title: Crisis Decision-Making During Hurricane Sandy: An Analysis of Established and Emergent Disaster Response Behaviors in the New York Metro Area.
abstract: This collective case study examined how and why specific organizational decision-making processes transpired at 2 large suburban county health departments in lower New York State during their response to Hurricane Sandy in 2012. The study also examined the relationships that the agencies developed with other emerging and established organizations within their respective health systems.
  
  
  
  In investigating these themes, the authors conducted in-depth, one-on-one interviews with 30 senior-level public health staff and first responders; reviewed documentation; and moderated 2 focus group discussions with 17 participants.
  
  
  
  Although a natural hazard such as a hurricane was not an unexpected event for these health departments, they nevertheless confronted a number of unforeseen challenges during the response phase: prolonged loss of power and fuel, limited situational awareness of the depth and breadth of the storm's impact among disaster-exposed populations, and coordination problems with a number of organizations that emerged in response to the disaster.
  
  
  
  Public health staff had few plans or protocols to guide them and often found themselves improvising and problem-solving with new organizations in the context of an overburdened health care system (Disaster Med Public Health Preparedness. 2016;10:436-442).
authors.affiliation: 1National Center for Disaster Preparedness,Earth Institute,Columbia University,New York,New York.
authors.forename: Thomas
authors.initials: T
authors.lastname: Chandler
authors.affiliation: 2NYU College of Global Public Health,NYU Medical Center Department of Population Health,New York,New York.
authors.forename: David M
authors.initials: DM
authors.lastname: Abramson
authors.affiliation: 1National Center for Disaster Preparedness,Earth Institute,Columbia University,New York,New York.
authors.forename: Benita
authors.initials: B
authors.lastname: Panigrahi
authors.affiliation: 1National Center for Disaster Preparedness,Earth Institute,Columbia University,New York,New York.
authors.forename: Jeff
authors.initials: J
authors.lastname: Schlegelmilch
authors.affiliation: 3Yale New Haven Health System Center for Healthcare Solutions,New Haven,Connecticut.
authors.forename: Noelle
authors.initials: N
authors.lastname: Frye
mesh_terms: D001364:Awareness; D055867:Cyclonic Storms; D003657:Decision Making; D004189:Disaster Planning / Q000379:methods / Q000592:standards*; D017144:Focus Groups; D006801:Humans; D009518:New York; D015279:Organizational Culture; D011635:Public Health Administration / Q000592:standards*; D036301:Qualitative Research
keywords: Hurricane Sandy; crisis decision-making; emergent behavior; leadership; public health