Swine flu, bird flu, and pandemic flu have been widely publicized by the news media over the past decade. Public health and emergency management officials walk a tight line, though, between the risk, on the one hand, of sounding an alarm prematurely and, on the other, of missing the pivotal moment when a warning will do the most good. When officials do sound the alarm and the prospective hazard either fizzles out or turns out to be less severe than anticipated, they are often portrayed as crying wolf – even if the reduced severity is because of their own hard work in mitigating the danger.
Capturing that moment is as much an art as it is about content – specifically including the following conditional imperatives: (a) Provide the right information at the right time (by doing so, the official looks like a hero); (b) pull the trigger too soon (and what actually happens may fall well short of expectations); and/or (c) wait too long (and the belated warning becomes more like an after-action report). Unlike the evacuation orders issued prior to an oncoming (and well tracked) hurricane – which often has a point after which there is no longer any action the public can take to avoid the destruction – infectious disease outbreaks offer the opportunity to continue action even after the event has already started.
A Timely Example in Boston On 9 January 2013, Boston (Massachusetts) Mayor Thomas M. Menino (D) declared a citywide public health emergency because of the overwhelming volume of flu-like illnesses and influenza deaths that had already occurred in the city. By 19 January 2013, according to the Boston Public Health Commission (BPHC), there had been 1,220 cases of influenza confirmed in Boston since October 2012 – compared to only 70 in the entire 2011-2012 flu season.
A typical declaration of emergency by the senior executive of any U.S. political jurisdiction, be it the mayor, the governor, or even the president, would be used for reaching one or more of the three following goals: (a) to unlock additional powers not normally available to the executive branch; (b) to provide additional emergency funding, if and when needed; and (c) to help meet the requirements necessary before requesting assistance from a higher level of government.
Typical emergency communications consist of a three-part message: a factual statement about the present or incoming hazard; the signs and symptoms used for recognizing the hazard; and the actions that the entire community and/or individual citizens can take to prevent or at least ameliorate the dangers and difficulties involved. In other words, public health communications are not limited to providing information but also changing behavior.
Delivering the Message Menino’s 9 January declaration did not unlock any additional political powers, seek or add any new funds, or even request any assistance from the state of Massachusetts or the federal government; instead, it served as a mechanism for emergency messaging – and pushed the risk of influenza immediately into the public consciousness. By pairing the declaration of emergency with a message about the availability of free flu vaccine clinics, the City of Boston was able – with its private-sector partners – to vaccinate approximately 7,000 people in the course of a single weekend.
Prior to the emergency declaration, only 12,000-15,000 Bostonians had been vaccinated to meet the possibility of an outbreak during the 2012-2013 flu season, according to Nicholas Martin, director of communications for the BPHC. The key features of the city’s messaging plan are brevity and staying on message. Perhaps the most important essential, though, for using an emergency declaration as a communications tool is the credibility of the executive.
That condition was met in this case, as Martin pointed out. Menino is widely respected and highly believable, and was therefore “the right person” to deliver the unpleasant message of warning. Lesson learned: A declaration of a public health emergency, or any other imminent danger, is not only an essential tool for responding to a disaster and/or providing recovery support, but often can be much more than that.
_________________________ Joseph Cahill is a medicolegal investigator for the Massachusetts Office of the Chief Medical Examiner. He previously served as exercise and training coordinator for the Massachusetts Department of Public Health and as emergency planner in the Westchester County (N.Y.) Office of Emergency Management. He also served for five years as citywide advanced life support (ALS) coordinator for the FDNY – Bureau of EMS. Prior to that, he was the department’s Division 6 ALS coordinator, covering the South Bronx and Harlem. He also served on the faculty of the Westchester County Community College’s Paramedic Program and has been a frequent guest lecturer for the U.S. Secret Service, the FDNY EMS Academy, and Montefiore Hospital.