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“Under a 1986 federal law titled the Emergency Medical Treatment and Labor Act (EMTALA), hospitals are required to treat people who come to the ED presenting with an emergency medical condition, defined as a condition that, without treatment, will likely lead to serious impairment or death. … EMTALA is one of the largest federal mandates to provide services to have gone unfunded (Friedman 2011); costs instead fall on states and local health care systems.” 481

“In bringing ethnographic attention to hot spotting as a technique of governance, we find that it provides lifesaving humanitarian interventions while operating within the racialized structures of violence that produce continual life crises. The institutional rationality of hotspotting and the encounters of care that it produces illustrate the often-contradictory role of medicine in the lives of poor people: both caring and coercive, it intertwines care and violence.” 475; “we conclude by suggesting that economic investment and return are becoming a reigning logic in the governance of poverty, generating hot spots as sites of interest for both policing and health care and decentering normative assessments of deviance, illness, and social problems” 476; “Neoliberal social assistance, as it is practiced in the health care safety net, is conceptualized as an “investment “in the population, as a strategic and targeted deployment of basic resources, one that promises to generate a return on investment for the state or health system in the form of cost savings.“ 485

 The authors examine the practice of “hot spotting,” a form of surveillance and intervention through which health care systems in the US intensively direct health and social services towards high-cost patients.  Health care hot spotting is seen as a way to improve population health while also reducing financial expenditures on healthcare for impoverished people. The authors argue that argue that ultimately hot spotting targets zones of racialized urban poverty—the same neighborhoods and individuals that have long been targeted by the police. These practices produce “a convergence of caring and punitive strategies of governance” (474). The boundaries between the spaces of healthcare and policing have shifted as a “financialized logic of governance has come to dominate both health and criminal justice” (474).

The author of this article is Scott Gabriel Knowles, the department head and an associate professor in the Drexel University Department of History Center for Science, Technology and Society. His focuses are on risk and disaster, with particular interests in modern cities, technology, and public policy. He also serves as a faculty research fellow of the Disaster Research Center at the University of Delaware and since 2011 he has been a member of the Fukushima Forum collaborative research community. His more recent works include:

The Disaster Experts: Mastering Risk in Modern America (University of Pennsylvania Press, 2011).4

Imagining Philadelphia: Edmund Bacon and the Future of the City (Editor, University of Pennsylvania Press, 2009).

"Defending Philadelphia: A Historical Case Study of Civil Defense in the Early Cold War" Public Works Management & Policy, (Vol. 11, No. 3, 2007): 217-232.

This article examines how disaster investigations in the United States have evolved over time, from the burining of the capitol building near the birth of the republic through the theater fires and boiler explosions of industrialization to the collapse of the world trade centers at the present, showing how the modern, bureaucratic system of disaster investigation was built. 

This arguement is supported by looking at 4 specific case histories and examining the factors contributing to the investigations in each.

1. The 1814 Burning of the Capitol Building - Investigation of the disaster conducted by one engineer, B.H. Lathobe, who was given vast resources with very few obsticles, except for financial constraits and an impatient congress, to complete his investigation and reconstruct the building. 

2. 1850 Hauge St. Explosion - After a major boiler explosion in Manhattan's Lower East Side, a pannel of "jurrors" and "experts" were called together to complete investigations, bring forth the history of the fauty boiler, and place the blame for the accident in an effort to "memorialize the dead and bring them justice." Because of the way this investigation was conducted, the blame could not be accurately placed so everyone involved was blamed for the failure.

3. 1903 Iroquois Theater Fire - John Ripley Freeman, a fireproof engineering expert and factory inspector, was brought in to complete a report and provided one of the first "modern" scientific disaster investigations. He utilized a new network of investigators, engineers, insurance companies, testing labs, and inter-industry coordination that characterizes modern disaster investigation. 

1. "Clashes over authority among powerful institutions both public and private, comptetition among rival experts for influence, inquiry into a disaster elevated to the status of a memorial for the dead: these are the base elements of the World Trade Center investigation. And yet, even a brief historical review shows us that these elements are not unique."

2. "In this article, I will show that conflicts over authority, expertise, memory, and finally the attribution of responsibility suffuse the history of disaster in the United States."

3. "Blame, memorial, and reconstruction tend to outpace technical consensus."

Detailed research into historical cases was done to produce the claims and arguements presented in this article. No new investigation was conducted to obtain support for the arguement, and the historical cases were used to draw ties with the ongoing investigations taking place at the World Trade Center site.

Emergency response is not specifically mentioned in this article, as the focus of the article is investigation in the aftermath of disaster. In some cases, such as the Iroquois Theater Fire and the World Trade Center, investigations found that had more adequite emergency fire response been available at the time of the accident the outcome of the disaster could have been much different.

This article has been referenced in various other articles in the DSTS field, including Engineering Risk and Disaster: Disaster-STS and the American History of Technology (S. Knowles) and The World Trade Center Analyses: Case Study of Ethics, Public Policy and the Engineering Profession (WH Coste).