Acts of Nature are Public Health Emergencies

By Meredith Li-Vollmer, Public Health – Seattle-King County

The news from Hurricane Harvey has been heart wrenching. Among the memorable images that emerged was one of nursing home residents sitting in wheelchairs, waist-deep in flood water as they waited for help to arrive. As reported by the New York Times, among the thousands of posts to volunteer rescue groups were common pleas such as “East Houston, 9:53 p.m.: Needs evacuation, one elderly person in a wheel chair” and “Northeast Houston, 5:36 a.m.: He’s on bottled oxygen now, and running out. Nausea from lack of oxygen has already started.” As some of the most vulnerable in the community struggled, news also covered the toll that the hurricane has taken on the world-class hospitals in the Houston area who were well prepared with back-up generators but hampered by the extremity of the weather and flooded roadways to evacuate patients and bring in emergency vehicles, food, and supplies. Hurricanes and floods aren’t just acts of nature. They are also public health emergencies.

What would we do?

Like Houston, King County is known for its large and innovative healthcare hub. But any number of emergency events could put strain on hospitals that often function at near capacity during an average day. Our region has the potential for flooding rivers, wind and ice storms that knock out power, and of course, earthquakes. Even a severe flu season or a large traffic incident, like the Aurora Bridge bus collision, can put additional pressure on hospital resources. So what’s in place for our healthcare and public health systems in crisis circumstances?

We’re fortunate to have a robust coalition of private healthcare and public health organizations working together on emergency planning, led by the Northwest Healthcare Response Network (“the Network”). It has roots in our health department before the Network became an independent nonprofit that coordinates healthcare preparedness in King, Pierce, and Kitsap counties.

Before a disaster, the Network collaborates with the healthcare community, including nursing homes, hospitals and other facilities, to prepare and train. This includes creating plans to provide the right care for each patient when a facility must be evacuated. During a crisis, they coordinate with healthcare, public health and other emergency response agencies to share critical healthcare information (like ER capacity, bed availability and resource shortages). The Network also helps secure needed supplies, services and federal assistance for hospitals, blood centers, dialysis centers, and other healthcare facilities.

One important function that the Network provides in an emergency is tracking of patients. Imagine that the big earthquake finally hits and injured people are scattered into hospitals all over the region. Many might also have been at work, or at school, out running errands, or even from out-of-town, so it’s hard to know who’s hospitalized and where they might be. In a chaotic landscape, the Network’s tracking system will be critical in helping people find their family members within the healthcare system.

This kind of planning pays off. The University of Texas MD Anderson Cancer Center was able to continue the critical work of caring for cancer patients through Hurricane Harveybecause they had planned for staffing, transportation, and flood barriers. A thousand staff rode out the storm and kept their patients alive.

Public health and disasters

Every disaster also has significant public health impacts. Power outages increase the risk of carbon monoxide poisoning and food spoilage. Floods result in contaminated water systems, and after the water recedes, mold. Any time that roads are blocked, people have trouble getting dialysis, insulin, home-delivered oxygen tanks, and other essential medical services. That can result in more problems related to asthma, hypertension, and diabetes, in addition to other health problems and injuries caused by the disaster. And there are some crisis scenarios that are squarely within the public health arena, like influenza pandemics and other serious disease outbreaks.

That’s why the health department also has an emergency response function. Our Preparedness Section plans and trains with the Network and other emergency response agencies so that we all stay coordinated. We’ve created detailed plans for how to distribute life-saving medications or vaccines in emergencies. We’ve trained up response teams that can deploy to rapidly disseminate critical health information, conduct disease investigations, and inspect food and water sources to ensure safety. We’ve recruited and trained a Public Health Reserve Corps of over 700 volunteers who can augment the healthcare system in a time of need. Our experts are ready to provide guidance on infection control to schools, healthcare facilities, and businesses.

And there’s a role for you, too

Federal funding from previous administrations made it possible for our public health and healthcare systems to plan and train for disasters. But as ready as we are, a disaster on the scale of Hurricane Harvey will stretch resources thinly (like a major earthquake on the Cascadia or Seattle faults).  Like our highly capable colleagues in Texas, we cannot anticipate every aspect of a catastrophic event. So we count on you to be ready, too.

There are many great resources to help you make an emergency kit or household communication plan, such as MakeItThrough.org or Ready.gov. Here’s what you can do to plan for your health needs:

• Include health-related items in your emergency kit, such as charged batteries for wheelchairs and hearing aids, and extra eyeglasses.
• Plan with your doctor, pharmacist, or medical service provider about what to do if medical supplies can’t be delivered or if you can’t get to the pharmacy for prescription medications. Ask your doctor and/or pharmacist if you can have a 3-day emergency supply.
• If you depend on dialysis, get information on other dialysis facilities if you cannot use your regular facility. Find out if they provide the type of treatment you need. Know what diet to follow if your dialysis must be delayed.
• If you depend on medical equipment powered by electricity (beds, breathing equipment or infusion pumps): check with your medical supply company and get information regarding a back-up power source such as a battery or generator.

Finally, be ready to help your neighbors. There simply won’t be enough emergency responders to meet the demand, so people helping each other will be our most valuable resource.

Coverage of Hurricane Harvey shows how emergency professionals and everyday people have rallied under dire circumstances to protect their communities and each other. Our hats are off to the Texans who are showing such courage, resourcefulness, and compassion in the face of the most catastrophic disaster they’ve experienced in living memory.

Information from King County about donating to Hurricane Harvey relief.