The Challenge Of Mandatory Evacuation: Providing For And Deciding For

Behavioral Economic Consequences of Disasters: A Basis for Inclusion in Benefit–Cost Analysis

The purpose of this paper is to develop an analytical framework for estimating the behavioral effects of disasters and their economic consequences. The reduction of these losses represents the benefits of pre-disaster mitigation and post-disaster recovery. We provide conceptualizations, definitions, classifications, and a formal welfare analysis of this category of economic consequences. We also examine methods used to measure behavioral reactions to fear for insight into improving their delineation. Because we are interested in a comprehensive assessment of behavioral effects, we also include resilience adjustments and extend our initial partial equilibrium analysis to the general equilibrium level. The analysis is intended to serve as the basis for the legitimate inclusion of behavioral consequences of disasters in benefit-cost analysis.

"You get three different hats on and try to figure it out:" home based care provision during a disaster

BACKGROUND

Home based care is a vital, and growing, part of the health care system that allows individuals to remain in their homes while still receiving health care. During a disaster, when normal health care systems are disrupted, home based care remains a vital source of support for older adults. The purpose of this paper is to qualitatively understand the barriers and facilitators of both patients and providers that influence the provision of home based care activities in two hurricane affected communities.

METHODS

Using qualitative inquiry informed by the social ecological model, five focus groups were conducted with home based care providers (n = 25) in two settings affected by Hurricane Irma and Hurricane Harvey. An open-source database of home health agencies participating in Centers for Medicare and Medicaid Services programs was used to identify participants. Data were manually coded and larger themes were generated from recurring ideas and concepts using an abductive analysis approach.

RESULTS

Twenty five participants were included in one of five focus groups. Of the 22 who responded to the demographic survey, 65 % were registered nurses, 20 % were Licensed Vocational Nurses (LVN), and 15 % were other types of health care providers. 12 % of the sample was male and 88 % was female. Five themes were identified in the analysis: barriers to implementing preparedness plans, adaptability of home based care providers, disasters exacerbate inequalities, perceived unreliability of government and corporations, and the balance between caring for self and family and caring for patients.

CONCLUSIONS

This study provides qualitative evidence on the factors that influence home based care provision in disaster-affected communities, including the barriers and facilitators faced by both patients and providers in preparing for, responding to and recovering from a disaster. While home based care providers faced multiple challenges to providing care during and after a disaster, the importance of community supports and holistic models of care in the immediate period after the disaster were emphasized. We recommend greater inclusion of home health agencies in the community planning process. This study informs the growing body of evidence on the value of home based care in promoting safety and well-being for older adults during a disaster.

Radiation risks and uncertainties: a scoping review to support communication and informed decision-making

Although radiation protection is challenged by many uncertainties, there is no systematic study investigating the definitions and types of these uncertainties. To address this gap, in this paper we offer a scoping review to comprehensively analyse, for the first time, peer-reviewed scientific articles (n = 33) related to uncertainties in the following radiation exposure situations: nuclear emergencies, decommissioning of nuclear/radiological installations and long-term radiological exposure situations (e.g. naturally occurring radioactive materials). The results suggest that firstly, there is no agreement regarding definitions of uncertainty, which is mainly defined based on its sources, types or categories rather than by its meaning. Secondly, different actors are faced with different types of uncertainties. Uncertainties of the scientific community are mostly data and methodology-driven (e.g. dose-response relationships), those of the decision-makers are related to the likely consequences of decision options and public reactions, while laypeople's uncertainties are mainly related to the trustworthiness of experts or the emotional potential of specific risk exposures. Furthermore, the majority of articles focus on the uncertainties of the scientific community, while those of the information receivers (i.e. decision-makers and laypeople) receive much less consideration. Finally, there was no difference in types of uncertainties across the different risk-related study areas analysed (radiation versus other risks). Based on these findings, we provide some preliminary recommendations regarding research on uncertainty related to radiation protection, as well as communication practices.

Understanding the psychological nature and mechanisms of political trust

Political trust is a perennially important concern and the events of the last few years have, in many ways, heightened this importance. The relevant scholarship has done much to meet this challenge but continues to struggle with definitional unclarities and an inability to provide accounts that consistently operate as expected. The current research seeks to test the potential of a classic model of trust from the organizational sciences that makes specific arguments regarding the psychological nature and mechanisms of the construct in helping to address these concerns. Using data from a national convenience sample, we provide preliminary evidence which suggests that measures and models addressing this theoretical account of psychological trust form unidimensional and reliable measures that may more precisely explain the process of political trust and outperform current measures in predicting relevant correlates. We conclude by discussing the implications and limitations of our work and, in so doing, lay a foundation for a new research agenda for political trust.

Evacuations as a Result of Hurricane Sandy: Analysis of the 2014 New Jersey Behavioral Risk Factor Survey

OBJECTIVE

We characterized evacuations related to Hurricane Sandy, which made landfall in New Jersey on October 29, 2012.

METHODS

We analyzed data from the 2014 New Jersey Behavioral Risk Factor Survey. The proportion of respondents reporting evacuation was used to estimate the number of New Jersey adults who evacuated. We determined evacuation rates in heavily impacted and less-impacted municipalities, as well as evacuation rates for municipalities under and not under mandatory evacuation orders. We tested associations between demographic and health factors, such as certain chronic health conditions, and evacuation.

RESULTS

Among respondents, 12.7% (95% CI: 11.8%-13.6%) reported evacuating, corresponding to approximately 880,000 adults. In heavily impacted municipalities, 17.0% (95% CI: 15.2%-18.7%) evacuated, compared with 10.1% (95% CI: 9.0%-11.2%) in less-impacted municipalities. In municipalities under mandatory evacuation orders, 42.5% (95% CI: 35.1%-49.8%) evacuated, compared with 11.8% (95% CI: 10.9%-12.9%) in municipalities not under mandatory orders. Female gender (odds ratio [OR]: 1.36; 95% CI: 1.14-1.64), unmarried status (OR: 1.22; 95% CI: 1.02-1.46), shorter length of residence (OR: 1.28; 95% CI: 1.03-1.60), and living in a heavily impacted municipality (OR: 1.84; 95% CI: 1.54-2.20) were significantly associated with evacuation. History of stroke (OR: 1.61; 95% CI: 1.02-2.53) was the only chronic condition associated with evacuation.

CONCLUSIONS

Approximately 880,000 New Jersey adults evacuated because of Hurricane Sandy. Those in heavily impacted municipalities and municipalities under mandatory evacuation orders had higher evacuation rates; however, still fewer than half evacuated. These findings can be used for future disaster planning. (Disaster Med Public Health Preparedness. 2017;11:720-728).

Legal Preparedness for Hurricane Sandy: Authority to Order Hospital Evacuation or Shelter-in-Place in the Mid-Atlantic Region

Hospitals were once thought to be places of refuge during catastrophic hurricanes, but recent disasters such as Hurricanes Katrina and Sandy have demonstrated that some hospitals are unable to ensure the safety of patients and staff and the continuity of medical care at key times. The government has a duty to safeguard public health and a responsibility to ensure that appropriate protective action is taken when disasters threaten or impair the ability of hospitals to sustain essential services. The law can enable the government to fulfill this duty by providing necessary authority to order preventive or reactive responses--such as ordering evacuation of or sheltering-in-place in hospitals--when safety is imperiled. We systematically identified and analyzed state emergency preparedness laws that could have affected evacuation of and sheltering-in-place in hospitals in order to characterize the public health legal preparedness of 4 states (Delaware, Maryland, New Jersey, and New York) in the mid-Atlantic region during Hurricane Sandy in 2012. At that time, none of these 4 states had enacted statutes or regulations explicitly granting the government the authority to order hospitals to shelter-in-place. Whereas all 4 states had enacted laws explicitly enabling the government to order evacuation, the nature of this authority and the individuals empowered to execute it varied. We present empirical analyses intended to enhance public health legal preparedness and ensure these states and others are better able to respond to future natural disasters, which are predicted to be more severe and frequent as a result of climate change, as well as other hazards. States can further improve their readiness for catastrophic disasters by ensuring explicit statutory authority to order evacuation and to order sheltering-in-place, particularly of hospitals, where it does not currently exist.