricane Helene, Asheville, North Carolina was considered to be a “climate haven” (Washington Post, 10/1/ 2024). Far away from coastal Carolina and nestled in the Appalachian Mountains, there was historically little threat of hurricane- related damage and moderated temperatures made it more of a resort location. Indeed, a large music scene and artist colony developed in Asheville.
So, nobody expected Helene. Asheville was considered to be a truly safe location protected against weather damage in general. This widely shared perception perhaps contributed to citizens’ complacency and the lack of planning and response to the hurricane once it moved inland from Florida and the Atlantic coast. Although these areas suffered considerable damage as well, the heavy rains picked up quickly leading to flooding and the deaths of as of this date number over 200, with as many as thousands of people missing. In short, this became the most overwhelming disaster since Hurricane Katrina struck New Orleans and surrounding areas 20 years ago.
Emergency planning and response was horrible. Community journalists took it upon themselves to get in their motorboats or whatever means they had and spread news about conditions in their regions, as well as with respect to any casualties. Initial hurricane warnings for the western Carolina region indicated that the storm would be “bad” but did not really say it would be very bad. No one was prompted to “start packing” nor were they necessarily so inclined. The emergency communication was too little and too late; some communities were even told at one point it might be better to shelter in place rather than get on a road to get them out of the flood path (New York Times, 10-4-2024). State lawmakers can also share the blame. With major campaign donations from home builders’ groups, houses were not built to the level of a previous code, with less restriction on hillside building, and on having a stilt-like foundation where water could flow under a house without damaging the house per se.
So, this brings us to the question: what is emergency management?
Figure 1. Asheville before and after Hurricane Helene (source: https://www.usatoday.com/videos/news/weather/2024/10/03/aerials-asheville-before-and-after-helene/75501214007/)
Part Two: What is Emergency Management?
We have all lived in and experienced public health emergencies. Whether natural disasters, infectious diseases, or human-made emergencies, health communication is critical to prevention of emergencies and responses to them once they occur. A public health disaster arises when the consequence of an event overwhelms a system and threatens physical, mental, or social human safety. An emergency is an event that happens to an individual or small group of people The field of public health and emergency management is relatively new with the two becoming intertwined since the terrorist attacks on September 11, 2001, as well as the accelerating climate-related disasters around the world. It is important to distinguish between emergency preparedness and emergency management as they are often incorrectly treated as the same action.
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Emergency Preparedness. Public health emergency preparedness (PHEP) is the ‘get ready’ stage: the “capability of the public health and health care systems, communities, and individuals, to prevent and protect against health emergencies, particularly those whose scale, timing, or unpredictability threatens to overwhelm routine capabilities” (Nelson et al.).
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Emergency Management. Emergency management comprises the ‘get set, and GO’ phases: “the managerial function charged with creating the framework within which communities reduce vulnerability to hazards and cope with disasters.”
Emergency Management Cycle (adapted from Rose et al.)
There are 4 phases in the Emergency Management Cycle that are helpful for displaying the bi-directional nature and activities of an emergency management system. The 4 phases consist of prevention, preparedness, response, and recovery. Health communication is essential at each stage of this cycle.
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Prevention consists of using strategies and measures to reduce the gravity of the impact when emergencies occur or taking steps to ensure an emergency. For example, surveillance systems allow us to monitor health trends, identify alarming issues, plan appropriate prevention programs, and evaluate whether programs are effective. The CDC COVID Data tracker provides an example of a readily available surveillance system that could directly inform public health messaging. Preventing extreme home damage by building homes with fire-resistant materials, replacing eaves with flat ledges, installing multi-pane windows, and cutting all plants back to 100 yards from the trees and natural habitat are all examples of prevention. Alternatively, not constructing in fire-prone areas would serve as prevention as well.
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Preparedness consists of activities that occur before a disaster occurs to prepare individuals to respond to emergencies such as trainings, building of infrastructure, or updating security systems. Vaccinations would serve as preparedness in contrast to avoiding all exposures by social distancing which would be an example of prevention. Food safety handling training, sanitation practices, and active shooter drills are all examples of preparedness in emergency management. There are several examples of data breaches in the United States that have occurred due lack of preparedness (i.e., not updating security and privacy systems to deter hackers). In 2015, 191 million U.S voters information was exposed on the Internet. Health communication is critical for preparedness and can range from asking individuals to register for an emergency response notification in the chance of an emergency: for example, see this Johnston County flyer, that visually demonstrates the steps to follow during an earthquake, or even videos surrounding building an emergency kit.
Some individuals may not believe preparing is relevant. As such, it is important to consider Prochaska’s Stages of Change and
at what stage you would like your message to reach audiences at. Depending on your target audience, tailoring your message
with survivor stories and using multiple channels and heat/light messaging is especially relevant. If you are asking your
audience to engage in a behavior (i.e., creating an emergency kit), consider if you are targeting early adopters or the early
majority using Rodger’s Diffusion of Innovation Theory. If the emergency is in its initial phases, can you somehow reach the
late majority or is it too late and you now need to switch to emergency response?
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Response is the emergency management cycle begins as soon as an event occurs that threatens to overwhelm a system. Health communication activities may include the following:
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Coordinating several sources to provide health information to the affected public (audience) regarding how governing agencies are responding to the emergency (think about Organization from the ONPRIME Model).
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Collecting, analyzing, and triangulating epidemiological data, laboratory testing, firsthand accounts to inform messaging with accurate and up-to-date information (Needs/Resources Assessment, Research, and Priority Setting from the ONPRIME Model).
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Developing emergency risk communication (ERC) strategies and recommendations for affected audiences (Intervention from the ONPRIME Model).
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Disseminating ERC recommendations using multiple channels to ensure targeted audiences or at-risk populations are properly informed on how to respond to the emergency and where to receive medical assistance if needed (Monitoring and Evaluation from the ONPRIME Model).
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Recovery is the last phase of the emergency management cycle and involves efforts to restore, rebuild, and revitalize communities after a disaster or emergency event. This phase focuses on returning to a normal or a stabilized condition where support is provided for affected communities and integrating lessons learned from the emergency to improve preparedness and response in the future.
Elements of Effective Emergency Risk Communication (ERC) Interventions
An ERC is an intervention performed before and during (as part of preparedness activities) as well as after (to support response and recovery) the emergency phase, to enable everyone at risk to take informed decisions to protect themselves, their families and communities against threats to their survival, health and well-being (Rose et al., 2017). ERC interventions reflect the 4P’s of product, price, place, and promotion as all communication is dependent on the emergency being addressed, the audience being targeted, and where to promote messaging. This is especially important during natural disasters when homes and internet connection may be lost. Examples of ERCs include public announcements from political or medical representatives (see Fauci’s November 2020 update on COVID-19 vaccines), communication plans that develop and disseminate issue warnings to audiences (see Zika virus warning in Puerto Rico), and social media platforms. Effective ERC will include the following components:
Audience Segmentation and Channels during Disasters and Emergencies
While emergency and disaster preparedness, response, and recovery should target all individuals affected, some individuals and groups may not be able to access or use resources offered due to language barriers, physical or mental disabilities, or other social inequalities (Savoia et al., 2013). Globally, individuals living in poverty are twice as exposed to natural disasters compared to those not living in poverty (Kim 2012). This is because individuals who are poor are forced to live in high-risk areas and many times do not have the financial savings to prepare, evacuate, or reconstruct their homes after disasters. Individuals may be forced to work in high-risk occupations that are not prepared to respond to emergencies. One of thousands of heart-breaking stories that arose from Hurricane Helene is presented by journalist Edgar Sandoval (NYT, 10-7-2024). On September 27, Ms. Bertha Mendoza of Erwin, TN was trying to escape her place of work in a low-lying area of the town. When the vehicle she hoped to get a ride in was unable to function and the water was rising up to her head, she held her cell phone as high as she could and called her husband and several children to say she loved them and wish them farewell. She and the other Spanish speakers at the worksite were not given instructions as to how to evacuate or even whether they were allowed to. Her husband and volunteers grabbed their own boats and risked their lives in an attempt to locate her but it was too late. Ms. Mendoza’s body was found two days later near her factory.
Further worsening these inequities are the prioritization of resources to specific groups over others during response and recovery. For example, the federal government’s response following Hurricane Katrina has been criticized for favoring White homeowners over Black homeowners. The Road Home program was created to provide residents calculated aid based on the value of their home prior to the storm. Unfortunately, this meant that homes with lower property values (found in predominantly Black neighborhoods) were allocated less aid compared to homeowners in predominantly White neighborhoods. Although Black people accounted for more than 70% of individuals displaced after Hurricane Katrina, less than ½ were able to rebuild and move back into their homes after Katrina compared to ¾ of whites (Heath, 2015). Considering these inequities and injustices when developing messages is important to ensure at-risk populations are reached.
During an emergency, various psychosocial and social factors can affect people's responses, even when information about a potential hazard is readily available and quickly shared with the public. For instance, Mexican Americans often experience delays in reacting to natural disasters as they prioritize communication with extended family. Additionally, elderly individuals with hearing impairments may struggle with processing information and understanding evacuation orders. Those with low literacy skills may find it difficult to interpret written messages and would likely benefit from preparedness materials that are easy to read and visually accessible (Savoia et al., 2013). Making efforts to reach these populations BEFORE an emergency/disaster (i.e., during the prevention and preparedness phases) is critical. Some important considerations adapted from CDC emergency workbook include:
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Audience Segmentation: Begin by identifying and defining the vulnerability of the population you are tailoring your risk communication for. While broad, many populations that fall within these categories can use similar strategies. For example, populations that fall within language and literacy vulnerabilities may all be addressed at once by using picture-based messages or as a group by adapting messages by language spoken.
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Psychographic: Culture, language, and literacy (i.e., limited English proficiency or cannot read at all)
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Epidemiological: Medical issues and disability (i.e., physical, mental, cognitive, or sensory limitations)
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Geographic: Isolation (i.e., cultural, geographic, or social separations from society at large)
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Demographic: Age (e.g., older adults or individuals under 18 years of age who may be separated from legal guardians), Economic disadvantages (i.e., people living at or below the federal poverty level)
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Analysis Activity 1
Answer the following question about whether you would consider this an emergency or not. If you believe it to be an emergency, how would you prevent or prepare for it?
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Homelessness and evictions
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Earthquakes
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Identity theft
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Broken Finger
Research Activity 1
Hunt down a huge SUCCESS story regarding emergency preparedness, and one HORRIBLE failure (e.g., Hurricane Katrina). What lessons were learned from BOTH?
Analysis Activity 2
Review former President Trump's changing statements and Dr. Anthony Fauci’s statement on COVID-19. Compare and contrast the tone between each and discuss whether they or not both acknowledged uncertainties, were easy to understand, presented consistent and not contradictory information, and linked audiences to self-efficacy.
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Sources: Identify appropriate and relevant organizations, agencies, and key contacts that have extensive experience with the vulnerable population. Arrange to meet with several key contacts from multiple organizations and be prepared to share preliminary information/data, goals and objectives, and how they can be a critical source during public health emergencies. Also important is to identify trusted sources within communities such as local pastors, respected schoolteachers, reporters, matriarch of a family, and community members. If it is not clear who these sources should be, conduct focus groups and interviews with organizations and community members to ask who they trust to provide them with accurate information. Potential questions to ask include:
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What barriers have you faced in the past that have prevented you from receiving important information?
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Which sources do you typically turn to for news?
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Who do you trust for reliable information?
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How do you usually find out about emergencies?
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If a public health crisis were to occur, where would you seek information?
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What is your preferred method for receiving information (e.g., language, verbal/written)?
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Channels: Messages that are developed for vulnerable populations should demonstrate respect, consideration of their needs, and that they are included in emergency planning. Messages should be disseminated using appropriate channels for that group. Consider literacy level and whether written materials or brochures are appropriate. Photographs, images, and videos should be culturally and linguistically appropriate. For example, take a look at this emergency video for individuals with a disability or an example of an emergency video in a different language. Evaluate messages with members from vulnerable groups and determine if your materials are appropriate in design (i.e., visuals, colors, font size), accessible, accurately translated, and content. Other channels to consider include, if appropriate:
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Television, Internet access, cell phones/text messaging
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Ethnic media: media that are produced for and by racial, ethnic, linguistic, and immigrant groups, as well as indigenous populations
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Reverse 911: uses a databases of phone numbers and geographic information systems to send record emergency notifications to select phone users
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Telephone calling trees: community developed early warning system where each individual is responsible for calling three to eight others
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211: readily available community specialists that can help community members find important information such as housing, food, financial assistance
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Research Activity 2
Discuss how you would identify sources and channels to reach the following vulnerable populations (choose two) in a disaster:
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Single mothers and sole caregivers
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People living in shelters (e.g., unhoused people, runaways, battered persons)
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Immigrants/refugees
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Asian and Pacific Islanders (all ethnic subgroups)
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Individuals who are drug and/or alcohol dependent
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People living in remote rural areas with spotty or no reception of mass media
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Teens, school-aged children, latchkey children
Part Three: The Asheville Disaster - A Counterfactual Alternative
As the United States Weather Service and other branches of government watched the approach of Hurricane Helene with increasing anxiety, they task a widespread emergency notification and management system. Hundreds of pre-fabricated, solar powered electrical plants were ready to be distributed to places hardest hit, especially where clean water, cell phone service, and other critical functions were likely to be needed. The hurricane and subsequent tropical storm drove well into the southeastern United States with some of the worst damage in western North Carolina. As soon as it was safe to do so, tons of water and food were shipped into especially remote areas by FEMA (the federal emergency management service) and several mini power plants were installed in more remote areas using crane helicopters and a small army of technical experts.
As had been planned for months, however this time the US government also launched a cooperative agreement with the world’s other major polluter, China, to start taking action that would stall and eventually reduce global warming and the resulting climate related disasters (floods, out of control fires, extreme drought, and heat, etc.). Shorter term goals were to reduce fossil fuel use as quickly as possible while continuing to invest in solar, wind, and other forms of alternative, non-polluting energy sources. Within each country and other countries who signed up to do the same, individuals, communities and entire regions also put their energy into developing alternatives, while reducing eventually eliminating plastic use, gasoline- powered personal transportation, and other sources. While conservative and progressive political forces in the USA had substantial disagreements on many of these actions and of course on broader economic and social issues, they agreed that climate change required a united nonpartisan intervention and that it needed to occur immediately, regardless of impending elections. These models of local and individual cooperation eventually were imitated by citizens of other wealthy nations in the world while societies in poverty were given assistance to contribute as well. When Hurricane Milton hit 2 weeks later, a comparatively small force was behind it and damage was minimal. By the year 2030, climate change had slowed to a crawl and by the year 2040 there has even been some noted reversals to it.
This counterfactual prospectus is of courses nonsense. But it does show some of the enormous challenges ahead of us if we are to be able to prevent and manage climate-related emergencies such as those that hit our country every year and most recently Asheville, North Carolina and nearby communities. And, like so many disasters, people in poverty suffered much more than average. The extreme right of the country at the same time as use this disaster to say that first of all FEMA was totally unprepared for the climate-warming related weather extremes and even that much of the money that was supposed to go to FEMA was instead directed toward giving immigrants free healthcare and other services and products. Preposterously, Marjorie Taylor Green (R-GA) stated that the Federal Government used weather control technology to redirect the force of the storm toward Republican regions in order to favor Vice President Harris in the presidential election toward the Democrats.
The level of disinformation has become so great that FEMA officials felt forced to publish a specific rebuttal to the specific and most common lies, namely about Hurricane Helene rumors. Among the most common are rumors that are meant to discredit FEMA and impede disaster relief are the following:
Rumor 1: FEMA distributes aid based on demographic characteristics (race, language, etc.).
Rumor 3: FEMA does not have enough money to provide disaster assistance for Helene.
Rumor 4: FEMA is asking for cash donations and turning away volunteers.
FEMA's full Rumor Response is presented here.
But FEMA needs our help asking people to reduce disinformation through following straightforward steps:
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"Find trusted sources of information.
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Share information from trusted sources.
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Discourage others from sharing information from unverified sources."
So, this fight against disinformation has now become part of the job description of the overburdened emergency management system. And the disinformers aren’t giving up. Hours after a community self-support group met in Rutherford County NC on October 8, social media posts accused these concerned citizens of planning to bulldoze entire neighborhoods for their personal profit, with some even claiming that dead bodies were being covered by the bulldozing to hide the number killed by the floods. And then on October 13th, a true believer of the disinformation was arrested for threatening to shoot none other than the FEMA workers who were struggling to get the communities back on their feet.
Both in terms of climatology and political environments, the challenges will remain, and efforts must be taken at every level of behavioral and social change. Until then, Asheville, Katrina and equivalent disasters will be knocking at our doors again and again---Helene was followed almost immediately by Milton, with its spun-off tornados aimed directly at the west coast of Florida.
Sources:
[1] Rose, D. A., Murthy, S., Brooks, J., & Bryant, J. (2017). The Evolution of Public Health Emergency Management as a Field of Practice. American Journal of Public Health, 107(Suppl 2), S126. https://doi.org/10.2105/AJPH.2017.303947
[2] Nelson, C., Lurie, N., Wasserman, J., & Zakowski, S. (2007). Conceptualizing and Defining Public Health Emergency Preparedness. American Journal of Public Health, 97(Suppl 1), S9. https://doi.org/10.2105/AJPH.2007.114496
[3] Savoia, E., Lin, L., & Viswanath, K. (2013). Communications in Public Health Emergency Preparedness: A Systematic Review of the Literature. Biosecurity and Bioterrorism : Biodefense Strategy, Practice, and Science, 11(3), 170-184. https://doi.org/10.1089/bsp.2013.0038
[4] Communicating risk in public health emergencies: a WHO guideline for emergency risk communication (ERC) policy and practice. Geneva: World Health Organization; 2017. Licence: CC BY-NC-SA 3.0 IGO.
https://www.who.int/publications/i/item/communication-for-behavioural-impact-(combi)