Incident Report Scenario: Ballistic Missile Inbound To Hawaii

The false ballistic missile alert sent in Hawaii on January 13, 2018

The false missile alert, January 13, 2018. The correction didn’t reach phones until 38 minutes later. Image: The Atlantic

The Situation

On the morning of Saturday, January 13, phones, televisions, and radios across Hawaii carried a warning that a ballistic missile was headed for the islands.

For 38 minutes, more than a million residents and visitors believed they might be about to die, and many of them took action based on this information.

Three reports have already looked at what went wrong. The state emergency management agency investigated itself. A National Guard general reviewed the state’s emergency systems at the Governor’s order. The Federal Communications Commission investigated from Washington.

But Hawaii Governor David Ige wants his own report: one account, written plainly, that explains what happened, why it happened, and how it affected the public. The report has to make sense to a member of the public, and it has to be honest about everyone’s part in the failure — including his own office’s response.

You’re a state employee on the team writing it. The report is split into four sections, and your group has been assigned one section to complete. Junior staff have already dug through reports and the news coverage and flagged the information they think matters most. Your job is to take that material and turn it into a real first draft.

The Three Reports

Report	What It Is
Oliveira Report	HI-EMA False Ballistic Missile Alert Investigation HI-EMA’s internal investigation, written by Brig. Gen. (Ret.) Bruce Oliveira for the agency’s director. January 29, 2018. 13 pages. Staff are identified by number (“Employee 1”), not by name or job title.
Hara Report	All-Hazards Preparedness Improvement Action Plan and Report A review of the state’s emergency response systems, written by Brig. Gen. Kenneth Hara under the Governor’s Executive Order 18-01. February 18, 2018.
FCC Report	Report and Recommendations: Hawaii Emergency Management Agency January 13, 2018 False Alert The Federal Communications Commission’s investigation, written by its Public Safety and Homeland Security Bureau. April 2018. Page numbers in the flagged sources are the report’s printed page numbers.

Your Task

Each team drafts one part of the report.

Team	Topic
Team 1	Background: The Missile Preparedness Campaign
Team 2	How the False Alert Happened
Team 3	Response Timing and Complicating Factors
Team 4	Public Reaction and Social Media

Each team’s assignment below lists the questions your draft needs to answer and the sources staff flagged for it. Treat the flagged list as a starting point, not the whole picture — and where sources disagree with each other, say so in your draft. Tags like Q2 mark the questions a source is likely to help with. They’re hints, not a map.

Team 1: Background — The Missile Preparedness Campaign

Your team will explain the background: the state’s missile preparedness campaign, the drills and systems it put in place, and the concerns raised before January 13.

Questions Your Draft Must Answer

What is the missile preparedness campaign?
When did the missile preparedness campaign start, and why?
What did the state tell the public when it launched the campaign?
How were the missile drills created, and when did no-notice drills begin?
What new systems and software were put in place, and why?
How often were drills run?
What concerns were raised before January 13, and by whom?

Sources Flagged by Staff

Official Sources

FCC Report, pp. 10–11 — drill program history; falling-debris drill converted to a missile drill; no-notice drills; 20-step checklist; new software; 18 tests Q1 · Q4 · Q5 · Q6
FCC Report, p. 16 — six drills in eight days, compared with other agencies Q6
Oliveira Report, p. 8 — checklist practiced 26 times; three no-notice exercises in December; shifts running their own drills Q4 · Q6
Oliveira Report, p. 9 — new software in mid-December; December guidance to run the checklist twice a week Q5 · Q6
Hara Report, p. 1 — campaign start, April 2017; outreach effectiveness Q1 · Q2
Hara Report, pp. 9–10 — statewide siren system (June–Dec. 2017); switch to new alert software Q5
Hara Report, p. 11 — outreach phases and numbers: town halls, fairs, radio and TV announcements Q1 · Q3
Hara Report, pp. 23–25 (Appendix B) — dated campaign chronology, March 2017–Jan. 2018, including Mayor Kim’s meetings, email, and letter Q1 · Q2 · Q7

Public Sources

Civil Beat/AP — Hawaii prepares for “unlikely” North Korea missile threat (July 2017) — campaign launch Q2 · Q3
Big Island Video News — Hawaii: What to do if North Korea launches nuke (July 2017) — campaign launch; planning since Dec. 2016 Q2 · Q3
VOA — Hawaii prepares (July 2017) — campaign launch Q2 · Q3
Hawaii Tribune-Herald — No date set for missile attack siren test (Aug. 2017) — siren test timing; meetings with mayors Q5 · Q7
Hawaii Tribune-Herald — Kim on missile alerts: “Review the entire system” (Jan. 2018) — Mayor Kim says he asked the state not to proceed Q7
Big Island Now — Mayor Kim responds to state report — Mayor Kim on readiness Q7
Civil Beat — Hawaii fires man who sent out false missile alert (Jan. 2018) — number of prior drills Q6
Civil Beat — Governor knew 2 minutes after missile alert that it was false (Jan. 2018) — Maj. Gen. Logan on drill count; an October 2017 plan Q4 · Q6

Back to Your Task ↑

Team 2: How the False Alert Happened

Your team will explain how a drill turned into a real alert: the drill itself, the people and procedures involved, and the safeguards that weren’t there.

Questions Your Draft Must Answer

How did a non-public drill become a real-world alert?
What is a no-notice drill, and what role did the drill being no-notice play?
Why was the drill run at shift change, and what impact did this timing have?
What did the drill message say, how was it drafted, and was it confusing?
How many people did it take to send the alert message, and why?
What role did the alert software play?
Was this one person’s error, a system failure, or both?
Regarding the employee who sent the alert message, were there performance issues beforehand, and what was done about it?
How can Hawaii guard against this kind of mistake in the future?

Sources Flagged by Staff

Official Sources

FCC Report, pp. 14–15 — causes: human error, shift change, no-notice drill, no two-person rule, the drill script Q1 · Q2 · Q3 · Q4 · Q5 · Q7
FCC Report, p. 14, footnotes 68–70 — employee’s history; his NBC interview; why the drill ran at shift change Q3 · Q8
FCC Report, pp. 16–18 — training, drop-down menu, confirmation prompt, test vs. live environments Q6
Oliveira Report, p. 1 — the investigation’s four questions; synopsis of causes Q1 · Q7
Oliveira Report, p. 3 — 8:00–8:07: drill planned for shift change; recording prepared; “EXERCISE” announcement; the drop-down menu and confirmation Q3 · Q4 · Q6
Oliveira Report, pp. 6–7 — the full 20-step Ballistic Missile Quick Response Checklist; Employee 1’s account of what he heard Q4
Oliveira Report, p. 8 — findings: no procedures in the SOP; Step 1 language (“Real world,” “This is not a drill”); shifts drilling separately Q2 · Q4
Oliveira Report, p. 9 — findings: checklist not detailed; shift-change confusion; software training; no training records Q3 · Q6
Oliveira Report, p. 10 — findings: supervision; Employee 1’s performance history; what other staff heard Q4 · Q8
Hara Report, pp. 1–2 — four contributing factors Q1 · Q7
Hara Report, p. 13 — Observation 2: drills and the response plan Q2
Hara Report, p. 15 — Observation 4: managing poor performance Q8
U.S. Senate hearing — This Is Not a Drill (transcript) — FCC testimony on human error and missing safeguards Q5 · Q7

Public Sources

Hawaii News Now — Missile alert mistake coverage and redacted drill audio — 24-second redacted recording of the drill message Q4
NBC News — Worker who sent Hawaii missile false alarm believed threat was real — employee’s belief; earlier drill confusions Q1 · Q8
NBC News — Man who sent Hawaii false alert speaks out (video) — the employee’s own account Q1 · Q7
Big Island Video News — False alert fallout: Miyagi resigns, employee terminated — co-workers’ statements from Oliveira Q8
Civil Beat — Governor knew 2 minutes after missile alert that it was false — state legislators’ hearing Q7
WAMU — Why a false emergency alert is less likely in Washington than in Hawaii — how Washington, D.C. guards against false alerts Q9

Back to Your Task ↑

Team 3: Response Timing and Complicating Factors

Your team will explain how officials responded once they knew the alert was false: what they did and in what order, who was and wasn’t told, what approvals and procedures were involved, and where the response process broke down.

Questions Your Draft Must Answer

Once personnel knew the alert was false, what action did they take?
When were public officials notified the alert was false, and when was the public told?
Whose job was it to notify the public?
Were any key personnel or public officials left out of the notifications? If so, who?
What approvals were needed to send the correction?
What procedures existed for correcting a false alert?
What factors contributed to a delay in the Governor’s office notifying the public?
Were there problems with the correction message or messages?

Sources Flagged by Staff

Official Sources

FCC Report, pp. 13–14 — timeline 8:12–8:45; FEMA calls (footnote 65) Q1 · Q2 · Q5
FCC Report, p. 13, footnote 63 — the Governor and Twitter Q7
FCC Report, p. 14, footnote 66 — what the correction message lacked Q8
FCC Report, p. 16, including footnote 77 — false-alert protocol Q6
FCC Report, p. 18 — correcting through the same channels Q6
FCC Report, pp. 22–23 — network saturation; priority phone service Q1
Oliveira Report, p. 4 — 8:07–8:14: who knew it was false and when; county notification; Employee 1 at the cancellation; the 8:13 cancellation Q1 · Q2
Oliveira Report, p. 5 — 8:15–8:26: media notifications; first FEMA call Q2 · Q5
Oliveira Report, p. 6 — 8:27–8:45: choosing the correction code; FEMA call; correction text Q1 · Q5 · Q8
Oliveira Report, p. 7 — checklist steps 8–20, including Step 16 on the media and the deactivation steps Q4 · Q6
Oliveira Report, p. 8 — findings on a false-alert protocol and an “All Clear” message Q6
Oliveira Report, p. 10 — finding (n) on FEMA Q5
Hara Report, p. i (Foreword) — event code; primary cause of the delay Q1
Hara Report, p. 2 — whose job public warning is; the public information officer Q3 · Q4
Hara Report, p. 15 — Observation 3: officials trying to get the correction out Q1
Hara Report, p. 17 — Observation 7: officials unable to reach each other Q1
U.S. Senate hearing — This Is Not a Drill (transcript) — amateur radio testimony on FEMA approval and earlier corrections Q5

Public Sources

CNN — Hawaii false alarm investigation — Employee 1 at the cancellation Q1
Civil Beat — Governor knew 2 minutes after missile alert that it was false — Governor’s timing; HI-EMA administrator’s testimony on FEMA Q5 · Q7
Washington Post — Governor didn’t know his Twitter password — the Governor’s delay Q7
Hawaii Public Radio — Legislature conducts hearing on false missile alert — state legislators’ hearing Q1
Big Island Video News — State lawmakers grill Hawaii officials (video) — hearing video Q1
Hawaii Tribune-Herald — Kim on missile alerts: “Review the entire system” — county’s timeline and radio correction Q2 · Q3

Back to Your Task ↑

Team 4: Public Reaction and Social Media

Your team will explain what the public went through: how people reacted, how the truth reached them, who never got the alerts, and what it did to trust in future warnings.

Questions Your Draft Must Answer

How did people understand the information they received at each stage — the alert, the period of silence, and the correction?
What did people do based on that information? Give specific examples.
Who got accurate information to the public first, and through which channels?
When did official social media posts go out, relative to the alert?
Which members of the public never received the alert or the correction, and why?
What happened to 911 services and to HI-EMA’s website?
What lasting effects have been identified with regard to future alerts?

Sources Flagged by Staff

Official Sources

FCC Report, pp. 3–4 — public fear; deaf board members sheltering Q1 · Q2
FCC Report, p. 13 — official social media posts and the Governor’s retweet Q4
FCC Report, p. 28 (Appendix C) — screenshots of social media corrections Q4
FCC Report, pp. 18–21 — broadcasters and phones that missed the alerts Q5
FCC Report, pp. 21–22 — 911 call volume Q6
Oliveira Report, p. 4 — 8:13 personal Facebook post by a staff member Q3
Oliveira Report, p. 5 — news station push alert; official Twitter and Facebook posts; who was notified when Q3 · Q4
Hara Report, p. i (Foreword) — public reaction and trust Q1 · Q7
Hara Report, p. 16 — Observations 5–6: phones that didn’t get the alert; remote areas Q5
Hara Report, p. 17 — Observation 9: HI-EMA’s website Q6
Hara Report, pp. 17–18 — Observation 10: public outreach Q7
U.S. Senate hearing — This Is Not a Drill (transcript) — Sen. Schatz’s account of that morning; damage to credibility Q1 · Q7

Public Sources

The Atlantic — Pandemonium and Rage in Hawaii — public reaction Q1 · Q2
Slate — People in Hawaii wondered what to do with the last moments of their lives — what people did Q2
KHON — Teen was first on social media to debunk missile alert — unofficial correction Q3
New York Magazine — The frightening lessons from Hawaii’s false missile alert — people who didn’t get alerts; future trust Q5 · Q7
Hawaii Tribune-Herald — Missile-alert mistake feeds doubts about a real emergency — future trust Q7
Hawaii News Now — If you didn’t get the false missile alert, this might be why — why phones missed the alert Q5
East Bay Times — Hawaii missile scare 911 audio — police dispatch audio Q6
CBC — We Thought the World Was Ending (video) — residents’ accounts Q1 · Q2
Futurity — Tweets show lingering fear after Hawaii’s false missile alert — Jones & Silver study of anxiety on Twitter Q7

Back to Your Task ↑

Additional Sources

These official documents and news stories didn’t make any team’s flagged list, but any team can use them.