Public health professionals are constantly building the capacity and capabilities needed to respond to a variety of possible emergencies such as biological events, pandemic influenza, emerging diseases, manmade disasters, and a host of other dangers. It can be argued that weather emergencies over the last few years have become more severe and unpredictable, causing a major increase in the widespread damage that results. Because severe weather events and other natural disasters are the only such events almost guaranteed to occur several times a year across the United States, public health is playing an increasingly important role in the nation’s preparedness, response, recovery, and mitigation efforts. In response to these and other natural and manmade hazards, the public health role during response efforts will continue to grow, evolve, and mature.
When extreme weather hits, first responders, faith-based organizations, non-profit groups, volunteers, private-sector businesses, and other community partners mobilize to respond and ensure a quick recovery with minimal disruption to lives, property, and the environment. Weather emergencies and natural disasters have outcomes that public health professionals are not only legally charged to address, but are often what they already do every day.
The U.S. Centers for Disease Control and Prevention (CDC) lists on its website the following types of natural disasters and weather emergencies: earthquakes, extreme heat, floods, hurricanes, landslides and mudslides, tornadoes, tsunamis, volcanoes, wildfires, and severe winter weather. The public health response to these events is focused primarily on mitigating their effects and outcomes by: preventing disease and injury; responding to food, water, and sanitation concerns; controlling the damage caused by animals and insects; ameliorating environmental problems; coping with power outages; providing the special care needed by at-risk/vulnerable populations (e.g., pregnant woman; children; the elderly; those suffering from asthma, cardiovascular problems, and/or other respiratory diseases; and persons living in rural and/or isolated areas); helping those stressed by trauma and disaster-related mental health problems; educating the public on emergency preparedness matters in general; and promoting both individual and community resilience.
Public Health’s Role in Natural Disasters
In the years since the unprecedented destruction caused by Hurricane Katrina in 2005, numerous reports have been written about the frequently inadequate response and recovery efforts of the various agencies responding at that time; somewhat less discussed are the public health implications that follow such disasters. One area that public health specifically responds to during and after hurricanes involves the damaging effects of flooding and heavy rainfall. These can often lead to and/or exacerbate, among other problems: sewage overflows that might quickly and easily contaminate the food and water supply; an increase in the dangers caused by waterborne parasites; and storm-water runoff that contaminate community water supplies.
In California, to cite another example, environmental health concerns prompt quick public health responses during wildfires. The 2008 wildfires that ravaged both northern and southern California were particularly devastating, leaving many citizens injured and several communities partially or totally destroyed. Public health is particularly concerned with the dangerous effects of wildfire smoke, for example: an increase in fatalities; the aggravation of pre-existing respiratory and cardiovascular diseases; the dangers posed by carbon monoxide exposure; and other problems, particularly in at-risk/vulnerable populations.
In 2010, two years after the wildfires disaster, the nation’s Mid-Atlantic States experienced the same type of problem, but in reverse – namely, the extremely severe back-to-back snowstorms, now known as “Snowmaggedon,” that forced epidemiologists to quickly assess and evaluate the acute and chronic health effects caused by human exposure to extremely cold temperatures. The authorities in charge quickly realized the need to operate public shelters and to ensure that the organizations that serve at-risk/vulnerable populations were provided the resources required to carry out their mission. One typical example that could happen anywhere, in any country, is when a weather emergency prevents dialysis patients from receiving their scheduled treatments, thus creating major problems for emergency medical services agencies, the community’s overall healthcare system, as well as the individual patients directly affected.
Double-Duty Thermometers; Different Degrees of Danger
In addition to extremely cold temperatures, extreme heat also requires not only an epidemiological response but the expenditure of material resources as well (to operate air-conditioned shelters, for example). Moreover, although providing mass care is not necessarily the direct responsibility of the health department, public health plays an integral role in providing resources, staffing such as doctors and nurses, various types of health services, and facility inspections. In addition, epidemiological surveillance and monitoring tracks potential health-related changes and patterns and, using that information, can help determine what additional resources might be required and then plan an appropriate response.
Disaster epidemiology also focuses specific attention on such topic areas as acute and communicable diseases, environmental health, occupational health, chronic diseases, injuries, and mental and behavioral health – all of which are separate aspects of a continuing effort both to assess the short- and long-term adverse health effects of various types of disasters and to predict the likely consequences of future mass-casualty events and incidents.
The summer of 2012 was hotter than usual, but whether it was a major exception or a “new norm” has yet to be determined. Nonetheless, almost every year, heat waves cause the most common weather-related deaths, usually from heat stroke and dehydration, throughout the country. Higher air temperatures also often increase the number of cases of bacteria-related food poisoning reported and, in 2002, even created a new strain of West Nile Virus.
In ways similar to those used in charting any other weather emergencies or natural disasters, studies show that certain at-risk/vulnerable population groups are more vulnerable than other citizens to weather-related illnesses. The Chicago heat wave of 1995, for example, actually resulted in the deaths of over 700 people in those same statistical categories. Public health departments, of course, are charged with the responsibility of identifying, reaching out to, and coordinating the medical services required by these and other at-risk/vulnerable populations.
Learning From Yesterday to Improve Future Planning Efforts
Hurricane Katrina forced emergency managers and a broad range of first responders along the Gulf Coast to rethink their short-term as well as long-term preparedness and response plans. Public health departments across the country, along with federal and state government agencies, also planned and carried out major public outreach and education campaigns to promote both individual and family preparedness. In addition, numerous public health emergency preparedness programs were established specifically to address such closely related topics as mass care, fatality management, medical surge, environmental health and safety, healthcare for at-risk/vulnerable populations, and behavioral health needs – before, during, and after a major disaster.
Many of the preparedness plans created during that busy period were tested, revised, and updated by and for the various jurisdictions along the East Coast that responded to Hurricane Irene in 2011. Although Irene was not as devastating as originally anticipated, it did cause widespread flood damage, required several closures of mass transportation hubs and the evacuation of a number of New York City neighborhoods, and precipitated some massive power outages.
Irene also reinforced the need for public health agencies to develop and/or update their previous plans for shelters, the continuity of operations, and responder safety and health. One of the more important national areas of responsibility it reinforced was the need for a public health presence (as spelled out in the Federal Emergency Management Agency’s Emergency Support Function #8 – Public Health and Medical Services Annex) at emergency operations centers.
In June 2012, the Mid-Atlantic and Midwestern United States were hit by unexpected, fast-moving, and extremely powerful thunderstorm complexes called a derecho (a wide-area windstorm associated with a fast-moving line of thunderstorms). In the greater Washington, D.C., area, more than one million residents were left without power for days. Thanks to the lessons learned from previous emergencies, and from a number of effective training exercises, the overall public health response to the storm was fairly quick, and the collaboration with traditional first-responder agencies was immediate.
The public health emergency-preparedness agencies in all jurisdictions in the D.C. area received well-deserved praise for their performance in: (a) quickly and effectively activating their Emergency Operations Plans and the Incident Command System; (b) working long hours, at a high level of intensity, in various Emergency Operations Centers; (c) testing and validating their Communication and Information Sharing Plans; and (d) in certain areas, implementing their Public Health Mass Care/Shelter Plans.
The Foreseeable Future of Public Health Responses
Clearly, weather emergencies of all types will continue to occur – and to validate the need for various types of special resources and operational capabilities. As a still fairly new and continuously evolving component of national preparedness, public health emergency preparedness (PHEP) programs must continue to use the lessons learned from previous weather events to improve their current and future preparedness and response efforts.
Although public health has successfully taken a more forward role in some emergency planning, preparedness, and response efforts, an even greater focus is still needed. Among the more important guidelines needed to ensure that PHEP programs can effectively build and sustain the community-wide communications, cooperation, and overall resilience needed to cope with all likely hazards are the following:
- Continue to engage with partners and to participate in jurisdiction-wide and/or regional preparedness planning groups (e.g., healthcare coalitions, advisory committees);
- Ensure that public health leaders and managers, and local decision makers, are fully vested in PHEP initiatives – and in promoting the participation of all health department staff in planning efforts, training exercises, and a broad spectrum of response and recovery efforts;
- Use national standards – such as the CDC’s “Public Health Preparedness Capabilities: National Standards for State and Local Planning” and/or the NACCHO (National Association of County and City Health Officials) “Project Public Health Ready” – in preparedness efforts both to ensure and enhance efficient and effective planning and to increase overall response capabilities;
- Use outreach efforts and partnerships (with members of the Medical Reserve Corps, for example, as well as those participating in other PHEP activities such as local Closed Point of Dispensing Sites) to continue to work with nontraditional partners such as the private sector and academia;
- Participate in and/or help coordinate exercises that test the specific capabilities most likely to be needed during future emergencies; and
- Take an active part in any “hot wash” reviews (which should be carried out after every major emergency) to ensure that: (a) the appropriate decision makers and other leaders are in attendance; (b) the lessons learned, particularly those related to public health, are included in the incident’s After Action Report and Improvement Plan; and (c) that all of the “right people” (i.e., political leaders, budget managers, and other decision-makers) not only read such reports but also act upon them early and effectively.
In March 2009, public health officials coordinated evacuations, temporary housing, and healthcare for acute injuries as well as other long-term health risks – including hypothermia, bacteria, and mold – after heavy floods inundated several areas of North Dakota. In September 2009, public health partners worked together again – in the days and weeks after an earthquake and tsunami devastated many areas of Samoa, American Samoa, and Tonga – to ensure there would be an appropriate medical response. Those and other emergencies have shown the progress that public health has already made in establishing itself and proving the continuing need for an all-hazards approach to deal with such incidents. But there is still much more that has to be done.
For additional information on: CDC’s “Natural Disasters & Severe Weather,” visit http://emergency.cdc.gov/disasters/
CDC’s “Disaster Epidemiology,” visit www.cdc.gov/nceh/hsb/disaster/epidemiology.htm
FEMA’s “Emergency Support Function #8 – Public Health and Medical Services Annex,” visit http://www.fema.gov/pdf/emergency/nrf/nrf-esf-08.pdf
NACCHO’s “Project Public Health Ready,” visit http://www.naccho.org/topics/emergency/PPHR/index.cfm
Significant contributions to this article were made by Raphael M. Barishansky. Raphael M. Barishansky, MPH, Director, Office of EMS, Connecticut Department of Public Health. He has previously served as the Chief for Public Health Emergency Preparedness for the Prince George’s County (Maryland) Health Department and Executive Director of the Hudson Valley (N.Y.) Regional EMS (Emergency Medical Services) Council. Ray is a frequent contributor to the DomPrep Journal and other publications and can be reached at firstname.lastname@example.org.
Audrey Mazurek, MS, has worked at all levels of government for nearly 20 years in public health and healthcare preparedness, emergency management, and homeland security. She was a program manager with the National Association of County and City Health Officials (NACCHO) Project Public Health Ready program. She supported the U.S. Department of Homeland Security in the development of an accreditation and certification program for private sector preparedness. She also served as a public health emergency preparedness planner for two local public health departments in Maryland, where she developed over 30 preparedness and response plans, trainings, and exercises. She is currently a director of public health preparedness with ICF, primarily supporting the U.S. Department of Health and Human Services, Assistant Secretary for Preparedness and Response’s (ASPR) Technical Resources, Assistance Center, and Information Exchange (TRACIE) program as the ICF program director.