The National Center for Disaster Preparedness and the Public Health Training Center present: Hurricane Sandy Roundtable: A Conversation Among Local Public Health Leaders
(Originally broadcast on January 17th, 2013)
The National Center for Disaster Preparedness (NCDP) and the New York City-Long Island-Lower Tri-County Public Health Training Center (NYC-LI-LTC PHTC), at Columbia University’s Mailman School of Public Health co-sponsored a live web-conference on Jan. 17, 2013, the “Hurricane Sandy Roundtable: A Conversation Among Local Public Health Leaders.”
This event brought together the public health commissioners from New York City, Suffolk, Nassau, Putnam, Rockland, and Westchester counties along with their respective emergency preparedness planners and response coordinators. These local health department panelists shared experiences, highlighted their challenges, and discussed critical decision-making prior to, during, and following Hurricane Sandy.
This unique opportunity for public health practice and academic collaboration brought together public health and emergency preparedness planners and responders to contemplate, study, learn from, and incorporate lessons learned to increase readiness for future hurricanes and other catastrophic events. The conference was live-streamed on the internet and provided an opportunity for national audiences to learn from the challenges of this natural disaster.
The Roundtable began with welcoming remarks by Dean Linda Fried, MD, of the Mailman School of Public Health at Columbia University, followed by framing remarks and introductions by Irwin Redlener, MD, Director of NCDP and co-chair of the New York State Ready Commission. Each health commissioner or representative of a health department gave a brief presentation of the impact of the hurricane on their jurisdiction and the challenges that they faced. David Abramson, PhD, Deputy Director of NCDP, moderated the panel discussion. The panelists focused on the following areas of concern:
1. The unique stresses and demands of the disaster on their senior public health staff and on themselves;
2. The most challenging decisions they had to make at their health department;
3. The emergency of new or previously unknown vulnerable populations, particularly those whose needs were especially challenging;
4. Innovative communication and partnership strategies;
5. Complex problems faced by their public health department.
MAIN DISCUSSION POINTS:
Where public health needs to be in the future:
• Environmental health is critical, as is disaster response. Those in public health also need to be trained on disaster response. Public health needs to play a larger role in emergency response. Education is a huge factor.
• Westchester officials noted that carbon monoxide poisoning proved to be a significant threat. Generators, gas grills, portable heaters were found indoors, including in restaurants; the public needs to be better educated on this.
• Suffolk county officials noted that they needed to look at expanding their capacities and increase stockpile. Looked at ways to improve their vulnerable population registry to achieve a broader outreach, including creating an online registry. Also noted the need to transition an emergency shelter into a temporary housing shelter.
• In terms of long-term recovery, Rockland county officials noted that they are working on staffing changes. One success story is that they were able distribute DTaP and tetanus vaccines to emergency workers and those cleaning their homes through electronic registration.
• Putnam County officials noted the main challenge at the moment is finding ways to educate at the same time that recovery is taking place. There is a need to create stronger partnerships with the community through the recovery process.
• General agreement that how public health addresses vulnerable populations often serves as the litmus test of the efficacy of response and recovery plans.
• While a clear idea of what a vulnerable population may entail during a disaster, one county is creating an online form of registry to better assess and identify the vulnerable population.
• There are different levels of vulnerable populations based on the level of need for care.
• Suffolk County partners with the Red Cross and has mixed shelters. They also maintain a skilled nursing station at the shelters.
• It was noted that even “healthy” populations can become vulnerable due to sustained power outage (e.g., healthy children can become part of the vulnerable population if there is lack of food or sanitary conditions)
• Rockland county officials noted two “new” vulnerable populations that challenged their shelter situation: homeless, who did not want to leave the emergency shelter, and those outpatient mental health patients who had pets.
• Counties noted the importance of the use of municipalities to help with vulnerable populations and shelter during the disaster.
• Noted the need to acknowledge that not all workforces will be available when disaster strikes
- Workers will need to tend to their families and make sure that they are safe.
• Noted the responsibility to help the population that cannot help themselves (e.g. seniors), which are often the hardest population to communication with.
• Boots on the ground provided the most accurate information of what is going on in the field.
• Main concerns included: power outage, road closures due to down trees, and down wires.
• Health commissioner, who is fairly new to the position and emergency preparedness, offered his perspectives from his years of clinical service and decision-making) noted the need to reassess the decisions (health vs. political) to open shelters after disasters.
• While they reassessed their hurricane plan and modified and prepared for Hurricane Sandy as appropriate, they found that they needed to more flexible with their plans, as different issues may arise.
• To prepare, they notified people via reverse 911 to fill up empty/half full oil tanks to avoid chemical spills (in prior Hurricane Irene, empty oil tanks posed environmental hazards when flooding forced them to the surface). They also pre-deployed vehicles to locations that may need the vehicles, and created a staff roster.
• After the storm, they noted that the environment office had no power, and that the environmental department played an important role due to possible chemical spills, so they checked locations that could have possible spills.
• They had staffing issues after the hurricane (due to lack of transportation, etc.)
• They also had food establishment locations to ensure that the food was safe to provide to the public.
• Noted that generators were a concern, as many were being placed indoor.
• Also checked water districts to ensure facilities were running correctly
- Had to provide generators and fuel to several facilities
- In one particular facility, noted that partially treated sewage water was going into the Hudson River, and towards Rockland County, so they contacted Rockland County to notify them of this danger.
• Had over 100 families displaced.
• Major issues included extended period of power outage and fallen trees.
• Noted the need of retaining flexibility during the response and recovery of a disaster.
• Some of the challenges they faced included how to deal with the unexpected vulnerabilities.
- For instance, those who are oxygen dependent but did not require being in hospitals, and dialysis patients whose centers had no power. Some private adult homes had no generators or had no way of transporting seniors who needed to be evacuated. Staff also had trouble getting into work as they were running low on fuel or had no power at home.
• Another challenge that they faced was the need to provide information and advice to the general public regarding information in real time.
- Gas grills and generators were located indoor—9 cases of carbon monoxide poisoning.
New York City –
• ICS activated for 2.5 months with over 150 staff; over 1,500 staffed shelters – maintaining position continuity and preventing burn-out was a significant challenge.
• Unanticipated vulnerable populations: Identified various needs in newly and temporarily vulnerable populations, i.e. individuals were staying in their homes without heat, power and water triggering search and rescue efforts involving National Guard troops. Wellness checks continue to identify critical food, water and medical needs. Staff were willing to step into this role but not planned for or adequately trained.
• Noted the importance of activating shelters up front is important and getting the information out.
• Another issue was the impact that the disaster will have to an agency’s staff’s work schedule.
• Another issue is how to reach communities after the fact.
• Dissemination of information was important, as they did find toxic waste in communities as oil tanks have burst.
• Counted on field staff for accurate information.
• Noted the importance of prioritizing issues.
New York City Department of Health & Mental Hygiene
Erich Giebelhaus, MPP, Director for Interagency and Vulnerable Populations Planning
Office of Emergency Preparedness and Response
Nassau County Department of Health
Lawrence Eisenstein, MD, Commissioner of Health
Ann DeSimone, Director, Public Health Emergency Preparedness
Suffolk County Department of Health Services
James Tomarken, MD, Commissioner of Health
Robert Delagi, Acting Director, Division of Emergency Medical Services
Putnam County Department of Health
Allen Beals, MD, Commissioner of Health
Kathy Percacciolo, Supervising Public Health Nurse
Rockland County Department of Health
Joan Facelle, MD, Commissioner of Health
Junie Delizo, Director of Emergency Preparedness, Public Health
Westchester County Department of Health
Sherlita Amler, MD, Commissioner of Health
Peter Delucia, Assistant Commissioner, Bureau of Public Health Protection