In fact, 74 percent of those polled expected help to come less than an hour after their tweet or Facebook post.

The Red Cross commissioned the survey in advance of its Emergency Social Data Summit set for Thursday, August 12, in Washington, D.C. The meeting, convened by the Red Cross, will bring together thought leaders and experts in the government, social media, emergency response and the non-profit sectors to discuss better ways to handle information that flows through the web during disasters.

According to the Red Cross press release:

The online survey asked 1,058 adults about their use of social media sites in emergency situations. It found that if they needed help and couldn’t reach 9-1-1, one in five would try to contact responders through a digital means such as e-mail, websites or social media. If web users knew of someone else who needed help, 44 percent would ask other people in their social network to contact authorities, 35 percent would post a request for help directly on a response agency’s Facebook page and 28 percent would send a direct Twitter message to responders.

Web users also have clear expectations about how first responders should be answering their requests. The survey showed that 69 percent said that emergency responders should be monitoring social media sites in order to quickly send help—and nearly half believe a response agency is probably already responding to any urgent request they might see.

As the story I posted yesterday about the Boston subway flasher indicates, not all government agencies are yet monitoring social media.

The survey also found that among web users, social media sites are the fourth most popular source for emergency information, just behind television news, radio and online news sites. More web users say they get their emergency information from social media than from a NOAA weather radio, government website or emergency text message system.

to increase awareness about immunizations across the life span, from infants to the elderly.

August is the perfect time to remind family, friends, co-workers, and those in the community to catch up on their vaccinations. Parents are enrolling their children in school, students are entering college, and healthcare workers are preparing for the upcoming flu season.

Last week, I wrote about the Get Ready preparedness campaign of the American Public Health Association (APHA), which calls for immunization as part of the basic emergency readiness steps. Though immunization is not presented as part of the Department of Homeland Security/Ready.Gov emergency preparedness recommendations (last year with the threat of the H1N1 flu was an exception), including those shots as part of the overall message does make some sense, because it is a more familiar public health action.

It might be a good way to introduce citizens to the emergency preparedness in a less threatening way. Conveniently both National Immunization Awareness Month and National Preparedness Month occur sequentially around the beginning of the school year. (And, the Red Cross suggests that when parents buy back-to-school supplies, they consider adding an emergency preparedness kit to the shopping list.)

Of course, an argument can also be made that adding another step might dilute the Preparedness Month message, particularly if terrorism awareness is also potentially added as was discussed in a recent blog post.

One in three have no family disaster plan, the Mason-Dixon Polling and Research survey found on the eve of the summer hurricane season, which the government predicted Thursday could produce up to seven major hurricanes.

Even in Florida, where 44 percent of residents live in an evacuation zone, one in six respondents said they would refuse to evacuate if ordered.

The survey finds gaps in many areas, according to the article:

The poll found gaps in knowledge, insurance and evacuation plans among the respondents.

More than half the respondents didn’t know that storm surge represents the greatest threat of death from a hurricane and 95 percent didn’t know that garage doors are the most likely part of the house to fail.

About half the respondents don’t have flood insurance and nearly as many live in an evacuation zone without having an inventory of their belongings.

One in four respondents said they would evacuate as far as possible to outrun the storm. But 40 percent said they wouldn’t leave as a major storm approached. One in five said they would leave only a day before landfall of a storm, which threatened traffic gridlock.

“As important as it is to prepare before a storm, it is just as vital to stay out of harm’s way after a storm,” said Max Mayfield, a WPLG forecaster and former director of the National Hurricane Center. “Too many deaths occur in the aftermath of a storm, when conditions are still dangerous.”

The poll was part of the National Hurricane Survival Initiative, a 15-year collaboration of the National Emergency Management Association, the Salvation Army, Florida International University’s International Hurricane Research Center, the National Hurricane Center and corporate sponsor Plylox.

In 2004 and 2005, Florida went through one of the most hellacious two-year stretches on record. Four hurricanes slammed the state in 2004; and the following year, a record number of storms formed, with Katrina and Wilma smashing South Florida.

You’d think people got the message. But five hurricane-free years later, and with a new season starting today, a new study concludes that too many Floridians are woefully under-prepared, under-educated, and under-motivated.

And worse, they don’t know it. ”Too few people in the most dangerous areas realize they’re at risk, and too many people in relatively safe locations think they’re at greater risk than they are,” Florida State University geography professor Jay Baker, a veteran of such studies, said last week.

Baker’s study, commissioned by the Florida Division of Emergency Management, found that nearly two-thirds of residents in zones that would be evacuated in a major storm – of at least Category 3 on the Saffir-Simpson Scale – don’t believe they’d be at risk from both wind and water, or didn’t know.

And nearly as many inland residents believed their homes also would be unsafe, which leads to unwarranted evacuees clogging roads.

Survey figures are down from 2006, when 44 percent said they were better prepared for a disaster than they had been in the 2004-2005 storm seasons. In 2010, only 38 percent said they were better prepared than in 2000-2005.

The article continues:

Last week, a national Mason-Dixon poll of people from Virginia to Texas similarly found that nearly half the people in America’s hurricane strike zone say they don’t feel vulnerable to a hurricane or other severe weather; and one in three Floridians has no family disaster plan or hurricane preparation kit.

That poll came the same day federal forecasters predicted an “active to extremely active” hurricane season, with a 70 percent probability of 14 to 23 named storms, eight to 14 hurricanes and three to seven major hurricanes. The seasonal average is 11, six and two.

Baker’s most recent survey asked the same questions as those in a survey he did in the spring of 2006, with storms still fresh in people’s minds, he said from Tallahassee.

Among the highlights from respondents:

About half of residents did not have a definite evacuation plan, up slightly from 2006.

Very few people, knew the lead times for watches and warnings, and even fewer were aware those lead times are changing this year. Both will be announced 12 hours earlier than before, meaning tropical storm and hurricane watches will be issued when conditions are possible on the coast within 48 hours, and warnings will be issued when conditions are expected within 36 hours.

Florida residents said they had emergency lighting, important papers, prescription medicines, battery-powered radios, and adequate gasoline in their cars, but were less likely to say they have enough water and ice, about the same as 2006.

Most Floridians believe it is reasonable for agencies and organizations to have relief supplies available within 48 hours of a hurricane. When asked whether they expect that, a larger number said no; instead, they expect to be on their own for at least three days. That’s similar to 2006.

Two-thirds said they expected they’d be without power for a week or less after a storm, with 19 percent predicting 24 hours or less. The 2006 responses were similar, but people now were slightly more optimistic about how soon power would be restored.

Eighty to 90 percent said they’ve seen broadcast and print information. About 70 percent said they have access to the Internet, but only about a third had gone to local or state emergency management web sites or the National Hurricane Center’s web page. That’s similar to 2006.

Most said they have some sort of window protection, more than in 2006; but most had a system that had to be put in place when a storm threatens. The reported amount of window protection was higher in 2010 than in 2006.

that Americans say they are most comfortable giving CPR to family members, friends and coworkers, with less than half very likely to perform CPR on a stranger. The survey showed that physical appearance was a significant factor when people are deciding to perform CPR on a stranger, and men with a disheveled or sloppy appearance were the least likely to receive assistance, with only half of respondents saying they would very likely try to give them CPR.

Previous Red Cross research found that nearly 90 percent of Americans say they want to be prepared for an emergency, but they don’t know where to start or what to do.

Americans plan to be very active this summer, as the survey found that more than 40 percent will go hiking or camping and almost 75 percent will go swimming. While people expect to be active, the Red Cross found that many were not confident they knew what to do in an emergency – less than two-thirds felt confident helping a heat stroke victim and fewer than half could help someone with an allergic reaction to an insect or snake bite.

By the way, the Oregon Trail chapter of the Red Cross notes that Friday was the national organization’s 129th birthday.

U.S. Homeland Security Secretary Janet Napolitano receives Red Cross CPR training at Department headquarters

The report, “The Public’s Response to the 2009 H1N1 Influenza Pandemic,” reviewed 20 national opinion polls, including eight by Harvard School of Public Health (HSPH) researchers, taken during the 2009 H1N1 pandemic. It was authored by HSPH’s Gillian K. SteelFisher, and Robert J. Blendon, Professor of Health Policy and Political Analysis. The analysis appears as an Online First Perspective in this week’s New England Journal of Medicine:

Throughout the H1N1 pandemic, more than half the U.S. population appeared to have a positive impression of the government’s response, although a sizable minority did not. For example, in the early days of the pandemic, 54% believed the response of the federal government was appropriate, whereas 39% believed the government had overreacted (CNN, May 2009). Nine months later, in January 2010, 59% believed that public health officials did an excellent or good job in their overall response to the pandemic, whereas 39% believed they did a fair or poor job (HSPH, January 2010)…

Our review of these data suggests that in the event of a future influenza pandemic, a substantial proportion of the public may not take a newly developed vaccine because they may believe that the illness does not pose a serious health threat, because they (especially parents) may be concerned about the safety of the available vaccine, or both. More work may need to be done to understand the basis of these beliefs and to address them in the case of a serious influenza outbreak.

Parental concern must be better addressed in any future pandemic vaccine rollout, according to the HSPH press release:

First, many people who did not get the vaccine were not convinced that the illness was a serious threat to them personally. In one January poll, 30% of people who would not or might not get the vaccine said a “major reason” was their belief that they were not at risk of serious illness and 37% said the H1N1 outbreak was not as serious as public health officials once thought. A second reason for not taking the vaccine was concerns about the safety of the vaccine. This was especially a concern for parents. In one poll, 56% of parents who were not going to or might not get the vaccine said a “major reason” for their decision was their concern about “safety risks from the vaccine,” compared to 35% of adults making the same decision for themselves about the H1N1 vaccine.

“These findings suggest that in the event of a future influenza pandemic, a substantial proportion of the public may not take a newly developed vaccine,” said SteelFisher. “Public health officials who want to encourage vaccination must better understand and address the beliefs and concerns of those who chose not to get the H1N1 vaccine.”

Polls during the 2009 H1N1 pandemic also suggest that public health communication efforts related to other personal influenza prevention behaviors, like hand-washing and staying clear of people with flu-like illness, were effective in reaching a large swath of the public. Even early in the outbreak, a large majority of people (59%-67%) said they had washed their hands more frequently due to H1N1, according to polls in April, May and June 2009.

“Building on these self-protection measures, as well as a vaccine strategy, may be useful for future response planning and throughout an outbreak,” said Blendon.

Michael Coston at Avian Flu Diary says that the survey results indicate a potential public complacency issue:

The concern here is that the impressions left by the experience of 2009 may mean that a lot of people may not be quick to accept a pandemic vaccine in the future. It is the same sort of reaction we see in Florida, and along the Gulf and Atlantic Coastline, after every hurricane season.

People who emerged unscathed, or who may have ridden out a weaker storm, come away believing that they’ve seen a hurricane . . . and they weren’t particularly impressed. People who evacuated upon the order (or advice) of local officials, only to return and find their house intact, are less likely to evacuate in the future. But of course, all hurricanes aren’t created equal. And basing your future expectations on the last storm can be a fatal error.

The same holds true for pandemics. As epidemiologists like to say, “If you’ve seen one pandemic . . . you’ve seen one pandemic.”

Although there were some missteps along the way (particularly in the overpromising of vaccine supplies in October and November) the HHS and the vaccine manufacturers pulled off a considerable coup by delivering a safe and effective vaccine a month sooner than originally anticipated. Despite the ominous warnings of the anti-vaccine contingent, we have not seen any spike in Guillain-Barre syndrome, or any other serious vaccine related side effects.

The pandemic shot has proven to have roughly the same safety profile as the seasonal flu shot, which is excellent. Unfortunately, the message that the `vaccine is deadlier than the virus’ continues to persist – particularly online – and that raises doubts in many people’s minds.

While everyone is happy that the pandemic of 2009 proved less deadly than first feared, the public complacency that this has engendered may prove to be a substantial obstacle the next time we face an emerging public health threat.

Napolitano is right. If there’s one preparedness-related task Americans should do first it’s asking (and then trying to answer) that simple question — what would my family do in the event of an emergency? But I would suggest that simple question is not so simple for individuals to answer by themselves. Family emergency planning cannot totally be done in the family vacuum. To do it most effectively, citizens also need to know the plans of the institutions they are involved with — their workplace, kids’ school, elderly relative’s nursing home, governmental authorities, neighbors, etc.

In a recent National Preparedness Month speech, Napolitano made another related request of the public: that they go to some of those institutions, “raise your hand and ask ‘what’s our plan?’” (FEMA Administrator Craig Fugate has been emphasizing the primacy of planning in his public statements as well.)

I think that both of the questions Napolitano suggests Americans ask are closely tied and should be answered together. In fact, I don’t think you can really develop your own plan without knowing what the other places are doing. (And, I would further suggest that the lack of citizen compliance to date is that we don’t think that doing our own plan individually — without other stakeholders — will be all that useful in an emergency with family members spread all over.)

As part of that process it’s also up to governments, particularly at a local level, to tell the public more about their emergency plans to help us make ours. The idea is not that members of the public know every scenario but that they are at least familiar with what the possibilities are — that they are not hearing it for the first time after something happens. A survey released Friday by the National Homeland Defense Foundation and Colorado Technical University found that 94 percent of homeland security professionals don’t think Americans know the appropriate steps to take if a terrorist attack were to happen in their hometown.

DHS SECRETARY NAPOLITANO (ABOVE) GIVING A NATIONAL PREPAREDNESS MONTH SPEECH WITH FEMA ADMINISTRATOR CRAIG FUGATE AND AMERICAN RED CROSS PRESIDENT GAIL MCGOVERN LOOKING ON.

And, the planning process should not be a one-way and top-down. The public should have input on not only their own plans. In addition, to the knowledge they can impart, institutions should not be designing plans that may not be realistic for the people they are planning for.

Take the issue of pet preparedness and response. Animal protection groups made the point that it was not realistic to plan that pet owners would be willing to leave their animals in an emergency (a contention borne out during Katrina and something I have witnessed during CERT deployments on building collapses here in New York City). So, many governments altered their policies to allow pets in emergency shelters (though they would still prefer owners make out of area arrangements if possible on predicted disasters like hurricanes.) That change in policy only came when all stakeholders came together and thought through the planning and realized that the ideal was not the reality. The same kind of attention is now necessary for the entire public.

The fact that every family’s plan involves other parts of the community is why I strongly believe that there needs to be one day in the year dedicated to the emergency planning process. If we as a nation feel it is really important for the public to develop emergency plans, it would be far more effective if everyone was doing that at the same time — rather than asking individuals to do it on their own so the planning can be integrated. This ‘preparedness day’ would also be the time that we all asked the questions about planning then practiced and updated those plans. (One helpful model is Japan’s Disaster Prevention Day, held on the anniversary of the catastrophic 1923 Tokyo earthquake.)

Among the questions that will come out of that type of drilling day include: Where would you go? Would it depend on the type of emergency? Would you be able to get out of work? Would your kids’ school want you to come there? One, if not the most important, question to answer is how would you communicate with each other as well as how would the authorities communicate with you as information may be the most crucial element in determining the answers (one result I think would be more social media/networking preparedness/training in advance.)

The fact is that families will never be able to fully answer all these ‘what if’ questions in advance; it will always depend to some extent on circumstances (ie. evacuating vs. sheltering in place), but this day would at least begin the preparedness process.  It would be the time to think through some scenarios and link together some of the institutions/people families would need to rely on in a disaster. Ultimately, if we want people to ask the right questions on emergency preparedness, we need to help them find the answers.

According to the survey, 83% of women surveyed responded that they made an extra effort to cover coughs and sneezes with a tissue, compared to 67% of men; 35% of women surveyed have gotten their seasonal flu shots this year, compared to 26% of men.

Though overall the poll found that roughly 7 in 10 Americans are confident they could take time off from work, have the right supplies at home and know what flu symptoms signal a need to go to the hospital.

The poll also indicated that in the past two months, one in five households has someone who has gone to work or school when they were sick. The latter statistic would seem to be troublesome in part because it appears to underscore the fact that some people fear they need to go to work or risk losing pay or their jobs.

More information on the survey can be found on the Red Cross’ blog here.

At the hearing, Bill Jenkins Jr. from the Government Accountability Office (GAO) presented a preliminary report, Emergency Management Preliminary Observations on FEMA’s Community Preparedness Programs Related to the National Preparedness System, which said that FEMA does not currently have an overall strategic plan for community preparedness or the ability to accurately measure the performance of its various citizen readiness initiatives.

“The operating budgets for community preparedness programs currently represent less than one-half of 1 percent of FEMA’s total budget,” the report noted. “In fiscal year 2009, FEMA’s overall budget was about $7.9 billion, of which about $5.8 million was dedicated to operating community preparedness programs and $2.1 million was for the Ready Campaign.”

FEMA’s Deputy Administrator for National Preparedness Timothy Manning who also testified on the panel, said he not yet had a chance to closely examine the brand new GAO report (though he said he didn’t disagree with much of Jenkins’ testimony to the Subcommittee). And in his own written testimony, Manning made this instructive statement: ”Since September 11, 2001, and the creation of the Department of Homeland Security, the United States has invested tens of billions of dollars in bolstering government’s [his italics] preparedness, while paying little attention to personal and community preparedness.”

At the end of the hearing, Cuellar requested that Manning over the next two weeks develop a preliminary outline of a FEMA strategic plan for community and citizen preparedness that will include the vision, objectives and ways to measure success, and return to the Subcommittee to present it. Cuellar said he wasn’t blaming Manning, who was confirmed just five months ago, and the new FEMA management for the lack of a strategic plan. But by putting a quick turnaround deadline on the request, the Congressman wanted to underscore the need for fast action and for renewed focus on the issue.

Earlier in the week, DHS Secretary Janet Napolitano delivered a major speech on preparedness to mark the end of National Preparedness Month. She said that in order to improve our nation’s readiness all Americans should “raise your hand and ask, ‘What’s our plan?’” at meetings of their local community organizations. In some ways, Rep. Cuellar did exactly that at the Subcommittee hearing in regard to the nation’s overall community preparedness plan.

In his testimony, Manning made this pledge: “Increasing individual and community preparedness and resiliency is a FEMA priority; it is also a national priority, and I will make it a personal priority during my tenure.”

The hearing was called in part to examine a recent Citizen Corps survey which had many interesting findings (most of which highlighted shortcomings in public preparedness) and a number of useful recommendations (most of which urged far more attention be given to the subject).

Also testifying at the hearing were Suzy C. DeFrancis, Chief Public Affairs Officer, American Red Cross and Wendy Smith, Assistant City Manager, McAllen, Texas.

In his opening remarks, Cuellar mentioned a recent post from this blog, “On Sept 11, Some Ideas To Improve Emergency Preparedness & Engagement,” and introduced it into the hearing record.

In a statement after the hearing, Cuellar explained why he requested Manning produce a preliminary plan and return to the Subcommittee within a couple weeks:

“There is a new administration overseeing FEMA and I look forward to seeing their vision for how we can create a national preparedness strategy which puts an emphasis on citizen preparedness…It’s been eight years since the attacks of 9/11 and while we’ve been fortunate to not experience an event as devastating we see local emergencies unfolding across the country everyday. Fires, floods, tornadoes, snow storms, hurricanes. During these events, Americans continue to show they’re willing to respond when disaster strikes…We need FEMA to draft a strategy on how we harness that willingness to contribute before the crisis occurs.”

In fact, even the events of the past two weeks — significant terrorism arrests in several parts of the nation, major flooding in Georgia and other Southeastern states, the American Samoa tsunami, Asian earthquakes and H1N1 spreading in all 50 states — would seem to only reinforce the need for bolstering community preparedness. And, with all these crises in the news, one might have thought this hearing would have received a good deal of attention. Yet, there was only one reporter there (Matthew Korade from CQ Homeland Security), which just seems to highlight one theme of the hearing that despite the apparent importance of community and individual preparedness the subject is often overlooked.

“Even though most Americans aren’t extremely worried about the virus, they seem interested in taking steps to protect themselves and their families,” said Scott Conner, Red Cross senior vice president of preparedness and health and safety services. “Taking those basic steps-such as washing your hands more frequently and remaining at home if you are sick become even more important as the new flu season approaches.”

According to the results, women are more likely to take protective actions, with 84 percent making an extra effort to cover coughs and sneezes (versus 71 percent for men), and 81 percent washing their hands more carefully and more often (compared to 71 percent for men).

The survey also found that 62 percent plan on being vaccinated against this new flu virus if one is offered. Nearly half of those surveyed (46%) plan on assembling a two-week supply of food, water and medicine that they might need in the event they or someone in their family becomes sick and need to stay home for extended periods of time.

The survey results seem to indicate that Americans are in a relatively good mental posture for the Fall — not getting too scared but taking some actions and beginning to think about contingencies in the event of a widespread health emergency. (Of course one would want both personal and societal preparedness to be a higher for such a potential pandemic but the best should not be the enemy of the better here.)

As far as the gender findings, come on men get with it!

The 64% figure was striking to me, because it points out an interest of many Americans to become more knowledgeable in emergency preparedness/response (and it is a question that isn’t often polled). Twenty hours is the standard amount of training to become qualified as a member of a Community Emergency Response Team (CERT). That’s not to say that two-thirds of the population want to join the CERT program, but it does seem to indicate that a lot of Americans would be amenable to some sort of disaster education/training — maybe held in their workplace, house of worship, social club, etc.

Another interesting finding in the study is that a major impediment for people getting prepared is that they believe emergency responders will take care of them in a disaster (despite the warnings of the responders themselves that they can’t handle everyone, particularly in the first 72 hours). According to the survey:

From a list of possible reasons why individuals had not prepared, 30 percent of individuals indicated that a primary reason they had not prepared was because they believed that emergency personnel would help them in the event of a disaster. Further, 61 percent of participants indicated they expected to rely on emergency responders in the first 72 hours following a disaster.

The Citizen Corps, which is part of the FEMA’s Community Preparedness Division, has been measuring the public’s knowledge, attitudes, and behaviors on preparedness since 2003. I previously wrote about the 2007 survey which was released earlier this year. This updated report includes surveying fielded in the Spring; some of the initial results were released at the Conference. The rest of the data and further analysis will be presented at a later date. (n.b. the “training” question and  64% result is not in the report issued this week but was part of the presentation at the conference)

The survey is comprehensive and worth looking through for those interested in citizen preparedness research. Below are the “Summary And Recommendations”:

* Individuals’ high expectations of assistance from emergency responders may inhibit individual preparedness. Communicating more realistic expectations and personal responsibilities is critical.

* Too few people had stocked disaster supplies, and most supplies were incomplete. More emphasis is needed on the importance of stocking disaster supplies in multiple locations, and more specificity is needed on critical items to include, such as flashlights, radios, batteries, first aid kits, and personal documents.

* Greater appreciation for the importance of household plans and knowledge of local community emergency procedures and response resources is needed. Individuals who reported being prepared lacked critical plans and information.

* Practicing response protocols is critical for effective execution. Greater emphasis on drills and exercises is needed.

* An awareness of vulnerabilities to natural disasters motivates individuals to prepare. Most individuals, however, did not believe their communities will ever be affected by any type of disaster.

* Perceptions of the utility of preparedness and confidence in ability to respond varied significantly by type of hazard. Because all-hazards messaging may dilute critical differences in preparedness and response protocols, preparedness and response education should include a focus on hazard-specific actions appropriate for each community.

* Social networks, such as households, neighborhoods, the workplace, schools, and faith-based communities, and the concepts of mutual support should be emphasized

* Focusing on individuals in the contemplation and preparation stages for personal preparedness may yield greater results. Messaging and community outreach efforts should be designed to support those already considering taking action. Individuals’ strong interest in attending training courses and volunteering should be harnessed through social networks. Training and volunteer service should be linked with a responsibility for educating and encouraging others to prepare.

* Specific sociodemographic characteristics correlated with attitudes toward and actions for preparedness. Insights into these differences offer the ability to tailor outreach efforts to targeted audiences.

* Individuals believed they had a personal responsibility to report suspicious behavior but greater collaboration between citizens and law enforcement is needed.

The survey  was conducted by ICF Macro’s Carol S. Freeman who has done the previous Citizen Corps research and is a (if not the) leading opinion researcher in the area of citizen preparedness.

At the Citizens Corps conference, I had an opportunity to talk to some local emergency officials about the 64% finding. Below is a brief interview I did with San Francisco Fire Department Lt. Erica Arteseros, who coordinates the city’s Neighborhood Emergency Response Team program (CERT is called NERT in SF). In the video, she says government need to capitalize on the interest expressed in the poll.

San Francisco NERT coordinator Lt. Erica Arteseros talks about the Citizen Corps survey.

“These results suggest Americans are likely to support public health officials in prioritizing preparations for the possibility of a serious H1N1 outbreak in the fall or winter,” said Robert J. Blendon, Professor of Health Policy and Political Analysis at the Harvard School of Public Health.

Despite a majority believing that a serious outbreak is likely, more than half of Americans (61%) are not concerned about their personal risk — that is, that they or their family members will get sick from influenza A (H1N1) in the next year. This level is unchanged since the previous poll conducted May 5-6, 2009.

The current survey further suggests that the World Health Organization (WHO)’s decision to raise the worldwide pandemic alert level to Phase 6 did not dramatically impact Americans’ level of concern about their personal risk. Only 22% of Americans knew that the WHO had raised the level, and only 8% of Americans said it made them more concerned that they or their family would get Influenza A (H1N1) in the next 12 months.

One approach that has been used in the recent outbreak as a means to slow the spread of Influenza A (H1N1) is the closing of schools. In this survey, substantial numbers of parents who have children in school or daycare report that two-week closings in the fall would present serious financial problems for them. About half (51%) of these parents report that if schools/daycares closed for two weeks, they or someone else in their household would likely have to miss work in order to care for the children. Forty-three percent of these parents report that they or someone in their household would likely lose pay or income and have money problems; 26% of these parents report that they or someone in their household would likely lose their job or business as a result of having to stay home in order to care for the children.

The situation is likely to be worse for minority parents. More African American and Hispanic parents of children in school/daycare indicate that they are likely to lose pay or income and have money problems (56% and 64% respectively), as compared to whites (34%). And, more African American and Hispanic parents of children in school/daycare report that they or someone in their household would likely lose their job or business (40% and 49% respectively), as compared to whites (14%).

If the outbreak in the fall or winter is serious and leads to large-scale workforce absenteeism, the survey suggests the possibility of substantial difficulties for many people and the economy as a whole. If people had to stay home for 7-10 days because they were sick or because they had to care for a family member who was sick, 44% indicate that they would be likely to lose pay or income and have money problems, and 25% reported that they would be likely to lose their job or business.

“The findings highlight the important role that employers would play during a future outbreak. Flexibility in their employee policies may help minimize some of the problems identified in this survey,” said Blendon.

At the time of this survey, 27% of Americans reported that there had been cases of influenza A (H1N1) among people in their community, and 18% reported that schools in their community had closed due to influenza A (H1N1). Since the beginning of the outbreak, roughly two-thirds of people report that they or someone in their household has washed their hands or used sanitizer more frequently (62%).

“Handwashing was a major focus of public health education during the recent outbreak. The results of this survey show that these efforts helped people protect themselves,” said Blendon. This is the third in a series of polls about Americans’ response to the H1N1 flu outbreak.

In order to increase citizen readiness and engagement, the report recommends that government officials at a national and local level better inform Americans about what specifically they would need to do in response to a broader range of threats; explain (and even convince people) of the benefits of preparedness for disasters; involve the citizenry in practice exercises; improve collaboration between the public and law enforcement; and expand research in this area. A summary of the report’s findings can be found here.

FEMA’s Community Preparedness Division and the Citizen Corps also released a companion report, “Citizen Corps Urban Area Survey” which did separate research in the cities of New York, Houston, San Francisco and Indianapolis (summary sheet here). There are a lot of meaty conclusions and recommendations in the reports (which I suggest for anyone interested in citizen preparedness.) Below are some that were most striking to me:

There is a need to convince the public of the efficacy of preparedness, particularly in the event of terrorist attack:

“Many individuals did not believe that preparing for terrorist attacks would make a difference in an actual event. Preparedness and response education must contain messages about response efficacy for the recommended actions for each hazard. A particular emphasis on response efficacy is needed for hazards that are less understood by the public (hazardous materials accidents, severe disease outbreaks, and terrorist attacks).”

Public education is necessary, particularly in responding to less understood hazards, such as an explosion, chemical release, or dirty bomb:

“Many individuals lacked confidence in their abilities to know what to do in the first few minutes of different types of disasters. Communication and outreach strategies should educate individuals about specific response skills needed for natural hazards most likely to occur in their communities and include a particular emphasis on less understood hazards, such as an explosion, chemical release, or dirty bomb.”

An “All Hazards” approach must also highlight the difference between various hazards:

“Perceptions of the utility of preparedness and confidence in ability to respond varied significantly by type of hazard. Because all hazards messaging may dilute critical differences in preparedness and response protocols, preparedness and response education should include a focus on hazard-specific actions appropriate for each community.”

Though most people are not prepared, many of those who say they are really aren’t:

“Greater appreciation for the importance of household plans and knowledge of local emergency community procedures and response resources is needed. Individuals who reported being prepared lacked critical plans and information.”

Citizens should get an opportunity practice what is being preached:

“Practicing response protocols is critical for effective execution. Greater emphasis on drills and exercises is needed.”

Much of the public is (mistakenly) relying on the cavalry to show up and help them:

“Individuals’ high expectations of assistance from emergency responders may inhibit individual preparedness. communicating more realistic expectations and personal responsibilities is critical.”

There is a need to build upon “See Something, Say Something”:

“Individuals believed they had a personal responsibility to report suspicious behavior, but greater collaboration between citizens and law enforcement is needed.”

Preparedness efforts must be both bottom up and top down (as well as through social networks):

“While the Federal government and national leaders must continue to emphasize the importance of preparedness from a national platform, it is clear that effective strategies for preparedness must be implemented at the community level and through social networks.”

There is a lot that we still don’t know about citizen preparedness and engagement:

“In addition to repeating the Citizen Corps National Survey periodically to track changes in preparedness and shifts in attitudes and behavior, there are many other areas of needed research to understand more fully the complexities of motivating and sustaining personal preparedness and participation.”

Some of the recommended areas of study include:

“An exploration of different perceptions of hazard types and how perception affects preparedness, to include terminology such as ‘disaster,’ ‘terrorism,’ ‘pandemic flu,’ and ‘preparedness.’ An exploration of better ways to deliver training and to practice response skills through multiple and varied types of exercises.”

“How social networks such as neighborhoods, the workplace, schools, and faith communities can be better used to institutionalize preparedness information, training, and drills, and how civic leaders from these sectors can be engaged in government-led community resilience efforts.”

I think these are useful reports with some significant recommendations. I hope they serve as guides for FEMA and the entire Department of Homeland Security as their citizen preparedness and engagement approach is developed.

Laura Southard from the Virginia Department of Emergency Management sent me a report from one of its preparedness events which enlisted Radio Disney to reach out to families in a creative way:

“Between the two Radio Disney events Monday, I would say nearly 100 families were reached through a fun, game show-style “Get Ready Virginia” event. Every parent received a goody bag containing Ready Virginia information, including a template for making a family emergency plan, kids’ game sheets, and a flyer listing the hurricane/flood season items exempt from sales tax. This is the first time we have used special events to drive home the need for families to take action, so we are anxious to see how response pans out over the summer and into the fall. Just look at the faces of all the kids and parents and you can see they had fun. Interestingly, the kids knew a lot about how to get ready for emergencies. It will be curious to see if their knowledge will translate into current family readiness — or will show up in the next generation.”

Ready Virginia/Radio Disney family preparedness event in Richmond, Virginia tied to the state’s hurricane preparedness tax holiday week (above).

One of the reasons that I am an advocate of these tax free weeks is that they provide an opportunity for government to get the private sector and their marketing operations involved in public preparedness. For example, in Virginia, ‘big-box’ chains Lowe’s and Target took out full-page ads in Sunday newspapers to promote the readiness week — a win/win/win for the businesses, the public and government emergency management officials.

Full-page Lowe’s newspaper advertisement promoting Virginia’s tax free hurricane preparedness supplies week (above).

This is the second in a series of polls about Americans’ response to the H1N1 flu outbreak. The first survey was released May 1st. Like this new one, it showed that some of the public were taking cautionary actions that were not necessarily recommended by government officials.

This survey finds that about six in ten Americans (61%) are not currently concerned that they or someone in their immediate family may get sick from H1N1 flu in the next 12 months. The proportion that does not express concern has risen from 53 percent last week. However, three-fourths (77%) say they are closely following news about the recent H1N1 flu outbreak, the same proportion as a week ago. ”The fact that most people continue to follow the news closely suggests that there is a lot of interest and uncertainty about the risk for themselves and their families over the next year,” said Robert J. Blendon, Professor of Health Policy and Political Analysis at the Harvard School of Public Health.

Nearly half (48%) of parents of children under age 18 and currently enrolled in school are concerned that they or a family member will get sick from H1NI flu in the next 12 months. This level of concern is significantly higher than it is among people who do not have children in school (36%). Half (50%) of parents with children in school report that their schools have not given them any information about what they are doing to reduce the possible spread of H1N1 in the school. ”It might help allay parents’ concerns if schools provided them with more information about what they are doing to reduce the risk of infection,” said Blendon.

Overall, Americans are satisfied with the performance of public health officials in the H1N1 outbreak. More than eight in ten Americans say they are satisfied with the way that public health officials have managed the response to the outbreak (83%) and with the information public health officials have been providing (88%). Recently public health officials made a decision to introduce the term “H1N1 virus.” More than four in ten (43%) of Americans now say that they have heard the term and know it means the same thing as “swine flu.” This proportion has more than doubled from 20 percent a week ago.

“Perceptions of the availability of an effective medicine or vaccine against H1N1 could affect public response to the continuing outbreak. Nearly two-thirds (64%) believe that there is an effective medicine to treat the disease, up from 54 percent a week ago. Most Americans (66%) don’t believe that there is a vaccine to prevent the disease, virtually unchanged from a week ago (65%). Currently 48 percent of Americans believe that wearing a face mask will protect them from getting H1N1 flu, down from 53 percent a week ago. About three-fourths (78%) believe that wearing a face mask when sick will prevent them from spreading H1N1 flu to others, the same proportion as a week ago.”

What I found more interesting is some of the actions that respondents say they had already taken — some positive, others seemingly a little dubious (though again behavior may have changed in the 48 hours since the survey was conducted): More than half of Americans are responding to the outbreak by washing their hands or using hand sanitizer more frequently (59%), and a quarter are avoiding places where many people are gathered, like sporting events, malls or public transportation (25%). Some Americans have also responded in other ways: avoiding people who they thought may have recently traveled to Mexico (20%), avoiding Mexican restaurants or stores (17%), wearing a face mask (8%), buying a face mask (5%), talking with their doctor about health issues related to swine flu (5%), or getting a prescription for antiviral medications (1%). Only a small number (4%) of parents have kept their children home from school or daycare.

“It is a good sign that most people, though not all, are taking the most important precaution recommended by the Centers for Disease Control and Prevention to prevent the spread of swine flu: washing their hands,” said Robert J. Blendon, Professor of Health Policy and Political Analysis at the Harvard School of Public Health.

I think that government officials should address some of the findings of this survey to correct any misapprehensions that the public (even a minority) might have and also to reinforce any positive actions reported. For example, I know that avoiding crowds, public transportation and Mexican restaurants is not behavior being recommended by authorities. And I’m pretty sure that staying away from people who have been in Mexico recently is being over cautious. But as a good deal of Americans are doing so, I would think it would make sense for officials to address it explicitly.

UPDATE: In a teleconference discussing the results this afternoon, Dr. Blendon said based on the findings about a relatively significant number of respondents saying they were avoiding big crowds, people who have travelled to Mexico and Mexican restaurants & stores, there was indeed a “need for authorities to explain to the public” which behaviors were “high risk” and which were not.

Other results of the survey: an overwhelming majority of Americans believe that they can get the current swine flu from being in close contact with someone who has it (83%), and few believe that they can get the disease from eating pork (13%). Some Americans also believe that they can get the swine flu from being near, but not in close contact with, someone with swine flu (29%), or from being in contact with pigs (34%). Americans are less certain about prevention and medicine for swine flu. Just over half believe that there is an effective medicine to treat the disease (54%). Most Americans (65%) don’t believe that there is a vaccine to prevent the disease. About half of Americans (53%) believe that wearing a face mask could prevent them from getting sick from the swine flu, while more than three-quarters (78 percent) believe that wearing a face mask when sick would help keep them from getting others sick.

Although the spectre of having to deal with major disaster is somewhere in most people’s minds, particularly those of us in the New York area, the subject of public emergency preparedness is rarely discussed publicly. So, it was refreshing to get some feedback on air and online in the comments section.

Obviously a handful of calls and commenters is not a scientifically significant sample of public opinion. However, Brian Lehrer’s audience tends to be quite engaged and savvy when it comes to public policy. So, their reactions are instructive.

I thought it might be productive to analyze and address some of the comments as a way to continue a dialogue on the issue.

I completely understand why people are skeptical about preparedness. It seems complex, offputting, time consuming and possibly, worse of all, useless. The concerns raised by listeners are very fair and legitimate. And they need to be addressed if we are to move forward at all in this area. In fact, I got into this subject after 9/11 when my wife asked “what should we be doing” to prepare? One of the biggest shortcomings of the preparedness efforts I found, and many officials would acknowledge this, is that they have not fully addressed the obstacles to preparedness nor been able to fully address the public’s questions and concerns about it. 

At present, there is no one place where a citizen can get his or her specific question answered on emergency preparedness. So, it is not surprising that there would be a lot of misconceptions, confusion, and uncertainty out there. This has contributed to the current situation where much of the public dismisses the whole subject out of hand.

Initially, my objective is less to advocate for preparedness than to help stimulate a public debate on whether we want to be more prepared as a society and, if so, at what level — in time, money, and inconvenience.

My research to date leads me to believe that the U.S. could become a more prepared society in a way most Americans could accept and even embrace. In fact, I would argue preparedness offers us an unique non-partisan and substantive opportunity to bring our country together and strengthen our communities. 

Despite the skepticism from some listeners, I did get a sense that if there was a way for them, their families and the nation to become more prepared in a rational, useful way, they would consider it. But most don’t think it’s really possible and therefore not worth even trying. They well may be right, but I think it is at least worth discussing. 

Let me first address the comments of some of the skeptics (which made up the biggest group) like James who posted on Brian’s comment page at WNYC.org: 

I can think of at least 30 – 50 different types of “emergencies” ranging from a fire in my building to Category 5 hurricane, nuclear attact, Tsunami, biological-chemical warfare attack etc. So, are we to spend time studying all of the MANY terrible possibilities & preparing for them? Is that realistic or useful?

I know exactly what James is talking about, because I am trying to figure out how to write a book that addresses all of those scenarios — not to even mention the ones we cannot even dream up in advance. But the fact we cannot prepare for everything shouldn’t mean we shouldn’t prepare for anything. Rather, we need to be willing to accept a gradual learning curve and look to do things that will help no matter the disaster (and even have positive impact on the community even if nothing ever happens).  

Some commenters were even more dubious about the subject (and the guest!). Such as Robert:

This is like the republican fear tactics around election time. I checked out that page and freaked out. I mean really, what exactly are Mr. Solomon and all those fear mongering folk think is going to happen! Yeah, we should prepare ourselves but we shouldn’t become paranoid over it and spend every minute thinking about it because we don’t know what EXACTLY is coming or when and what will be left after!!!

I have no idea whether we are going to have any more major disasters or not. But most people — 77% of New Yorkers in a recent OEM survey — believe that another terrorist attack is coming. Further, 91% of Americans live in an area where a major man-made or natural disaster is likely. I am just raising the idea that it wouldn’t be the worst thing in the world to prepare for that possibility. Similarly, we buy insurance and do fire drills though it is unlikely most of us are going to experience a major home or school fire. 

A similarly skeptical Chestinee raised a fair question:

…as for go bags – how ridiculous is that – who on earth is going to be home when it’s time to go?

GeeGee agreed:

Yep, I’m with Robert. It is all fear tactics DON’T BELIEVE THE HYPE! This is crazy! Like Chestinee brought up HOW DO YOU KNOW WHERE YOU ARE GOING TO BE? Where were you during 911, during the crane collapse, during the street the blew up, during the OTHER plane that hit the apartment building. My friend was on a train during the black out he had to walk through a subway in his sandals, I was at work during 911 and during the blackout (why do I live here?-ha!) I had to walk home from MIDtown over the B-bridge and through BKLYN, if I would have had a bag at home, a lot of good that would have …

Again, the fact that preparedness will not save you in every scenario doesn’t mean it won’t help you in some scenario. It doesn’t have to be all or nothing. We do plenty of things to lessen our risk and danger, even though they do not guarantee the total elimination of that risk or danger.

My participation in CERT and the team outfit was not convincing to  Lorenzo : “Sounds like a senile boy scout to me.” 

Or Craig:“I’m sorry to say it’s this kind of behavior that causes a lot of the world to think Americans are nuts…Well intended and, even useful, or not, the thought of him sitting there is his gear promoting his book is darkly comical sign of the times.”

I don’t mind being made fun of. I wouldn’t have risked wearing my goofy green CERT outfit into the studio if I did. But all I ask is after you parody preparedness also be willing to consider it on the merits.

Scott posted a question I often get. 

How do I plan to keep my cat and dog safe? Like if I have to evacuate? In New Orleans, people couldn’t bring their pets on the buses and so some people just stayed home.

As Hurricane Katrina vividly showed, pets need to be included in any kind of governmental emergency planning, because many people will not leave their animals even if it means risking all of their lives. The problem was that most emergency shelters did not have a capability to hold animals. That is changing with more shelters now including a separate area for pets. I would suggest you prepare your pet as you would any member of your household (make that pet ‘go bag) and check to see if the shelter in your area will have the capability to handle pets.

The question of emergency evacuation was raised by Glenn:

I kept a dry bag full of some essentials which could be inflated and used as a floatation device, and a wet suit near my front door after 9/11. This in case I had to jump in the Hudson River and swim (float) to NJ (with the tide).

One of the callers during the show had also mentioned, sheepishly, that she kept a rubber boat in her apartment in case of an emergency. (First, we have to change the idea that the most prepared people should be embarassed about doing it — that it is paranoid, uncool, fearful or selfish to be worried and do anything about it. The people who do think about preparing should be seen as the responsible ones. Because it’s true. The more prepared you are, the less likely it is that emergency responders will have to take care of you and be able help others. That’s called personal responsibility not paranoia.)

These types of questions underscore my feeling that there needs to be more information provided in advance about evacuation planning. Without doing so, people are left to do their own devices to determine their own plans and contingencies, some of which may not be realistic.

In New York, on 9/11, an ad hoc fleet played a major role in evacuating people from lower Manhattan. The City may likely have a similar need at some point in our future. There is an organization here, the Metropolitan Waterfront Alliance, whose Board I serve on, which will be making waterborne emergency planning/information a focus of its policy work in the next year. I look forward to working on that and discussing it further on the blog.

Giving the public more information will help them become more self-sufficient when it comes to preparedness.

Mike was kind enough to post a link to a free online course/module from SUNY-Albany’s School of Public Health

I am always interested in seeing any new preparedness education methods so I went through the module online. It turns that the course is quite good. It’s easy to use, engaging and thoughtfully designed. It also uses potential emergency scenarios you might face, which helps people get into the necessary ’you are there’ mindset to think about what they would do. When you complete it, you and your family will be far more prepared than you were.

However, this module, through little fault of its own, shares some of the limitations of preparedness public education efforts. It cannot provide the localized, tailored information and then answers citizens want when they go through the preparedness process. The module’s suggestion that users ask their local emergency management office to fill in informational gaps is the right place to look, but it is unlikely that those folks will have the capacity or inclination to answer everyone’s questions. Similarly, the suggestion that people practice their evacuation plans makes sense but is not realistic. (Personally, I believe there should be community drills in which would help people rehearse their plans. To me, the bottom line is that is very difficult for individuals to prepare in a vacuum without more robust government information and guidance.

A perfect example of the need for more government support for individual initiative is the experience of Naomi whose email Brian read halfway through the segment:

i’m curious about what john solomon has to say re residential EP in high rise buildings. just spent 2 frustrating years trying to raise awareness in a 1,000-apartment co-op in manhattan. found OEM completely unavailable; something has to change!

In my response on air, I suggested that that Naomi try to contact her local CERT team and Community Board.

Naomi posted again: 

mr. solomon did not respond to my comment. brian, please, i’ve done all he suggests and OEM in NOT responsive. -naomi

When I read that post later in the day, I wanted a) to better answer her question and b) find out more about what happened. We spoke by phone later that evening. It turns out that Naomi’s effort is a perfect case study in the current challenge of public preparedness. 

Concerned about the number of home-bound elderly in her Harlem apartment complex, Naomi, 74, set out to try to set up an emergency preparedness program in the building. She created her own “Emergency Preparedness Survey” for her building and distributed it to every tenant. She found that 24% of the residents had a supply kit, but that 66% would attend an information/training session; 59% thought the building should have fire drills; and 86% thought there was a need to prepare children for an emergency. She also wrote and performed a puppet show, “So, What About The Stuff In Your Home?”, in the lobby for children and parents to generate interest. Yet, ultimately, despite the interest among her fellow residents, Naomi said she (and her co-chair) found the obstacles too big to do it. 

It may take a national commitment to preparedness — as we had for example during World War 2 — to address all of these obstacles. But there needs to be a way to make sure that if someone in a building in New York does as much as Naomi did those efforts do not go to waste.

I would love to hear any comments on these responses from the listeners or anyone else. 

The press release’s link title is:

Preparedness Poll Shows New Yorkers Are Prepared

The release’s headline is: 

NYC OFFICE OF EMERGENCY MANAGEMENT (OEM) POLL FINDS MORE NEW YORKERS ARE PREPARED FOR EMERGENCIES

The press release’s first sentence says:

“…more New Yorkers say they are prepared or informed about emergencies than said they were prepared or informed in 2005″.

Each of three actually makes a different contention, and the results of the survey only back up the third. According to the poll, 57% of New Yorkers say they are prepared, up from 49% two years before. That would be a positive development if their actions were in line with their answers.

The disconnect between perception and reality is not unexpected. But the gap is huge. When you drill down into the numbers, it turns out that the actual level of public preparedness is not even close to 57%. In fact, according to the survey, conducted by the Global Strategy Group:

*only 6% of New Yorkers report having a disaster plan that includes all the preparedness elements OEM recommends

*Only 11% say they would know what to do in the event of a terrorist attack (though 77% believe an attack is going to occur in New York). A couple more (12%) say they would know what to do in the event of a hurricane.

Now, there are some potentially encouraging findings in the survey — for example, 53% reported they have assembled a ‘go-bag’, which is higher than I would have predicted. And generally, I do think that, due to in large part to the public education efforts of OEM (conflict of interest alert — I am a OEM-CERT member) and the Red Cross among others, awareness of emergency preparedness in New York has grown.

That said, I think there should be some concern among City officials that only 1 in 10 of their citizens knows what to do in the event of a disaster (which, by the way, three-fourths are expecting to happen soon). And, these numbers would seem to call for more focus on figuring out how to raise them.

In the months since this survey was released, I have spoken to a number of those involved in the City’s emergency preparedness activities, but have never asked them about these results. I intend to do so soon.