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

The Effect of Risk Communication on Public Behavior to Non-Conventional Terrorism-Randomized Control Trial

Non-conventional terrorism (NCT) incorporates an extended dimension of uncertainty that can lead to fear among the public. Health officials have an unsubstantiated assumption that thousands will seek treatment in hospitals following NCT. This study aims to examine public behavioral intentions in the case of NCT and the effect of risk communication on intents. An online randomized controlled trial was conducted among 1802 adult participants in Israel. Threat perception and behavioral intent before and after exposure to hypothetical NCT scenarios were assessed stratified to the type of media, exposure to rumors, and risk communication. The majority (~64%) of participants are aware of the NCT threat. Almost half (45%) of participants indicated a "high" or "very high" chance of seeking medical attention following an NCT incident. Regression analysis suggests that the odds of participants exposed to risk communication to report an elevated intent of seeking medical attention were 0.470 (95% CI: 0.359, 0.615) times that of participants not exposed to risk communication, χ² = 30.366, p < 0.001. The findings demonstrate the importance of effective risk communication in reducing undesired public behavior during NCT crises. Efforts must be invested to create a robust risk communication infrastructure to allow the proper management of possible NCT incidents.

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.

How to inform the public about protective actions in a nuclear or radiological incident: a systematic review

Studying how the public behaves after a nuclear emergency will help to assess overall morbidity and mortality. Pre-event education might help to shape behaviour, but how best to engage people with emergency communications for low likelihood, high-impact events is unknown. We did a systematic review to identify factors that predict behaviour in preparation for a nuclear incident, factors that predict behaviour in the immediate aftermath of a nuclear incident, and preferences among members of the public for information designed to educate them about which actions to take in the event of a nuclear incident. In general preparedness, behaviour was predicted by factors including perceived coping effectiveness and having children, among others, but absence of preparedness was attributed to fatalistic attitudes. Importantly, for pre-incident communications to be accepted and recommendations adhered to, the source had to be trusted and perceived to be credible. However, it is notable that family needs, such as picking up children from school, were a stronger predictor of behaviour in a nuclear emergency than communicated directives from authorities. If pre-incident education about nuclear incidents is to be used, several factors-including the source and method of communication, the content, and format of messaging-might increase public engagement with messages and promote the uptake of protective behaviours in a radiation event.

French Policies for Victim Management During Mass Radiological Accidents/Attacks

In the current international context, emergency medical services have to be prepared for chemical, biological, radiological, and nuclear events. Emergency response to radiological or nuclear events requires coordination between many components: the fire brigade, emergency medical services (including nurses and physicians), police, hospitals, etc. To optimize efficiency, victim management in France is governed by specific policies and planned responses. This plan for radiological/nuclear event response is inspired by military chemical, biological, radiological, and nuclear victim management in the operational theatre and is based on extraction (removal to a safe environment), first triage, decontamination, second triage, treatment, substance identification, and training. It is also supported by specific equipment. Prehospital victim management in case of nuclear and radiological accident or attack will be described, as well as French-specific supplies. This response plan is constantly evolving due to the complexity of radiological and nuclear events.

Support to triage and public risk perception considering long-term response to a Cs-137 radiological dispersive device scenario

A radiological dispersive device (RDD) spreads radioactive material, complicates the treatment of physical injuries, raises cancer risk, and induces disproportionate fear. Simulating such an event enables more effective and efficient utilization of the triage and treatment resources of staff, facilities, and space. Fast simulation can give detail on events in progress or future events. The resources for triage and treatment of contaminated trauma victims can differ for pure exposure individuals, while discouraging the “worried well” from presenting in the crisis phase by media announcement would relieve pressure on hospital facilities. The proposed methodology integrates capabilities from different platforms in a convergent way composed of three phases: (a) scenario simulation, (b) data generation, and (c) risk assessment for triage focused on follow-up epidemiological assessment. Simulations typically indicate that most of the affected population does not require immediate medical assistance. Medical triage for the few severely injured and the radiological triage to diminish the contamination with radioactivity will always be the priority. For this study, however, higher priorities should be given to individuals from radiological “warm” and “hot” zones as required by risk criteria. The proposed methodology could thus help to (a) filter and reduce the number of individuals to be attended, (b) optimize the prioritization of medical care, (c) reduce or prepare for future costs, (d) effectively locate the operational triage site to avoid possible contamination on the main facility, and (e) provide the scientific data needed to develop an adequate approach to risk and its proper communication.

Communicating the Risk of MRSA: The Role of Clinical Practice, Regulation and Other Policies in Five European Countries

BACKGROUND

The threat posed by Meticillin-resistant Staphylococcus aureus (MRSA) has taken on an increasingly pan-European dimension. This article aims to provide an overview of the different approaches to the control of MRSA adopted in five European countries (Austria, Germany, Netherlands, Spain, and the UK) and discusses data and reporting mechanisms, regulations, guidelines, and health policy approaches with a focus on risk communication. Our hypothesis is that current infection control practices in different European countries are implicit messages that contribute to the health-related risk communication and subsequently to the public perception of risk posed by MRSA. A reporting template was used to systematically collect information from each country.

DISCUSSION

Large variation in approaches was observed between countries. However, there were a number of consistent themes relevant to the communication of key information regarding MRSA, including misleading messages, inconsistencies in content and application of published guidelines, and frictions between the official communication and their adoption on provider level.

SUMMARY

The variability of recommendations within, and across, countries could be contributing to the perception of inconsistency. Having inconsistent guidelines and practices in place may also be affecting the level at which recommended behaviors are adopted. The discrepancy between the official, explicit health messages around MRSA and the implicit messages stemming from the performance of infection control measures should, therefore, be a key target for those wishing to improve risk communication.

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.

How Do Low-Literacy Populations Perceive "Dirty Bombs"? Implications for Preparedness Messages

Potential terror events such as "dirty bombs" could have significant public health effects, but little is known about how low-literacy populations perceive dirty bombs, their trust in public health or government officials to provide credible information, and their willingness to comply with recommended actions. We surveyed 50 low-literacy adults from a large urban center; they were mostly members of ethnic minority groups. We used unique social marketing methods-perceptual mapping and vector message modeling-to create 3-dimensional models that reflected respondents' knowledge of what a dirty bomb is, their intended behaviors should one occur, and their concerns about complying with "shelter in place" recommendations. To further understand individual variations in this at-risk group, a k-means cluster analysis was used to identify 3 distinct segments, differing on trust of local authorities and their emergency response, willingness to comply with emergency directives, and trust of information sources. Message strategies targeting each segment were developed to focus on concepts important to moving the groups toward a "shelter in place" behavior, revealing key differences in how best to communicate with risk communication. We discuss how these methods helped elucidate specific differences in each segment's understanding of and likely response during the event of a "dirty bomb" and how these techniques can be used to create more effective message strategies targeted to these groups.

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.

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.