Hostname: page-component-cd9895bd7-dzt6s Total loading time: 0 Render date: 2024-12-19T06:57:09.119Z Has data issue: false hasContentIssue false
  • English
  • Français

A Framework for Training Public Health Practitioners in Crisis Decision-Making

Published online by Cambridge University Press:  18 November 2015

Harvey Kayman Open the ORCID record for Harvey Kayman [Opens in a new window]  and
Tea Logar
Harvey Kayman*
Affiliation:
University of California School of Public Health, Richmond, California
Tea Logar
Affiliation:
University of California San Francisco.
*
Correspondence and reprint requests to Harvey Kayman, MD, MPH, 1301 Quarry Court #404, Richmond, CA 94801 (e-mail: [email protected]).
Get access Rights & Permissions [Opens in a new window]

Abstract

Three sets of issues tend to be overlooked in public health emergency preparedness and response, which can be addressed with new training protocols. The first issue is procedural and concerns the often intuitive (as opposed to deliberative) nature of effective crisis decision-making. The second issue is substantive and pertains to the incorporation and prioritization of ethical, political, and logistical concerns in public health emergency guidelines. The third issue is affective and concerns human feelings and human frailty, which can derail the most well designed and best practiced procedural and substantive approaches to emergency response. This article offers an outline for a decision-making framework for public health emergencies that addresses and incorporates these issues within relevant guidelines and training. (Disaster Med Public Health Preparedness. 2016;10:165–173)

Keywords

public health decision-makingdual process (intuition/deliberation)emergency responseethicsincident command system (ICS)
Type
Concepts in Disaster Medicine
Information
Disaster Medicine and Public Health Preparedness , Volume 10 , Issue 1 , February 2016 , pp. 165 - 173
Copyright
Copyright © Society for Disaster Medicine and Public Health, Inc. 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Kayman, H, Salter, S, Mittal, M, et al. School closure decisions made by local health department officials during the 2009 h1n1 influenza outbreak. Disaster Med Public Health Prep. 2015;9:464-471.CrossRefGoogle ScholarPubMed
2. FEMA. Threat and Hazard Identification and Risk Assessment Guide. Comprehensive Preparedness Guide (CPG) 201. 2nd ed. http://www.fema.gov/media-library-data/8ca0a9e54dc8b037a55b402b2a269e94/CPG201_htirag_2nd_edition.pdf. Published August 23, 2013. Accessed February 23, 2015.Google Scholar
3. FEMA. National Disaster Recovery Framework Strengthening Disaster Recovery for the Nation. http://www.fema.gov/media-library-data/20130726-1820-25045-5325/508_ndrf.pdf. Published September 2011. Accessed February 24, 2015.Google Scholar
4. National Preparedness. FEMA website. https://www.fema.gov/national-preparedness. Last updated February 6, 2015. Accessed February 24, 2015.Google Scholar
5. Association of State and Territorial Health Officials. Public Health Emergency Preparedness Six Years of achievement. http://cdm266901.cdmhost.com/cdm/singleitem/collection/p266901coll4/id/1749. Published 2008. Accessed March 27, 2013.Google Scholar
6. Novation. Emergency Disaster Plan Template. https://www.novationco.com/media/safety/DisasterPrepPlanTemplate.doc. Accessed May 20, 2014.Google Scholar
7. Kahneman, D. Thinking, Fast and Slow. New York: Farrar, Straus and Giroux; 2011.Google Scholar
8. Khatri, N, Alvin, H. The role of intuition in strategic decision making. Hum Relat. 2000;53:57-86.CrossRefGoogle Scholar
9. Tversky, A, Kahneman, D. Judgment under uncertainty: heuristics and biases. Science. 1974;185:1124-1131.CrossRefGoogle ScholarPubMed
10. Gigerenzer, G, Gaissmaier, W. Heuristic decision making. Annu Rev Psychol. 2011;62:451-482.CrossRefGoogle ScholarPubMed
11. Kahneman, D, Klein, G. Conditions for intuitive expertise: a failure to disagree. Am Psychol. 2009;64:515-526.CrossRefGoogle ScholarPubMed
12. California Department of Public Health. Prioritizing Populations for Pandemic Influenza Vaccine in California. http://www.cdph.ca.gov/HealthInfo/discond/Documents/CDPH%20Interim%20Guidance-Prioritizing%20Populations%20for%20Pandemic%20Influenza%20Vaccine%20in%20California.pdf. Published August 2013. Accessed March 9, 2014.Google Scholar
13. White, D, Katz, M, Luce, J, Lo, B. Who should receive life support during a public health emergency? Using ethical principles to improve allocation decisions. Ann Intern Med. 2009;150:132-138.CrossRefGoogle ScholarPubMed
14. Singer, P, Martin, DK, Giacomini, M, Purdy, L. Priority setting for new technologies in medicine: qualitative case study. BMJ. 2000;321:1316-1318.CrossRefGoogle Scholar
15. Mbah, M, Gilligan, C. Resource Allocation for Epidemic Control in Metapopulations. PLoS One. 2011;6(9):e24577. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3172228.CrossRefGoogle Scholar
16. Barnett, DJ, Taylor, HA, Hodge, JG, et al. Resource allocation on the frontlines of public health preparedness and response: report of a summit on legal and ethical issues. Public Health Rep. 2009;124:295-303.CrossRefGoogle ScholarPubMed
17. Docter, P. Inside Out [DVD]. Walt Disney Pictures, distributor. Emeryville, CA: Studio Pixar Animation Studios; 2015.Google Scholar
18. California Emergency Medical Services Authority. Hospital Incident Command System Guidebook. CA.gov website. http://www.emsa.ca.gov/HICS/default.asp. Published August 2006. Accessed April 28, 2013.Google Scholar
19. Homeland Security. National Preparedness Report 2012. Homeland Security. 2012.Google Scholar
20. Association of Schools and Programs of Public Health. Public health preparedness and response core competency model. http://www.asph.org/document.cfm?page=1081. Version current December 17, 2010. Accessed October 28, 2013.Google Scholar
21. Centers for Disease Control and Prevention. Public health preparedness capabilities: national standards for state and local planning. CDC website. http://www.cdc.gov/phpr/capabilities. Last updated August 25, 2015. Accessed October 28, 2013.Google Scholar
22. Guidelines for field triage of injured patients: recommendations of the National Expert Panel on Field Triage, 2011. MMWR Recomm Rep. 2012;61(RR01):1-21.Google Scholar
23. Tversky, A, Kahneman, D. Rational choice and the framing of decisions. J Bus. 1986;59:S251-S278.CrossRefGoogle Scholar
24. Simon, HA. Behavioral model of rational choice. Q J Econ. 1955;69:99-118.CrossRefGoogle Scholar
25. FEMA. IS-241.B: Decision Making and Problem Solving. Student Manual, 1–134. FEMA website. http://training.fema.gov/is/courseoverview.aspx?code=is-241.b. Published March 31, 2014. Accessed August 11, 2015.Google Scholar
26. Hogarth, RM. Intuition: a challenge for psychological research on decision making. Psychol Inq. 2010;21:338-353.CrossRefGoogle Scholar
27. Haidt, J. The emotional dog and its rational tail: a social intuitionist approach to moral judgment. Psychol Rev. 2001;108:814-834.CrossRefGoogle ScholarPubMed
28. Graham, J, Haidt, J, Koleva, S, et al. Moral foundations theory: the pragmatic validity of moral pluralism. Adv Exp Soc Psychol. 2012;64:55-130.Google Scholar
29. Weaver, S, Rosen, M, Diaz Granados, D. Does teamwork improve performance in the operating room? A multilevel evaluation. Jt Comm J Qual Patient Saf. 2010;36:133-142.Google ScholarPubMed
30. King, H, Battles, J, Baker, D. TeamSTEPPSTM: Team Strategies and Tools to Enhance Performance and Patient Safety. NCBI webSite. http://www.ncbi.nlm.nih.gov/books/NBK43686/. Accessed August 12, 2015.Google Scholar
31. Briese, GL. Crew Resource Management: A Positive Change for the Fire Service. International Association of Fire Chiefs website. http://www.iafc.org/files/1SAFEhealthSHS/pubs_CRMmanual.pdf. Published August 2002. Accessed April 3, 2013.Google Scholar
32. Schwenk, CR. Cognitive simplification processes in strategic decision-making: insights from behavioral decision theory and cognitive psychology. Strateg Manage J. 1984;5:111-120.CrossRefGoogle Scholar
33. Connolly, T, Reb, J. Omission bias in vaccination decisions: Where’s the ‘omission’? Where’s the ‘bias’? Organ Behav Hum Decis Process. 2003;91:186-202.CrossRefGoogle Scholar
34. Jacob, P, Dupoux, E. Universal moral grammar: a critical appraisal. Trends Cogn Sci (Regul Ed). 2007;11:373-378.Google Scholar
35. Moralfoundations.org. Website. http://www.moralfoundations.org. Accessed February 24, 2015.Google Scholar
36. Centers for Disease Control and Prevention. CDC Influenza Pandemic Operation Plan (OPLAN). Washington, DC: US Department of Health and Human Services; 2006.Google Scholar
37. Department of Homeland Security, Federal Emergency Management Agency. National Preparedness Report. http://www.fema.gov/media-library-data/20130726-1833-25045-2705/national_preparedness_report_20120330_v2_1.pdf. Published March 30, 2012. Accessed April 17, 2013.Google Scholar
38. Drazen, JM, Campion, EW, Robin, EJ, et al. Ebola in West Africa at one year — from ignorance to fear to roadblocks. N Engl J Med. 2015;372:263-264.CrossRefGoogle ScholarPubMed
39. Gonsalves, G, Staley, P. Panic, caranoia, and public health—the AIDS epidemic’s lessons for Ebola. N Engl J Med. 2014;371:2348-2349.CrossRefGoogle ScholarPubMed
40. US Government Accountability Office. Influenza Pandemic: Lessons from the H1N1 Pandemic Should Be Incorporated into Future Planning. GAO website. http://www.gao.gov/products/GAO-11-632. Published June 27, 2011. Accessed April 4, 2013.Google Scholar
41. Kinlaw, K, Levine, R, Barret, D. Ethical guidelines in pandemic influenza: recommendations of the Ethics Subcommittee of the Advisory Committee to the Director, Centers for Disease Control and Prevention. Disaster Med Public Health Prep. 2009;3(suppl 2):S185-S192.CrossRefGoogle Scholar
42. Kass, NE, Otto, J, O’Brien, D, et al. Ethics and severe pandemic influenza: maintaining essential functions through a fair and considered response. Biosecurity Bioterrorism Biodefense Strategy Practice Science. 2008;6(3):227-236.CrossRefGoogle ScholarPubMed
43. Vawter, DE, Garrett, JE, Gervais, KG, et al. Dueling Ethical Frameworks for Allocating Health Resources. Am J Bioeth. 2010;10(4):54-56.CrossRefGoogle ScholarPubMed
44. California OES. Meeting the Needs of Vulnerable People in Times of Disaster: A Guide for Emergency Managers. http://www.caloes.ca.gov/AccessFunctionalNeedsSite/Documents/Vulnerable%20Populations.pdf. Published May 2000. Accessed October 25, 2012.Google Scholar
45. Thompson, AK, Faith, K, Upshur, RE, et al. Pandemic influenza preparedness: an ethical framework to guide decision-making. BMC Med Ethic. 2006;7:12. doi:10.1186/1472-6939-7-12.CrossRefGoogle ScholarPubMed
46. LA County Department of Public Health. How prepared are Los Angeles County residents for an emergency? http://publichealth.lacounty.gov/wwwfiles/ph/hae/ha/EmergencyPreparedness05.pdf. Published May 2007. Accessed March 27, 2013.Google Scholar
47. Cauchemez, S, Ferguson, NM, Wachtel, C, et al. Closure of schools during an influenza pandemic. Lancet Infect Dis. 2009;9:473-481.CrossRefGoogle ScholarPubMed
48. Driver, J. The history of Utilitarianism. The Stanford Encyclopedia of Philosophy website. http://plato.stanford.edu/archives/sum2009/entries/utilitarianism-history/. Published March 27, 2009. Accessed June 18, 2014.Google Scholar
49. Forest Service. The Greatest Good. A Forest Service Centennial Film. http://www.fs.fed.us/greatestgood/press/mediakit/facts/pinchot.shtml. Accessed June 18, 2014.Google Scholar
50. Center for Infectious Disease Research and Policy. K-12 School Closure Guidance. CIDRAP website. http://www.cidrap.umn.edu/practice/k-12-school-closure-guidance-az. Published May 4, 2009. Accessed July 7, 2013.Google Scholar
51. Noble, D, Letsky, M. Cognitive-based metrics to evaluate collaboration effectiveness. Paper presented at: RTO SAS Symposium Analysis of the Military Effectiveness of Future C2 Concepts and Systems; April 23-25, 2002; The Hague, The Netherlands. http://www.au.af.mil/au/awc/awcgate/navy/onr_metrics_on_collab.pdf. Accessed October 30, 2013.Google Scholar
52. Kapucu, N, Garayev, V. Collaborative decision-making in emergency and disaster management. Int J Public Adm. 2011;34:366-375.CrossRefGoogle Scholar
53. Van den Bossche, P, Gijselaers, W, Segers, M, et al. Team learning: building shared mental models. Instr Sci. 2011;39:283-301.CrossRefGoogle Scholar
54. Childress, JF, Faden, R, Gaare, R, et al. Public health ethics: mapping the terrain. J Law Med Ethics. 2002;30:170-178.CrossRefGoogle ScholarPubMed
55. Levin, D, Cadigan, RO, Biddinger, PD, et al. Altered standards of care during an influenza pandemic: identifying ethical, legal, and practical principles to guide decision making. Disaster Med Public Health Prep. 2009;3(suppl 2):S132-S140.CrossRefGoogle ScholarPubMed
56. Daniels, N. Accountability for reasonableness. BMJ. 2000;321:1300-1301.CrossRefGoogle ScholarPubMed
57. Manuell, M, Co, M, Ellison, R. Pandemic influenza: implications for preparation and delivery of critical care services. J Intensive Care Med. 2011;26:347-367.CrossRefGoogle ScholarPubMed
58. Bourne, L, Yaroush, R. Stress and cognition: a cognitive psychological perspective. NASA/CR—2003–212282. http://ntrs.nasa.gov/archive/nasa/casi.ntrs.nasa.gov/20040034070.pdf. Published September 2003. Accessed October 15, 2015.Google Scholar
59. McCauley, M, Minsky, S, Viswanath, K. The H1N1 pandemic: media frames, stigmatization and coping. BMC Public Health. 2013;13:1116-1132.CrossRefGoogle ScholarPubMed
60. Riley, W, Bowen, P, Scullard, M, et al. Methodologies to Study and Improve Team Performance, Decision-Making and Training in a Department Operations Center. http://www.academyhealth.org/files/phsr/3-Bowen.pdf. Published 2012. Accessed January 29, 2013.Google Scholar
61. Riley, W. Moving Beyond HSEEP. Improving Team Performance Instructor Manual Focus on Team Function and Communications To Create High Reliability Teams For Public Health Preparedness Instructor Manual. St. Paul, MN: Minnesota Department of Health & University of Minnesota School of Public Health; 2012.Google Scholar
62. Boyd, J. The OODA or Boyd Loop in performance, learning, leadership, & knowledge. http://www.nwlink.com/~donclark/leadership/ooda.html. Accessed November 8, 2012.Google Scholar
63. Angerman, WS. Coming Full Circle With Boyd’s Ooda Loop Ideas: An Analysis of Innovative Diffusion and Evolution [thesis]. Wright-Patterson Air Force Base, OH: Air Force Institute of Technology; 2004. http://www.dtic.mil/dtic/tr/fulltext/u2/a425228.pdf. Accessed April 18, 2013.Google Scholar
64. Klein, G, Snowden, D, Pin, CL. Anticipatory thinking. In Mosier KL, Fischer UM, eds. Informed by Knowledge: Expert Performance in Complex Situations. New York: Psychology Press; 2011:235-245.Google Scholar
65. Dalkey, N. The Delphi Method: An Experimental Study of Group Opinion. RM-5888-PR. http://www.rand.org/content/dam/rand/pubs/research_memoranda/2005/RM5888.pdf. Published June 1969. Accessed April 18, 2013.Google Scholar
66. Jeste, DV, et al. Expert consensus on characteristics of wisdom: a Delphi Method study. Gerontologist. 2010;50:668-680.CrossRefGoogle Scholar
67. Manketlow, J. The Mind Tool Guide to Group Decision Making. https://ejerciciosmentales.files.wordpress.com/2010/08/groupdecisionmakingguide1.pdf. Published 2009. Accessed April 18, 2013.Google Scholar
68. Gosenheimer, C, Rust, B, Thayer-Hart, N. Project Prioritization: A Structured Approach To Working On What Matters Most. http://oqi.wisc.edu/resourcelibrary/uploads/resources/Project_Prioritization_Guide_v_1.pdf. Published 2012. Accessed May 24, 2014.Google Scholar
69. Dalal, S, Khodyakov, D, Srinivasan, R, et al. ExpertLens: a system for eliciting opinions from a large pool of non-collocated experts with diverse knowledge. Technol Forecast Soc Change. 2011;78:1426-1444.CrossRefGoogle Scholar
70. AHRQ. Pocket Guide: TeamSTEPPS. Strategies & Tools to Enhance Performance and Patient Safety. Agency for Healthcare Research and Quality website. http://www.ahrq.gov/professionals/education/curriculum-tools/teamstepps/instructor/essentials/pocketguide.html#contents. Revised December 2013. Accessed June 3, 2014.Google Scholar
71. Olson, D. Multi-attribute utility theory. cbafiles.unl.edu/public/cbainternal/facStaffUploads/mcdm.PPT. Published May 15, 1996. Accessed October 22, 2015.Google Scholar
72. MAUT. Multiattribute utility theory: concepts, application, examples [slide presentation]. cbafiles.unl.edu/public/cbainternal/facstaffuploads/mcdm.ppt. Accessed February 25, 2015.Google Scholar
73. Bahill, T. The Decision Analysis and Resolution Process. http://www.sie.arizona.edu/sysengr/slides. Accessed January 9, 2013.Google Scholar