Viewpoint: Terrorism and Dispelling the Myth of a Panic Prone Public

Psychological and behavioral responses to the declaration of COVID-19 as a pandemic: A comparative study of Hong Kong, Singapore, and the U.S

What is the effect of declaring a pandemic? This research assesses behavioral and psychological responses to the WHO declaration of the COVID-19 pandemic, in Hong Kong, Singapore, and the U.S. We surveyed 3,032 members of the general public in these three regions about the preventative actions they were taking and their worries related to COVID-19. The WHO announcement on March 11th, 2020 created a quasi-experimental test of responses immediately before versus after the announcement. The declaration of the pandemic increased worries about the capacity of the local healthcare system in each region, as well as the proportion of people engaging in preventative actions, including actions not recommended by medical professionals. The number of actions taken correlates positively with anxiety and worries. Declaring the COVID-19 crisis as a pandemic had tangible effects-positive (increased community engagement) and negative (increased generalized anxiety)-which manifested differently across regions in line with expectancy disconfirmation theory.

Communicating with the Public About Marauding Terrorist Firearms Attacks: Results from a Survey Experiment on Factors Influencing Intention to "Run, Hide, Tell" in the United Kingdom and Denmark

Effective risk communication is an integral part of responding to terrorism, but until recently, there has been very little pre-event communication in a European context to provide advice to the public on how to protect themselves during an attack. Following terrorist attacks involving mass shootings in Paris, France, in November 2015, the U.K. National Police Chiefs' Council released a Stay Safe film and leaflet that advises the public to "run," "hide," and "tell" in the event of a firearms or weapons attack. However, other countries, including Denmark, do not provide preparedness information of this kind, in large part because of concern about scaring the public. In this survey experiment, 3,003 U.K. and Danish participants were randomly assigned to one of three conditions: no information, a leaflet intervention, and a film intervention to examine the impact of "Run, Hide, Tell" advice on perceptions about terrorism, the security services, and intended responses to a hypothetical terrorist firearms attack. Results demonstrate important benefits of pre-event communication in relation to enhancing trust, encouraging protective health behaviors, and discouraging potentially dangerous actions. However, these findings also suggest that future communications should address perceived response costs and target specific problem behaviors. Cross-national similarities in response suggest this advice is suitable for adaptation in other countries.

‘Alert not alarm’: The UK experience of public counter-terrorism awareness and training, with explicit reference to Project ARGUS

This study evaluates the contribution of a UK counter-terrorism training tool, the Project ARGUS simulation exercise format, designed to increase preparedness by ‘alerting not alarming’ the populace to the prevailing ‘severe’ international terrorist threat. The paper draws upon the theoretical basis for preparedness in order to contend that, despite exceeding expectations in terms of quantity of events delivered and evidence of immediate post-event learning, Project ARGUS does not wholly live up to its promise to change the behaviour of individuals and organisations by embedding long-term learning. The researchers designed and analysed pre- and post-event questionnaires (N = 120) in order to explore the impact of attendance at an ARGUS Retail event within a shopping centre. This information was then augmented with a follow-up survey (N = 44) and semi-structured interviews (N = 9) of key facilitators and participants. The authors recommend the immediate adoption of an appropriate evaluation and certification scheme to mandate participation and embed organisational learning. They argue that adoption of these approaches would better enable ARGUS to fulfil its potential and make a significant contribution to improving the resilience of busy crowded places to terrorism in the UK.

Facilitating Collective Psychosocial Resilience in the Public in Emergencies: Twelve Recommendations Based on the Social Identity Approach

Accumulated evidence demonstrates the centrality of social psychology to the behavior of members of the public as immediate responders in emergencies. Such public behavior is a function of social psychological processes—in particular identities and norms. In addition, what the authorities and relevant professional groups assume about the social psychology of people in emergencies shapes policy and practice in preparedness, response, and recovery. These assumptions therefore have consequences for the public's ability to act as immediate responders. In this Policy and Practice Review, we will do three things. First, we will overview research on the behavior of survivors of emergencies and disasters, drawing out key factors known to explain the extent to which survivors cooperate in these events and contribute to safe collective outcomes. We will demonstrate the utility of the social identity approach as an overarching framework for explaining the major mechanisms of collective supportive behavior among survivors in emergencies. Second, we will critically review recent and current UK government agency guidance on emergency response, focusing particularly on what is stated about the role of survivors in emergencies and disasters. This review will suggest that the “community resilience” agenda has only been partly realized in practice, but that the social identity approach is progressing this. Third, we will derive from the research literature and from dialogue with groups involved in emergencies a set of 12 recommendations for both emergency managers and members of the public affected by emergencies and disasters. These focus on the crucial need to build shared identity and to communicate, and the connection between these two aims. Including our recommendations within emergency guidance and training will facilitate collective psychosocial resilience, which refers to the way a shared identity allows groups of survivors to express and expect solidarity and cohesion, and thereby to coordinate and draw upon collective sources of support. In sum, this evidence-base and the recommendations we derive from it will help professionals involved in emergency management to support public resilient behaviors and will help the public to develop and maintain their own capacity for such resilience.

Medical Spending for the 2001 Anthrax Letter Attacks

ABSTRACTIntroductionThis paper assesses the total medical costs associated with the US anthrax letter attacks of 2001. This information can be used to inform policies, which may help mitigate the potential economic impacts of similar bioterrorist attacks.

METHODS

Journal publications and news reports were reviewed to establish the number of people who were exposed, were potentially exposed, received prophylactics, and became ill. Where available, cost data from the anthrax letter attacks were used. Where data were unavailable, high, low, and best cost estimates were developed from the broader literature to create a cost model and establish economic impacts.

RESULTS

Medical spending totaled approximately $177 million.

CONCLUSIONS

The largest expenditures stemmed from self-initiated prophylaxis (worried well): people who sought prophylactic treatment without any indication that they had been exposed to anthrax letters. This highlights an area of focus for mitigating the economic impacts of future disasters. (Disaster Med Public Health Preparedness. 2019;13:539-546).

Mass Casualty Decontamination Guidance and Psychosocial Aspects of CBRN Incident Management: A Review and Synthesis

INTRODUCTION

Mass casualty decontamination is an intervention employed by first responders at the scene of an incident involving noxious contaminants.  Many countries have sought to address the challenge of decontaminating large numbers of affected casualties through the provision of rapidly deployable temporary showering structures, with accompanying decontamination protocols.  In this paper we review decontamination guidance for emergency responders and associated research evidence, in order to establish to what extent psychosocial aspects of casualty management have been considered within these documents. The review focuses on five psychosocial aspects of incident management: likely public behaviour; responder management style; communication strategy; privacy/ modesty concerns; and vulnerable groups.

METHODS

Two structured literature reviews were carried out; one to identify decontamination guidance documents for first responders, and another to identify evidence which is relevant to the understanding of the psychosocial aspects of mass decontamination.  The guidance documents and relevant research were reviewed to identify whether the guidance documents contain information relating to psychosocial issues and where it exists, that the guidance is consistent with the existing evidence-base.

RESULTS

Psychosocial aspects of incident management receive limited attention in current decontamination guidance.  In addition, our review has identified a number of gaps and inconsistencies between guidance and research evidence.  For each of the five areas we identify: what is currently presented in guidance documents, to what extent this is consistent with the existing research evidence and where it diverges.  We present a series of evidence-based recommendations for updating decontamination guidance to address the psychosocial aspects of mass decontamination.

CONCLUSIONS

Effective communication and respect for casualties' needs are critical in ensuring decontamination is completed quickly and effectively.  We identify a number of areas requiring further research including: identifying effective methods for communicating in an emergency; better understanding of the needs of vulnerable groups during decontamination; effective training for emergency responders on psychosocial issues, and pre-incident public education for incidents involving emergency decontamination.  It is essential that the psychosocial aspects of mass decontamination are not neglected in the pursuit of solely technical solutions.

Applying crowd psychology to develop recommendations for the management of mass decontamination

Mass decontamination is a public health intervention employed by emergency responders following a chemical, biological, or radiological release. It involves a crowd of people whose interactions with each other and with the emergency responders managing the incident are likely to affect the success of the decontamination process. The way in which members of the public collectively experience decontamination is likely to affect their behavior and hence is crucial to the success of the decontamination process. Consequently, responders and the responsible authorities need to understand crowd psychology during mass emergencies and disasters. Recently, the social identity approach to crowd psychology has been applied to explain public perceptions and behavior during mass emergencies. This approach emphasizes that crowd events are characteristically intergroup encounters, in which the behavior of one group can affect the perceptions and behavior of another. We summarize the results from a program of research in which the social identity approach was applied to develop and test recommendations for the management of mass decontamination. The findings from this program of research show that (1) responders' perceptions of crowd behavior matter; (2) participants value greater communication and this affects their compliance; and (3) social identity processes explain the relationship between effective responder communication and relevant outcome variables, such as public compliance, public cooperation, and public anxiety. Based on this program of research, we recommend 4 responder management strategies that focus on increasing public compliance, increasing orderly and cooperative behavior among members of the public, reducing public anxiety, and respecting public needs for privacy.

Understanding public responses to chemical, biological, radiological and nuclear incidents--driving factors, emerging themes and research gaps

This paper discusses the management of public responses to incidents involving chemical, biological, radiological and nuclear materials (CBRN). Given the extraordinary technical and operational challenges of a response to a CBRN release including, but not limited to, hazard detection and identification, casualty decontamination and multi-agency co-ordination, it is not surprising that public psychological and behavioural responses to such incidents have received limited attention by scholars and practitioners alike. As a result, a lack of understanding about the role of the public in effective emergency response constitutes a major gap in research and practice. This limitation must be addressed as a CBRN release has the potential to have wide-reaching psychological and behavioural impacts which, in turn, impact upon public morbidity and mortality rates. This paper addresses a number of key issues: why public responses matter; how responses have been conceptualised by practitioners; what factors have been identified as influencing public responses to a CBRN release and similar extreme events, and what further analysis is needed in order to generate a better understanding of public responses to inform the management of public responses to a CBRN release.

Psychosocial care to affected citizens and communities in case of CBRN incidents: a systematic review

Disasters are associated with a substantial psychosocial burden for affected individuals (including first responders) and communities. Knowledge about how to address these risks and problems is valuable for societies worldwide. Decades of research into post-disaster psychosocial care has resulted in various recommendations and general guidelines. However, as CBRN (chemical, biological, radiological, nuclear) events form a distinctive theme in emergency planning and disaster preparedness, it is important to systematically explore their implications for psychosocial care. The aim of this study is to answer two questions: 1). To what extent does psychosocial care in the case of CBRN events differ from other types of events? 2). How strong is the scientific evidence for the effectiveness of psychosocial care interventions in the context of a CBRN event? A systematic literature review was conducted. Searches were performed in Medline, PsychINFO, Embase and PILOTS. Studies since January 2000 were included and evaluated by independent reviewers. The 39 included studies contain recommendations, primarily based on unsystematic literature reviews, qualitative research and expert opinions. Recommendations address: 1) public risk- and crisis communication, 2) training, education and exercise of responders, 3) support, and 4) psychosocial counselling and care to citizens and responders. Although none of the studies meet the design criteria for effectiveness research, a substantial amount of consensus exists on aspects relevant to CBRN related psychosocial care. Recommendations are similar or complementary to general post-disaster psychosocial care guidelines. Notable differences are the emphasis on risk communication and specific preparation needs. Relevant recurring topics are uncertainty about contamination and health effects, how people will overwhelm health care systems, and the possibility that professionals are less likely to respond. However, the lack of evidence on effectiveness makes it necessary to be careful with recommendations. More evaluation research is absolutely needed.

The psychological and psychiatric effects of terrorism: lessons from London

The 7 July 2005 bombings in London caused heightened levels of distress among some in the general community. This distress was most notable in Muslims and members of ethnic minority groups. These effects were transient for most. An estimated 30% of those who were more affected by the attacks, including victims and witnesses, developed psychiatric disorders as a result. An outreach program was set up to screen those who were exposed to potentially traumatic events and to offer them evidence-based treatment. This article discusses what lessons might be learned from studies of the general community and the screen-and-treat approach.

The impact of communication materials on public responses to a radiological dispersal device (RDD) attack

It is a common assumption that, in the event of a chemical, biological, radiological, or nuclear (CBRN) attack, a well-prepared and informed public is more likely to follow official recommendations regarding the appropriate safety measures to take. We present findings from a UK study investigating the ability of crisis communication to influence perceptions of risk and behavioral intentions in the general public in response to CBRN terrorism. We conducted a focus group study involving a scenario presented in mock news broadcasts to explore levels of public knowledge, information needs, and intended behavioral reactions to an attack involving an overt radiological dispersal device (RDD), or dirty bomb. We used the findings from these focus groups to design messages for the public that could be presented in a short leaflet. We then tested the effects of the leaflet on reactions to the same scenario in 8 further focus groups. The impact of the new messages on levels of knowledge, information needs, and intended compliance with official recommendations was assessed. The provision of information increased the perceived credibility of official messages and increased reported levels of intended compliance with advice to return to normal/stop sheltering, attend a facility for assessment and treatment, and return to a previously contaminated area after decontamination of the environment has taken place. Should a real attack with an RDD occur, having pretested messages available to address common concerns and information needs should facilitate the public health response to the attack.

Psychosocial considerations for mass decontamination

Mass exposure to explosions, infectious agents, foodborne illnesses, chemicals or radiological materials may require mass decontamination that have critical psychosocial implications for the public and for both traditional and non-traditional responders in terms of impact and of response. Five main issues are common to mass decontamination events: (i) perception, (ii) somatisation, (iii) media role and communication, (iv) information sharing, (v) behavioural guidance and (vi) organisational issues. Empirical evidence is drawn from a number of cases, including Chernobyl; Goiania, Brazil; the sarin gas attack in Tokyo; the anthrax attacks in the USA; Three Mile Island; and by features of the 2003 severe acute respiratory syndrome pandemic. In this paper, a common platform for mass casualty management is explored and suggestions for mass interventions are proposed across the complete event timeline, from pre-event threat and warning stages through to the impact and reconstruction phases. Implication for responders, healthcare and emergency infrastructure, public behaviour, screening processes, risk communication and media management are described.

Community engagement: leadership tool for catastrophic health events

Disasters and epidemics are immense and shocking disturbances that require the judgments and efforts of large numbers of people, not simply those who serve in an official capacity. This article reviews the Working Group on Community Engagement in Health Emergency Planning's recommendations to government decision makers on why and how to catalyze the civic infrastructure for an extreme health event. Community engagement--defined here as structured dialogue, joint problem solving, and collaborative action among formal authorities, citizens at-large, and local opinion leaders around a pressing public matter--can augment officials' abilities to govern in a crisis, improve application of communally held resources in a disaster or epidemic, and mitigate community wide losses. The case of limited medical options in an influenza pandemic serves to demonstrate the civic infrastructure's preparedness, response, and recovery capabilities and to illustrate how community engagement can improve pandemic contingency planning.