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One of the major perils in 21st century is terrorism. The terrorism should be preventable but is quite scary challenge to the law enforcement and other public agencies. In particular, the health agencies are more worried about their ability to handle any dire situation of its occurrence. Among the terrorisms, the bioterrorism stands out as a nightmare to the agencies including the public health agencies. In spite of the necessities of being prepared to tackle any undesirable bio-terroristic event, the public health agencies in developing as much as in developed nations including the United States of America (USA) are worried and alert. With respect to displaying the alert level of 51 states in USA, the United States General Accounting Office (2003) prepared a report for the US Congressional Committee.
To make this report, the General Accounting Office sent a survey of relevant questions to 2,021 hospitals in 51 states (including Washington, DC) in USA. Only 73% of the hospitals responded with a pattern (See Figure 1). The response rate of the states ranged from 44% to 100% and it was higher in states with more hospitals. There was a state with one hospital to a state with 189 hospitals with an average of 40 hospitals per state in the nation. Unusually large number of hospitals existed in California, Florida, New York, Ohio, Pennsylvania and Texas. Interestingly, the response rates were higher in the states: Delaware, Idaho, Nebraska, Tennessee, Vermont and Wyoming while lower response rates occurred in states: Louisiana and Rhode Island. The random response rates were approximately normally distributed as indicated by the probability-plot (PP) in Figure 2. The configuration in Figure 2 hints that there are different groups of states in USA and it will be explored later in the article. Among the responded states, only 34 states in USA are prepared to deal with bioterrorism (See Figure 3 for their normally distributed trend). However, the frequency trend of the percent of hospitals in 34 states to deal effectively the emergency medical service (EMS) is not normally distributed with a lower percent in states California and Oregon.
Figure 1. Number of urban hospitals responded versus surveyed in 51 states in USA
Figure 2. The response rates by urban hospitals prepared to deal bioterrorism in USA
Key Terms in this Chapter
Risk-Neutral: A decision maker who is indifferent between taking a risk and definitely gaining the expected value of the risk.
Utility: It is a measurable consequence of a correct decision.
Regret: It is a measurable quantity of what might have happened if the decision is different from what it was.
Decision Analysis: ( DA ) Is the discipline comprising the philosophy, theory, methodology, and professional practice necessary to address important decisions in a formal manner.
Decision Maker: A single person or a collective unit of persons who have the responsibility to select a choice among the alternative options.
Sensitivity analysis: Is the study of how the uncertainty in the output of a mathematical model or system (numerical or otherwise) can be apportioned to different sources of uncertainty in its inputs. [
Value: The value is an indicator of priority and it can be quantitative or qualitative.
Security risk: Describes employing the concept of risk to the security risk management paradigm to make a particular determination of security orientated events.
Outcome: A noticeable feature of a unit.
Evaluation: Is a systematic determination of a subject's merit, worth and significance, using criteria governed by a set of standards. It can assist an organization to assess any aim, realisable concept or proposal, or any alternative, to help in decision-making; or to ascertain the degree of achievement or value in regard to the aim and objectives and results of any such action that has been completed.
Loss: It is the opposite of gaining a utility due to wrong decision.
Correlation: It is a measure of linear relation between two quantitative variables and . Note that .The positive (negative) correlation value means that and values increase or decrease together ( increases when decreases or vice versa).
Cost-Effectiveness Analysis (CEA): And analysis of alternative courses of action, the objective of which is to identify either the alternative that yields the maximum effectiveness achievable for a given amount of spending, or the alternative that minimizes the cost of achieving a stipulated level of effectiveness. CEA is generally used when it is not possible to measure benefits in dollar units.
Risk: It is the expected loss due to uncertain random outcomes. A state of uncertainty where some possible outcomes have an undesired effect or significant loss.
Risk Aversion: To avoid the gamble, the patient will accept less than the expected value of the gamble.
Expectation: A hypothetical average of an uncertain random variable, X whose potential possible values occur with a chance.
Model: Model is an abstraction of the reality.
Decision Tree: It is graphical illustration of sequence of actions which result in utility or loss.
Uncertainty: When a feature is not quite deterministic in its occurrence or absence, there could be an associated uncertain reason. The lack of certainty, a state of having limited knowledge where it is impossible to exactly describe the existing state, a future outcome, or more than one possible outcome.
Decision Analyst: A technical expert who can synthesize the complex information in data or statements and explain in simple understandable manner to a decision maker.
Group Decision Making: (Also known as collaborative decision making) is a situation faced when individuals collectively make a choice from the alternatives before them. This decision is no longer attributable to any single individual who is a member of the group.
Odds: It is the ratio of the chance of happening over the chance of not happening.
Decision Making: Decision making is a collective process of selecting an option over others based on a value system.