by Steven Crimando
Over the past several months, pandemic influenza planning has been a serious endeavor, consuming a great deal of time and energy for those tasked with continuity planning and disaster recovery in organizations around the world. Experts tell us that the risk of an influenza pandemic is very real, even though media coverage of new cases in birds, animals and humans is only a fraction of what it was a year ago. Despite the reduced news coverage, the H5N1 avian flu continues its march around the globe, with non-human cases now in 60 countries and human cases in 10. As of November 29th, there have been 258 people diagnosed with avian influenza and 154 people have died from the disease.
While there are many unknowns about the next pandemic, the three most significant questions still remain:
-When will it begin?
-How powerful will the strain be?
and
-How ready will we be?
The answers to the first two questions are unknowable, but by taking the risk seriously and acting now, we can influence the answer to the third.
A pandemic is a very different type of emergency. It is potentially much longer and more complex than other disasters that business continuity planners typically address and it represents a threat that leaves facilities and infrastructure intact and primarily targets an organization’s people. As such, the human factor, both physical and emotional, become critical aspects of preparedness, response and recovery. This article offers executives and planners insight into the emotional and behavioral challenges critical to the business continuity planning process.
This article addresses 10 important disaster behavioral assumptions to inform your business continuity/disaster recovery planning efforts. “Accurate Disaster Behavioral Response Planning: A Guide for Business Continuity Planners” addresses key concepts of individual and organizational behavior before, during and after disasters and other violent or threatening events. The concepts can be applied to disasters, terrorism, workplace violence, public health emergencies and a wide range of potential crisis scenarios.
I invite you to read, discuss and share this article with your colleagues. Anyone involved in the business continuity planning process will hopefully find this information compelling and useful. Whether you are developing “all hazards” or hazard- specific plans, how employees act or don’t act during a crisis will play a significant role in the effectiveness of your emergency plans. Accurately anticipating individual and group behavior can help ensure the safety, security and survivability of your workforce and your business.
Introduction
In most business environments, the term “behavioral” is typically associated with the mental health, wellness or employee assistance programs (EAPs) that address a range of emotional and psychological needs for employees and perhaps their families. From the perspective of those charged with crafting your organization’s disaster response and recovery plans, it is important that the planning efforts be accurately informed with empirical evidence about how employee behavior before, during and after a disaster can significantly increase or decrease the success of your emergency operations.
This guide was developed as an introduction for anyone who participates in the disaster preparedness and response discussion, in both the public and private sectors. It explains three useful behavioral response types and 10 important behavioral planning assumptions to assist planners in accurately informing their decision-making process across all phases of disaster and emergency management. These are evidence-informed assumptions, based on a thorough review of current research and literature, expert consensus, and field experience in disaster and terrorism response and planning. It is hoped that this guide will provide organizations around the world with some insights on effectively predicting and preparing for the likely human response to disasters, terrorism and other threatening events.
Accurate behavioral assumptions should be a standard part of overall disaster response and recovery planning. Nothing in this guide should be interpreted as suggesting that planners embark on an all-new way of approaching their jobs. Rather, inclusion of these ideas can fortify and enhance existing or evolving plans in critical ways that increase their effectiveness and value to the organization.
Emotional vs. Behavioral Responses
Emotional
For the sake of clarity, it is important to understand the distinction between emotional and behavioral responses to disasters. In this context the emotional response refers to what is typically thought of as “mental health” issues. For example, the numbers of those with either diagnosable and sub-diagnosable depression, anxiety, posttraumatic stress and other mental health problems are likely to increase following a disaster that results in a tremendous loss of life and/or disruption of personal, professional, and social functioning. In most disasters research suggests that only about 11-15% of those exposed go on to develop such long-term mental health problems. The majority of people will experience short-term emotional distress and rebound in their own time and on their own terms.
Human resources professionals and health, medical and EAP providers understand and anticipate “post-disaster” reactions, and there are typically many resources available to those experiencing the emotional consequences of a critical incident.
Behavioral
Disaster behavioral responses occur on a continuum from purposeful and productive to potentially harmful and counterproductive. The range of positive reactions includes heightened levels of motivation, greater attention to detail and increased group cohesion, but there are many potential “tipping points” within various disaster scenarios that can quickly influence individual and group reactions toward negative response behaviors.
Such negative reactions, at the low end of the continuum, are represented by unfocused, illogical or irrational behavior, such as panic, hoarding supplies, non-compliance with vaccination or quarantine orders, and so on. They are not the signs or symptoms of a mental illness, but rather significant behavioral alterations that may cause further harm to the individual, the community and/or to the larger society.
Where Emotion and Behavior Intersect
While a line has been drawn between emotion and behavior for planning purposes, emotion clearly influences behavior and that there are behaviors that will certainly increase or decrease emotional response. Two important concepts for planners, illustrating the inseparability of emotion and behavior during actual emergencies, are the cognitive and physiological responses to stress and fear.
Stress
A long-held and still valid concept in basic psychology addresses the relationship between stress and performance. Developed by psychologists Robert M. Yerkes and J. D. Dodson in 1908 and grounded within the discourses of biopsychology and neuroscience, this concept can be applied to the performance of the organization’s disaster planners, first responders, executives and general employee population, as they may operate in a high-stress scenario.
Simply put, the Yerkes-Dobson research demonstrated an empirical relationship between arousal (stress) and performance. Their research supported the common observation that low and moderate degrees of stress can pique performance, but that at some point stress overwhelms functioning and performance rapidly and dramatically drops off. The bottom-line finding:
There is an optimal level of arousal for a given task. While this concept can have day-to-day applications in our lives, it can take on much greater meaning for those working in high-stress and/or high-consequence environments.
Useful to planners is the idea that the “tipping point” is unique to the individual and the circumstance. In assigning roles and responsibilities in the planning process, it is important to have knowledge of the individuals’ skills, temperament, and even home-life situation as it “pulls” or creates “person/role conflict” during an actual disaster response. Planners are often surprised at the differences in the performance of personnel during drills and exercises, and real-time events, since it is very difficult for most people to simulate the high levels of fear or stress that are present in an actual disaster. The absence of realistic behavioral role-playing in drills and exercises unfortunately skews planning efforts from the largest government-run emergency management drills to drills in the school environment.
Fear
Much of what occurs in our basic fear response is deeply physiologically-driven. It is immediate, powerful and for many, seemingly uncontrollable. Like stress, fear can play a positive role. It is a necessary part of our basic survival kit. Also like stress, any potential positive reactions influenced by fear can pass a similar “tipping point” and begin to work against us.
There have been many empirical studies of the effects of fear on performance that can realistically inform planners about behavior in disasters and emergencies. Some studies have successfully used physical indicators, such as heart rate, as milestones to mark behavioral “tipping points” and identify the conversion from positive to negative or counterproductive fear responses.
There is, of course, a range of variation in such models that is dependent on the unique characteristics of both the individual and situation, but one important concept is that physical conditioning does not change this equation. The underlying neuroanatomy and neurochemistry that drive “exercise-induced arousal” (i.e., heart rate, blood pressure, respirations, etc.) during intense exercise, and the mechanisms that drive “fear-induced arousal” are essentially two different systems that produce two different results. There is also a growing body of evidence that the “fear-induced” process is primarily responsible for post-disaster mental health problems, which further demonstrates how tightly linked the emotional and behavioral responses truly are.
The following three planning scenarios further distinguish these emotional and behavioral responses, incorporating both the individual and group responses.
Three Important Planning Scenarios
As a discipline, public emergency management is laced with certain behavioral assumptions that arise from a “game theory” model. As events have forced a closer partnership between public and private organizations in disaster and emergency management, much of this thought has saturated planning efforts within the business environment as well. The sort of “game theory” most of us are familiar with may have been introduced by the film, “A Beautiful Mind”, about Nobel Prize winning mathematician John Nash.
Game theory assumes a level of cooperation between individuals that moves everyone toward a better response. Evidence of behavior in disasters suggests this is true in many instances, but not all, and when it is not true, it can so radically change the course of events, that planners must have a much broader view of the range of potential reactions.
Type I Response
The most common and/or foreseeable response to a disaster or crisis is a “neighbor-helps-neighbor” response. People look out for each other, help each other, follow instructions that they believe will help themselves and those around them. They do not panic, loot or impede emergency operations. This, of course, is the best case scenario, and in most instances, this is the response your organization’s disaster planners are banking on.
Type II Response
In some instances, particularly those that are perceived to be threats to health or security, a “neighbor-fears-neighbor” response is predictable. In most instances your neighbor or co-worker would gladly run over to lend a hand during and after a disaster, but if they believed that you might be sick and contagious, or in some other way a threat to them, then all bets are off. Obviously, as we perceive that others around us in the workplace or in the community are now part of the problem, we become more defensive and less likely to pitch in to the collective response or recovery effort.
For planners, a realistic approach to this response is based on the understanding that some people will cut and run. Research inquiring about behavioral responses to “dirty bomb” and smallpox scenarios suggests that substantial numbers of people would refuse to shelter-in-place or receive vaccinations if ordered, based on such fears. Another recent study indicated that nearly half of all public healthcare workers would stay out of work during an influenza pandemic. Therefore, it would be important to reconsider your available “people power” during Type II situations in which not all your employees may come in, stay in or be able to execute the response and recovery tasks you may be counting on.
Type III Response
A Type III response represents the worst-case scenario. It is statistically unlikely, but must be understood and considered in your general planning efforts. Such a response is characterized by panic. Panic, by definition, arises from two perceptions: 1) The perception of limited opportunity for escape; and 2) the perception of limited availability of critical supplies. The presence of panic changes all the rules; now it is a “neighbor-competes-with-neighbor” situation and becomes much more complex and dangerous. In theoretical form, there is a critical shift from “game theory” to “game theory with non-cooperative players” and everything changes in significant ways.
Planners should no longer count on social or organizational cohesion if such a “tipping point” is reached. Elements of public response to Hurricane Katrina unfortunately illustrate this point too well. Homeland Security officials’ comment that “…they did not foresee that lawlessness in New Orleans” demonstrates narrowness or “lack of imagination” in the minds of planners to incorporate behavioral considerations into disaster plans.
Recommendations
All disaster plans, public and private, are extremely behavior-sensitive. Changes in perception about the risk, the response or your company’s motives before, during and after a disaster can affect every aspect of your recovery. Understanding these behavioral considerations exclusively from a “mental health” standpoint is too narrow and not useful for disaster planning purposes, although it is essential to plan for emotional consequence management with qualified internal and external resources.
The following standard disaster behavioral planning assumptions are offered to help inform disaster preparedness and response efforts. Certainly they are not all inclusive, but may serve as a starting point as you craft new plans and recalibrate existing ones. Factor a realistic range of possible human behavior into your plans, work with partners who understand and can help validate these assumptions in your environment, and leave a flexible margin for variations in this behavior, since so much will be influenced by event-specific factors.
Standard Disaster Behavioral Assumptions
No one who lives through a disaster is untouched by the experience.
At both the emotional and behavioral level, anyone directly and many indirectly exposed to disasters, violence and other traumatic events experience some sort of impact. How and when this is experienced is very subjective and unique to the individual and can alter performance and behavior relative to disaster recovery operations. Understand and anticipate that even “hardboiled” disaster professionals are subject to this behavioral impact assumption.
Disaster behavioral response concerns are different than “mental health” concerns.
Do not rest easy with the idea that the behavioral concerns are someone else’s problem. Yes, EAP or Wellness providers are typically ready and able to address the emotional impact of disasters. Planners should ensure that there are sufficient numbers of such resources, that they are readily accessible, and also validate that their models of intervention are consistent with current “best practices” in the mental heath industry.
The mental health concerns are largely “post-event”. Behavioral concerns are present in all phases of emergency preparedness and response. Do not expect that the behavioral concerns can be managed effectively post-event.
The response will be phase-specific.
Obviously how people respond to the threat of an approaching disaster or crisis is different from their response during and after the event. Fear and anxiety may be the dominant emotional reactions in the early phases of an event, diminishing communication and performance in the workplace. Later phases may be characterized by anger, sadness and hopelessness, impacting productivity and rates of return to work. Each phase holds its own challenges, so understand and incorporate the changing nature of the behavioral response across your response and recovery timelines.
The response will be event-specific.
All-hazards planning is an important and necessary advance in disaster management, but there are important scenario-driven behavioral responses that are not captured in the all-hazards approach. For example, plans to address unconventional acts of terrorism, such as chemical, biological or radiological hazards, must be informed with accurate information about how people react to being or believing that they have been exposed to such substances.
Reactions can be immediate, overwhelming and generate such acute levels of fear that prior assumptions about containment and decontamination may be moot. Informing your hazard-specific plans with a “clinical reality” of the behavioral response to such emotionally powerful events is essential. Reach into and outside of your organization and community for credible sources of this clinical information and compare it with your current hazard-specific thinking.
The behavioral response may greatly overshadow the medical/physical response.
In certain events, the behavioral “footprint” will dwarf the medical and/or physical “footprint” of the event. This is often true when the exact nature of a threat is not fully known, or is difficult to detect. Chemical, biological and radiological risks are again strong examples, since these harmful substances may be odorless, colorless and tasteless. It may be difficult or impossible at the onset of an incident to truly know which individuals or groups have been exposed, and the typical behavioral response is “as if.” Therefore, people behave “as if” they have been exposed, by: generating (psychogenic) signs and symptoms of exposure or illness requiring medical attention; over-reacting to their normal stress reactions thereby elevating levels of personal and group fear; potentially triggering panic; and feeling damaged in both the short-and long-terms, potentially affecting many aspects of their personal and professional lives.
Research with those exposed to sarin gas in the Tokyo subways in 1995 and the anthrax postal attacks in 2001 clearly support this assumption, and suggest that especially in the response phase, the numbers of the “worried well” or otherwise experiencing acute behavioral reactions can greatly outnumber those with physical injuries.
Many/most all-hazard concepts can be generalized to the behavioral assumptions.
It is not necessary to have a stand-alone disaster behavioral response plan. In fact, it would be counterproductive. Behavioral planning should inform, and perhaps saturate planning efforts, but must be integrated, not isolated from general planning activities. From the behavioral standpoint, most disaster scenarios, natural and technological, have somewhat similar emotional and behavioral consequences that can be anticipated and incorporated into overall planning efforts. There is one useful distinction that may clarify if and where different assumptions are indicated, and that is along the dimension of time.
Most disasters can be thought to have “bookends.” When the event occurs, you clearly know if you are in or out, when it started and when it ended, and can begin to take inventory in terms of the damage done. Given those dynamics, it is reasonable and empirically sound to assume that the emotional and behavioral response will be acute (short but powerful) and subside relatively quickly over time. It is also scientifically sound to estimate that only a small number of those exposed may need direct mental health support services, especially for the longer term.
In the sort of events discussed in Assumptions 4 and 5, when the threat is less clear, and it has a sense of “future orientation” (i.e. “I may get sick years from now from the chemicals or radiation I was exposed to today”), the impact is more long-term. There is a much greater possibility for chronic, long-term medical and mental health problems following an event that lacks such “bookends.”
Addressing the emotional and behavioral considerations helps ensure effective emergency operations.
As the accuracy of your behavioral assumptions increases it is possible to revisit disaster plans with a new realism regarding how employees, stakeholders, and even the markets may behave during certain emergencies. Tempering your planning effort with sound behavioral assumptions can help you sleep a little more soundly as well. If you have developed plans with clear roles and responsibilities for all levels of personnel, it is certainly reassuring to know that people will actually be able to execute critical tasks, come and stay at work, and deal with the challenges that are likely present throughout the event and recovery.
The behavioral component is part of “Job #1″.
Job 1-A: People’s safety is the first concern in a disaster;
Job 1-B: The bottom-line is a first concern in a disaster.
These are not mutually exclusive concerns by any stretch. The business organization has obligations, moral, ethical and legal, regarding the safety of its people and in the immediacy of a pending or breaking disaster, life safety trumps all other concerns. Beyond the obvious humanitarian considerations, this makes perfect business sense. Machines and technologies do not continue, maintain or recover businesses during or after disaster; people do. And once a business is perceived to care more about the bottom-line than its people, damage has been done that can be costly in many ways and for a long time to come.
At the same time, the business has similar obligations to its employees, stakeholders and others to maintain the business. Once the initial impact of the disaster is absorbed, the single greatest source of stress for most individuals and communities is the residual economic damage. Financial stresses stemming from a disaster continue to wear on people even years after the event and often become much more detrimental to overall recovery than the initial trauma of the event. One of the most responsible things the business can do is develop and maintain robust disaster response and recovery plans. Plans that are sensitive to the emotional and behavioral concerns are advantageous, but simply having and using a plan addresses some of people’s basic needs: to survive and to have a job to come back to when it’s over. The lesson: Job I-A and I-B are the same job. Don’t let anyone tell you otherwise.
Accurate behavioral assumptions should inform all four phases of your emergency plans.
Although this concept has been hinted at throughout several earlier assumptions, it is helpful to clarify the phased approach to planning. For the purpose of optimal interoperability between private and public organizations during disasters, the National Response Plan advocates for the use of the Federal Emergency Management Agency’s “All-Hazards” model. This time-tested approach to emergency management is based on a federal planning document known as “State and Local Guidance 101″ which has long dictated that emergency management officials plan consequence management activities across four discrete phases or stages of disasters. These phases are defined as mitigation, planning/preparedness, and response and recovery.
Within your organization, emergency planning may exist in different formats, using different terminologies. That’s fine. From the behavioral planning assumption standpoint, it is important to remember Assumption 3, in that behavioral reactions are phase-specific. Therefore, as you work with your planning templates and timelines, imagine the likely behavioral response to each phase and thoughtfully consider effective countermeasures to address those foreseeable reactions before, while, and after they occur.
There are resources in your organization and community that can help you plan.
In many organizations there are pockets of expertise with varying degrees of familiarity with the emotional and behavioral response to disasters, violence and other traumatic events. These may exist in some unlikely places, and individuals with such insight do not often make it to the table for disaster planning activities. The same can be said of the community around you. Academic institutions of all types and sizes, community mental health centers, private practitioners, and others can be helpful as advisors.
It is extremely important to qualify your sources for such critical and sensitive information. As discussed, accurate disaster behavioral planning begins with a clear distinction between the emotional (mental health) issues and the behavioral issues specific to disasters. Most mental health professionals will have a working knowledge of the mental health side of this equation. Few will have empirically sound advice about the behavioral concerns. The advisors best able to help will have a balanced view of both, a depth of actual disaster experience and training, and affiliations with the relevant professional groups associated with disaster response work (ex: American Psychological Association’s Disaster Response Network, etc.). In this niche, it is not enough to be a licensed, practicing mental health professional. Your resources will require a higher level of sophistication.
Not Just for Planners
Hopefully this knowledge will be useful for the Business Continuity Planner as well as human resources, legal and medical staff and others in your organization concerned with mitigating the entire range of disaster-related consequences. The emotional and behavioral reactions to violent or threatening events, whether naturally occurring or human-caused, factor greatly into all aspects of emergency management in public and private settings. Whether your current planning activities are focused on pandemic preparedness or the next storm season, understanding and incorporating accurate behavioral planning assumptions into your efforts can help take your disaster recovery plans to a whole new and more effective level.
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Steven M. Crimando, MA, BCETS, is a noted author, consultant and trainer to governmental agencies, NGOs and multinational corporations. He is the Managing Director of Extreme Behavioral Risk Management (“XBRM”), a consultancy focused on the human factor in disaster recovery, business continuity and homeland security. XBRM is a division of ALLSector Technology Group, Inc., a New York based full service technology consulting company offering systems integration, managed services and applications development and implementation. ALLSector Technology Group, Inc. is a subsidiary of the F∙E∙G∙S Health and Human Services System, one of the nation’s largest and most diversified not for profit organizations.
