August 2003: Reflections on a French Summer Disaster. Why were its medical consequences so serious? Are we sure to do better next time?

Enhancing crisis leadership in public health emergencies

Reviews of public health emergency responses have identified a need for crisis leadership skills in health leaders, but these skills are not routinely taught in public health curricula. To develop criteria for crisis leadership in public health, published sources were reviewed to identify attributes of successful crisis leadership in aviation, public safety, military operations, and mining. These sources were abstracted to identify crisis leadership attributes associated with those disciplines and compare those attributes with crisis leadership challenges in public health. Based on this review, the following attributes are proposed for crisis leadership in public health: competence in public health science; decisiveness with flexibility; ability to maintain situational awareness and provide situational assessment; ability to coordinate diverse participants across very different disciplines; communication skills; and the ability to inspire trust. Of these attributes, only competence in public health science is currently a goal of public health education. Strategies to teach the other proposed attributes of crisis leadership will better prepare public health leaders to meet the challenges of public health crises.

Correlates of hot day air-conditioning use among middle-aged and older adults with chronic heart and lung diseases: the role of health beliefs and cues to action

Extreme ambient heat is a serious public health threat, especially for the elderly and persons with pre-existing health conditions. Although much of the excess mortality and morbidity associated with extreme heat is preventable, the adoption of effective preventive strategies is limited. The study reported here tested the predictive power of selected components of the Health Belief Model for air-conditioning (AC) use among 238 non-institutionalized middle-aged and older adults with chronic heart failure and/or chronic obstructive pulmonary disease living in Montréal, Canada. Respondents were recruited through clinics (response rate 71%) and interviews were conducted in their homes or by telephone. Results showed that 73% of participants reported having a home air conditioner. The average number of hours spent per 24-hour period in air-conditioned spaces during heat waves was 14.5 hours (SD = 9.4). Exploratory structural equation modeling showed that specific beliefs about the benefits of and drawbacks to AC as well as internal cues to action were predictive of its level of use, whereas the perceived severity of the effects of heat on health was not. The findings are discussed in light of the need to adequately support effective response to extreme heat in this vulnerable population.

Taking off the Heat: Narrative Sensemaking in Post-crisis Inquiry Reports

Crises represent moments when sensemaking fails. Official reports of post-crisis analyses re-establish patterns of sensemaking. Whereas scholars agree on the narrative basis of post-crisis sensemaking, the means by which meaning is recreated about the confusing events have not been fully investigated. To fill this gap, empirical data are drawn from the series of investigations that took place after the sudden and deadly heat wave that occurred in France during the summer of 2003. Introducing tools from narratology, this article analyses how these reports restore meaning by addressing the following questions: What happened? Was it foreseeable? and Who is responsible? The key narrative choices implied are mapped. A typology of crisis plots is proposed. Building on this typology, the article demonstrates that successive reports progressively built a focused, simplified story about the crisis. Methodological and practical implications for scholars and practitioners using inquiry reports for research and learning are also discussed.