emergency risk communication

Over-the-shoulder photo of two older women looking down at health communication materials in their hands.

When Category 4 Hurricane Maria made landfall in Puerto Rico, CDC assembled a team of experienced communicators who were flexible, bilingual, and culturally sensitive communicators. This group of experts prepared to deploy to Puerto Rico on short notice to support the communication needs of the Puerto Rico Health Department. I was asked to lead content development, and as a native Puerto Rican I did not hesitate to go home and help in any way I could.

I was part of the first team of four health communications specialists who arrived on the island just three weeks after the hurricane. We knew our job was not going to be easy— severe electrical power outage meant that residents had no access to internet, social media, or television. Antennas had fallen during the storm, so there was very limited radio coverage and almost no cell phone connectivity. Large billboards were literally on the ground and newspapers were not circulating widely because there was no way to publish and transport them for delivery.

Hurricane Maria was an unprecedented disaster, exposing residents to an increased risk for foodborne, waterborne, infectious and non-infectious diseases, and other public health risks. We had to figure out how to communicate about multiple health risks to the public, especially to those in rural and isolated communities, when basic resources and services were not available.

We met this challenge head on, and I took away five key lessons that I hope can help other communication responders prepare for the 2018 hurricane season and any future emergency events:

1. Develop Key Messages in Advance

Every natural disaster is unique and emergency responders have to quickly adapt to the ever-changing nature of a crisis. Nonetheless, many key messages can be written before disaster strikes so they can be quickly disseminated before an event, during the response, and in the recovery stages. In disaster planning this is known as a phased approach, and it can save valuable time when in the midst of a crisis response. Before the 2017 hurricane season started, CDC developed a key message reference document for partners to have the most up-to-date science about multiple hurricane-related health threats. The key message document helped us on the ground so we could quickly create and adapt health communication products for Puerto Rican audiences.

2. Identify New Communication Channels

When all primary communication systems and technology fail, communicators must think creatively and adapt to the crisis by identifying new communication channels. In Puerto Rico, we realized that mass producing printed materials was our best bet to get important health messages to the most vulnerable communities. As the response evolved, we identified alternate channels, such as using FEMA’s text messaging capability to disseminate health messages to their subscribers, or using outdoor speakers to run public service announcements in rural areas. We also posted targeted and relevant messages on the CDC en Español Facebook channel. We knew Puerto Ricans on the United States mainland, known as “la diáspora,” were heavily using technology to connect with family and help people on the island, so we posted targeted and relevant digital messages that could be relayed to people in Puerto Rico by word of mouth.

3. Create Culturally Appropriate Materials

Cultural norms influence how people behave, so culture has important implications for emergency communication. For the Puerto Rico response, we translated materials to Spanish and made sure to linguistically and culturally tailor our health prevention messages so they would be relevant with the Puerto Rican audience. Our team made sure to use widely understood terminology in the island to provide clear and localized language, particularly for audiences with low literacy. For example, in Puerto Rico the term “hongos” is widely understood as a translation for “mold” as opposed to “moho,” which is used in other Spanish speaking countries but has a dual-meaning in Puerto Rico. We also implemented a streamlined process for the Puerto Rico Department of Health, and CDC scientists and communication experts to vet, approve, and co-brand the communication materials.

4. Partner Up

We collaborated with the Puerto Rico Health Department to determine our number one priority, which was reaching the most vulnerable communities, including those with no access to clean water, and people who were still in isolated and rural areas. When we heard about military partners who were delivering food and water supplies to isolated communities by helicopter, we gave them boxes of our fact sheets so they could be distributed in these areas. We delivered materials to federal and local government agencies who were doing health assessments in hospitals and shelters. We also provided copies to grassroot and non-profit organizations, and religious and community leaders who went door-to-door to assist residents and organize community events. Through our commitment to partnerships, we distributed over 1.6 million copies of printed materials in a 3-month period. Topics ranged from food and water safety, to carbon monoxide, vector control, mold, leptospirosis, mental health, among others. This included fact sheets, posters, palm cards, and children’s coloring books.

5. Boots on the Ground

Once we started mass producing printed materials, we organized and attended more than 30 community events with partners to disseminate information to the public. We visited hospitals, shelters, disaster recovery centers, schools, and provided information door-to-door in rural communities. Talking with people face-to-face gave us a better understanding of the realities survivors were facing and helped identify public health information gaps in our materials so we could make adjustments.

Learn more

CDC: Crisis and Emergency Risk Communication (CERC)
CDC: CERC Manual
Public Health Matters: Shouting in the Dark: Emergency Communication in USVI After Irma and Maria
Public Health Matters: Educating Children After Hurricane Maria
Public Health Matters: After the Storm: Helping Kids Cope

Nykole Tyson, Director of Public Relations for the US Virgin Islands Department of Health, speaking into a radio microphone.

Communication experts often say, “When you’re communicating during an emergency, always think about what you’d say to your mom. What information would she need the most? How would you explain it to her? What would you need to know for sure before you told her? And just how far would you go to reach her?”

When Hurricanes Irma and Maria hit the U.S. Virgin Islands (USVI) in September 2017, this wasn’t just advice for Nykole Tyson. Nykole is the USVI Department of Health’s (DOH’s) Director of Public Relations. She serves as the DOH spokesperson and emergency communicator. Like all of USVI’s responders and government officials, she is a survivor who was impacted by the storms. Nykole’s home had water and roof damage and she was without water or power for four months. “I caught rain water in barrels and used solar lights sent to me by friends living stateside,” Nykole said. She lived on a cot in her office in the DOH for several weeks between and after both storms. .

The storms destroyed most of the territory’s communication infrastructure, making both personal and mass communication nearly impossible. Nykole was unable to reach her own family for four days after the second hurricane. However, within hours of both storms, she was on the radio talking to her community about how to stay safe, find shelter, and stay strong. Nykole wasn’t just talking to the public, she was talking to her neighbors, her community, her family, and even her mom.

Hurricane Irma

Just hours before Hurricane Irma hit USVI, Nykole was a spokesperson on local radio stations and distributed press releases, public service announcements (PSAs), and social media messages with critical information about how to prepare for the storm. When the storm hit on September 6, electricity, cell, and Internet access was cut off across most of the territory. People sought resources, shelter, and safety, and many struggled to locate friends and loved ones. Virgin Islanders needed to know how to stay safe around downed power lines, debris, mold, and floodwaters. There was only one working radio station after the storm and Nykole immediately went on the air to give safety tips and updates about available services. She also realized that some people were still able to access Facebook, and the social network became one of the primary means of communication throughout the response. The USVI DOH Facebook posts from September provide a glimpse into how events unfolded and demonstrate the DOH’s commitment to responding to the public’s concerns.

Hurricane Maria

Just 12 days after Irma, USVI was preparing for another major hurricane—Maria. Only this time there were limited ways to alert the public and provide health and safety information. Virgin Islanders, Nykole included, needed to find shelter or prepare their homes, many of which were already damaged, for the impact of another hurricane. Nykole did a PSA on the local radio station from her own home as she was securing her furniture and checking her emergency supplies. “We will get through this,” she repeated over the radio. Unbeknownst to the listeners, Nykole’s family had lost phone service after Irma. She had been unable to reach them so she was driving to her mom’s house to give her family the same safety information she was sharing on the air.

When the storm hit, Nykole and about one hundred other DOH staff took care of special needs patients sheltered in the DOH building. As the wind battered and shook the concrete building, they thought of their communities, homes, and families on the islands. “We were all scared,” she recalls. As soon as the clouds cleared, Nykole was back on the radio, “We survived two category fives. We lost property but we still have our lives. All is not lost. It is time for us to rebuild.”

Resourcefulness and Resilience

USVI DOH staff had to be creative and resourceful after the storms because the typical means of communication were down. The best ways to share information immediately after the storms was through paper flyers, radio, and in-person outreach. CDC and the U.S. Postal Service assisted with printing and distributing a flyer on key health tips to every mailbox on all four islands. CDC health communicators deployed to USVI to support outreach efforts started conversations the islands at churches, stores, disaster recovery centers, radio stations, and schools.

When asked about lessons learned, Nykole reflected, “Do not underestimate the power of radio.” She is still making radio appearances to engage the community, repeat the key messages, answer questions, and encourage community members. While she is running errands, people stop to thank her and comment on her energy. “There were so many times I wanted to cry when I was on the radio, but the listeners didn’t know that,” she says. People tell her how she kept them calm during the worst of the storms, and, hearing her now, still on the radio, lets them know that their government officials are still working hard for them.

Nykole’s experience shows how a talented spokesperson who is also a survivor can be the best voice to engage and reassure a community after a disaster. All responses could benefit from people who care for and communication with the public as if they are family.

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Category Archives: emergency risk communication

5 Communication Lessons Learned from Hurricane Maria