module 7: risk communication - acmt · module seven: risk communication 7 elk river chemical leak...

Chemical Agents of Opportunity for Terrorism: TICs & TIMs

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Module 7: Risk Communication

Andrew Stolbach, MD, FACMTJohns Hopkins Hospital


2Module Seven: Risk Communication

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Faculty Disclosure

• Faculty: Andrew Stolbach, MD, FACMT– Relationships with commercial interests: none– Speakers Bureau/Honoraria: none – Consulting Fees: none– Other: none



Course Overview1. Introduction / Principles of Medical Toxicology2. Why Toxic Industrial Chemicals as Terrorist Weapons?3. Inhalation of Toxic Industrial Gases4. Agricultural Chemicals of Concern5. Cyanide and Fumigants6. Psychological Consequences of Mass Chemical Exposure7. Risk Communication8. Neurotoxicology9. Water, Food & Medication as Vehicles for Chemical Terrorism10. Delayed-Onset Toxins11. Post-Event Medical Monitoring12. Tabletop Exercise



Risk Communication in Toxicologic Emergency

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Elk River Chemical Leak

• January 9, 2014- Around 8:15 am, people began calling the West Virginia Department of Environmental Protection Complaining of a “sweet, licorice” smell from their drinking water

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• WVEPD sent inspectors to a Freedom Industries plant. FI initially said there was no problem but inspectors saw chemical stream leaking from a tank

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• According to FI, the tank contained methylcyclohexanemethanol (MCHM), an oily alcohol used to clean coal

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• That evening, West Virginia American Water detected MCHC in treated water and issued a “do not use” order

• All throughout that day, however, residents were drinking and bathing in the water

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• The water supply for 300,000 people in 9 counties was affected

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• People saw media reports such as this

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• People waited in lines for fresh water

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• Freedom Industries initially estimated 1-2 thousand gallons spilled

• The estimate was eventually raised to 7,500 gallons

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• The company originally said MCHM was the only chemical involved

• Two weeks later, the company stated there was also a second chemical mixture that had leaked, PPH, a proprietary mixture of two propylene glycol phenyl ethers

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• Freedom Industries CEO apologized for leak, then added “It’s been a very long day.”

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• The wife of the CEO posted on her Facebook page: – “no one and no thing, has been harmed due to this

leakage.”

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• January 9, local health authorities asked CDC to help

• Initially, the only data CDC had on the chemical was the MSDS

• Based on the LD50, they calculated a threshold for safe drinking concentration of 1 ppm

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• Environmental Defense Fund senior scientist:

“Now, let me be clear. I am not saying that the level of 1 ppm is unsafe. I am saying that we have no way of knowing whether or not it is safe. The data needed to make that assessment simply do not exist for this chemical.”

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• There are no known casualties• The risk communication errors made the situation

worse

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Risk

• What is risk?• Dictionary definition:

1. possibility of loss or injury : peril2: someone or something that creates or suggests a

hazard

Merriam-Webster

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Risk

• Mathematical definition:

Risk = Frequency x Consequence

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Risk

• Security definition:

Risk = Threat x Vulnerability x Consequence

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Risk

Risk = Hazard x Outrage

-Peter Sandman

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Factors That May Alter Acceptance of RiskMore Acceptable

• Natural “cause”• Associated with a

trusted source• Familiar• Voluntary• Potentially beneficial• Statistical (low harm

likelihood)• Fairly distributed or

shared by all• Affects adults

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Less Acceptable

• Man-made “cause”

• Not associated with a trusted source

• Exotic• Involuntary• Limited or absent benefit• Catastrophic (high harm likelihood)• Unfairly distributed (injustice)• Affects children



Elk River Chemical LeakMore Acceptable

• Natural “cause”• Associated with a

trusted source• Familiar• Voluntary• Potentially beneficial• Statistical (low harm

likelihood)• Fairly distributed or

shared by all• Affects adults

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Less Acceptable

• Man-made “cause”

• Not associated with a trusted source

• Exotic• Involuntary• Limited or absent benefit• Catastrophic (high harm likelihood)• Unfairly distributed (injustice)• Affects children



Degree of Outrage

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Severity of Effect

Involuntary nature of exposure

“Unfamiliarity” factor



Spectrum of Scenarios and ResponseEVENT OR SETTING

• Low risk – Low outrage• High risk – Low outrage• Low risk – High outrage• High risk – High outrage

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APPROPRIATE RESPONSE

• Informational (or none)• Advocacy• Outrage Management• Crisis

Communication/Action

The Peter M. Sandman Risk Communication Website. http://www.psandman.com/

http://www.psandman.com/



Risk Communication

“Given these definitions, here is the First Law (maybe the only law) of Risk Communication: outrage, not hazard, drives reputation. Even significant hazards are usually tolerated when outrage is low, and even insignificant hazards are usually rejected when outrage is high.”-Peter Sandman

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Risk Communication

To put more simply:

Risk communication is as much about communication as it is about risk

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Risk Communication

Good risk communication may not make a situation better, bad risk communication will make a situation worse

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Where Does Risk Communication Fit In Our Practice?

Risk Communication is the final component of a risk characterization

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Where Does Risk Communication Fit In Our Practice?

Risk Characterization– Risk Assessment

• Hazard Identification• Exposure Pathway• Modifying Factors• Toxicity Assessment

– Risk Communication

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Risk Communication

• What is the purpose of risk communication?• To deliver information

– Describe risks– What preventative measures should be taken– Where/when to seek medical care

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Crisis and Emergency Risk Communication Principles

• Be first• Be right• Be credible• Express empathy• Promote action• Show respect

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CDC. Crisis and Emergency Risk Communication



Elk River Risk Communication LessonsBe credible

Be right

• Freedom Industries changed their estimates of the chemical spill and size of spill a few times

• People lost their trust

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Elk River Risk Communication LessonsExpress empathy

Show respect

• Freedom Industries CEO (and his wife) did not seem apologetic

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Risk CommunicationPreparation

• Use accurate statements• Use understandable statements• Use positive statements• Use quotable statements

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Risk CommunicationPreparation

• Prepare 3 key points

Communication “rules”

• 3 x 3 = 3• 9 x 1= 0

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Memory and Stress

• People retain an average of 7 bits (range 5-9) of information in low-medium stress situations

• People retain an average of 3 bits of information (range 1-5) in medium to high stress situations

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Risk CommunicationUse Positive statements

• “Here’s what we believe…”

• “Let’s review the facts…”

• “What we do is…”

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Risk CommunicationQuotable statements

• Every statement you make should be able to stand alone when quoted out of context

“I actually did vote for the $87 billion before I voted against it.”

-John Kerry

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Risk CommunicationQuotable statements

• Concise• Stand alone without the question

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Message Map

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Key Message 1

Supporting Fact 1.1

Supporting Fact 1.2

Supporting Fact 1.3

Key Message 2

Supporting Fact 2.1

Supporting Fact 2.2

Supporting Fact 2.3

Key Message 3

Supporting Fact 3.1

Supporting Fact 3.2

Supporting Fact 3.3



What Should People Take Away?• Uncertainty significantly impacts the ability of an

individual to take appropriate action• People should not leave with the impression

– “No one knows what is going on or what we should do."

• Important to convey:– Likely magnitude of the risk– Urgency of the risk – Personal applicability of a risk characterization– Uncertainties of the risk assessment– Management options

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45Module Seven: Risk Communication 4

Exercise• You are managing disaster response in an

area that was just struck by a hurricane. The night before, two separate families were killed by carbon monoxide. In both cases, the families had operated a generator indoors. You are asked to make a statement.

• What would your statement include?


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Participant Question:

a) Carbon monoxide binds hemoglobin with more affinity than oxygen

b) Thankfully, only 6 people have diedc) If people hadn’t misused the generators, they would

still be alived) CO causes flu-like symptoms, don’t use a generator

indoors, use a CO detector

Which would be appropriate to include in a statement?



Message Map Example

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CarbonMonoxide

Key Message 1Symptoms like

the flu

Key Message 2Generators should

be operatedoutside the home

Key Message 3Use Carbon

Monoxide Detectors



Household Carbon Monoxide Map

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Symptoms like flu

Headache

Weakness

Nausea

Do not use a generator indoors

Exhaust cannot vent

properly

Sadly, typical in disasters

Generators outside, away

from open windows

Use carbon monoxide detectors

Provide early

warning

Locate near sleeping

area

Test/Change battery

regularly



Risk CommunicationExecution

• Use “set up” phrases– “This is the key point…”

– “What I can tell you is this…”

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Risk CommunicationResponding to questions

• Do not automatically accept the premise of the question

• Answer the question you wish you were asked

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• Use boomerang statements– “I wish I had the answer to that question, what I know is

this:….”– “Before I address that, let me make this point…”

– “I wish I had that answer, what I am sure of is this…”

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Risk CommunicationResponding to questions



Things to Avoid• False Allegations• Guarantees• Hypothetical (worst case) scenarios• Blaming others• Yes/No (making black/white out of gray)• Speaking for others• Guessing• “No comment”

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Conclusion

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Risk Characterization–Risk Assessment•Hazard Identification•Exposure Pathway•Modifying Factors•Toxicity Assessment–Risk Communication



Risk Communication

• What is the purpose of risk communication?• To deliver information

– Describe risks– What preventative measures should be taken– Where/when to seek medical care

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Risk Communication

• Risk communication is as much about communication as it is about risk

• Good risk communication may not make a situation better, bad risk communication will make a situation worse

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Crisis and Emergency Risk Communication Principles

• Be first• Be right• Be credible• Express empathy• Promote action• Show respect

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CDC. Crisis and Emergency Risk Communication



Risk CommunicationPrepare 3 Key Statements

• Use accurate statements• Use understandable statements• Use positive statements• Use quotable statements

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References• CDC. Crisis and Emergency Risk Communication. 2012 Edition. Atlanta, GA:U.S. Centers for

Disease Control and Prevention (August 2012). Available: http://emergency.cdc.gov/cerc/resources/pdf/cerc_2012edition.pdf [accessed May 2015].

• Manuel J. Crisis and emergency risk communication lessons from the Elk River spill. Environmental Health Perspectives, 2014.

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module 7: risk communication - acmt · module seven: risk communication 7 elk river chemical leak...

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