Redefining Readiness:

Important Findings for Planners and Responders

People Wouldn't Fully Cooperate or Follow Instructions

Below are some of the key findings about the public’s reactions to the smallpox and dirty bomb scenarios. Each raises a number of questions about the role of disaster mental health responders in their collaboration with health and safety officials to address the public’s fears and apprehension. Bottom line: Far fewer people than needed would follow protective instructions in these two terrorist attack situations. This lack of cooperation could significantly impede efforts to effectively respond to these emergencies and in some instances, might contribute to worsening the impact of the disaster.

• Only two-fifths of the American people would go to vaccination sites during a smallpox outbreak.
• Only three-fifths of the American people would shelter-in-place for as long as instructed in a dirty bomb explosion.
• Two-fifths of the American people would be seriously worried about what government officials would say or do.
• During the dirty bomb scenario, many people explained that they would have conflicting obligations and stated that assuring the safety of other people who are dependent on them would be more important than their own safety. Due to this fact:
• One-quarter of all people surveyed would leave the shelter of their building to take care of other family members.

Given these findings, emergency planners may have to reconsider how best to address the pubic during these events. Despite much media coverage of homeland security efforts, three-fifths of the American population knew little or nothing about how they would be cared for in dirty bomb shelters or smallpox vaccination sites. Overall, the American public is half as likely to cooperate if they don’t know a lot about their building’s shelter-in-place plans, or if they lack confidence in their community’s preparedness plans.

The study shows that the public’s concerns must be incorporated into behaviorally realistic approaches for dealing with smallpox and dirty bomb attacks. Failure to address the behavioral aspects of these emergency plans may send planners and responders down the wrong path in anticipating public response, and that error in judgment can result in far fewer people being protected than would otherwise be possible.

Who Will People Talk To?

On the question of who the public would most want to talk to during and after such attacks, the survey clearly suggests that, “For free telephone support from a trained person, considerably more people would find it extremely or very helpful to talk with someone who they know wants what is best for them than to talk to someone they don’t know who works for their local government.” This certainly helps support the case for telephone counselors who are indigenous to the affected communities, as opposed to unknown subject matter experts. This approach is consistent with the “neighbor-helping-neighbor” model of psychosocial support promoted by the Federal Emergency Management Agency (FEMA), Substance Abuse Mental Health Services Administration (SAMHSA) and New Jersey’s Disaster Mental Health response system.

Almost everyone (94% of the American population) wants someone they know well and who wants what is best for them to be trained in advance to give other people information and advice in this situation.

Important Recommendations

In summary, the survey makes a number of important recommendations about how best to gain public trust and cooperation during these types of terrorist events. The most concrete recommendation for planners and responders is to:

Give people a meaningful voice in planning as a way to enhance their cooperation with protective instructions in emergency situations.

The report reinforces the idea that elected officials, government agencies, and private sector organizations have a unique opportunity to build the public’s trust, confidence, and cooperation by involving the public directly with planning. This model of empowerment is found at the heart of our current approach to crisis counseling and the survey supports the need to focus on the behavioral aspects of disaster and terrorism response as closely as the operational and logistical concerns if emergency response efforts are to be successful.

It is strongly recommended that disaster management planners, mental health responders, and others involved in terrorism response download and thoroughly read through this important study. The importance of a behavioral approach to disaster management has never been as clear. You can find the Redefining Readiness report at http://www.cacsh.org/pdf/RedefiningReadinessStudy.pdf