Addressing the current homeland security challenges requires scholars, practitioners, elected officials, and community partners working in unison to mitigate the hazards confronting first responders. Built on public choice theory, this research addressed a specific component of the emergency preparedness matrix: the most preferred fire service organizational design. The fire department organizational designs in this study included a Florida county, city, and independent special control fire district (ISFCD) that serve residents on a full-time platform. The concurrent embedded methodology used attempted to unearth which organizational design achieves economies of scale based on quarterly emergency service calls: the centralized county model or the decentralized city/ISFCD models. This study was an inquiry into the centralization versus decentralization argument, with emphases on fire service scale economies and inter-local service agreements Using multiple linear regression modeling accompanied by face-to-face interviews with the respective fire chiefs, this research showed that the county and ISFCD achieve scale economies over 44 quarters, fiscal years 2004-2014. Moreover, the interviews uncovered that response times were the driving factor behind instituting voluntary inter-local service agreements between the three fire departments. Other positive benefits from the service agreements include an increase in personnel and scene safety, dispatch center protocol enhancements, multi-company/jurisdictional training, overtime savings on large-scale disaster incidents, and trust building. The implications of this research for the scholarly and practitioner community include a better understanding of the technical and allocative efficiencies within the fire service arena. Melding public choice theory with strands of inter-local service agreement literature provides policymakers and scholars with a template for uncovering the fire service production/provision narrative. Though the centralization-decentralization argument is not solved within the research scope presented, the future narrative as uncovered in the research requires a citizenry inclusion. The future public choice prescriptions regarding fire service consolidation requires not only statistical modeling, but a normative democratic ethos tone incorporating multiple stakeholders with the citizens’ concerns at the forefront. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2016. / FAU Electronic Theses and Dissertations Collection

With increased advances in technology, the overall survival rates in the Neonatal Intensive Care Unit (NICU) for premature infants at lower gestational ages, has also increased. Although premature infants survive at lower gestational ages, they are often discharged to home with unresolved medical issues. While the birth of a new baby for parents is a joyous occasion, they often have difficulty coping and transitioning into a parental role. Premature infants also have ongoing complications such as difficulty with feeding, developmental delays in growth, and long-term eye and respiratory complications. As a result of chronic health sequelae, premature infants require extensive utilization of hospital and community health resources. In addition, hospitals must coordinate between community resources, while preparing parents for specialized discharge teaching. Furthermore, individuals living in rural and underserved areas face unique challenges and barriers to access healthcare resources. An interpretive phenomenology study was conducted to bring insight and develop an understanding into how families perceive discharge readiness, accessing health care resources, and ability to cope at home after discharge from a Level III NICU located in Appalachia. Ten parents total were enrolled in the study and consisted of three couples, three married mothers, and two single mothers. Interviews were conducted over a period of six months and transcript analysis revealed development of major and minor themes. The studies overarching theme was Adapting to a New Family Roles, Finding Normalcy, which described parents experience of being prepared for discharge and their transition to home. Three major themes related to discharge readiness from detailed analysis included; 1) Riding out the storm, 2) Righting the ship, and 3) Safe port, finding solid ground. Subthemes that supported development of the major these were 1a) having the carpet pulled out from under me, 1b) things I lost, 1c) feel like an outsider, 1d) sink or swim, 2a) quest for knowledge, 2b) caring for me, care for my baby, 2c) customized learning, 3a) getting to know baby, 3b) becoming the expert, 3c) ongoing emotions, and 3d) adjusted parental role. Practice and research implications for discharge readiness include providing customized support for parents as they adjust to a new normal for their family, identify necessary resources, and become self-reliant once home.

Mortgage loan debt is prevalent among middle-aged and older Americans. With higher average outstanding balances, many people are unlikely to pay off their mortgage debt by retirement. Meanwhile, as people age, health shocks are more likely to occur. Medical expenses may compete with mortgage payments and relate to financial insecurity in later years. In order to alleviate financial strain during times of financial hardship, senior homeowners may find reverse mortgage the solution they are looking for. Targeting American adults age 50 and older, this dissertation investigates mortgage loan debt and financial security using panel data from the Health and Retirement Study. Chapter 1 provides an overview of this dissertation and three studies. Chapter 2 investigates whether retirement preparedness plays a role in mortgage status at retirement, shown here as whether a person has mortgage debt and how much the remaining balance is (Waves 2004-2014). Chapter 3 examines health impact on likelihood of paying off mortgage loans under different health conditions, with estimates on expected time to mortgage payoff (Waves 2004-2014). Chapter 4 focuses on reverse mortgages and their impact on senior borrowers’ financial satisfaction and liquidity constraint (Waves 2010-2016). Chapter 5 summarizes major findings in three studies and highlights the contribution of this dissertation toward middle-aged and older Americans’ financial security. Limitations of three studies are discussed in Chapter 6. Three studies provide evidence on 1) the importance of preparedness on reduced mortgage burden; 2) adverse impact of health shock on likelihood of mortgage payoff; and 3) using reverse mortgages to reduce financial strain and increase financial satisfaction. Implications are addressed in each study.

Common diagnoses have greater emphasis in the Master of Social Work (MSW) Program, yet there is an oversight on other disorders that are just as important to address, such as Reactive Attachment Disorders (RAD). Although researchers have determined a need for additional training and education on RAD, none have measured MSW students’ level of knowledge on RAD and whether or not it influences their perceived preparedness. The purpose of this study was to analyze the perceived preparedness of MSW students to serve children with RAD before and after participating in an educational training. The study consisted of an explanatory quantitative design using pre/post self-administered surveys and an educational training on RAD. Findings determined that participating in the RAD Training significantly increased MSW students’ knowledge and perceived preparedness to serve children with RAD. The study’s findings may influence MSW administration to recognize the significance of implementing additional training on rare disorders.

Tornadoes are occurring with increased frequency in Oklahoma. Emergency preparedness planning is essential to decreasing individuals' risks of injury or death from a tornado. Research on immigrant Hispanics' knowledge and perceptions of emergency preparedness is limited. The purpose of this study was to explore the perceptions and lived experiences of immigrant Hispanics who had experienced a tornado or other crisis weather conditions in Oklahoma during spring of 2013. The research questions explored their perceived risk for injury and knowledge of tornado preparedness planning. The health belief model provided the theoretical underpinnings for this qualitative phenomenological study. Semi structured interviews were conducted with a purposeful sample of 10 immigrant individuals living in and around Oklahoma City, Oklahoma. Data were subjected to triangulation and analyzed to identify themes and patterns. Findings indicated that immigrant participants had experienced multiple tornadoes, routinely sought shelter during a tornado, and 50% had created a family emergency plan and supply kit because of their experience with tornadoes and perceived risk for injury. Identified barriers to preparedness planning were language barriers and lack of information on natural disaster preparedness. Recommendations included conducting public health outreach and establishing multidisciplinary partnerships within communities to provide cultural and linguistically appropriate disaster preparedness information to immigrant individuals. Findings provide public health practitioners with the ability to improve access and dissemination of preparedness planning information that may promote positive social change by decreasing immigrants' risk of injury and death.

The Military Police Corps' active shooter preparedness plan is inadequate because several updated tactics, techniques, and procedures that have been developed over the past 20 years and implemented by civilian law enforcement agencies have not been incorporated, leaving the Corps less prepared during active shooter events. The purpose of this phenomenological study was to examine how Military Police Corps leaders trained their law enforcement and support personnel to respond to an active shooter event. The institutional analysis and development framework was used to analyze the day-to-day operational decisions within the Military Police Corps. Data for the qualitative case study were collected through semi structured interviews with 15 Military Police Corps leaders and soldiers across 5 military police battalions in the United States and Europe and military police training records. These data were subjected to axial and open coding, followed by a thematic analysis procedure. Participants perceived that the Corps' active shooter preparedness training hours and methodology are insufficient to maintain proficiency in active shooter preparedness, that dispatchers are not properly trained on receiving active shooter calls, and that live exercise training for first responders is inadequate. Recommendations for Military Police Corps leadership include updating the training methodology for first responders and dispatchers, providing better tactical equipment for first responders, and revising policies in order to improve the Military Police Corps' active shooter preparedness program. Implementation of these recommendations may promote public safety.

Research has established that national homeland security policy requires a whole community or all-of-nation approach to national security preparedness. What is less clear is whether all stakeholders are integrated into or benefit from this collective effort. This narrative policy analysis examined the relationship between a federally-recognized group of Native American tribal nations and homeland security national preparedness to explore whether tribal nations are effectively integrated with the collective effort for national preparedness. The theoretical framework stemmed from a convergence of social contract theory and conflict theory. Interviews (n = 21) were conducted with preparedness authorities from government agencies, and from tribal nations and nongovernmental organizations that advocate on behalf of tribal nations. Data were analyzed using Roe's narrative policy analysis technique. Results revealed areas of convergence of the government and tribal narratives on the historical disenfranchisement of tribal nations; findings also showed areas of divergence on how to better integrate tribal nations in homeland security national preparedness. The study concludes with a number of recommendations highlighting the manner in which national interests and tribal nation preparedness interests are intertwined. This study suggests that the nation's homeland security may be better served by greater inclusion of tribal nations in national preparedness efforts. The results of this study contribute to positive social change by giving voice to a heretofore disenfranchised social group, Native Americans, and by allowing them to strengthen the metanarrative of homeland security national preparedness.

Recent events throughout the world and in the US lend support to the belief that another terrorist attack on the US is likely, perhaps probable. Given the potential for large numbers of casualties to be produced by a blast using conventional explosives, it is imperative that health systems across the nation consider the risks in their jurisdictions and take steps to better prepare for the possibility of an attack. Computer modeling and simulation offers a viable and useful methodology to better prepare an organization or system to respond to a large scale event. The real question, given the shortage, and in some areas absence, of experiential data, could computer modeling and simulation be used to predict the resource requirements generated by this type of event and thus prepare a health system in a defined geographic area for the possibility of an event of this nature? Research resulted in the identification of variables that surround a health system at risk, the development of a computer model to predict the injuries that would be seen in an injured survivor population and the medical resources required to care for this population. Finally, methodologies were developed to modify the existing model to match unique health system structures and processes in order to assess the preparedness of a specific geographic location or health system. As depicted in this research, computer modeling and simulation was found to offer a viable and usable methodology for a defined geographic region to better prepare for the potential of a large scale blast event and to care for the injured survivors that result from the blast. This can be done with relatively low cost and low tech approach using existing computer modeling and simulation software, making it affordable and viable for even the smallest geographic jurisdiction or health system.

Abstract Nurses constitute the largest group in the healthcare workforce and are called on to assist in emergencies such as disasters. Research has shown that professionals with higher levels of knowledge are more likely to respond to actual emergencies. Yet most hospital based nurses do not possess the skills needed for disaster response. The Basic Disaster Life Support (BDLS) course, with its comprehensive content, represents the gold standard for disaster education. Since confidence also plays a role in response, a tool to measure this variable could be useful. There were five purposes of this study: determine whether one teaching method (computer or classroom instructor-led) is superior over another for disaster education; evaluate how knowledge retention varies between instructional models; examine whether a correlation exists between self-efficacy and disaster knowledge; pilot a new instrument, Disaster Self-Efficacy Scale (DSES); complete psychometrics on the Basic Disaster Life Support exam. The study was an experimental pretest/posttest/follow-up with a single between-group factor (type of training with three levels) and three within-group factors measured at three intervals. The sample included 82 hospital-based nurses randomly assigned to a computer-based, instructor-led, or control group. A MANOVA and MANCOVA were conducted to evaluate group differences at three time intervals. Psychometric evaluation was conducted on both the BDLS and the piloted Disaster Self-Efficacy measures. The BDLS test was shown to be in need of revisions and updating. The DSES measure shows promise for determining disaster self-efficacy and may be useful to target training though it needs further validation. Learning results showed that when controlling for pretest differences, experimental groups had higher posttest BDLS and DSES scores than the control group but there was no difference between experimental groups. There was no difference between experimental groups for BDLS scores at follow-up. Conclusions were that training, regardless of how it was delivered, led to a dramatic increase in disaster knowledge and disaster self-efficacy; computer-based education is a feasible alternative to teaching BDLS; retention still poses a challenge for disaster education. Implications for nursing education and practice were identified. Future research should focus on further development and validation of the DSES and BDLS instruments.

Women’s wartime work is a well-known phenomenon in belligerent countries. But what happened in a neutral country like Sweden? With the outbreak of the Second World War, Sweden was put in a state of “national preparedness” that would last from September 1939 until the end of war in May 1945. From the autumn of 1939 the State Labour Market Commission (Statens arbetsmarknadskommission, SAK) had sent out signals to the employers’ associations in the engineering industry and at the ironworks that their male employees would not be granted exemptions from military service. Employers therefore had to find reserve workers, either men too old to be conscripted or women. The main purpose of this thesis is to explore how the threat of war affected the plans for and the use of women’s labour during the years of national preparedness. The national preparedness organisation did not include a plan ready for use to mobilise women either for work or for voluntary efforts for the nation during this period. The absence of a state plan for women’s national efforts became the point of departure for the Women's Organisations' Preparedness Committee, (Kvinnoföreningarnas beredskapskommitté, KBK) in 1938. The founding intention of this organisation was to gather Swedish women as a demonstration of their will to defend their country. A huge number of women – 800 000 – signed up for various tasks. This organisation was dominated by women who were eager to contribute to the national defence, and was not fully representative of the traditional women’s movement. With the passing of The National Compulsory Service Act (tjänstepliktslag) in December 1939 both men and women had become eligible for conscription. This was supposed to provide an instrument through which the government would be able to guarantee the supply of industrial labour. But the National Compulsory Service Act was never put into effect with regard to women. Instead, the governmental strategy to reach the female workforce was to establish a liaison between the state and the KBK. The Swedish way was the volunteer way. But this policy required propaganda. And so “Mrs. Loyal” made her entry in a state initiated propaganda newsreel on Swedish cinemas in January 1944. Mrs. Loyal was introduced as an example of “the national preparedness woman of today”. As a reserve worker in the engineering industry, she replaced a man who was called up for military service. The Mrs Loyal propaganda was aimed at married women whose children were grown up. The film presented the ideal situation where women registered for these courses voluntarily, to be fully trained if and when they were needed in industry. Towards the end of the war the SAK made inquiries to investigate the outcome of industrial employment during the war years. It then appeared that the Mrs Loyal-campaign had had an unexpected result. Few of the married housewives Mrs Loyal was supposed to attract had followed her example. In reality, it was a different group of women who took advantage of the opportunity. Young, unmarried women – daughters who still lived at home – saw an opening for them to leave home and earn their own livings. For these young women the preparedness situation and labour shortage actually became an opportunity for emancipation. How are we to understand the significance of the years 1939–1945 in terms of gender relations? The years of national preparedness in Sweden never became the opportunity for a broad range of women to leave their homes and become wage earners. In terms of gender contract, the housewife contract remained dominant. The traditional gender order never changed. The call for women workers was never a question of equal rights, just the temporary needs of the nation. But even if the changes were as superficial as the propaganda image, the need for women workers led to some changes. The question of equal pay was finally brought up on the political agenda with women’s entry in the engineering and ironworks industries. The conditions of labour shortage also placed a focus on other questions concerning the consequences of the protective labour legislation for women, like the prohibition against women’s night work and the question of women’s part-time work. The government had the opportunity to present new guidelines for women’s work at the end of the war. Instead a pattern was institutionalised that reinforced an image of women workers as a “latent labour reserve”. The propaganda picture of Mrs Loyal was forgotten, but in reality both married and unmarried women went on seeking solutions to the difficulties of combining wage work with children and housework.