Chapter Objectives
Describe how to conduct a communication audit.
Summarize how the Public Health Emergency Preparedness capabilities are related to emergency risk communication planning.
Present the roles and responsibilities of key crisis communication team members.
Explain how partnerships play a role in emergency risk communication.
Overview of Planning for Public Health Emergencies and Leveraging Current Crisis Communication Plans
Since the early 2000s, thousands of public health officials and practitioners have been trained in emergency risk messaging principles, and creating an emergency risk communication plan is part of that training.[Reference Seeger, Reynolds, Day, Finn and Winni1] Health departments that receive federal public health preparedness funding through the Centers for Disease Control and Prevention (CDC) cooperative agreement must develop a crisis communication plan to demonstrate emergency risk communication functionality.[2] As outlined in the Public Health Emergency Preparedness (PHEP) capabilities, assessing the current state of a health agency’s ability to respond to and communicate about a health emergency is part of the emergency preparedness and response capabilities planning model.[3]
Assessing the current state of the health department’s ability to respond to a health emergency includes analyzing resource elements, which include planning documents, human resources (i.e., skilled workers), and physical resources such as office space, computers, and other items needed to respond to an emergency. For emergency risk communicators, this means reviewing and updating communication plans to identify missing or outdated information, unclear processes and procedures, and updates to who serves as a spokesperson or the identification of additional subject matter experts. Reviewing crisis and emergency risk communication (CERC) plans, toolkits, standard operating procedures, and who serves as key subject matter experts is a crucial preparedness activity. Engaging in these preparedness activities will also help strengthen relationships within the agency and support cross-team and cross-program coordination.
A communication audit entails reviewing existing materials within your organization and identifying where to make improvements. Organizations often conduct communication audits to ensure their materials are in line with their brand, identity, and communication policies, but audits can also assess what information materials are available to a given program or, in some cases, to a revised outdated program.[4] Communication audits review relevant policies related to reviewing and clearing documents for public consumption, identified spokespeople, and media and social media usage for official business. For emergency risk communication, communication audits are usually conducted before or after an emergency response.
When a communication audit is conducted before an emergency, it will focus on how much information (e.g., communication materials) is available on a given topic such as influenza, E. coli, measles, hepatitis C, or other health threats that could arise in the community. The audit will also assess when the information was created and whether the materials need to be revised and updated. When communication audits happen after an emergency, they are usually part of an after-action review (AAR) to improve organizational processes during an emergency. See Chapter 10 for more on evaluation and AARs.
Conducting a Communication Audit
To conduct a communication audit during the precrisis phase, follow these five steps:
1 Identify priority health threats for the community that the health agency serves. These health threats could include the flu season, common foodborne illness outbreaks (e.g., salmonella), or smoke from wildfires. Check with leadership if you are unsure on how to prioritize health threats.
2 Create an inventory of the communication materials available to communicate about the health threat. These communication materials can include communication toolkits, talking points, social media messages, press release templates or previously used press releases, webpage copy, and fact sheets. Using a spreadsheet is a good way to keep track of what materials are available by health threat. It is also a good idea to include when the item was created and last reviewed.
3 Identify what is missing or what is outdated. Make a plan to create and/or edit communication materials and make sure to work in coordination with subject matter experts and leadership. Consider coordinating with community members to gather their feedback on the materials as part of a message testing process.
4 Once the communication materials have been created and edited, hold a briefing meeting to update key communication staff, program staff, and leadership about what materials have been created, where the materials are, and how they will be used during an emergency. You can also work with your preparedness program to identify how the new materials could be tested, such as during a tabletop discussion or functional exercise.
5 Make a note to check and review these materials both annually and following an emergency in which they were employed.
If new messages need to be created, consider testing those messages to ensure they will resonate with and reach target audiences. See later in this chapter for more on message testing.
Communication Plans, Planning, and Toolkits
Since 2001, CDC has funded state and local health departments through the PHEP cooperative agreement program, which provides critical funds for health departments to create and sustain information and communication systems, conduct routine surveillance efforts for infectious diseases, provide community education and risk communication, organize exercises, and identify ways to address vulnerable populations.[Reference Houser5]
CDC outlines 15 public health and emergency preparedness and response capabilities[2]:
2 Community Recovery
5 Fatality Management
7 Mass Care
8 Medical Countermeasure Dispensing and Administration
9 Medical Material Management and Distribution
10 Medical Surge
12 Public Health Laboratory Testing
13 Public Health Surveillance and Epidemiological Investigation
14 Responder Health and Safety
15 Volunteer Management
Emergency risk communication and messaging can be found in all of these preparedness capabilities. When your organization is in the precrisis, preparedness stage, it is key that emergency risk communicators understand emergency response operations. This fundamental understanding is so important because, for each key operation area, communicators need to develop messaging that explains what their organization is doing and what the public can do to protect their health. Nonpharmaceutical interventions will be developed by subject matter experts and implemented by health department staff, but emergency risk communicators will need to share and educate the public about nonpharmaceutical interventions through public messaging. Additionally, within the PHEP capability guidance, there are key areas where some functions overlap with emergency risk communication. For example, Capability 2: Community Recovery coordinates with Capability 4: Emergency Public Information and Warning to develop messages and identify audiences impacted by the emergency.
For emergency risk communicators, it is important to understand Capability 4: Emergency Public Information and Warning. This capability outlines key functions and tasks that must take place to facilitate effective emergency communication in a health emergency. These functions include:
1 Activate the emergency public health information system.
3 Establish and participate in information system operations.
4 Establish avenues for public interaction and information exchange.
5 Issue public information, alerts, warnings, and notifications.
The key is for these PHEP functions to align with an emergency risk communication plan that strategically guides communication during a health emergency. For emergency risk communicators, the key is to crosswalk the Capability 4: Emergency Public Information and Warning with the CERC’s recommended components of a crisis communication plan.
The 2014 CERC manual outlines required components of the crisis communication plan[6, 7]:
Signed endorsements from senior leadership.
Designate responsibilities for the public information team.
Establish agreements on release authorities (who releases what and when).
Media contact lists.
Plan to coordinate public health response teams.
Notification procedures for public information and preparedness and response teams.
Contact lists for emergency response partners.
Have agreements and procedures to join Emergency Operations Center and/or Joint Information Center/System (JIC).
Develop procedures to secure needed resources.
Outline information dissemination efforts.
Lists of stakeholders, including who they are, where they are located, and how to reach them.
Crisis communication plans need to include the materials identified during a communication audit that can be used during a health emergency. The following sections crosswalk the PHEP capabilities with sections of a CERC plan to provide practical guidance on how to revise and update existing communication plans.
Function 1: Activate the Emergency Public Health Information System
This function ensures that the crisis communication team and spokespeople are alerted to the health emergency and can provide information to the public.
The core tasks of the function are:
Identify key personnel (including spokespeople, subject matter experts, public information officers) to implement and disseminate emergency risk communication.
Identify the location of a physical or virtual Joint Information Center or Joint Information System.
Outline how key personnel will be notified about the emergency.
Identify the roles and responsibilities of those who are responsible for emergency risk communication.
Ensure key personnel are trained.
Clarify roles between and among partner agencies regarding public information activities.
What Does This Look Like in a CERC Plan?
Within a crisis communication plan, clearly outline who will act as spokespeople and for what emergency response they will be used. Also clarify when particular spokespeople will be used depending on the magnitude and severity of the emergency response. For example, for some foodborne illness outbreaks, having an epidemiologist serve as a spokesperson is appropriate as they will be the expert on the outbreak investigation. However, if the outbreak involves multiple counties or a high-profile organization, having a health officer or health department as spokesperson is more appropriate.
Next, include members of the crisis communication team and identify what roles and responsibilities they will hold. In this, it is critical to identify individuals with specific skillsets related to writing, communication, media monitoring and analysis, media relations, and website and social media management. If you have a small agency, you may need to identify staff from programs outside of the preparedness program. For example, if the preparedness program only staffs three individuals, leveraging staff from the immunization program or nursing division will be necessary during a health emergency. If staff do not have the necessary skills or need to receive training, ensure that the preparedness program facilitates the necessary training and tracks which individuals have received training.
Developing Sustainable Crisis Communication Teams
In addition to outlining policies and procedures, CERC plans designate who will carry out emergency risk communication activities. Two key tenets of public health preparedness include scaling operations to meet emergency response demands and having a skilled workforce that is able to perform during health emergencies. A health department that leverages and integrates public health preparedness with existing systems and public health practices will be able to quickly scale up their emergency response activities during an active response.[Reference Nelson, Lurie, Wasserman and Zakowski8]
An expert and fully staffed workforce includes having skilled team members who can perform during a health emergency and leaders who can manage the health emergency, engage with stakeholders, and effectively communicate response operations and mitigation strategies. To develop a sustainable crisis communication team, first look internally at current staff labor categories and skillsets and then determine if, and when, external support is needed. Table 2.1 outlines the key roles needed for a crisis communication team.
Table 2.1 Crisis communication team member roles and responsibilities
Communication plans can add other positions depending on the scope and scale of the health emergency. Additionally, if a Joint Information Center is established, there may be more roles to consider, such as a Joint Information Center manager, who oversees the administration of the JIC and may coordinate public email inquiries regarding the emergency response.
Function 2: Determine the Need for a Joint Information Center/System
This function focuses on coordinating public information, both internally within the health agency and externally with other jurisdictions and agencies. A point of distinction is needed here: A JIC can be created either as a structure internal only to public health (i.e., a public health JIC) or public health can participate in a JIC created by an emergency management agency (i.e., emergency management JIC).
The core tasks of this function are:
Coordinate with emergency management to determine the need for a public health JIC and coordinate with emergency management.
If a public health JIC is not activated, identify who will participate in an emergency management JIC.
Coordinate the delivery of public information from the JIC through four common functions: information gathering, information dissemination, operations support, and liaison roles.
What Does This Look Like in a CERC Plan?
JICs are a part of the National Incident Management System (NIMS), and they were developed to coordinate communication activities across multiple agencies during emergency management disaster responses.[9] In a traditional JIC, a physical location is set up for public information officers from different agencies to develop messages based on their agency’s role in the response, and the incident commander approves the message before it is released. The virtual form of this coordinating center is called a Joint Information System. This book will refer to both a Joint Information Center and a Joint Information System as a JIC.
CDC and local public health departments often operationalize JICs to organize internal communication functions and coordinate with other health departments. This is called a public health JIC.[3] The public health JIC functions as the main media distribution point during health emergencies and ensures the distribution of consistent and accurate information.[10, Reference Conley11]
The following functions of a JIC were used as part of the CDC 2005 severe acute respiratory syndrome (SARS) emergency response[10]:
Issue local public health announcements and updated information on the outbreak and response efforts.
Disseminate information about the health emergency, its management, and the possible need for travel restrictions, isolation, and quarantine measures.
Establish a “news desk operation” to coordinate and manage media relations activities.
Provide a location for state, local, and federal communication and emergency response personnel to meet and work side by side on developing key messages, handling media inquiries, and writing media advisories and briefing documents.
Respond to frequently asked questions by developing fact sheets, talking points (key messages), and question-and-answer documents.
Coordinate requests for spokespeople and subject matter experts.
Issue media credentials to the press.
Address other local/regional information requests related to the outbreak that require distribution to the media and the general public.
Develop, coordinate, and manage local websites as required.
Public health JICs are often established to coordinate internal and external emergency risk communication activities. For example, health departments work on outbreaks on a regular basis, with many of them never reaching a declared health emergency status. In these situations, activating an external JIC is not necessary because the outbreak situation does not overwhelm current resources and current resources can handle the public health incident. Instead, the health agency may bring together an internal JIC to coordinate communication across multiple internal programs. However, when outbreaks are larger and require more communications support, creating a JIC will scale up communication activities and the number of people working on communication activities. Remember, emergencies start at the local level. During communication planning and review, it is good practice to develop a threshold or trigger chart that outlines that when certain conditions are reached, a JIC will be activated. Procedures for activating and maintaining the structure of a JIC if one is activated will be outlined in a later section of this chapter.
How Best to Engage with Partner Agencies
A key factor to establishing a public health JIC is including partner agencies. Health departments respond to outbreaks and other smaller health threats on a regular basis, but sometimes they need additional support when local systems are overwhelmed. It is imperative for health department staff to know and understand what local resources are available to handle health emergencies and what trigger events or thresholds will initiate a formal emergency response declaration and multidisciplinary and multijurisdictional responses.
When a formal health emergency is declared, local and state health departments can request additional resources. Depending on the situation, other government agencies may also be involved. Consider the following quote: “When you want to go fast, go alone. When you want to go farther, go together.” This quote is relevant to large-scale emergencies because multiple government agencies will be involved in the response, all of which will have key tasks and responsibilities to carry out. However, even in large-scale emergency responses, one agency is designated the lead; this lead role is determined by the type of emergency (i.e., natural disaster, terrorism, health, etc.).
Designating who does what is often established through formal training, tabletop exercises, full-scale exercises, and, of course, real-world experience. These are key activities that happen during the precrisis phase of a health emergency. Developing a regular frequency for meetings, tabletops, and function exercises will help build relationships and maintain trust between and among agencies. For emergency risk communicators, establishing communications-specific tabletop exercises and meeting discussions with other communicators, public information officers, and identified spokespeople will create a strong working relationship with internal public health staff and with communicators external to the agency.
When a relationship is established with another agency, it is imperative to maintain and nurture that relationship over time. Knowing the responsibilities of other agencies and identifying key staff in other agencies – such as the public information officer for the transportation department or the forestry department – could help make an emergency response more efficient. Having these preidentified relationships in place before an emergency occurs makes agency collaboration during a response easier, more effective, and more efficient.[12] Trying to develop relationships and build trust with new response partners during a health emergency can be challenging.[Reference Zafari, Biggemann and Garry13]
Further, when public health agencies participate in an emergency that is led and managed by emergency management – whether at the local, state, or federal level – within the JIC the health agency serves as the subject matter expert for health and medical issues and questions. For example, under Emergency Support Function 8 (ESF 8), public health and medical services annex,[14, 15] when emergency management is leading an emergency response, the public health function is supporting delivery of medical countermeasures, equipment and supplies, and technical assistance. Further, under ESF 8, the public health function is to communicate emergency risk information, including proactive actions the public can take to protect their health.
Function 3: Establish and Participate in Information System Operations
This function focuses on how to engage with CERC activities through monitoring the media, conducting media briefings, and addressing rumors:
Participate in public information sharing.
Control rumors.
Provide a single point of dissemination of information for public health and health care issues.
What Does This Look Like in a CERC Plan?
Within the CERC plan, it is critical to outline such matters as issuing press releases, establishing an incident-specific emergency website, holding media briefings, and establishing call centers. Understanding how the agency will address rumors is important. See Chapter 7 information on addressing rumors.
For health emergency responses, it is critical to streamline communication so that the public, stakeholders, and media inquiries are identified, documented, and responded to in an efficient manner. One way to streamline emergency communication is to funnel emergency inquiries to specific emergency response phone numbers and emails. These emergency-specific communication channels are often used when a JIC is established.
Function 4: Establish Avenues for Public Interaction and Information Exchange
Provide ways for the public to contact the health agency during an emergency, such as:
Establish systems for handling public and media inquiries.
Post incident-related information on health agency websites.
Use social media platforms and text messaging.
Identify, protect, and ensure information exchange occurs with hard-to-reach and socially vulnerable populations.
What Does This Look Like in a CERC Plan?
Within the CERC plan, it is critical to outline how and when certain types of media relations activities are used, such as issuing press releases, establishing an incident-specific emergency website, holding media briefings, and establishing call centers. Leverage the agency’s digital channels to share and disseminate information, including the agency website, social media channels, GovDelivery newsletters, and text messaging. See Chapter 5 for more information on communication channels. Coordinating with the public health and preparedness program can help identify the locations of hard-to-reach and socially vulnerable populations. See Chapter 3 for more information on identifying audiences.
Function 5: Issue Public Information, Alerts, Warnings, and Notifications
Use CERC principles to disseminate critical health and safety information to the media, the public, and other stakeholders.
The core tasks include:
Comply with jurisdictional legal guidelines when communicating information.
Disseminate information to the public using message maps (including those who are deaf or hard of hearing or have visual impairments, limited English proficiency, diverse cultural backgrounds, cognitive limitations, or those who do not use traditional media).
Disseminate information to responder organizations.
What Does This Look Like in a CERC Plan?
This function of the crisis communication plan leverages communication messages such as talking points, webpage copy, social media messages, fact sheets, and webpages about the virus, among others, all of which can be used during an emergency. It is also imperative that communication materials be available in multiple formats. Although not a state requirement, 508 compliance is a federal law that requires US federal agencies to provide accessible information to people with disabilities when using electronic and information technology.[16]
Finally, the crisis communications plan needs to outline procedures regarding information distribution to stakeholders, the public, and the media. For example, identify what communication channels will be used to send press releases to the media. If a specific media email list is established, identify how that will be used during a health emergency and who has the ability to send such releases. If a GovDelivery email newsletter is established, outline how that will access the system and send the message.
Key Tip: Emergency Communication Clearance Processes, Release Schedules, and Updating Published Materials
As outlined earlier, a crisis communication plan will include communication clearance processes and procedures, including a release schedule and processes for updating published materials. The communication clearance process is a critical step for agency leadership and subject matter experts to review and approve emergency messaging before it is officially released to the public, media, partner agencies, and stakeholders. This final review ensures the emergency messaging is scientifically accurate and does not violate agency policies. The release schedule is managed by the communications team and outlines how often information will be released. For example, during the initial phase of an emergency, information may be updated every 24 hours. As the emergency moves into the maintenance phase, information may be updated weekly. As the emergency moves into the recovery phase, information may be updated monthly. A process for updating published materials ensures that the emergency information available on the agency’s website and social media channels is accurate and up to date. When updating published materials, it is helpful to designate a subject matter expert to review agency web pages in order to ensure the posted information remains accurate. It is also imperative to outline how often the review of published materials will take place (e.g., daily, weekly, monthly). Finally, designate a web or communications team member to make the actual updates.
When developing a communication clearance process, consider the following:
Who needs to review the document? Consider agency leadership, subject matter experts, and the policy team. Give each reviewer specific instructions on what to look for when reviewing. For example, have subject matter experts look at the accuracy of the content and have a communications specialist focus on proofreading and grammar issues. It is a best practice to have the policy team review the documents to ensure emergency messages do not impact current agency policies.
How will the review process take place? For example, will you send the materials by email or create a specific SharePoint site to facilitate the review process?
Who is the final approver? Often the highest-ranking official of the agency gives final approval regarding a message. If the Incident Command System has been activated, the Incident Commander may be the final approver.
How much time is needed to review? It is a best practice to provide reviewers with clear deadlines and timelines for review. For example, if the information needs to be sent to the media in 2 hours, tell the reviewers they only have 1 hour for review, which provides the communications team with 1 hour to address edits and package the materials for release.
Mini-Case Study: Douglas Complex Fire
On July 26, 2013, lightning and thunderstorms moved into Douglas County in central Oregon, and a lightning strike ignite multiple wildfires, which were collectively referred to as the “Douglas Complex Fire.”[17] The Douglas Complex Fire was made up of three separate fires – the Milo branch fire, the Rabbit Mountain/Union Creek fire, and the Dad’s Creek/Panther Butte fire – impacting land and communities.[Reference Templeton18] The Oregon Office of the State Fire Marshall and the Oregon Department of Forestry coordinated fire operations and evacuations. While the fire threatened land and property, the smoke from the wildfire began impacting the community’s health. Air quality readings from the Oregon Department of Environmental Quality indicated “unhealthy” and “hazardous” levels in some areas of the state.[Reference Templeton18, Reference Metcalfe19]
The local health departments began working with the Oregon Department of Forestry, which was the lead agency managing the emergency response efforts. The fire’s scope and severity overwhelmed local resources, and additional state and federal resources were requested.
When the state health department got involved, they used the CERC toolkit for wildfires to guide public messaging. The toolkit had been developed earlier that year and included samples of phase-based messaging: messages designed for the precrisis, initial, maintenance, and recovery phases of a health emergency. For the initial and maintenance phases, the toolkit was color-coded with a red band at the top of the page so that people could flip right to the predeveloped crisis messages they could send out.
During the emergency response, emergency risk communicators discovered that the predeveloped messaging was not focusing on the right health threat: The messaging needed to focus on the impacts of smoke inhalation. Working with public health medical doctors, messages began to focus on the potential health impacts from inhaling wildfire smoke. For example, wildfire smoke contains a type of particulate matter called PM2.5, and if these particles get into a person’s lungs, they can cause cardiovascular and respiratory issues.[20] Individuals with lung conditions or other underlying medical conditions can become very ill when exposed to wildfire smoke.[Reference Gan, Liu, Ford, O’Dell, Vaidyanathan and Wilson21]
Additionally, geographical location also posed a risk to the public’s health. Two affected communities, Shady Cove and Glendale, are located in valley or bowl-like areas, so the smoke-contaminated air did not dissipate from these areas. Both communities were advised to evacuate. Some evacuees were able to head to the nearby Oregon coast. However, these communities included a large percentage of older people and people of lower socioeconomic status, and evacuation was less feasible or realistic for these individuals.
Through working with the local community health department, the federal Forest Service, the local forest service, and the local environmental health department, the CERC toolkit began to adapt the messages to contain what was needed regarding the health threat of smoke inhalation. Coordinating public messaging became a joint effort among local and state agencies, including multiple disciplines and multiple jurisdictions. Additionally, the US Forest Service developed and monitored a blog that became the “go-to” source of public information about health impacts from wildfire smoke. The health agencies provided the US Forest Service with health information and proactive steps people could take to protect their health.
During an AAR, emergency risk communicators learned that the CERC toolkit for wildfires needed to be edited and revised to focus on the impacts of smoke inhalation. The updated CERC manual has been used in subsequent wildfire smoke responses and continues to be edited and adapted based on lessons learned through each wildfire smoke response.
Overview of Message Testing and Developing Consensus Recommendations
The CDC CERC model[Reference Reynolds and Seeger22] and the National Center for Food Protection and Defense’s Best Practices for Risk and Crisis Communication[Reference Seeger23] both advocate that, during the precrisis phase, emergency risk communicators create and test messages that could be used during a health emergency. Additionally, communicators should work with other agencies and coordinate these messages to ensure coordinated and consistent public messaging is achieved.
Creating messages can be an easy task: Identify what information is available, work with subject matter experts to ensure the information is scientifically accurate, and format the information according to the communication channel that will be used to disseminate it. Message testing and coordinating with partner agencies take message development further and will require more time and additional coordination.[7, Reference Reynolds and Seeger22]
Message Testing and Consensus Recommendations
Message testing emerged in the 1970s as a form of public relations evaluation and measurement. Message testing provides an opportunity to determine whether messages will persuade individuals to take an action, but often message testing does not occur because it can be expensive and time-consuming.[Reference Kim and Cappella24] Developing consensus recommendations differs from message testing in that consensus recommendations for public health emergencies are agreed upon by subject matter experts regarding the health, medical, and other strategic recommendations to mitigate health threats.[Reference Lazarus, Romero, Kopka, Karim, Abu-Raddad and Alemida25] Consensus recommendations bolster future emergency response efforts. These recommendations ensure that agencies will engage in similar response activities and achieve consistent public messaging regarding these activities. Gathering key leadership, subject matter experts, and communication officers from multiple disciplines and jurisdictions – especially those with shared media markets – to discuss consensus recommendations is a key preparedness activity; however, during the COVID-19 pandemic response – due to the novel virus and its global impact – consensus recommendations were developed during the emergency response.[Reference Kim and Cappella24, Reference Lazarus, Romero, Kopka, Karim, Abu-Raddad and Alemida25, Reference Marie, Thomas, Cassandra, David, Loth and Eva26] When agencies come together to discuss similarities and differences in activities and messaging, they ultimately must agree upon consensus recommendations. After agencies are clear on response activities and recommendations, message testing can occur.
To engage in message testing, first assess whether there is a budget for message testing. If there is a large budget available, your health agency may consider hiring a public relations firm, communication consultants, or university researchers to conduct formal message testing. If there is a smaller budget or no budget available, there are two options to consider: (1) Assess whether there is any opportunity for pro bono work with public relations firms, communication consultants, or university researchers or (2) if there is no budget, identify partner agencies and stakeholder groups who might be willing to donate some of their time to assist with a scaled-down version of message testing.
Many health departments do not have budgets for formal message testing, so the following recommendations are for real-world applications of message testing with a small or no budget. Even without a budget, low- to no-cost message testing provides the opportunity to get outside of your organizational bubble, check your messaging assumptions, and learn more about the people you are trying to communicate with.[Reference Sanderson27]
Steps to Take When Planning for Message Testing
1 Identify if there are evaluation experts within your own health department, neighboring health departments, or state health department. If there aren’t any evaluation experts in the public health system, consider working with evaluation partners from universities or other government agencies who would be willing to donate their time.
2 Work with evaluation subject matter experts to develop a basic evaluation plan to test messages. Identify what messages you want to test, the metrics to test them, and ways to analyze the data. When testing messages, consider the following factors: the values of the people you are trying to reach, whether they trust or like the official spokespeople, and aesthetics like images, colors, words, and phrasing.[Reference Sanderson27] Ensure the messages being tested are based upon the consensus recommendations regarding response activities.
3 Identify the method you want to use. Different methods of collecting data include focus groups, semistructured interviews, online surveys, or “ask a friend.”[Reference Sanderson27] Consider the target audience of the messages and invite individuals who can do so to provide feedback to ensure the messages will resonate with the target audience. Again, if you have a small budget, offering incentives such as a gift card or another form of payment will be appreciated by the participants.
Two common ways with which to engage in message testing are to gather input and feedback on the messages, including text, wording and phrases, and images.[Reference Kim and Cappella24] The goal of message testing is to ensure the message will resonate with the target audience and that this audience will be motivated to take an action. Ideally, surveys are then used as mini-field tests to gather feedback from a large population of people.[Reference Kim and Cappella24] Since surveys gather information from a larger population of people, the quantitative data can be analyzed to provide additional information about the likelihood that individuals will take an action.
Many health departments will create plans to utilize focus groups and qualitative methods in order to gather and analyze information. While these findings will not be generalizable to a larger population, they often provide valuable information regarding language (including wording and phrasing), images, and color, and they even provide information on dates to avoid when disseminating messages. For example, there may be events, holidays, or religious observances that are occurring, and information shared during these times will likely not be read or acted upon.
4 Collect and analyze the data. After outlining methods, start collecting data. After collecting data, analyze them using the appropriate methods and tests. If qualitative methods are used, consider following up with the focus groups or stakeholders to gather more information or to clarify the information they provided.
5 Update the communication materials as needed. Using the data that were gathered, begin a systematic process of updating existing materials based upon feedback. If qualitative methods were used, share the edited material with the focus groups and stakeholders to ensure the edits match their feedback.
6 Finalize the materials and share them. After editing and reviewing the materials through the agency’s internal review and clearance procedures, begin to share the materials as outlined in the CERC plan.
Mini-Case Study: Middle Eastern Respiratory Syndrome
In the spring and summer of 2014, Saudi Arabia experienced a large outbreak of Middle Eastern respiratory syndrome coronavirus (MERS-CoV), which generated some concern of a larger outbreak occurring during Hajj in October.[Reference Lessler, Rodriguez-Barraquer, Cummings, Garske, Van Kerkhove and Mills28] In Oregon, the state health department engaged in public health preparedness activities to educate individuals who were traveling to the area about the risk of MERS-CoV. They created a fact sheet with known information about the virus, about risks of getting ill, and about what to do upon return from the area.[29, 30]
To ensure that the fact sheet and key messages would resonate with the intended audience, the communication materials were shared with different nongovernmental organizations to obtain feedback. Through the feedback process, the health department learned that the two images originally included in the fact sheet would not resonate with the audience. For example, one image constituted a map that incorrectly identified the area impacted by the MERS outbreak. The other photo was of a person whose image did not resonate with the intended audience. By engaging with groups that work with the intended audience to check messaging assumptions, the health department received feedback that helped them to update the images and change some of the text. This provides a basic example of informal message testing conducted by a health agency in anticipation of an emerging health emergency.
Theory Callout: CERC Framework
The CERC framework provides emergency risk communicators with an integrated approach to using strategic communications approaches to communicate health and risk information during a health emergency. Leveraging the six principles of Be First, Be Right, Be Credible, Provide Empathy, Promote Action, and Show Respect coupled with the crisis communication lifecycle phases of precrisis, initial, maintenance, recovery, and evaluation, CERC is a robust framework that can guide novice and seasoned emergency risk communicators before, during, and after a health emergency.
As a theoretical framework, CERC offers six propositions[Reference Veil, Reynolds, Sellnow and Seeger31]:
1 Risks and crises create uncertain conditions that produce unique information needs among the public, stakeholders, and partners.
2 Two-way communications are needed to reduce uncertainty and promote action to mitigate health threats.
3 As the health threat evolves, communication will undergo a particular life cycle based on the crisis phases. Leveraging different communication channels to communicate throughout the crisis is critical.
4 The way information is communicated can influence the development and mitigation of the health emergency.
5 Proactive messages, or messages of self-efficacy, help reduce health risk during health emergencies.
6 Crisis communication requires message senders to consider a diverse audience.
More research is needed to analyze and test these propositions before the CERC framework can become more established as a theory. See Chapter 10 for more details on the current academic literature evaluating the CERC framework.
Overview of the East Palestine Train Derailment
East Palestine, Ohio, is a small village located near the Ohio–Pennsylvania border, about 45 miles northwest of Pittsburgh, Pennsylvania. On February 3, 2023, a Norfolk Southern train derailed east of the town, less than 1 mile from the Pennsylvania border. A total of 38 cars derailed, 11 of which contained hazardous materials.[Reference Ebrahimji and Yan32] Norfolk Southern officials and local emergency response crews became concerned about rising temperatures in five of the derailed cars containing hazardous materials, including vinyl chloride. Major concerns emerged in the days following the derailment of the risk of an imminent and potentially catastrophic explosion.[33]
A joint decision was made by Ohio and Pennsylvania state officials, the private Norfolk Southern rail company responders, and the public first responder response crews to conduct a controlled release of the chemicals to limit the possibility of an explosion. On February 5, residents within 1 mile of the derailment site were evacuated, and 5,000 other residents were put under a shelter-in-place order. On February 6, a controlled release, also sometimes called a “controlled burn,” was conducted.[Reference Orsagos34] This caused large black plumes of smoke to be released and raised immediate concerns about air quality. Shortly after the controlled release, residents were also noting effects on wildlife, such as observing dead fish. Officials noted on February 15 that three waterways that are tributaries of the Ohio River were contaminated.[35]
On February 8, the evacuation order was lifted. Residents began to return home. By February 10, residents began to report symptoms such as rashes and nausea.[Reference Salahieh, Yan and Sutton36] There are ongoing concerns about the possible health effects on humans, wildlife, and the quality of the air, water, and soil. In the time since the controlled release, many local, state, and national leaders and agencies have been involved in the response to the crisis. National and international interest in the story and concern over the derailment have led to calls for national policy change to improve rail safety. As of September 2024, the US Environmental Protection Agency (EPA) continues with testing and clean-up efforts in the area.[37] Additionally, a class action lawsuit was filed in 2024 seeking a $600 million settlement in economic damages to individuals and business affected by the disaster.[Reference Bronstad38, Reference Funk39] Furthermore, the US Department of Justice and EPA are seeking a $310 million consent decree. If the degree is approved, “Norfolk Southern will be required to take measures to improve rail safety, pay for health monitoring and mental health services for the surrounding communities, fund long-term environmental monitoring, pay a $15 million civil penalty and take other actions to protect nearby waterways and drinking water resources.”[37, 40]
Timeline of Key Events
February 3, 2023, 8:55 p.m. EST: 38 cars derailed, 11 of which were carrying hazardous materials including vinyl chloride, benzene residue, and butyl acrylate.
February 5: Ohio Governor Mike DeWine activated the Ohio National Guard; 5,000 residents were put under a shelter-in-place order; residents within a 1-mile radius in both Ohio and Pennsylvania were given an evacuation order.
February 6, 3:30 p.m. EST: A controlled release of five cars contained vinyl chloride was conducted to prevent explosion. Governor DeWine gave a press conference prior to the controlled release.
February 8: The evacuation order was lifted, and residents began to return to their homes.
February 10: Some residents who returned home reported developing a rash and nausea within half an hour of returning.
February 14: Governor DeWine gave a press conference with updates about concerns regarding air quality, water quality, and impacts on wildlife.
February 16: An EPA administrator arrived to assess Norfolk Southern’s response; Governor DeWine asked CDC for assistance in assessing residents experiencing symptoms.
February 21: Ohio State Health Department set up a clinic to assess symptoms in residents.
February 22: Former president Donald Trump visited and hosted a press conference.
February 23: Secretary of Transportation Pete Buttigieg visited and hosted a press conference.
Overview of CERC Principles and Phase-Based Messaging
CDC has outlined six key principles for CERC. These six overarching CERC principles, as well as the specific phase-based messaging guidance, will serve as the basis for the following analysis of the messaging during the Norfolk Southern train derailment in East Palestine, Ohio.
The six CERC principles are Be First, Be Right, Be Credible, Express Empathy, Promote Action, and Show Respect. Additionally, the CERC principles outline the goals for messaging during different phases of a crisis response. The initial phase of crisis and emergency response is typically characterized by uncertainty during the first 24–72 hours of an event, while the maintenance phase typically lasts much longer and constitutes the bulk of the risk communication effort. Resolution- or recovery-phase messaging comes much later, when the community has fully dealt with the impacts of the event and is starting to move toward a new normal.[6]
According to CERC guidelines, each phase has specific communication needs to be addressed. In the initial messaging phase, expressing empathy, establishing credibility, and explaining what is known about the risks are the focuses of these communications. Other important practices for initial-phase messaging include the CERC principles of Be First and Promote Action. In the maintenance phase of messaging, more emphasis is placed on deeper risk explanations, answering questions, and addressing misinformation. This is also a time for risk communication that those promotes actions that can move the community toward risk mitigation and resolution. In the resolution phase, risk communicators seek to express a need to establish a new normal and to help both the public and organizations involved in the response to learn from the crisis in order to be better prepared for similar crisis events in the future.
Introduction to the Analysis of CERC Principles in the East Palestine Train Derailment Response
To analyze the emergency and risk messaging that emerged after the train derailment in East Palestine, I focused on the Ohio state government communication responses through the lens of the office of the Governor, Mike DeWine. I was interested in leadership responses to the crisis. In particular, I was interested in how Governor DeWine performed as a spokesperson while coordinating with many local, state, and national agencies as well as the private rail company Norfolk Southern. The analysis is focused on two press conferences that occurred during different phases of the crisis that both featured Governor DeWine as the spokesperson. The first press conference analyzed was conducted during the initial phase of the crisis, less than 72 hours after the original event and before the controlled release was executed. The next press conference analyzed was conducted during the early maintenance phase of the crisis, about 9 days after the original event and approximately 1 week after the controlled release.
In addition to these press conferences, I analyzed some of the Ohio state government’s written press releases and website updates that were hosted on the Governor’s website as well as the Ohio Emergency Management Agency (EMA) website.
In May 2023, the crisis was still in the maintenance phase, and little clear recovery messaging has been put forward by the state of Ohio, the office of the Governor, or other national leaders. That being the case, I took the opportunity to also perform a comparison analysis of two other prominent national leaders who visited the area and conducted maintenance-phase press conferences: Donald Trump and Pete Buttigieg. It was interesting to see how different leadership responses did or did not follow CERC phase-based messaging principles and how this might yield insights into being an effective crisis event spokesperson and risk communicator.
Analysis of Initial-Phase Messaging
On February 6, 2023, Ohio Governor Mike DeWine appeared as the spokesperson at a press conference in East Palestine. This was at the end of the initial phase of the crisis, within the first 72 hours of the initial event and just before the controlled release of the five cars that were considered explosion risks. According to the CERC principles for initial-phase messages, Governor DeWine did several things well. Governor DeWine came across as a credible source of accurate information, fulfilling the CERC requirements of being right and being credible. He was straightforward, honest about what he did and did not know, and deferred to experts when they had answers that he did not. He gave facts, communicated risk, and described a life-or-death situation.
In addition to being right and being credible, Governor DeWine is also “first” in the sense that he gave a formal press conference within a reasonable amount of time after the crisis and before next major steps were taken. Some attendees questioned whether Governor DeWine could have responded sooner than 2.5 days after the event. When questioned directly about the timing of the press conference, the Governor cited that the level of threat was being continuously assessed. As soon as the threat of rising temperatures in five cars escalated, he went to East Palestine to address the situation, and once a decision was reached between the rail company and the Pennsylvania and Ohio governments, he shared that information.
Finally, Governor DeWine promoted action, which is an important CERC principle for the initial phase of messaging. Namely, he issued an evacuation order in stark terms. He explained that this emergency evacuation was necessary due to the imminent controlled release and the threat this posed to residents in the immediate vicinity.
While Governor DeWine did an admirable job of meeting many of the CERC initial-phase messaging criteria, there were also areas that could have been improved. One area that could have been significantly improved was expressing empathy, a key principle of CERC messaging, especially in the initial phase of a crisis response. There was no real acknowledgment of the fear and confusion residents may have been feeling, nor any acknowledgment of the risks being taken by those individuals who were directly responding to the crisis. Another area where there was room for improvement was showing respect. Governor DeWine’s tone was very matter-of-fact, perhaps reflecting his exhaustion. This tone verged on lacking showing of respect for residents and the media, though it was not outright disrespectful. Despite the lack of empathy and the potential for improvement in the tone of the delivery, this was a solid initial-phase message overall, with most of the content that would be expected according to CERC principles.
In addition to this initial-phase press conference, I also looked at press release statements issued by the Governor’s office, which are currently housed on the Ohio EMA website. During the emergency response, the Governor’s website had a banner at the top of the page linking to these Ohio EMA resources. To analyze press releases written during the initial phase, I look at two of the earliest from the days of February 5 and February 6.
Similar to the Governor’s delivery as spokesperson at the press conference, these press releases met a number of key CERC principles for initial-phase messaging. They were “first” in the sense that they were written in the early days of the crisis response and contained explanations of the emerging threat of rising temperatures in several of the rail cars. They promoted immediate emergency action in the form of evacuation. They also established credibility by containing accurate information delivered in a matter-of-fact tone.
Just as these strengths were similar to those of the Governor’s press conference, these press releases also shared the press conference’s weaknesses. These statements lacked any expressions of empathy regarding the fear, confusion, and disruption to the lives of residents, nor any empathy or shows of respect for first responders who had been at this dangerous scene for several days. The inclusion of a statement of empathy would have made these press releases stronger initial messages.
Analysis of Maintenance-Phase Messaging
On February 14, Governor DeWine was again the spokesperson during a follow-up press conference addressing maintenance-phase concerns in East Palestine following the train derailment. Governor DeWine once again presented himself as a credible spokesperson who delivered accurate information, meeting the criteria of being right and being credible. In this press conference he did a much better job of showing respect to conference attendees and the media, other experts, and the general audience. Governor DeWine also delivered more in-depth risk explanations and coordinated with many field experts, who also gave in-depth risk explanations. He explained in greater detail what had gone into the decision to conduct the controlled release. He talked about what was within his power to prevent something like this from happening in the future and discussed policy changes for the transportation of hazardous materials. He also made a strong commitment to the community of stakeholders, stating: “We’ll be here until everything in East Palestine is done.”[35]
Governor DeWine and the panel of experts also spent about half of the press conference addressing questions and misinformation. Many of the questions they addressed had been topics of speculation and misinformation circulating on the internet. These topics included: the possibility of contaminated waterways and drinking water sources; the possibility of air contamination; and the impacts on human health and wildlife health. The team did a fairly good job of addressing these questions by presenting facts first. Especially regarding waterways and drinking water sources, in-depth explanations of what was being done and what was known were given.[Reference Fortin41]
Despite meeting many of the CERC principles and guidelines for maintenance-phase messaging, there was room for improvement in this press conference in a few areas. Once again, there was a complete omission of any kind of statement of empathy for East Palestine residents or for the people working in response to the crisis. In addition to not making a statement of empathy, Governor DeWine made no attempt to explain how the derailment happened mechanically or how to prevent a derailment like this from happening in the future outside of promoting policy change. It is possible that this was not addressed because the National Transportation Safety Board (NTSB) had not yet concluded its investigation into what had caused the derailment. Finally, while many concerns and areas of misinformation were addressed, there were also some confusing and contradictory messages. For example, confidence in the message that the drinking water supply was likely to be safe was tempered by, and possibly undermined by, recommendations to drink bottled water and seek private well water testing. Despite these opportunities for improvement, this was a solid maintenance-phase response, and Governor DeWine performed admirably as a spokesperson.
Looking at press releases and website updates from the same time period of February 15 and February 16, the analysis of maintenance-phase print messaging once again reflects the press conference analysis. The press releases and website updates adequately provided detailed risk explanations about multiple subjects, many of which also helped to mitigate the impacts of rumors and misinformation. There were also links and phone numbers provided to many different resources, including well water testing, air quality testing, a care line for mental health resources, and descriptions of future plans for health clinics. However, once again, these press releases and website updates lacked messages of empathy for residents and first responders.[42]
Comparison with Maintenance-Phase Messages from Other National Leadership Figures
I decided to look at two more press conferences with national leaders to assess their responses according to the CERC principles for maintenance-phase messages. The first is a press conference delivered by former president Donald Trump, and the second is a press conference that was delivered by Secretary of Transportation Pete Buttigieg. Comparing these responses to each other as well as to press conferences lead by Governor DeWine yielded valuable insights into the strengths and weaknesses of leadership responses to crisis events.
On February 22, 2023, former president Donald Trump visited East Palestine and delivered a press conference. In contrast to Governor DeWine, Trump expressed empathy for residents and first responders. Empathy was probably the strongest part of his emergency and risk communication. He also made a commitment statement, but it was not firm and made use of if/then statements, such as: “We’re gonna find time to come back, if necessary. If they don’t give you the treatment that you need, we will be back.”[43] Finally, Trump explained that he had brought bottled water with him on his plane, and that his team had helped coordinate other water deliveries for the East Palestine community.
While Trump’s message delivered empathy, made an attempt at commitment, and mentioned one action step that residents could potentially take (to acquire bottled water), it lacked many other components of CERC maintenance-phase messaging criteria. For example, it did not give any risk explanations pertinent to the situation, as would be expected in a maintenance-phase message. Outside of the mention of bringing bottled water, Trump did not offer an explanation of what else was being done to help the community or where to seek resources (including this bottled water). This means that there were no actionable steps residents could take based solely on this message. Furthermore, he did not show respect to political rivals who had responded to the crisis, such as the Governor of Ohio and the federal agencies who responded to the event. Finally, he spent a good deal of time speaking about topics that were unrelated to the crisis event entirely, such as the COVID-19 response under his presidential administration, Big Ten football, and the war in Ukraine. These omissions and detractions made this message a poor maintenance-phase message overall according to CERC principles.
On February 23, the Secretary of Transportation Pete Buttigieg visited East Palestine and delivered a press conference. This was the same day that NTSB released its initial report.[44] Buttigieg expressed empathy for the people of East Palestine as well as first responders, particularly calling attention to a recent loss that a specific first responder group was experiencing that day. Buttigieg also showed respect to local officials and to those attendees who asked questions. He appeared to be a credible source of information, giving coherent answers to questions within his sphere of influence. He gave a firm commitment to safety assessment and described what he was doing regarding policy that could improve safety standards for the transportation of hazardous material. He was the only leader to specifically name and thank public health officials and to address the mental health of residents. He also gave an in-depth explanation of the current hazardous train risk designations, which helped to explain both how this crisis could have happened and why the proposed policy changes would help to prevent something like this from happening in the future.
While Buttigieg got a lot of things right in this maintenance-phase message, one thing he missed as a risk communicator was being first. While this is more important as a part of initial-phase messaging, many questions that he fielded during the press conference were about why this response, 3 weeks after the incident, was the first response. Essentially, the questions were: Why did you fail to deliver an initial message? And why are we only just now hearing from you with a maintenance-phase message? While the maintenance-phase message itself was good, it seems that the impact of this message was blunted by Buttigieg’s lack of an initial-phase message.
Buttigieg acknowledged he could have said something sooner and explained that he intended to defer to the NTSB report, which had been released that same day. My critique of this situation is that Buttigieg should have immediately offered an initial message of empathy that showed respect for residents and first responders, as well as citing that more information would be available after NTSB had had time to complete its investigation. Had he delivered an initial message to that effect, the impact of his maintenance-phase message would have been stronger.
Recovery-Phase Messaging
Recovery-phase messaging is characterized by helping the public to move on from the crisis and to learn from past mistakes to better prepare for future similar emergencies. Although much of this case study analysis is focused on initial and maintenance messaging, as of November 2024 the following information provides insights regarding recovery messaging.
Recovery Messaging
Ohio Governor Mike DeWine’s website signals a shift to the recovery phase of crisis messaging with the last press release regarding East Palestine dated February 1, 2024.[45] The EPA website also suggests a shift from the maintenance phase to the recovery phase, shifting from weekly updates on the East Palestine remediation and testing efforts to “as-needed” messaging as of June 28, 2024.[46] The final phase of CERC phase-based messaging also appears to be on the horizon. As of February 2024, the National Institute of Environmental Health Sciences awarded six grants to conduct research and community engagement in East Palestine.[47] The findings of these research endeavors may help contribute to future evaluation of messaging regarding the Norfolk Southern derailment.
Water and Soil Testing Updates
The Ohio Environmental Protection Agency currently reports no risk to the municipal water supply and continues to conduct monthly testing of surface water impacted by the derailment. This testing does not include private wells, but residents who are concerned about their private wells are encouraged to request free testing.[48] The last surface water sampling test report is dated September 3, 2024, showing alternately nondetectable, decreasing, and/or low levels of chemicals (vinyl chloride, benzene, acrylates, and glycols) from the derailment-affected waterways in and around East Palestine. The report also notes that levels may increase after rainfall.[49] The Pennsylvania Department of Environmental Protection has stated its intent to continue testing residents’ private drinking well water within 1 mile of the derailment site for up to 10 years. Its August 27, 2024, update also confirmed that the EPA has finished its soil remediation efforts.[50]
Public Health Impacts Research
Independent researchers have found both more chemicals and more widespread contamination than officials originally stated. Researcher Andrew Whelton states that “We found contamination more than two miles downstream of the derailment site. At the time, officials were telling people that had all been contained at the derailment site. But we found, when we initially arrived, contamination openly flowing in the creeks farther downstream than officials were claiming it was.”[Reference Grant51] The research team also found that the evacuation order may have been lifted too soon from a public health standpoint. While the interiors of buildings in East Palestine were tested, the devices approved for this testing were incapable of detecting contamination.[Reference Grant51, Reference Whelton52] Independent research and testing are ongoing, including at the nearby University of Pittsburgh Department of Public Health, where two groups of researchers are looking into impacts on residents, crops, and livestock and are conducting soil sampling and water testing.[47, 53]
Discussion of Implications
The first major implication of these findings is that selection of a spokesperson who can deliver a detailed explanation of the crisis as well as express empathy is crucial to executing messaging according to CERC principles. While Governor DeWine successfully included many of the key CERC principles of both initial- and maintenance-phase messaging, his omission of empathy in both phases left something to be desired in his role as spokesperson. By contrast, Trump’s message had little substantive content that would be expected of effective CERC maintenance-phase messaging but did effectively express empathy. This empathy alone would probably be compelling to some people who were directly affected by this disaster. This brings me to the conclusion that an otherwise effective message can be strengthened quite a lot by including even a simple expression of empathy, and an otherwise ineffective message, lacking grounding in CERC principles, might be well received solely because of its inclusion of empathy. Empathy is an important component of crisis messaging that should not be overlooked. If the office of the Governor asked for just one piece of feedback that could improve overall messaging, I believe implementing empathy would have allowed the Governor’s messaging to have had a greater impact.
The next implication of the analysis of this messaging is that timing matters. Being first – or at minimum being present early on or as soon as possible – is important. Of all the press conferences analyzed, Buttigieg’s met the greatest number of CERC principles for maintenance-phase messages, but the impact of this otherwise strong example of a leadership response was blunted by his failure to be first. Had he delivered an initial-phase message, his maintenance-phase message would have been stronger. Governor DeWine encountered similar questions in his initial-phase message on why he had not spoken to the public sooner. While his answer seemed coherent and logical, he could nevertheless have made a public statement sooner expressing empathy and stating what was known and what officials were doing to learn more. The overarching implication is that it is never too early to express empathy and state that you are looking into the situation as it emerges, at a minimum. In this example of a train derailment, I would have suggested that the Governor issue a response of some kind within the first 24 hours rather than waiting almost 3 days to respond.
Another finding of this analysis is that consistency across platforms increases credibility. The Governor and his team did well in this area, presenting consistent messaging across the press conferences, written press releases, and website updates regarding the train derailment. One critique I would offer regarding this area is that the consistent omission of any empathetic messaging reduced organizational credibility and might have led the public to have a negative perception of the Governor.
Even issuing just one message of empathy in the initial phase or including one or two solid lines of empathetic messaging throughout the message campaign would have gone a long way.
Another important observation that arose from this analysis is that accuracy requires coordination with many experts, organizations, departments, and levels of government. To be right and to be credible, leaders and spokespeople must coordinate with many experts while remaining within the scope of their own professional expertise. This also highlights the necessity of showing respect to other experts and leaders, since so much coordination is required for an effective response. I thought the Governor did an exemplary job in this regard and would only recommend that he continue to do this well.
A final observation that emerged from this analysis is that strong emergency and risk communication in all phases requires the practice of deep listening. Taking ample time to adequately address all questions, or as many as possible, leads to more successful messaging and more effective spokespeople. The press conferences that more successfully followed the CERC principles for phase-based messages but also gave ample time for questions demonstrated respect to those asking the questions and provided the time for thorough responses to those questions. This format also gave opportunities to address misinformation, to give more detailed risk explanations, and to explain next steps and calls to action with greater specificity. While Governor DeWine did a reasonably good job at this, he could have used these questions to show respect and perhaps express empathy rather than merely answering them in a matter-of-fact tone.
End-of-Chapter Reflection Questions
1 Reflect on your health department’s readiness to communicate during an emergency. Can you identify who develops messages during emergencies? Do you know your agency’s policies regarding social media and the role of spokespeople?
2 Review your agency’s crisis communication plans. Do you have plans in place to respond to a variety of public health threats? Do these plans include sample messages based on consensus recommendations from partners and stakeholders? Do you have vendors identified who are approved by the business office to receive contracts quickly to support marketing campaigns?
3 If you could change one thing about how your agency communicates during an emergency, what would it be?
4 How does your agency communicate internally with its employees during an emergency? How do you keep your employees updated on public health emergencies that the agency is responding to?
