FIGURING OUT THE FIXING: UNDERSTANDING THE UNDERLYING PROCESSES FOR DESIGNING AND IMPLEMENTING CRISIS MEDICAL RELIEF EFFORTS by Samantha Penta A dissertation submitted to the Faculty of the University of Delaware in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Sociology Summer 2017 © 2017 Samantha Penta All Rights Reserved FIGURING OUT THE FIXING: UNDERSTANDING THE UNDERLYING PROCESSES FOR DESIGNING AND IMPLEMENTING CRISIS MEDICAL RELIEF EFFORTS by Samantha Penta Approved: __________________________________________________________ Karen Parker, Ph.D. Chair of the Department of Sociology and Criminal Justice Approved: __________________________________________________________ George Watson, Ph.D. Dean of the College of Arts & Sciences Approved: __________________________________________________________ Ann L. Ardis, Ph.D. Senior Vice Provost for Graduate and Professional Education I certify that I have read this dissertation and that in my opinion it meets the academic and professional standard required by the University as a dissertation for the degree of Doctor of Philosophy. Signed: __________________________________________________________ Tricia Wachtendorf, Ph.D. Professor in charge of dissertation I certify that I have read this dissertation and that in my opinion it meets the academic and professional standard required by the University as a dissertation for the degree of Doctor of Philosophy. Signed: __________________________________________________________ Barret Michalec, Ph.D. Member of dissertation committee I certify that I have read this dissertation and that in my opinion it meets the academic and professional standard required by the University as a dissertation for the degree of Doctor of Philosophy. Signed: __________________________________________________________ James Kendra, Ph.D. Member of dissertation committee I certify that I have read this dissertation and that in my opinion it meets the academic and professional standard required by the University as a dissertation for the degree of Doctor of Philosophy. Signed: __________________________________________________________ Eric Stern, Ph.D. Member of dissertation committee ACKNOWLEDGMENTS I have to extend a huge thank you to my dissertation committee: Tricia Wachtendorf, Barret Michalec, James Kendra, and Eric Stern for all of their support and feedback as I worked on my dissertation and throughout my graduate career. To Tricia, especially, I owe tremendous thanks. I am so glad I took your Disasters and Society course fall semester of my sophomore year. Thank you so much for everything you have done to guide me through three degrees over the last nine years. I could not have asked for a better mentor. Thank you to everyone at the Disaster Research Center as well, for helping me grow from a nineteen-year-old undergraduate student beginning my first research project, to the professional disaster researcher I am now as I leave the University of Delaware. During my undergraduate degree, I had the good fortune to find friends who have stayed with me over the last decade. Skyler, Alissa, and Meredith, you all have been such an incredible supportive and grounding force in my life. I have been so fortunate to be surrounded by wonderful graduate student colleagues, both in the Sociology and Criminal Justice Department and at DRC. Whether during classes, in the field on quick response deployments, during our work on research projects, or during weekly lunches, dinners, and coffee runs, I have learned so much from all of you. Of course, my deepest gratitude goes to my parents, Peter and Wavey, who have always supported me in everything I have done. Thank you all for encouraging me through my self-doubt, and celebrating with me during my accomplishments. It is a privilege to have you all in my life. iv TABLE OF CONTENTS LIST OF TABLES ......................................................................................................... x LIST OF FIGURES ....................................................................................................... xi ABSTRACT ................................................................................................................. xii Chapter 1 INTRODUCTION .............................................................................................. 1 2 LITERATURE REVIEW ................................................................................... 5 The Importance of Studying Disaster Medical Response .................................. 5 Convergence ..................................................................................................... 11 Decision-Making and Sensemaking (Figuring Out) ......................................... 12 Models and Theories .................................................................................. 12 Characteristics: Distributed Over Time, People, and Decisions/Processes .................................................................................... 17 Medical Decision-Making—Influencing Factors ............................................. 19 Characteristics of the Decision-Maker and Recipient ................................ 19 Characteristics of the Decision-Making Context ....................................... 21 Non-Medical Aspects of Relief ........................................................................ 23 3 METHODS ....................................................................................................... 29 Summary of Methodological Approach ........................................................... 29 Sampling ........................................................................................................... 30 Sampling: Extreme Events ......................................................................... 30 Events ......................................................................................................... 36 Ebola Epidemic .................................................................................... 36 Nepal Earthquake ................................................................................. 38 Sampling: Organizations ............................................................................ 43 Sampling: Individuals ................................................................................. 46 Data Collection ................................................................................................. 49 Interviews ................................................................................................... 49 Interview Sample ........................................................................................ 51 v Documents .................................................................................................. 52 Observation ................................................................................................. 53 Human Subjects Considerations ................................................................. 56 Analysis ............................................................................................................ 59 Overall Coding Summary ........................................................................... 59 Analyzing the “How” ................................................................................. 60 Analyzing the “Why” ................................................................................. 61 Additional Coding ...................................................................................... 63 4 CHARACTERISTICS OF THE DECISION-MAKING SETTING: CONDITIONS AFFECTING DECISIONMAKING AND THE RESPONSE ...................................................................................................... 64 Introduction ...................................................................................................... 64 Characteristics of the Decision-Making Context ............................................. 65 Characteristics of the Event ........................................................................ 65 Political, Legal, Social, and Cultural Context ............................................ 70 Physical Environment ................................................................................. 76 Resources .......................................................................................................... 81 Informational Resources ............................................................................. 81 Uncertainty ........................................................................................... 82 Personnel Resources ................................................................................... 87 Materiel Resources ..................................................................................... 95 Summary ........................................................................................................... 99 5 DEVELOPING SITUATIONAL AWARENESS .......................................... 102 Gathering and Communicating Information ............................................ 103 Previous Experience ........................................................................... 109 On the Ground Information and Sources ............................................ 113 Processing that Information (Assessing) .................................................. 115 Content ..................................................................................................... 116 Comparing .........................................................................................