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The Lancet, Volume 380, Issue , Page S28, 23 November 2012
doi:10.1016/S0140-6736(13)60384-0Cite or Link Using DOI

Public communication needs during incidents involving emergency decontamination

Holly Carter BSc a b Corresponding AuthorEmail Address, John Drury PhD b, G James Rubin PhD c, Prof Richard Williams PhD d e, Richard Amlôt PhD a



The threat of chemical, biological, radiological, nuclear, and explosive incidents has increased because of technological advancements and the willingness of terrorists to use unconventional weapons. Emergency responders can use interventions such as decontamination and quarantine during such incidents. However, when emergency responders do not communicate effectively, public anxiety could increase and compliance with decontamination could be poor, reducing the efficacy of decontamination and creating a secondary contamination hazard for receiving hospitals. There is a need to examine whether current procedures sufficiently acknowledge public communication needs.


First, a systematic review of published decontamination guidance for responders was undertaken. Second, semistructured telephone interviews were carried out with a convenience sample of 13 responders from the UK Fire and Rescue Service who had similar training but different amounts of decontamination experience. A thematic framework was developed to analyse the findings for previously identified issues, such as perceptions of public compliance with the need for decontamination, excessive public anxiety, and orderly behaviour. Relevant passages were coded into one or more of the themes. Care was taken to document the full variety of responses given; contradiction in interview accounts was actively sought. The potential for interviewer bias was reduced with a semistructured interview schedule and telephone interviews, thereby eliminating the effect of non-verbal cues. Finally, data from five emergency preparedness exercises involving decontamination were analysed. All participants who underwent decontamination during these exercises (n=402) completed questionnaires. Numbers of men and women were roughly equal; ages ranged from 18 years to 85 years. Quantitative data were analysed with correlational and path analysis, and qualitative data with the framework approach. A second researcher coded a subsection of the data, producing an inter-rate reliability rate of 89%.


The systematic review showed poor planning for communication with members of the public. The interview study established that responders who had previous experience of decontamination perceived communication with the public to be important. Responders who did not have experience of decontamination did not recognise the role of communication, and instead emphasised the importance of controlling members of the public who were said to be vulnerable to mass panic. Analysis of qualitative data from emergency preparedness exercises showed that most participants felt that they had not been given adequate communication from responders. A path model based on the results from the quantitative data had good overall fit (χ2 test; p=0·607). Poor perceived communication contributed to decreased levels of reassurance (r=0·28, p=0·006) and willingness to comply with decontamination (r=0·31, p=0·007).


Effective communication is a key intervention through which emergency responders can contribute to the successful management of decontamination. The small number of responders in the interview study could reduce the ability to generalise results. However, 12 interviews is usually enough for data saturation and hence an understanding of common perceptions and experiences in homogeneous sample groups. Additionally, exercises attempt to replicate a real situation, but some variables (especially anxiety) can differ significantly in real incidents. However, the relation between variables should not be different; successful communication would probably be even more important during a real incident than in exercises.


HC is funded by a Health Protection Agency R&D PhD Studentship. GJR is funded under the terms of a Career Development training fellowship issued by the National Institute for Health Research.
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a Emergency Response Department, Health Protection Agency, Porton Down, Salisbury, UK
b School of Psychology, University of Sussex, Brighton, UK
c Institute of Psychiatry, King's College London, London, UK
d Welsh Institute for Health and Social Care, University of Glamorgan, Pontypridd, UK
e Extreme Events and Health Protection, Centre for Radiation, Chemical and Environmental Hazards, Health Protection Agency, London, UK
Corresponding Author Information Correspondence to: Miss Holly Carter, Emergency Response Department, Health Protection Agency, Porton Down, Salisbury, Wiltshire SP4 0JG, UK
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