Public Health Lessons from Hurricane Irene & Tropical Storm Lee

Flooding from Hurricane Irene and Tropical Storm Lee devastated communities and left many businesses and families facing unbelievable destruction. To ensure that health needs were met during and after the disaster, public health organizations provided continued surveillance and frequent assessments. In every community, a variety of vital emergency services are dedicated to protecting the health, safety, and well-being of local citizens. Police, firefighters, and emergency medical and healthcare personnel – both career and volunteer, who put their own lives on the line to save others – as well as public works and human/social service agencies and departments all play key roles in response to emergencies and disasters.

Historically, however, none of these emergency service groups or individuals has been assigned the legal responsibility to organize all emergency services within the community. No single group has the responsibility to work closely with all of the other groups and individuals involved to develop, implement, and test a truly comprehensive emergency operations plan. Moreover, no single group has been assigned the responsibility of ensuring that, during an emergency/disaster, the collective response of all emergency service departments and agencies will be effectively coordinated. That role almost always falls, therefore, to emergency managers – who coordinate such efforts before, during, and after the disaster.

Traditionally, the fire department handles fire responses during a disaster and assists EMS (emergency medical services) agencies in their responses. The police department focuses on public safety, crime prevention, traffic control, and evacuation concerns. The public works agency maintains the infrastructure support and ensures the reinstatement of services. Public health and environmental health agencies focus on disease surveillance and potential outbreaks of disease as a result of the disaster. Mass care coordinationentifies the public health roles and responsibilities in providing medical care, health services, and shelter services during a disaster.

However, during a natural disaster of a relatively large magnitude – particularly one that requires the evacuation of densely populated communities – all emergency responder groups must be able, well in advance of the disaster, to quicklyentify and support people within their communities. Emergency evacuation operations begin with the evacuation order and extend through the relocation and recovery period. The need for evacuations may result from any number of concerns, ranging from the loss of utilities to rising flood waters, and may be either “limited and localized” – i.e., lasting for a relatively short period of time – or “general and widespread” (lasting for a more extended period of time). Regardless of the size of a major disaster, evacuation plans must be in place – in advance – to support the entire population, particularly including those persons with functional needs.

Communications Before, During, and After – But Especially Before 

Determining the needs of the impacted population before a disaster occurs is usually the responsibility of public health, emergency management, and various other partner agencies and organizations. However, the processes for the dissemination of situational awareness information also require close coordination prior to the disaster. Planning messages before the disaster escalates are critical for prompting people to take the appropriate precautionary steps needed to lessen the impact of the disaster. It is often difficult to communicate essential information about these steps before the disaster is declared; however, repeated messages that inform the public about the threat and provide basic instructions on the ways to protect individuals, families, businesses, and employees are or should be part of an overall crisis communications plan.

Issues with communications are often directly connected to coordination activities within and among organizations. In efficient and routine emergency operations, the vast majority of communications have occurred before the incident. Goals and tasks are often determined by tradition and, in fact, frequently have been formalized in statutes, contracts, charters, mutual-aid agreements, and standard operating procedures – all of which are especially important if critical infrastructure has been compromised and/or if a community must be evacuated because of an impending disaster.

Problems with communications and collaboration can be and frequently are compounded when organizations responding to disasters include those that, because they do not routinely respond to local emergencies, have had minimal previous contact. That can be the case in medical surge situations, during which community- and church-based organizations and their facilities, schools, businesses, etc., are used as alternate care sites or shelters. Ironically, some disaster reports suggest that smaller communities, despite possessing fewer resources, tend on average to coordinate their disaster responses more effectively than larger and more urban areas do. This seeming anomaly may be attributed to: (a) a smaller community’s greater need to work together; and (b) an increased likelihood that the responders involved have worked together before. Nonetheless, the guideline remains the same: When disaster strikes, prompt and proactive communications are essential to effectively mitigate the problems and lessen the damage.

Unfortunately – as planners, responders, and receivers for Irene and Lee had learned from previous disasters – there has far too often been a lack of pre-impact communications between and among key responder organizations. The reason, usually but not always, is that emergency managers did not wait to sense the “red flags” (i.e., danger signals) until they were already caught up in the middle of the disaster. Of course, the “receiving” communities and facilities need, and use, situational awareness and accurate communications to properly plan for the evacuees they probably will be receiving from hospitals or nursing homes in the areas most directly affected. Ensuring that accurate information – about the quantity and functional needs for each of the evacuees – is provided to the receiving communities allows for a much smoother transition.

Debris, Diseases, and Other Residual Damage 

Public health concerns do not stop at that point, but continue through the recovery phase. Following events such as Irene and Lee, local water authorities and emergency management officials provide the guidance needed to impose water restrictions. In one recent example, the New Jersey Department of Health urged all residents to throw away any food that might have come into contact with storm waters – or went without refrigeration.

More recently, Pennsylvania officials alerted the public (on 9 September 2011) about public health concerns affecting anyone coming into contact with floodwater. Approximately 159 water and sewage treatment plants were affected, and in some areas caused sewage to spill into local streams and rivers. In addition, any floodwaters containing contaminants and/or debris became a continuing concern.

The days and weeks immediately following a disaster are particular difficult. Disasters such as flooding almost always come on quickly, and with little or no warning. Following the aftermath of Irene and Lee, the State of New York implemented a Public Health Emergency warning (on 24 September 2011). The standing water left behind from Irene and Lee waseal for mosquitoes and, therefore, possible mosquito-associated disease (which usually is the most widespread problem after heavy rains and flooding). In the aftermath of Irene and Lee, most Departments of Public Health in the states directly affected also provided guidance about the availability of tetanus vaccinations for those involved in recovery efforts and/or exposed to flood waters.

A Helpful List of Public Service Reminders 

In addition, public service announcements were issued to remind citizens about proper precautions to protect their health and safety prior to returning to a flooded home or business. Following is a “must read” list of the most important of those announcements (including some that are frequently overlooked):

• Remove all floodwater, dirt, and debris left behind by the floodwater;
• Remove mold and mildew;
• Remove from the buildings any materials or furnishings that soaked up water;
• Remove carpets and padding that cannot be cleaned thoroughly enough to prevent mold and mildew from growing;
• Strip walls that were wet to the studs and remove the insulation – walls must remain open to allow them to completely dry;
• Inspect other wall cavities for visible mold growth;
• Open, clean, decontaminate, and dry any area inside a wall cavity showing visible mold growth;
• Inspect, clean, and decontaminate exterior and interior heating ventilation and/or air-conditioning systems that were in contact with floodwater;
• Remove, clean, disinfect, and reinstall air registers (vents) and diffusers;
• Throw away upholstered furniture, mattresses, and furniture made of particleboard or wafer board that is still moist or wet 24 hours after the floodwater recedes;
• Remove any chemical contamination and hazardous materials from the building; and
• Ensure that all areas of the building are dry before rebuilding or repairing – mold will grow on replacement materials if the studs, subfloor, and/or other building areas or surfaces are not completely dry.

To briefly summarize: It is more important today than ever before that individual citizens, and communities, work together to be prepared to respond to a disaster such as a hurricane or flood. Knowing the increasingly important steps in prevention listed above will improve the health and safety of everyone affected by such a disaster.

It is essential for all partners and stakeholders to work together to respond and recover from disasters such as Irene and Lee that affect everyone in the community. Public health preparedness incorporates the practice of reality- and knowledge-based management and the link to the human element of a disaster. Most important of all: Take the initiative now available to plan, prepare, and communicate before such an event occurs in order to better protect and care for all persons who may be affected during or after the event.

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For additional information related to public health concerns and precautions, click on: www.cdc.gov/disasters