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The program has developed an extensive catalogue of case studies addressing crisis events. These cases serve as an important tool for classroom study, prompting readers to think about the challenges different types of crises pose for public safety officials, political leaders, and the affected communities at large.
The following cases, here organized into three broad categories, are available through the Harvard Kennedy School Case Program; fifteen cases can also be found in the textbook Managing Crises: Responses to Large-Scale Emergencies (Howitt and Leonard, with Giles, CQ Press). Click on a case title to read a detailed abstract and purchase the document.
Surviving the Surge: New York City Hospitals Respond to Superstorm Sandy
Exploring the experiences of three Manhattan-based hospitals during Superstorm Sandy in 2012, the case focuses on decisions made by each institution about whether to shelter-in-place or evacuate hundreds of medically fragile patients -- the former strategy running the risk of exposing individuals to dangerous and life-threatening conditions, the latter being an especially complex and difficult process, not without its own dangers. "Surviving the Surge" illustrates the very difficult trade-offs hospital administrators and local and state public health authorities grappled with as Sandy bore down on New York and vividly depicts the ramifications of these decisions, with the storm ultimately inflicting serious damage on Manhattan and across much of the surrounding region.
Ready in Advance: The City of Tuscaloosa’s Response to the 4/27/11 Tornado
On April 27, 2011, a massive and powerful tornado leveled 1/8 of the area of Tuscaloosa, AL. Doctrine called for the County Emergency Management Agency (EMA) to take the lead in organizing the response to the disaster – but one of the first buildings destroyed during the event housed the County EMA offices, leaving the agency completely incapacitated. Fortunately, the city had taken several steps in the preceding years to prepare for responding to a major disaster. This included having sent a delegation of 70 city officials and community leaders, led by Tuscaloosa Mayor Walter Maddox, to a week-long training organized by FEMA. “Ready in Advance” reveals how that training, along with other preparedness activities undertaken by the city, would pay major dividends in the aftermath of the tornado, as the mayor and his staff set forth to respond to one of the worst disasters in Tuscaloosa’s history.
The Deepwater Horizon Oil Spill: The Politics of Crisis Response (A and B)
Following the sinking of the Deepwater Horizon drilling rig in late April 2010, the Obama administration organized a massive response operation to contain the oil spreading across the Gulf of Mexico. Attracting intense public attention, the response adhered to the Oil Pollution Act of 1990, a federal law that the crisis would soon reveal was not well understood – or even accepted – by all relevant parties.
This two-part case series profiles how senior officials from the U.S. Department of Homeland Security sought to coordinate the actions of a myriad of actors, ranging from numerous federal partners; the political leadership of the affected Gulf States and sub-state jurisdictions; and the private sector. Case A overviews the disaster and early response; discusses the formation of a National Incident Command (NIC); and explores the NIC’s efforts to coordinate the actions of various federal entities. Case B focuses on the challenges the NIC encountered as it sought to engage with state and local actors – an effort that would grow increasingly complicated as the crisis deepened throughout the spring and summer of 2010.
The 2010 Chilean Mining Rescue (A and B)
On August 5, 2010, 700,000 tons of rock caved in Chile's San José mine. The collapse buried 33 miners at a depth almost twice the height of the Empire State Building-over 600 meters (2000 feet) below ground. Never had a recovery been attempted at such depths, let alone in the face of challenges like those posed by the San José mine: unstable terrain, rock so hard it defied ordinary drill bits, severely limited time, and the potentially immobilizing fear that plagued the buried miners. The case describes the ensuing efforts that drew the resources of countless people and multiple organizations in Chile and around the world.
The National Guard’s Response to the 2010 Pakistan Floods
Throughout the summer of 2010, Pakistan experienced severe flooding that overtook a large portion of the country, displacing millions of people, causing extensive physical damage, and resulting in significant economic losses. This case focuses on the role of the National Guard (and of the U.S. military, more broadly) in the international relief effort that unfolded alongside that of Pakistan’s government and military. In particular it highlights how various Guard and U.S. military assets that had been deployed to Afghanistan as part of the war there were reassigned to support the U.S.’s flood relief efforts in Pakistan, revealing the successes and challenges of transitioning from a war-footing to disaster response. In exploring how Guard leaders partnered with counterparts from other components of the U.S. government, Pakistani officials, and members of the international humanitarian community, the case also examines how they navigated a set of difficult civilian-military dynamics during a particularly tense period in US-Pakistan relations.
Inundation: The Slow-Moving Crisis of Pakistan’s 2010 Floods (A, B, and Epilogue)
In summer 2010, unusually intense monsoon rains in Pakistan triggered slow-moving floods that inundated a fifth of the country and displaced millions of people. This case describes how Pakistan’s Government responded to this disaster and highlights the performance of the country’s nascent emergency management agency, the National Disaster Management Authority, as well as the integration of international assistance.
"Operation Rollback Water": The National Guard’s Response to the 2009 North Dakota Floods (A, B, and Epilogue)
In spring 2009, North Dakota experienced some of the worst flooding in the state’s history. The state's National Guard responded by mobilizing thousands of its troops and working in concert with personnel and equipment from six other states. This case profiles the National Guard’s preparations for and response to the floods and focuses on coordination within the National Guard, between the National Guard and civilian government agencies, and between the National Guard and elected officials.
Typhoon Morakot Strikes Taiwan, 2009 (A, B, and C) (Forthcoming)
In less than four days, Typhoon Morakot dumped close to 118 inches of rain on Taiwan, flooding cities, towns, and villages; washing away roads and bridges; drowning farmland and animals; and triggering mudslides that buried entire villages. With the typhoon challenging its emergency response capacity, Taiwan’s government launched a major rescue and relief operation. But what began as a physical disaster soon became a political disaster for the President and Prime Minister, as bitter criticism came from citizens, the opposition party, and the President’s own supporters.
Getting Help to Victims of 2008 Cyclone Nargis: AmeriCares Engages with Myanmar's Military Government (Case and Epilogue)
In May 2008, Cyclone Nargis in Myanmar (Burma) left 138,373 dead or missing and 2.4 million survivors’ livelihoods in doubt, making it the country’s worst natural disaster and one of the deadliest cyclones ever. Friendly Asian countries as well as western governments which previously had used economic sanctions to isolate Myanmar’s military government now sought to provide aid to Myanmar’s people. But they met distrust and faced adversarial relationships from a suspicious government, reluctant to open its borders to outsiders.
China's Blizzards of 2008 (Forthcoming)
From January 10-February 6, a series of heavy snow storms intertwined with ice storms and subzero temperatures created China’s worst winter weather in 50 years. The storms closed airports and paralyzed trains and roads, damaged power grids and water supplies, caused massive black-outs, and left several cities in hard-hit areas isolated and threatened. The disruption of the power supply and transport also severely affected the production and flow of consumer goods and industrial materials, triggering a cascade of crisis nationwide. Coal reserves at power plants were nearly exhausted, production was significantly cut back at big factories, the chronic winter power shortage was exacerbated, and food prices spiked sharply in many areas because of shortages.
Thin on the Ground: Deploying Scarce Resources in the October 2007 Southern California Wildfires
When wildfires swept across Southern California in October 2007, firefighting resources were stretched dangerously thin. Readers are prompted to put themselves in the shoes of public safety authorities and consider how organizations can best address resource scarcities in advance of and during emergency situations.
"Broadmoor Lives:" A New Orleans Neighborhood’s Battle to Recover from Hurricane Katrina(A, B, and Sequel)
Stunned by a city planning committee’s proposal to give New Orleans neighborhoods hard-hit by Hurricane Katrina just four months to prove they were worth rebuilding, the Broadmoor community organized and implemented an all-volunteer redevelopment planning effort to bring their neighborhood back to life.
Gridlock in Texas (A and B) (Forthcoming)
As Hurricane Rita bore down on the Houston metro area in mid-September 2005, just a few weeks after Hurricane Katrina had devastated the Gulf Coast, millions of people flocked to the roadways. Part A details the massive gridlock that ensued, illustrating the challenges of implementing safe evacuations and of communicating effectively amidst great fear. Part B explores post-storm efforts to improve evacuation policies and procedures -- and how the resulting plans measured up in 2008, when the area was once again under threat, this time from Hurricane Ike.
Wal-Mart’s Response to Hurricane Katrina: Striving for a Public-Private Partnership(Case and Sequel)
This case explores Wal-Mart's efforts to provide relief in the immediate aftermath of Hurricane Katrina, raising important questions about government’s ability to take full advantage of private sector capabilities during large-scale emergencies.(Included in Howitt & Leonard, Managing Crises)
Moving People out of Danger: Special Needs Evacuations from Gulf Coast Hurricanes(A and B)
In the face of Hurricanes Katrina and Rita, officials in Louisiana and Texas grappled with the challenging task of evacuating people with medical and other special needs to safety. The shortcomings of those efforts sparked major initiatives to improve evacuation procedures for individuals requiring transportation assistance – plans that got a demanding test when Hurricanes Gustav and Ike threatened the Gulf Coast in the fall of 2008.
Hurricane Katrina: (A) Preparing for the Big One, and (B) Responding to an "Ulta-Catastrophe" in New Orleans
Exploring the failed response to Hurricane Katrina and its implications for the greater New Orleans area, the case begins with a review of pre-event planning and preparedness efforts. Part B details the largely ineffective governmental response to the rapidly escalating crisis. (Included in Howitt & Leonard, Managing Crises; Also available in abridged form.)
Rebuilding Aceh: Indonesia's BRR Spearheads Post-Tsunami Recovery (Case and Epilogue)
The December 26, 2004, Indian Ocean tsunami caused tremendous damage and suffering on several continents, with Indonesia's Aceh Province, located on the far northern tip of Sumatra Island, experiencing the very worst. In the tsunami's wake, the Indonesian government faced a daunting task of implementing a large-scale recovery effort, and to coordinate the many reconstruction projects that soon began to emerge across Aceh, Indonesia's president established a national-level, ad hoc agency, which came to be known by its acronym BRR. This case examines the challenges encountered by BRR's leadership as it sought to implement an effective recovery process.
When Imperatives Collide: The 2003 San Diego Firestorm(Case and Epilogue)
In October 2003, multiple wildfires burned across southern California. Focusing on the response to the fires, this case explores what can happen when an operational norm — to fight fires effectively but safely — collides with the political imperative to override established procedures to protect the public. (Included in Howitt & Leonard, Managing Crises)
"Almost a Worst Case Scenario:" The Baltimore Tunnel Fires of 2001 (A, B, and C)
When a train carrying hazardous materials derailed under downtown Baltimore, a stubborn underground fire severely challenged emergency responders. Readers are prompted to give particular attention to the significant challenges of managing a multi-organizational response. (Included in Howitt & Leonard, Managing Crises)
Safe But Annoyed: The Hurricane Floyd Evacuation in Florida
When far more citizens than necessary evacuated in advance of Hurricane Floyd, Florida’s roadways were quickly overloaded and emergency management operations overwhelmed. In detailing these (and other) problems, the case highlights the challenges of managing evacuations in advance of potentially catastrophic events.(Included in Howitt & Leonard, Managing Crises)
The US Forest Service and Transitional Fires
This case outlines the operational challenges of decision making in a high stress, high stakes situation – in this instance during rapidly evolving wildland fires, also known as "transitional fires."(Included in Howitt & Leonard, Managing Crises)
Defending the Homeland: The Massachusetts National Guard Responds to the 2013 Boston Marathon Bombings
On April 15, 2013, Dzhokhar and Tamerlan Tsarnaev placed and detonated two homemade bombs near the finish line of the Boston Marathon, killing three bystanders and injuring more than two hundred others. This case profiles the role the Massachusetts National Guard played in the complex, multi-agency response that unfolded in the minutes, hours, and days following the bombings, exploring how its soldiers and airmen helped support efforts on multiple fronts – from performing life-saving actions in the immediate aftermath of the attack to providing security on the region’s mass transit system and participating in the search for Dzhokhar Tsarnaev several days later. It also depicts how the Guard’s senior officers helped manage the overall response in partnership with their local, state, and federal counterparts. The case reveals both the emergent and centralized elements of the Guard’s efforts, explores the debate over whether or not Guard members should have been armed in the aftermath of the bombings, and highlights an array of unique assets and capabilities that the Guard was able to provide in support of the response.
Recovery in Aurora: The Public Schools' Response to the July 2012 Movie Theater Shooting (A and B)
In July 2012, a gunman entered a movie theater in Aurora, Colorado and opened fire, killing 12 people, injuring 58 others, and traumatizing a community. This two-part case briefly describes the shooting and emergency response but focuses primarily on the recovery process in the year that followed. In particular, it highlights the work of the Aurora Public Schools, which under the leadership of Superintendent John L. Barry, drew on years of emergency management training to play a substantial role in the response and then unveiled an expansive recovery plan. This included hiring a full-time disaster recovery coordinator, partnering with an array of community organizations, and holding mental health workshops and other events to support APS community members. The case also details the range of reactions that staff and community members had to APS' efforts, broader community-wide recovery efforts, and stakeholders' perspectives on the effectiveness of the recovery.
"Miracle on the Hudson" (A, B, and C)
Case A describes how in January 2009, shortly after takeoff from LaGuardia Airport, US Airways Flight 1549 lost all power when Canada geese sucked into its engines destroyed them. In less than four harrowing minutes, Flight 1549’s captain and first officer had to decide whether they could make an emergency landing at a nearby airport or find another alternative to get the plane down safely. Cases B and C describe how emergency responders from many agencies and private organizations on both sides of the Hudson River – converging on the scene without a prior action plan for this type of emergency – effectively rescued passengers and crew from the downed plane.
Security Planning for the 2004 Democratic National Convention in Boston (A, B, and Epilogue)
When the city of Boston applied to host the 2004 Democratic Party presidential nominating convention, it hoped to gain considerable prestige and significant economic benefits. But convention organizers and local officials were forced to grapple with a set of unanticipated planning challenges that arose in the aftermath of the 9/11 terrorist attacks. (Included in Howitt & Leonard, Managing Crises)
Command Performance: County Firefighters Take Charge of the 9/11 Pentagon Emergency
This case describes how the Arlington County Fire Department – utilizing the Incident Management System – took charge of the large influx of emergency workers who arrived to put out a massive fire and rescue people in the Pentagon following the September 11, 2001, suicide jetliner attack. (Included in Howitt & Leonard, Managing Crises)
Rudy Giuliani: The Man and His Moment
Although not long before the September 11, 2001 terrorist attacks, New York Mayor Rudolph Giuliani had been under fire for aspects of his mayoralty, the post 9/11 Giuliani won national and international acclaim as a leader. This case recounts the details of Giuliani’s response such that students of effective public leadership can analyze both Giuliani’s decisions and style as examples.
Threat of Terrorism: Weighing Public Safety in Seattle (Case and Epilogue)
When a terrorist was arrested in late December 1999 at the Canadian-Washington State border in a car laden with explosives, public safety officials worried that the city of Seattle had been a possible target. This case explores the debate that ensued concerning the seriousness of the threat and whether the city should proceed with its planned Millennium celebration. (Included in Howitt & Leonard, Managing Crises)
Protecting the WTO Ministerial Conference of 1999 (Case and Epilogue)
Two very different sets of actors made extensive preparations in advance of the World Trade Organization's Ministerial Conference of 1999 — protesters opposing international trade practices and public safety officials responsible for event security. This case examines the efforts of both, highlighting why security arrangements ultimately fell short. (Included in Howitt & Leonard, Managing Crises)
The Bonfire Collapse at Texas A&M University (A and B) (Forthcoming)
In one of the most significant tragedies in the history of American higher education, 12 students were killed and another 27 injured in the catastrophic 1999 collapse of the Texas A&M University Bonfire, a 90 year-old campus tradition. Thousands of rescue workers, university administrators, campus staff, students, alumni, and community volunteers worked non-stop to clear the bonfire site, provide medical attention to the victims, and address the concerns of grief-stricken families and friends. But how would the University handle the assessment of what went wrong and begin the healing process in the university community?
The Shootings at Columbine High School: Responding to a New Kind of Terrorism (Case and Epilogue)
Within minutes of the shootings at Columbine, numerous emergency response agencies – including law enforcement, fire fighters, emergency medical technicians, and others – dispatched personnel to the school site. Under intense media scrutiny and trying to coordinate their actions, they sought to determine whether the shooters were still active and rescue the injured.
To What End? Re-Thinking Terrorist Attack Exercises in San Jose (Case, Sequel 1, Sequel 2)
In the late 1990s, a task force in San Jose, CA mounted several full-scale terrorist attack exercises, but—despite the best of intentions—found all of them frustrating, demoralizing, and divisive. In response, San Jose drew on several existing prototypes to create a new “facilitated exercise” model that emphasized teaching over testing, and was much better received by first responders.
Security Preparations for the 1996 Centennial Olympic Games (A, B, and C)
This case describes efforts by state and federal government entities to plan in advance for security protection for the Atlanta Olympics. It also recounts the Centennial Park bombing and emergency response. (Included in Howitt & Leonard, Managing Crises)
Standoff in Waco – The Branch Davidians, the ATF, and the FBI(A, B, and Epilogue) (Forthcoming)
In February 1993, the federal Bureau of Alcohol, Tobacco, and Firearms (ATF) conducted a raid on Mt. Carmel, the home of an insular religious sect called the Branch Davidians located just outside of Waco, Texas. The operation devolved into a violent conflict that left four ATF agents and six Branch Davidians dead. The Federal Bureau of Investigation then took over the incident and spent two months trying to persuade the residents to leave Mt. Carmel. These discussions ended in April when the FBI attempted to force the Branch Davidians to vacate the structure by pumping tear gas into it. Unfortunately, a fire -- one that most believe the Branch Davidians started -- then began, causing the compound to burn down and 75 people to die. The case describes ATF’s decision making and planning for the initial raid as well as how the FBI managed the months-long siege that followed.
The Flawed Emergency Response to the 1992 Los Angeles Riots (A, B, and C)
Following the announcement of the not guilty verdicts for the law enforcement officers accused of beating Rodney King, the City of Los Angeles was quickly overrun by severe rioting. This case reviews how local, county, state, and federal agencies responded and coordinated their activities in an effort to restore order. (Included in Howitt & Leonard, Managing Crises)
Fears and Realities: Managing Ebola in Dallas (Case and Epilogue)
“Fears and Realities” describes how public health authorities in Dallas, TX - along with their counterparts at the state and local levels, elected officials, and hospital administrators - responded to the first case of Ebola identified on U.S. soil during the 2014 outbreak of the disease. The hugely difficult tasks of treating the patient and mounting a response was made all the more challenging by confusion over the patient's background and travel history, and, eventually, by the intense focus and considerable concern on the part of the media and public at large. Efforts to curtail the spread of the disease were further complicated when two nurses who had cared for the patient also tested positive for Ebola, even though they apparently had followed CDC protocols when interacting with him. With three confirmed cases of the disease in Dallas – each patient with their own network of contacts – authorities scrambled to understand what was happening and to figure out a way to bring the crisis to an end before more people were exposed to the highly virulent disease.
Confronting a Pandemic in a Home Rule State: The Indiana State Department of Health Responds to H1N1
When Indiana State Health Commissioner Dr. Judy Monroe learned of the emergence of H1N1 in late April 2009, she had to quickly figure out how to coordinate an effective response within a highly balkanized public health system in which more than 90 local health departments wielded considerable autonomy. She would rely heavily on relationships she had worked hard to establish with local health officials upon becoming commissioner -- but she and her senior advisors would still have to scramble to find new ways to communicate and coordinate with their local partners.
On the Frontlines of a Pandemic: Texas Responds to 2009 Novel H1N1 Influenza A
As cases of a new strain of influenza strike in the spring of 2009, Texas, just over the border from the initial epicenter of the epidemic in Mexico, faces great uncertainty about the severity and extent of the epidemic. State officials, presiding over a highly decentralized public health and health care system and needing to work with school systems and other non-health actors, strive to improvise their response to reduce the spread of this disease, while providing anti-viral drugs and, ultimately, a new vaccine to its citizens.
Tennessee Responds to the 2009 Novel H1N1 Influenza A Pandemic
Tennessee, not so severely struck by H1N1 in the spring of 2009 as some other states, expects to encounter worse in the fall. Working through a hybrid state- and local government-run health system, as well as a network of privately run pharmacies, Tennessee officials mobilize to cope with the expected demand for anti-viral medications and to distribute an expected new vaccine.
Harvard Encounters H1N1(Forthcoming)
In the spring of 2009, as the H1N1 epidemic was beginning to emerge, Harvard University’s medical, dental, and public health schools had to be shut down when a rash of cases and the possibility of widespread exposure emerged among the student body. The case tracks the decision-making by University officials as they cope with the uncertainties surrounding the outbreak of a potentially dangerous emergent infectious disease.
Beijing’s Response to the 2009 H1N1 Pandemic(Forthcoming)
In spring 2009, H1N1 emerged in North America and began to spread rapidly throughout the world. Municipal government officials in Beijing, China – who feared a repeat of their painful experience with SARS in 2003 – responded by conducting health screenings at the airport, quarantining people with flu-like symptoms, and scaling capacity at Beijing’s hospitals. The case describes Beijing’s expansive effort to combat H1N1 and is designed to teach students about Beijing’s government as well as China’s public health system.
Keeping an Open Mind in an Emergency: CDC Experiments with 'Team B' (Case and Epilogue)
In the early 2000s, the US Centers for Disease Control and Prevention (CDC) sought to adapt its protocols for coping with public health emergencies. This case examines the usefulness of one such method, "Team B," which was designed to provide the principal investigating team with alternative explanations for and approaches to the incident at hand. (Included in Howitt & Leonard, Managing Crises)
X-Treme Planning: Ohio Prepares for Pandemic Flu
With concern developing about the possibility of a worldwide pandemic of avian flu, the Ohio Department of Health developed plans for how it would handle such an emergency, while at the same time seeking to exercise its nascent incident management system and continue its efforts to develop as an emergency response agency.
Emergency Response System Under Duress: Public Health Doctors Fight to Contain SARS in Toronto (A, B, and Epilogue)
When an emergent infectious disease arrived in Toronto in 2003, the Canadian public health system struggled to bring it under control. This case explores the efforts of Canadian public health authorities to identify and understand the mysterious illness, which threatened the health — and lives — of Toronto’s residents and healthcare workers for months on end. (Included in Howitt & Leonard, Managing Crises)
Hong Kong Copes with SARS, 2003: The Amoy Gardens (Case and Epilogue)
In the last days of March 2003, the frightening new disease known as Severe Acute Respiratory Syndrome, or SARS, seemed to threaten to spread out of control in one of the world’s most densely-populated cities: Hong Kong. The SARS outbreak at Amoy Gardens became an exercise in crisis management for public health officials in Hong Kong—with their counterparts around the world either observing or actively advising.
When Prevention Can Kill: Minnesota and the Smallpox Vaccine Program (Case and Epilogue)
Following the 2001 terrorist attacks, President Bush launched a program to vaccinate health workers and emergency responders against smallpox. This case describes that effort, placing particular emphasis on the difficulties that emerged in making that program work in Minnesota.
Charting a Course in a Storm: US Postal Service and the Anthrax Crisis
This case describes how the USPS responded when it was struck by devastating anthrax attacks through the mails. It covers the initial response to protect employees, efforts to keep the mails moving to the greatest extent possible, and early steps toward decontamination of facilities and recovery. (Included in Howitt & Leonard, Managing Crises)
White Powders in Georgia: Responding to Cases of Suspected Anthrax After 9/11
Although no spore of real anthrax showed up in Georgia during the anthrax attack period, the state was inundated with thousands of calls about suspect white powders. The case describes efforts by local and state officials to develop appropriate procedures to triage and prioritize possible cases, conduct tests of possible anthrax, and protect and reassure worried first responders.
The West Nile Virus Outbreak in New York City (A, B, and Sequel)
Case A tells how in the summer of 1999 New York City public health officials discovered sentinel cases of a hitherto unknown disease and identified it with assistance from the state, CDC, veterinary pathologists at the Bronx Zoo, and university researchers. Case B and the Sequel describe how the city organized a massive mosquito spraying effort, first in a single borough and then citywide.
Anthrax Threats in Southern California
This case recounts how California officials responded (and over-responded) to an Anthrax hoax in late 1998, as well as how they then developed protocols of response and disseminated them to multiple jurisdictions.
Coping with Crisis: Hong Kong Public Health Officials and the "Bird Flu"
In 1997, public health authorities in Hong Kong worked to identify and control a dangerous new flu virus not previously known to infect humans. The case focuses on the authorities' communication with the public, as they sought to quell public fears notwithstanding their own incomplete knowledge of the disease. The case, too, describes the crisis management decision to undertake a massive slaughter of Hong Kong chickens, once they were shown to be the host of the deadly but difficult-to-transmit virus.
The City of Chicago and the 1995 Heat Wave (A and B)
During the summer of 1995, more than 700 people died of heat-related illness in Chicago, Illinois. With most deaths occurring before the city recognized that an “epidemic” was going on, this case explores the silent crisis that overtook the city.