Skip to main content Accessibility help

Building Evidence for Legal Decision Making in Real Time: Legal Triage in Public Health Emergencies

  • James G. Hodge, Timothy Lant, Jalayne Arias and Megan Jehn


Similar to the triaging of patients by health care workers, legal and public health professionals must prioritize and respond to issues of law and ethics in declared public health emergencies. As revealed by the 2009-2010 H1N1 influenza outbreak and other events, there are considerable inconsistencies among professionals regarding how to best approach these issues during a public health emergency. Our project explores these inconsistencies by attempting to assess how practitioners make legal and ethical decisions in real-time emergencies to further critical public health objectives. Using a fictitious scenario and interactive visualization environment, we observed real-time decision-making processes among knowledgeable participants. Although participants' decisions and perspectives varied, the exercise demonstrated an increase in the perception of the relevance of legal preparedness in multiple aspects of the decision-making process and some key lessons learned for consideration in future repetitions of the exercise and actual, real-time emergency events.

(Disaster Med Public Health Preparedness. 2011;5:S242-S251)


Corresponding author

Correspondence: Address correspondence and reprint requests to James G. Hodge Jr, Lincoln Professor of Health Law and Ethics, ASU Sandra Day O’Connor College of Law, Ross-Blakley Library, Room 318, PO Box 877906, Tempe, AZ 85287-79906 (e-mail:


Hide All
1.Hodge, JG, Anderson, ED.Principles and practice of legal triage during public health emergencies. NYU Ann Surv Am L. 2008;64:249291.
2.Hoffman, S, Goodman, RA, Stier, DD.Law, liability, and public health emergencies. Disaster Med Public Health Prep. 2009;3 (2):117125.
3.Rosenbaum, S, Harty, MB, Sheer, J.State laws extending comprehensive legal liability protections for professional health-care volunteers during public health emergencies. Public Health Rep. 2008;123 (2):238241.
4.Altered Standards of Care in Mass Casualty Events: Bioterrorism and Other Public Health Emergencies.Publ No. 05-0043. Rockville, MD: Agency for Healthcare Research and Quality; 2005.
5.Hodge, JG, Garcia, AM, Anderson, ED, Kaufman, T.Emergency legal preparedness for hospitals and health care personnel. Disaster Med Public Health Prep. 2009;3 2(Suppl)S37S44.
6.Anderson, ED, Hodge, JG.Emergency legal preparedness among select U.S. local governments. Disaster Med Public Health Prep. 2009;3 (S2):S1S9.
7.Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP): Legal and Regulatory Issues.Washington, DC: Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, Division of Healthcare Preparedness, ESAR-VHP Program; 2008:1-187.
8.Declaration of a National Emergency With Respect to the 2009 H1N1 Influenza Pandemic. Published October 24, 2009. Accessed March 9, 2011.
9.Governor Martin O’Malley Declares Public Health Emergency. Published May 1, 2009. Accessed March 9, 2011.
10.Bensimon, CM, Upshur, REG.Evidence and effectiveness in decisionmaking for quarantine. Am J Public Health. 2007;97(Suppl 1)S44S48.
11.Rychetnik, L, Hawe, P, Waters, E, Barratt, A, Frommer, M.A glossary for evidence based public health. J Epidemiol Community Health. 2004;58 (7):538545.
12.Upshur, REG, Colak, E.Evidence and argumentation. Theor Med Bioeth. 2003;24:283299.
13.Amendola, A.Recent paradigms for risk informed decision making. Saf Sci. 2001;40:1730.
14.Horlick-Jones, T.Meaning and contextualisation in risk assessment. Reliab Eng Syst Saf. 1998;59:7989.
15.Davis, P, Kulick, J, Egner, MImplications of Modern Decision Science for Military Decision-Support Systems.Santa Monica, CA: RAND Corporation; 2005.
16.Robbins, SP, Judge, TAOrganization Behavior.12th ed. Upper Saddle River, NJ: Pearson Prentice Hall; 2007:156-158.
17.Brehmer, B.Dynamic decision making: human control of complex systems. Acta Psychol (Amst). 1992;81 (3):211241.
18.Edwards, W.Dynamic decision theory and probabilistic information processing. Hum Factors. 1962;4:5973.
19.Rapoport, AResearch paradigms for the study of dynamic decision behavior.In: Wendt D, Viek C, eds. Utility, Probability, and Human Decision Making. Dordrecht, Germany: Reidel; 1975.
20.Sokolowski, JA, Banks, CMPrinciples of Modeling and Simulation.Hoboken, NJ: Wiley; 2009.
21.Homeland Security Exercise and Evaluation Program (HSEEP). HSEEP Overview and Exercise Program Management.Vol I. Washington, DC: Department of Homeland Security; 2007.
22.Centers for Law and the Public's Health. A Collaborative at Johns Hopkins and Georgetown Universities.The Model State Emergency Health Powers Act (MSEHPA). Published 2001. Accessed March 15, 2011.
23.Cohen, J.A coefficient of agreement for nominal scales. Educ Psychol Meas. 1960;20:3746.


Building Evidence for Legal Decision Making in Real Time: Legal Triage in Public Health Emergencies

  • James G. Hodge, Timothy Lant, Jalayne Arias and Megan Jehn


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed