By 9:20 a.m., 911 is flooded with calls reporting massive fatalities in the area surrounding the Foggy Bottom – GWU Metro Station. Within minutes, there are reports of effects as far away as the Pentagon. Fear is rampant throughout the region as news reports spread the word...
Weapons of mass destruction (WMD) terrorism by definition causes mass casualties, both direct and indirect. History (i.e., the Tokyo Subway sarin attack) teaches us that the greatest numbers of victims or casualties arise from the indirect psychological consequence – Fear. Extreme stress, such as would be involved in WMD terrorism situations, can be presumed to affect to some degree all persons exposed, with the actual consequences in an individual case determined by genetic, constitutional, and environmental factors.1
Fear management has been and continues to be one of the WMD terrorism preparedness issues raised during crisis management and emergency preparedness planning, training, and exercising. "Will the public panic and disrupt the planned response to and management of such an incident?" This is best exemplified by the dose-response relationship to trauma – i.e., the greater the magnitude of the stressor, the greater the response or consequence – which is clearly a serious concern of community response management organizations everywhere.
Fear management, as part of the recommended "all hazards" approach to emergency and consequence management, focuses on the mitigation of panic and the management of public response following a WMD or other mass casualty incident. Psychological disorders are prevalent following disaster incidents of all types, whether natural, technological, or other. A substantial percentage of the survivors of a disaster can be expected to show a combination of short and/or long-term psychological effects. According to literature reviews, the prevalence of the "classic" long-term psychological disorder following trauma exposure (i.e., Post-Traumatic Stress disorder or PTSD) ranges from a low of 3 percent to a high of 58 percent.2 Of particular relevance to the topic at hand, studies show that the effects of technological (as opposed to natural) disasters appear to be more pervasive and longer lasting.3 A strong fear management program, like all consequence management programs, should focus on a longitudinal approach to fear management, i.e., supporting a multi-stage intervention program that uses all major management modalities to emphasize the preparatory and response actions taken pre- and trans-event, not just those taken post-event.
The old adage – "prior proper planning prevents poor performance" – is particularly true in the context of emergency and consequence management. During the pre-event phase the focus is on the corner stone fear management program elements – mitigation and preparedness. Prevention, while important, is not emphasized because the nature of WMD terrorism makes any community a viable and accessible target.
Mitigation may be achieved through community awareness programs and general security practices. Community awareness and education program efforts encompass a wide range of applications. These efforts are based upon a psycho-educational model of intervention which asserts that knowledge and understanding of the level of risk involved with, and projected outcomes related to a possible eventuality can positively influence the response of the effected individual in the event of actual occurrence. This is the basis for the Stress Inoculation paradigm that uses awareness of a given threat to "inoculate" an individual against the potential negative consequences of that threat (as in physiological disease inoculation via injection of a "tolerable" form of the disease agent itself). With regard to the terrorist issue, this inoculation must balance the true risk of WMD terrorism against the negative impacts (social and economic) of fear mongering or exaggerating the threat. A recent example of exaggeration of the WMD threat concerns the amount of VX in the Persian Gulf area. Speculations made public insisted there was enough VX in that region to "kill everyone on earth." This is a good example of not conveying the true nature of the threat. WMD terrorism while drastic in nature is generally limited in direct effect. The key to mitigation is effective "risk communication" or efforts to provide both an accurate description of the hazards and a realistic evaluation of the community’s response capability. If properly balanced, mitigation efforts should instill with the public a confidence in the system established to protect life and property should such an event occur.
Remember that it is not only important to accurately represent the threat or risk involved, but also to do so in a manner that the general population can understand. Discussing the vapor pressure, specific gravity, viscosity, or even the toxicity of a chemical nerve agent does not mean much to the average citizen. Public information and communications should not use purely scientific terms and abbreviations, but rather should use simple language. For example: VX has roughly the consistency of common motor oil and does not evaporate or produce vapors unless it is heated. It is a contact hazard, toxic only if absorbed through your skin or your eyes, and is considered dangerous only if spilled or intentionally dispersed. Using simple language will not only facilitate proper conveyance of the threat, but will also increase the public’s level of comfort with the subject matter.
General security practices, the other component of mitigation, can enhance the fear management effort by reducing a community’s attractiveness as a target and positively influencing public perception of response capability. High profile security practices, though they may not completely deter WMD terrorism, will effectively minimize the number of viable targets and may narrow the scope and nature of an incident. It is believed by many that relaxed security or the perception of relaxed security may have contributed to the selection of Oklahoma City as the target of a massive explosion instead of Washington, DC, New York, Los Angeles, or another larger metropolitan area. High profile security practices will also bolster public confidence in the system established to protect them. High visibility, a strong community presence, and good public relations (including strong media relations) will do much to promote the capabilities of response agencies. Coupled, a high level of public confidence in both a community’s response capability and the reduction in attractiveness as a target will limit public exaggeration of the WMD terrorist threat.
Preparedness, the second element of the fear management program, requires planning, training, and exercising (validation). Planning develops and incorporates the fear management structure (organization and resources) into the "all hazards" program. An important step in the planning process will be the identification of objectives and the assignment of available resources. Given the broad geographical scope and intensity (number of victims, depth of psychological injury) of such community-wide disasters, use of already existing support agents in the fear management effort is widely advocated. Community mental health centers, pastoral counseling groups from local churches, educational-based resources, and various agencies and professional associations have been effectively used for broad-scale traumatic events, including terrorist attacks,4 the Love Canal incident,5 tornadoes, hurricanes, earthquakes, building/construction failures, and school bus accidents.6 Planning should also include development of themes and messages that will provide assurance and guidance to the public in the event of a WMD terrorist incident, and identification of the proper vehicle for conveyance. A combination of audio (radio and loudspeaker), video (broadcast and cable television), and print (newspapers and pamphlets) media may be used effectively. Most communities do not have a "Steven Spielberg" budget, so it is important to decide in advance what public communication medium will be used following a disaster. There are numerous opportunities for cost savings, e.g., developing pamphlets for dual application of both mitigation and response guidance.
Once the fear management program has been organized, it is important to take the time to train the participants or practitioners. The critical hours following a WMD terrorist event must not be spent fumbling through plans, procedure guides, and other references. Delays resulting from insufficient training and exercising can be extremely costly in terms of life and health. Training should be held regularly and should target a large audience. Inclusion of all the community agents typically involved in disaster response is critical to ensure understanding of the program objectives and individual roles and responsibilities. This practice will also stress the importance of fear management as a vital part of the community’s overall consequence management program. A key training element to be considered is spokesperson training. Key community-communicators should be selected and trained regarding the messages and themes that should be conveyed following such a disaster. After the fear management coordination team has been trained, it is important to exercise the full plan/program. Well designed, realistic exercises may be used effectively to test a program and to instill confidence throughout the community. Actually responding to and managing a mock WMD terrorist incident successfully is the best way to validate capabilities and progress. All individuals responsible for executing the plan should participate in the exercises, including chief elected officials and spokespersons.
During the pre-event phase, it is also important to establish a trust or partnering relationship with the local media. In many communities emergency managers look upon the media as an adversary. However, if approached correctly the media may represent a trusted ally. The media offers necessary print and broadcast resources within the community, representing the link to the ears and eyes of the community. The best way to form a functional alliance with the media is to invite representatives to actively participate in the fear management program. Program administrators should encourage the local media, as part of their public service commitment, to become familiar with the community’s consequence management program, report on training and exercises, and participate in the awareness and education programs. If allowed, it is a good idea to incorporate the media into the planning process and let them assist you in the development of themes and the selection of appropriate mediums. Allowing the media some "ownership" of the program will produce a more effective incident response and management tool.
During the trans-event phase the focus switches to assessment and activation. Fear management officials must coordinate with the other tiers of the emergency and consequence management hierarchy as they attempt to define the nature of the problem and to mobilize personnel. During the planning phase, resources were identified and procedures for notification and mobilization should have been outlined to enable rapid deployment. As soon as it is determined that a WMD terrorist incident (or any incident with the potential to generate mass casualties) is occurring or has occurred, the various components of the program should be activated to provide community support. For an event with wide-scale impacts additional resources should be notified and placed on a "stand-by" status. Activation of resources must be done relative to established response priorities that should include, in turn, pre-prepared message delivery, spokesperson appearances, and finally employment of stress and fear management psychological practitioners and counselors.
Post-event fear management activities encompass the elements of response and recovery. Although response and recovery are classically thought of in sequential terms, in practice this misconception can be disastrous. While response is clearly the first "out of the blocks," recovery operations should be initiated as soon as practical and not completely deferred until the response phase is over – i.e., early intervention has been proven the most effective strategy for effect minimization. For organizational purposes of this paper, response and recovery will be discussed sequentially; however, timing options will be explored as well.
During the response phase it is important to begin conveying the pre-prepared messages immediately to reinforce the pre-event stress inoculation. Of great concern following a WMD terrorist incident is onset of the Contagion Effect, whereby fear breeds fear among the general population, geographically and geometrically amplifying the disaster consequences7 . Such fear responses can quickly override intellectual defenses, resulting in frank cognitive distortions of reality, such as inflated estimations of actual proximity to the location of the terrorist attack. Full advantage should be made of emergency broadcast systems, cable television program interrupt options, and radio simultaneous broadcast to reach as many members of the community as quickly as possible. The messages for broadcast and reinforcement immediately following a WMD incident should focus on two themes in sequence:
1. the calming reassurance that the community is prepared to respond to a manage the consequences of the attack, and
2. that the attack, while seemingly widespread, is in fact limited in scope by the physical laws of nature.
Keep in mind that the messages should be tempered by the reality of the situation. While most WMD terrorism agents and materials have localized effects, some have the potential to generate thousands of casualties. Though in truth the effects are limited to a specific area or location, the magnitude of the number of casualties may conflict with and discredit your message. This can be compounded by news media reports that have a tendency to sensationalize WMD terrorist incidents or events. The importance of pre-incident partnering with the media may be realized at this stage, as it allows fear response agencies the opportunity to temper reports and accurately convey their themes. Remember, in instances with high casualty totals, accurately defining the limits of the effects geographically is critical to credibility maintenance.
Concurrent with the distribution of your pre-developed messages, updates should be developed that accurately convey the facts concerning the specific incident and the community’s success in managing actual impacts. It is at this point media selection for broadcast and/or distribution of messages is completed. Loud speaker broadcasts from either fixed or mobile systems and spokesperson appearances have proven extremely successful as tools for crowd control during stressful situations. The sound of a calm, reassuring voice can be very effective. It is important to employ a multimedia approach to inundate the community with reassuring messages of vital information regarding availability of resources for those in genuine need.
A key feature of the response effort that provides a forum for distributing the fear management message and reinforces the partnering efforts with the media is a properly situated and functional Joint Information Center (JIC). Simply stated, the JIC is the primary field location for the coordination of Federal, State, and local media relations. This is where press releases are generated and where press conferences are held. Because it is a regular source of information, the media will normally station representatives at the JIC. This provides fear managers with an important forum to distribute specific event tailored messages.
As previously stated, recovery efforts must begin concurrent with response. Studies confirm the criticality of Early Intervention in response to such incidents8 . Fear management recovery focuses on three key areas: 1. the assessment of continuing incident impacts or effects; 2. short-term interventions; and 3. longer term counseling.
Just as during the trans-event stage of fear management, it is important to continually assess the psychological impacts of the WMD terrorism event. Indicators of the amount of stress prevalent within the community as a whole are important to evaluate. Two indicators that should be observed are:
1. the occurrence of spontaneous evacuation (i.e., large numbers of residents fleeing the community in the absence of official evacuation orders) and
2. large numbers of individuals beyond the actual impact area requesting treatment for whatever causative agent was employed in the incident (i.e., manifestation of a contagion effect).
In addition, research demonstrates that victims across various traumatic situations show similar stress profiles, i.e., patterns of response to trauma/stress. As one might expect, these patterns show an age effect:
- For adults, typical manifestations include depression, somatic (physical) complaints, and increased difficulty in adaptation to novel situations.
- For children, there is a greater variability in relation to age; however, typical manifestations include pervasive fears, primary functional difficulties (e.g., in sleep, appetite, etc.), and increases in regressive and/or aggressive behavior9 .
Short-term interventions should be based on a "needs assessment" and tailored to satisfy identified or anticipated conditions. These interventions may typically include the following:
- Critical Incident Stress Debriefings – structured small group (15-20 participants) meetings led by clinical professionals involving specific disaster constituencies (e.g., victims, responders, relief workers, etc.) providing the opportunity for emotional ventilation, support, and psycho-educational dissemination.
- Focused Short-Term (Grief) Counseling – course of time-limited (generally under 2-3 months or 12 individual sessions) therapy with clinical professionals specializing in trauma counseling. Typically used in cases involving acute response to trauma/stress (i.e., Acute Stress Disorder)10 .
Beyond these two short-term interventions a variety of other approaches have proven effective (e.g., family counseling that maximizes the family support hierarchy and large group psycho-educational programs). The key to success in such efforts is to continually monitor the impact of selected interventions via ongoing needs assessments.
The sheer intensity of WMD terrorist incidents (volume of potential victims) justifies identifying and mobilizing multiple resources (including the American Red Cross, the American Psychological Association, and the American Counseling Association). A balanced practitioner/counselor to constituency ratio should be maintained throughout the application of the various fear management intervention modalities.
As with short-term interventions, longer-term interventions should also be based on the continuing assessment of the psychological consequences of the WMD terrorism event. Longer-term counseling should be employed where necessary to handle longer-term effects of trauma (i.e., Post-Traumatic Stress Disorder), especially in those cases where discrete trauma interacts with pre-existing psychological/psychiatric conditions (e.g., depression, latent substance abuse, etc.). Ongoing clinical assessments will indicate the effective duration of such longer-term efforts.
The proper application of a coordinated fear management program integrated into the community’s "all-hazards" program will provide many desired outcomes. During the initial portion of the response, controlling public reaction by minimizing the extent of fear and panic will pay high dividends to response operations. Spontaneous evacuation in particular has the potential to severely disrupt first response life saving and rescue efforts. Beyond the immediate effects other benefits may be realized. First, the short- and longer-term interventions may provide for a better-adjusted healthier constituency; and second, developing a partnership with the media generates a greater level of trust thoughout the community and provides a needed forum for not only psycho-educational interventions, but also for general emergency and disaster preparedness issues.
Inclusion of a comprehensive fear management program within the larger emergency and disaster response plan is critical to the success of the overall response effort. As we have seen, an effective fear management program incorporates various response agents and modalities – including news media, selected public officials and representatives; community mental health personnel; and professional association-sponsored response entities – and is employed across the entirety of the full incident response – pre-, trans-, and post-incident. As with other incident response components, an effective fear management program requires activity across all major incident preparedness categories – including planning, training, and exercising efforts. It requires resources and time. However the development and employment of such a comprehensive fear management program will truly pay great dividends in the event of a WMD or similar incident.
Mark J. Morgan is the Principal of the Crisis and Consequence Management Division at C2 Multimedia, Inc. He has over twenty years experience in emergency, disaster, & crisis/consequence management and response. His experience includes working with a variety of clients and industries in both the public and private sectors. Mr. Morgan also serves on both the National WMD training initiatives and the Issues for Definitive Care Facilities steering committees for the National Disaster Medical System and as a WMD terrorism subject matter expert for the Associated Press.
Paul M. Camper, Ph.D., is the President of Camper Consulting. He is a Clinical Psychologist specializing in the development and implementation of programs addressing the psychological consequences of crisis incidents in business and government settings. Mr. Camper has also developed numerous training programs designed to help private and public organizations respond effectively to workplace violence. Dr. Camper serves on the Public Information & Collective Behavior steering committee for the National Disaster Medical System.
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