title: School Closure Decisions Made by Local Health Department Officials During the 2009 H1N1 Influenza Outbreak.
abstract: OBJECTIVE
  The goal of this study was to gain insights into the decision-making processes used by California public health officials during real-time crises. The decision-making processes used by California public health officials during the 2009 H1N1 influenza pandemic were examined by a survey research team from the University of California Berkeley.
  
  
  METHODS
  The survey was administered to local public health officials in California. Guidelines published by the Centers for Disease Control and Prevention had recommended school closure, and local public health officials had to decide whether to follow these recommendations. Chi-squared tests were used to make comparisons in the descriptive statistics.
  
  
  RESULTS
  The response rate from local public health departments was 79%. A total of 73% of respondents were involved in the decision-making process. Respondents stated whether they used or did not use 15 ethical, logistical, and political preselected criteria. They expressed interest in receiving checklists and additional training in decision-making.
  
  
  CONCLUSIONS
  Public health decision-makers do not appear to have a standard process for crisis decision-making and would benefit from having an organized decision-making model. The survey showed that ethical, logistical, and political criteria were considered but were not prioritized in any meaningful way. A new decision-making tool kit for public health decision-makers plus implementation training is warranted.
authors.affiliation: 1Department of Epidemiology,University of California School of Public Health,Berkeley,California.
authors.forename: Harvey
authors.identifier: http://orcid.org/0000-0003-3922-2543
authors.initials: H
authors.lastname: Kayman
authors.affiliation: 2University of California Goldman School of Public Policy,Berkeley,California.
authors.forename: Sarah
authors.initials: S
authors.lastname: Salter
authors.affiliation: 3University of California,Berkeley,California.
authors.forename: Maanvi
authors.initials: M
authors.lastname: Mittal
authors.affiliation: 1Department of Epidemiology,University of California School of Public Health,Berkeley,California.
authors.forename: Winifred
authors.initials: W
authors.lastname: Scott
authors.affiliation: 3University of California,Berkeley,California.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Santos
authors.affiliation: 3University of California,Berkeley,California.
authors.forename: Diana
authors.initials: D
authors.lastname: Tran
authors.affiliation: 3University of California,Berkeley,California.
authors.forename: Ryan
authors.initials: R
authors.lastname: Ma
mesh_terms: D002140:California / Q000453:epidemiology; D003657:Decision Making; D004196:Disease Outbreaks / Q000517:prevention & control*; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000453:epidemiology / Q000628:therapy*; D011634:Public Health / Q000379:methods* / Q000592:standards; D012574:Schools / Q000592:standards*
keywords: Boyd (OODA) loop; decision-making; emergency responders; ethics; intuition; organizational