Crisis Decision-Making on a Global Scale: Transition from Cognition to Collective Action under Threat of COVID-19.

This essay examines basic functions of crisis decision-making-cognition, communication, coordination, and control-in response to COVID-19. This crisis decision-making framework is applied to cases from South Korea, Italy, and the United States as public officials grapple with how to recognize, respond, and recover from this deadly, invisible threat. The authors acknowledge the harsh trade-off between the compelling need to limit transmission of the virus to protect public health and the consequent economic losses of halting social interaction. They draw implications from this crisis for better decision-making and investment in a global information infrastructure system to manage large-scale, multidisciplinary threats to the health, economy, and sustainability of the world's community of nations. The essay concludes that collective cognition, amplified by timely, valid communication and supported by sound planning, trained personnel, appropriate technology, and bold leadership, enables coordinated action needed to bring a large-scale global crisis under control. Evidence for Practice: Invest in information technology to manage systematic data collection, analysis, and modeling.Provide timely, informed updates on community status to constituents.Maintain a knowledge base of resources, vulnerabilities, and plans.

Operational Networks: Adaptation to Extreme Events in China.

Natural hazards pose an increasing challenge to public administrators, as the frequency, costs, and consequences of extreme events escalate in a complex, interdependent, world. This study examines organizational networks as instruments for mobilizing collective response to extreme events, but effective design has been elusive. Governments have focused on planned networks to anticipate risk before hazards occur; communities have formed emergent networks as voluntary efforts after the event. Using a framework of complex adaptive systems, we identify operational networks that adapt to their immediate context in real time, using technologies to support the search, exchange, and feedback of information to enable informed, collective action. Applying mixed research methods-documentary analysis of laws, policies, and procedures; content analysis of news articles; onsite observation; and semistructured interviews with experienced personnel-we document operational networks as a distinct form of multiorganizational response to urgent events that combines the structure of designated authority with the flexibility of information technologies. The integration of planned and emergent organizational forms into operational networks is measured through External/Internal (E/I) index analysis, based on empirical data collected on response systems that formed following the 2008 Wenchuan and 2013 Lushan earthquakes in the centralized administrative context of China. Findings show that planned networks provide the organizational structure and initial legitimacy essential for operational networks to form, but ready access to information technology-cell phones, short-wave radio systems, internet access-enables rapid communication and exchange of information essential for flexible adaptation in real time to meet urgent needs.

Using Bayesian influence diagrams to assess organizational performance in 4 California county health departments, April-July 2009.

A Bayesian influence diagram is used to analyze interactions among operational units of county health departments. This diagram, developed using Bayesian network analysis, represents a novel method of analyzing the internal performance of county health departments that were operating under the simultaneous constraints of budget cuts and increased demand for services during the H1N1 threat in California, April-July 2009. This analysis reveals the interactions among internal organizational units that degrade performance under stress or, conversely, enable a county health department to manage heavy demands effectively.

Epidemiologic assessment of mortality, building collapse pattern, and medical response after the 1992 earthquake in Turkey

Post-earthquake engineering and epidemiologic assessments are important for the developments of injury prevention strategies. This paper describes mortality and its relationship to building collapse patterns and initial medical response following the 1992 earthquake in Erzincan, Turkey. Results: there was extensive structural damage throughout the region, especially in the city where mid-rise, unreinforced masonry buildings (MUMB). official medical and search and rescue ocurred. Prior first-aid or rescue training of lay, uninjured survivors was associated with a higher likelihood of rescuing and resuscitating other (P<0.001) Conclusions: During an earthquake, MUMB with soft ground floor construction are highly lethal, especially for occupants on the ground floor, suggeesting that this building types is inappropriate for areas of seismic risk.

Disater reanimatology potentials : A structured interview study in Armenia. III. Results, conclusions, and recommendations

Nacional medical responses to catastrophic disasters have failed to incorporate a resuscitation component. Purpose: This study sought to determine the lifesaving potentials of modern resuscitation medicin as applied to a catastrophic disaster situation. Previous articles reported the preliminary results(I) and methodology (II)of a structured, retrospective interview study of the 1988 earthquake in Armenia.(III) reports and discuses the definitive findings formulates conclusions. Results: Observations include: 1)The lack of adequate construction materials and procedures in the Armenian region contributed significantly to injury and loss life 2) The uninjured lay population together with medical teams including physician in Armenia were capable of rapid response 3) Due to a lack of Advanced Trauma Life Support (ATLS) training for medical teams and of basic first-aid training of the lay public and scarcity of supplies and equipment for extrication of casualties, they were unable to do much at the scene. As a result, an undetermined nnumber of severely injured earthquake victims in Armenia died slowly without the benefit of appropriate and feasible resuscitation(AU)

Disaster reanimatology potentials : A structural interview study in Armenia

The study of a disaster which has accurred cannot using the traditional techniques as it is not possible to conceive or conduct controlled, randomized experiments for such an event. Paper I of this series described non-experimental, scientific methodologies which were applied to study the detection-extrication-resucitatioj activities which occurred following the devastating 1988 earthquake in the Republic of Armenia, USSR. This paper critically evaluates the methodologies used for the Armenia study and proposes modification in these methods for application to the study of future disasters.(AU)

Disaster reanimatology potentials : A structured interview study in Armenia : I. Methodology and preliminary results

In general preparations for disasters which result in mass casualties do not incorporate a modern resuscitation approach. WE explored the life-saving potencial of and time limits for life-supporting first aid (LSFA), advanced trauma life support (ATLS) resuscitative surgery, and prolonged life support, Following the earthquake in Armenia on 7 december 1988. We used a structured retrospective interview method applied previously to evaluation of emergency medical services (EMS) in the United States. A total of 120 survivors of and participants in the earthquake in Armenia were interviewed on site (49 lay eyewitnesses, 20 search-search-rescue personnel, 39 medical personnel and records and 12 administrators).

Disaster reanimatology potentials : A structural interview study in Armenia : I. Methodology and preliminary results

In general, preparations for disasters which results in mass casualties do not incorporate a modern resuscitation approach. We explored the life-saving potential of, and time limits for life-supporting first aid (LSFA), advanced trauma life support (ATLS), resuscitative surgey, and prolonged life support (PLS: intensive care) following the earthquake in Armenia on 7 December 1988. We used a structured, retrospective interview method applied previously to evaluation of emergency medical services (EMS) in the United States. A total of 120 survivors of, and participants in the earthquake in Armenia were interviewed on site (49 lay eyewitnesses, 20 search-rescue personnel, 39 medical personnel and records, and 12 administrators). Answers were verified by crosschecks.Preliminary results permit the following generalizations: 1)a significant nomber of victims died slowly as the result of iinjuries such as external hemorrhage, head injury with coma,shock, or crush sundrome; 2) early search and rescue was perfomed primarily by uninjured covictims using hand tools; 3) many livespotentially could have been saved by the use of LSFA and ATLS started during extrication of crushed victims. 4) medical teams from neighboring EMS systems started to arrive at the site at 2-3 hours and therefore, ATLS could have been provided in time to save lives and limbs; 5) some amputations had to be perfomed in the field to enable extrication; 6) the usefulness of other resuscitative surgery in the fieldneeds to be clarified; 7) evacuations were rapid; 8) air evacuation proved essential; 9) hospital intensive care was well organized; and 10)international medical aid, which arrived after 48 hours, was too late top impact on resuscitation. definitive analysis of data in the near future will lead to recommendations for local, regional, and National Disaster Medical Systems (NDMS).(AU)