Holly Carter

Effective responder communication improves efficiency and psychological outcomes in a mass decontamination field experiment: implications for public behaviour in the event of a chemical incident.

The risk of incidents involving mass decontamination in response to a chemical, biological, radiological, or nuclear release has increased in recent years, due to technological advances, and the willingness of terrorists to use unconventional weapons. Planning for such incidents has focused on the technical issues involved, rather than on psychosocial concerns. This paper presents a novel experimental study, examining the effect of three different responder communication strategies on public experiences and behaviour during a mass decontamination field experiment. Specifically, the research examined the impact of social identity processes on the relationship between effective responder communication, and relevant outcome variables (e.g. public compliance, public anxiety, and co-operative public behaviour). All participants (n = 111) were asked to visualise that they had been involved in an incident involving mass decontamination, before undergoing the decontamination process, and receiving one of three different communication strategies: 1) ‘Theory-based communication’: Health-focused explanations about decontamination, and sufficient practical information; 2) ‘Standard practice communication’: No health-focused explanations about decontamination, sufficient practical information; 3) ‘Brief communication’: No health-focused explanations about decontamination, insufficient practical information. Four types of data were collected: timings of the decontamination process; observational data; and quantitative and qualitative self-report data. The communication strategy which resulted in the most efficient progression of participants through the decontamination process, as well as the fewest observations of non-compliance and confusion, was that which included both health-focused explanations about decontamination and sufficient practical information. Further, this strategy resulted in increased perceptions of responder legitimacy and increased identification with responders, which in turn resulted in higher levels of expected compliance during a real incident, and increased willingness to help other members of the public. This study shows that an understanding of the social identity approach facilitates the development of effective responder communication strategies for incidents involving mass decontamination.

Communication during mass casualty decontamination: highlighting the gaps

Purpose – Effective communication has been recognised as an important issue for the management of incidents involving decontamination; evidence shows that failure to communicate effectively may result in increased public anxiety and non‐compliance. This paper aims to examine current provision for communicating with members of the public during decontamination, to facilitate the development of improved responder communication strategies.Design/methodology/approach – To examine the current provision for communicating with members of the public, the authors reviewed open source decontamination guidance documents for responders, as well as published reports of emergency preparedness exercises involving decontamination.Findings – The review of decontamination guidance documents showed that specific guidance for professional responders on how to communicate with the public during incidents that involve decontamination could be improved. Similarly, the review of published decontamination exercises shows that a s...

The effect of communication during mass decontamination

Purpose – Reports from small‐scale incidents in which decontamination was conducted suggest that a successful communication strategy is vital in order to increase public compliance with, and reduce public anxiety about, decontamination. However, it has not been possible to examine public behaviour during large scale incidents involving decontamination. The aim of the research reported here was to examine the relationship between peoples positive perceptions of responding agencies’ communication strategies and relevant outcome variables, such as level of compliance and level of reassurance, in several field exercises involving mass decontamination.Design/methodology/approach – Data were collected using feedback questionnaires completed by simulated casualties, which contained items relating to casualties’ perceptions of the success of responding agencies’ communication strategies, their confidence in emergency responders, and their compliance with the decontamination process. Path analysis was used to exa...

Volunteer trials of a novel improvised dry decontamination protocol for use during mass casualty incidents as part of the UK’S Initial Operational Response (IOR)

Previous studies have demonstrated that rapid evacuation, disrobing and emergency decontamination can enhance the ability of emergency services and acute hospitals to effectively manage chemically-contaminated casualties. The purpose of this human volunteer study was to further optimise such an “Initial Operational Response” by (1) identifying an appropriate method for performing improvised skin decontamination and (2) providing guidance for use by first responders and casualties. The study was performed using two readily available, absorbent materials (paper towels and incontinence pads). The decontamination effectiveness of the test materials was measured by quantifying the amount of a chemical warfare agent simulant (methyl salicylate) removed from each volunteer’s forearm skin. Results from the first study demonstrated that simulant recovery was lower in all of the dry decontamination conditions when compared to matched controls, suggesting that dry decontamination serves to reduce chemical exposure. Blotting in combination with rubbing was the most effective form of decontamination. There was no difference in effectiveness between the two absorbent materials. In the following study, volunteers performed improvised dry decontamination, either with or without draft guidelines. Volunteers who received the guidance were able to carry out improvised dry decontamination more effectively, using more of the absorbent product (blue roll) to ensure that all areas of the body were decontaminated and avoiding cross-contamination of other body areas by working systematically from the head downwards. Collectively, these two studies suggest that absorbent products that are available on ambulances and in acute healthcare settings may have generic applicability for improvised dry decontamination. Wherever possible, emergency responders and healthcare workers should guide casualties through decontamination steps; in the absence of explicit guidance and instructions, improvised dry decontamination may not be performed correctly or safely.

Emergency responders’ experiences of and expectations regarding decontamination

Purpose: There is an assumption in emergency planning that the public will ‘panic’ or refuse to comply in the event of mass decontamination. This assumption has serious implications for how the public will be managed. Method: We carried out semi-structured interviews with 13 emergency responders, six of whom had experience of incidents involving decontamination. We asked them, first, about their experiences of these events and, second, about their expectations for decontamination involving a large crowd. The aim was to explore the extent to which responders perceived non-compliance and anxiety as (crowd) problems during decontamination, and if so, how they felt that they could be addressed. Findings: Responders with experience of decontamination perceived non-compliance and excessive anxiety to be rare, and suggested that orderly behaviour was more common. However, the majority of emergency responders with no experience of decontamination said they expected panic and non-compliance. They therefore emphasised the importance of ‘controlling’, rather than communicating with, the public. Implications: We argue that ‘control’-based emergency management strategies can impact negatively on the relationship between the public and responders, and hence hinder effective management of an incident. It would therefore be beneficial to provide training for emergency responders on likely public behaviour during incidents involving decontamination. Originality: This research extends previous research by facilitating a detailed understanding of emergency responders’ experiences and perceptions of managing incidents involving decontamination, and showing how these experiences and perceptions can affect the way in which such incidents are managed.

Public communication needs during incidents involving emergency decontamination

Background The threat of chemical, biological, radiological, nuclear, and explosive incidents has increased because of technological advancements and the willingness of terrorists to use unconventional weapons. Emergency responders can use interventions such as decontamination and quarantine during such incidents. However, when emergency responders do not communicate effectively, public anxiety could increase and compliance with decontamination could be poor, reducing the efficacy of decontamination and creating a secondary contamination hazard for receiving hospitals. There is a need to examine whether current procedures sufficiently acknowledge public communication needs. Methods First, a systematic review of published decontamination guidance for responders was undertaken. Second, semistructured telephone interviews were carried out with a convenience sample of 13 responders from the UK Fire and Rescue Service who had similar training but different amounts of decontamination experience. A thematic framework was developed to analyse the findings for previously identified issues, such as perceptions of public compliance with the need for decontamination, excessive public anxiety, and orderly behaviour. Relevant passages were coded into one or more of the themes. Care was taken to document the full variety of responses given; contradiction in interview accounts was actively sought. The potential for interviewer bias was reduced with a semistructured interview schedule and telephone interviews, thereby eliminating the effect of non-verbal cues. Finally, data from five emergency preparedness exercises involving decontamination were analysed. All participants who underwent decontamination during these exercises (n=402) completed questionnaires. Numbers of men and women were roughly equal; ages ranged from 18 years to 85 years. Quantitative data were analysed with correlational and path analysis, and qualitative data with the framework approach. A second researcher coded a subsection of the data, producing an inter-rate reliability rate of 89%. Findings The systematic review showed poor planning for communication with members of the public. The interview study established that responders who had previous experience of decontamination perceived communication with the public to be important. Responders who did not have experience of decontamination did not recognise the role of communication, and instead emphasised the importance of controlling members of the public who were said to be vulnerable to mass panic. Analysis of qualitative data from emergency preparedness exercises showed that most participants felt that they had not been given adequate communication from responders. A path model based on the results from the quantitative data had good overall fit (χ2 test; p=0·607). Poor perceived communication contributed to decreased levels of reassurance (r=0·28, p=0·006) and willingness to comply with decontamination (r=0·31, p=0·007). Interpretation Effective communication is a key intervention through which emergency responders can contribute to the successful management of decontamination. The small number of responders in the interview study could reduce the ability to generalise results. However, 12 interviews is usually enough for data saturation and hence an understanding of common perceptions and experiences in homogeneous sample groups. Additionally, exercises attempt to replicate a real situation, but some variables (especially anxiety) can differ significantly in real incidents. However, the relation between variables should not be different; successful communication would probably be even more important during a real incident than in exercises.

Public perceptions of emergency decontamination: Effects of intervention type and responder management strategy during a focus group study

In the event of an incident involving the release of a hazardous chemical, first responders may decide to initiate emergency decontamination in order to remove any contaminant from affected casualties. Recent initiatives such as the UK Home Office-led Initial Operational Response Programme have introduced new evidence-based decontamination protocols that reduce the time taken to initiate the decontamination process, including an increased emphasis on rapidly removing contaminated clothing (disrobe), and the use of improvised dry decontamination methods. The current study used a series of focus groups to examine public perceptions of different decontamination interventions and responder management strategies. Results revealed that a decontamination shower was perceived to be more effective than dry decontamination methods and that a management strategy that included effective responder communication resulted in increased willingness to comply with the need for decontamination. This study demonstrates that public understanding and acceptance of novel decontamination methods such as dry decontamination may present additional challenges for first responders. Increased emphasis on effective communication during decontamination is needed. Furthermore, provision of information during the focus group study resulted in an increase in participants’ knowledge and confidence in taking recommended decontamination actions, which was maintained three months after the study. The longitudinal nature of these effects suggest that it may be possible to increase public awareness about actions to take during chemical incidents by developing pre-incident public education; however, further research is needed to examine this more fully.