The disastrous ice storm that struck Kentucky in January 2009, affecting two-thirds of the state, caused 36 deaths, left an estimated 770,000 Kentucky residents without power for several weeks, and led to the largest ever call-out of the Kentucky National Guard. Because of the widespread-power outages and disruption of major transportation and communications sources, a state and federal disaster was declared and more than 200 shelters housing almost 8,000 people were quickly opened throughout the state.
The Kentucky Department for Public Health (KDPH) focused on four major disaster surveillance objectives: the assessment of immediate shelter needs; injuries and illnesses within the shelters; the standardized “Community Assessment for Public Health Emergency Response (CASPER)”; and possibly statewide carbon-monoxide exposures.
To assist these efforts, I was assigned, as one of Kentucky’s Career Epidemiology Field Officers (CEFOs), to lead the local health departments’ environmental health specialists, epidemiologists, and nurses in conducting a daily surveillance of the shelters and report the information received to KDPH through daily situation reports. Problems with shelters not being able to receive any communication via radio, satellite phone, fax, telephone, and/or the Internet were of particular concern. To address those problems,12 state-led strike teams assessed 37 shelters in three areas in western Kentucky.
Translating and Expediting
I had the privilege, and duty, of accompanying two senior officials – Charles Kendell, executive officer of the Kentucky Department of Health’s commissioner’s office; and John Esham, deputy policy advisor in the office of Kentucky Governor Steve Beshear – on visits to the communities hit hardest by the storm. While on those visits I was able to “translate” many of the hardships we witnessed into the need for specific public-health actions.
I also was able to expedite state requests for federal public health surge-capacity staffing assistance, which led to the assignment of a team of 23 EISOs (Epidemic Intelligence Service Officers) to Kentucky within 48 hours after the request had been received. EISO teams were deployed to Western Kentucky with standard data-collection equipment to interview household owners (and others) on such relevant topics as storm-related injuries and illnesses, the use of generators, the availability of basic necessities, and any barriers to shelter use that might have caused problems.
Almost two weeks after the storm, unfortunately, an estimated 25 percent or so of the state’s households were still without electricity, and up to 56 percent had had to use generators. (A variety of communication methods – including radio announcements, cell phone text messages, and fliers – were used to reach residents still lacking electricity.)
Identifying and Preparing for Future Problem Areas
Two important special-needs populations were identified: (1) oxygen-dependent citizens – 14 percent of the shelters reported having residents who did not have enough oxygen, and about 4 percent of those who remained at home also were oxygen-dependent; and (2) pet owners – up to 20 percent of those surveyed said that the lack of accommodations for pets prevented them from seeking alternative shelter.
Carbon monoxide-related incidents were assessed by the EISO task group, using data obtained from coroners, hyperbaric oxygen treatment centers, and Kentucky Regional Poison Control Centers (KRPCs). Carbon Monoxide (CO) exposures and poisoning were significant issues; 275 people called KRPC about possible CO exposures, and another 144 were affected by high CO levels in residential areas associated with the use of generators and CO-producing heating units, such as kerosene and propane heaters. Throughout the state, a total of ten CO-related deaths were reported, eight of which were clearly linked to the improper use of generators.
For future disaster preparation, the earlier release of public health information about the safe operation of generators, and of CO-producing heating units, would be beneficial. The KDPH is using the “lessons learned” from this year’s response, and plans not only to establish additional pet-friendly shelters but also to be better prepared in general by: (a) ensuring that enough shelters are available in the future for oxygen-dependent people who need access to electricity: and (b) having enough oxygen canisters immediately available for those in need.
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NOTE: CDC Career Epidemiology Field Officers (CEFOs) participate in consultation and capacity building for response activities to natural disasters as well as preparedness exercises at the local and state health departments to which they are assigned. States interested in having a CEFO assigned to them to support and enhance their epidemiologic and public health emergency preparedness capabilities may contact the CEFO program by email at cefo@cdc.gov. CEFOs are assigned for an initial two-year period and are supported out of each state’s CDC Public Health Emergency Preparedness (PHEP) grant funds through a direct-assistance mechanism. (For additional information about the program click on https://www.cdc.gov/cpr/readiness/field-staff.htm)
Margaret Riggs
Lieutenant Commander Margaret (Margo) Riggs, USPHS (U.S. Public Health Service) served in the U.S. Army for five years as a veterinary technician. She received a doctorate in immunology from the University of Florida in 2002, then served as a post-doctoral fellow at the National Institutes of Health. She later joined the Commissioned Corps of the USPHS and is now serving as an epidemiologist with the Centers for Disease Control & Prevention (CDC) in Atlanta (and in that role has been assigned to the Kentucky Department for Public Health). Her principal duties are to help build that state’s disease surveillance and disaster preparedness capabilities and to promote the use of evidence-based research in public-health practice. She also provides expertise in environmental health issues and outbreak investigations, health promotion, and disease prevention.
