To demonstrate how public health emergency systems can use health systems tools to analyze and learn from critical incidents, we employed a facilitated look-back approach to review the public response to a chemical spill in Charleston, West Virginia. We reviewed official reports, news articles, and other documents; conducted in-person interviews with key public health and emergency response officials and local community stakeholders; and organized a facilitated look-back meeting to identify root causes of the problems that were encountered. The primary response challenges were (1) public distrust stemming from scientific uncertainty about potential harms of chemicals involved in the spill and how this uncertainty was communicated and (2) communication within the public health system, broadly defined. We found that to address inherent uncertainty, health officials should acknowledge uncertainty and tell the public what is known and unknown, and what they are doing to get more information.
Program on Population Impact, Recovery, and Resilience, College of Global Public Health, New York University, New York, New York (Ms Piltch-Loeb); Emergency Preparedness Research Evaluation Practice Program, Division of Policy Translation and Leadership Development, Harvard T.H. Chan School of Public Health, Boston, Massachusetts (Ms Savoia); Kanawha-Charleston Health Department, Charleston, West Virginia (Ms Wright); Department of Health & Human Services' Bureau for Public Health and West Virginia State Health, Charleston, West Virginia (Dr Gupta); Health Systems Administration and Population Health, Georgetown University, Washington, District of Columbia (Dr Stoto); and Harvard T.H. Chan School of Public Health, Boston, Massachusetts (Dr Stoto).
Correspondence: Rachael Piltch-Loeb, MSPH, Program on Population Impact, Recovery, and Resilience, College of Global Public Health, New York University, 715 Broadway, 12th Floor, New York, NY 10003 (firstname.lastname@example.org).
The authors are grateful to the many individuals who gave their time to participate in the interviews and the facilitated look-back meeting on which this project depends so heavily. The authors acknowledge funding support from the US Centers for Disease Control and Prevention supplement to grant number 5PO1TP000307-05 Preparedness and Emergency Response Research Center—Linking Assessment to Measurement and Performance in Public Health Emergency Preparedness Exercises into Practice.
The authors declare no conflicts of interest.