Public Health Responds to Hurricane Dorian

September 05, 2019 | Jim Blumenstock

Aptly designated, September is National Preparedness Month, established in 2004 to promote family, community, and business disaster and emergency planning and readiness. As we all know and should continually reaffirm, disasters can happen anywhere at any time; come in various sizes, shapes, and forms in that they are both manmade and naturally occurring, can be somewhat predictable as well as "no-notice"; and can have a local, regional, national, or global societal impact. This year's theme is "Prepared, Not Scared" with an emphasis on encouraging parents, teachers, and caregivers to teach our youth what to do when a crisis occurs, and how we all can take preparedness actions together.

Emergency preparedness and response is emblematic of public health in action. Hurricane readiness is what all the coastal states plan and practice and Hurricane Dorian is certainly not their first "rodeo", so to speak, with all-too-many real world prior experiences to learn from and build upon so that each subsequent response is stronger and more effective in meeting the needs and protecting the lives of the public they serve.

Under the leadership of the state and territorial health officials, public health actions are fully integrated in the jurisdiction's unified incident command structure working closely and seamlessly with emergency management and homeland security colleagues and others such as transportation, education, and social/human services. State and territorial health departments are principally responsible for Emergency Support Function 8-Public Health and Medical Services, which lays out a comprehensive set of core functions critically necessary in times of crisis. This includes:

• Assessing the public health/medical needs of the affected communities.
• Maintaining public health surveillance to detect an increase in disaster-related illnesses and injuries.
• Ensuring that proper and sufficient medical care personnel and supplies are available.
• Helping coordinate patient movement.
• Monitoring the safety and security of medicines, blood products and services, and food.
• Addressing important environmental issues such as vector control and solid and hazardous waste management.
• Providing needed mental health and substance abuse care.
• Working to help identify and respectfully handle the remains of those lost.

Here is just a snapshot of critical public health activities currently underway in the impacted region necessitated by the potential for heavy rains and flooding, wind damage, storm surge inundation, loss of utilities and infrastructure, and supply chain disruption:

• Directing or overseeing both mandatory and voluntary evacuations or shelter-in-place determinations for at-risk hospitals, nursing homes, and other healthcare facilities.
• Contacting at-home individuals with access and functional needs (e.g. relying on power dependent medical equipment) for triage and potential transport to specially designated shelters.
• Pre-positioning EMS strike teams to enter and care for casualties in communities hit hard by the storm.
• Provide nurses and environmental health specialists to support general population shelters to ensure a safe and sanitary environment. 
• Standing ready to utilize the Emergency Management Assistance Compact when necessary, a national framework for states to request mutual aid from other jurisdictions when their capacity may be exceeded.
• Facilitating safe and timely transport of newborn screening specimens to the public health laboratory for analysis. Emergency supplies of special baby formula also being maintained for newborns found to have metabolic disorders that need to be managed by diet.
• Maintaining an Information Hotline for residents who have general public health questions and concerns.
• Exercising emergency authorities to allow for a one-time early renewal of certain medical prescriptions.
• Through websites and other media, provide important public health educational messages on such topics as reducing injuries through environmental exposure like, carbon monoxide poisoning caused by improper exhaust of generators and power tools, private well disinfection and, as necessary, the issuance of boil water notices for public water systems.
• Ready to mobilize to support reentry and public health recovery activities in impacted communities (e.g. safe food and water, re-occupancy of damaged healthcare facilities, water and mold damage assessment, etc.).

As these efforts continue to their conclusion, all states are also very aware that they may be called upon to mobilize to assist in providing mutual aid support to the Bahamas. These activities are coordinated primarily by the U.S. Department of State and U.S. Agency for International Development (USAID) should a federal mission be determined, such as receiving evacuees who are either US citizens being repatriated back to US soil or Bahamian citizens needing our help and a safe haven.

So, in recognition of National Preparedness Month, I share this with you as a testament to our nation's public health professionals who work tirelessly with skill and compassion to make a difference every day in so many people's lives; to community members for their grit and resilience, to our country's policy makers who have given our profession such outstanding doctrine and tools, such as the Pandemic and All Hazards Preparedness and Advancing Innovation Act, and for federal programs and investments like CDC's Public Health Emergency Preparedness and ASPR's Hospital Preparedness. Programs that enable state, territorial, local, and tribal public health agencies to have capacity and capabilities to be at the ready for both everyday as well as catastrophic emergencies are extremely important, whether they be natural disasters, industrial accidents, acts of violence or aggression, or infectious diseases such as Measles, Ebola, Zika, and Pandemic Influenza, to name just a few.