Immediately after the explosions at the Boston Marathon yesterday, both the U.S. Centers for Disease Control and Prevention (CDC) and the Substance Abuse and Mental Health Services Administration (SAMHSA) updated their crisis management resources and moved the information to the top of their home pages.

Yesterday, NPR reported that business owners near the blast site are beginning to return and reopen their doors.

"They fled in a panic last week and returned both eager and anxious," said NPR reporter Tovia Smith. The piece describes how business owners returned to find food left half-eaten and rotting, because so many left in such a hurry, and blood splattered in some spots from those who were injured.

To help make sure businesses get the help they need to reopen safely, public health inspectors played a role in visiting every building on every block. "They also stood ready with trauma counselors, pro-bono attorneys and clean-up crews," said Smith.

But the public health response to any disaster goes beyond helping to restore normalcy in the immediate aftermath. An earlier interview with John Lumpkin, director of the Health Care Group at the Robert Wood Johnson Foundation, about the sustained response to Hurricane Sandy also applies here:

We saw with Katrina and are seeing again now with Sandy, [public health officials] are not only concerned with food, air, and water during and immediately after an emergency, but also with ensuring that services related to health care delivery and mental health are provided when and where they’re needed. It’s an interesting statistic, for instance, that the demand for mental health services was higher five years after Hurricane Katrina than it was immediately after the hurricane hit.

The Boston Public Health Commission announced this week, for example, that the organization has opened a new drop-in center to continue to provide emotional support to anyone affected by the Boston Marathon attack.

"While the physical injuries and destruction that resulted from the bombings might be the most visible signs of trauma, many people experience serious emotional distress based on what they saw, heard, and felt during and after the attack. Sometimes these symptoms do not surface immediately," according to the Commission release. "Understanding the deep impacts of this emotional distress, city officials opened the drop-in center as a safe place for people to come together and talk about their experiences over the past week."

>>Read more about building community resilience to recover from disaster.

A Buzzfeed article posted in the days after the explosions at the Boston Marathon last week reported on hashtags and Google docs that emerged in the hours after the explosions, and pointed out the need for expanded “disaster and crisis coordination online, beyond hashtags.” The article notes a new San Francisco initiative in collaboration with the design firm IDEO—a social networking website and app to connect people who want to help with those who need it, which will let individuals preregister homes where people in need can find emergency shelter, supplies and useful skills such as First Aid certification. According to the post, “instead of scanning hashtags [in order to offer assistance], people will be able to simply log in to a preexisting community.”

There was a soft launch of the system in January and the organizations are now collecting user feedback.  

Jenine Harris, PhD, an assistant professor at the Brown School of Social Work at Washington University in St. Louis, reported on expanded use of social media by local health departments during the recent Keeneland Conference on public health services and systems research held in Lexington, Ky. Dr. Harris says of the San Francisco project that “the more active a social media channel, the more people follow it, so if these channels could be tweeting or retweeting regularly they would probably draw larger audiences.” Harris suggests that health departments could retweet information from their channels and increase visibility.

>>Read the Buzzfeed article.

Hurricane Sandy devastated much of the Atlantic coastal region—particularly New Jersey, where public health and other agencies from across the state came together to prepare for and respond to the extreme weather event. Ocean County alone saw more than 250 public health department employees working day and night to help the county’s 576,000 residents.

As part of its coverage on the public health response to Hurricane Sandy, the Robert Wood Johnson Foundation created a series of videos featuring public health officials and those touched by the disaster.

>> Go here to read more about Hurricane Sandy and watched the RWJF video "Unwavering: Public Health's Dedication in the Wake of Hurricane Sandy."

In this video, Christopher Rinn, Assistant Commissioner of the Division of Public Health Infrastructure, Laboratories and Emergency Preparedness for the New Jersey Department of Health, describes how the public health department led the response to Hurricane Sandy by collaborating across acute care hospitals, EMS agencies, local health departments, home healthcare agencies, private sector partners and other sectors of the community.

The sea communities of New York and New Jersey were the hardest hit by Hurricane Sandy. Ocean County, N.J., was especially devasted. It was there that more than 250 public health department employees provided medical care, shelter and more to approximately 576,000 residents.

These numbers are tremendous in scope—but they're more than just numbers. It's not every day that we get the opportunity to see the results of successful public health policies firsthand. But when we do get the chance to step into a person's life and witness how they were personally affected by a public healh crisis, it can make the case for careful preparedness planning even stronger.

In this video Tom Cioppa, an Ocean County resident, relives the heavy rain and harsh winds brought by Hurricane Sandy. Images of upturned cars and demolished two-story houses illustrate the storm’s destruction and its life-changing effects.

While the effects of Hurricane Sandy were felt up and down the east coast, the sea communities of New York and New Jersey were the hardest hit. Ocean County, N.J. saw more than 250 public health department employees working day and night to help the county’s 576,000 residents—providing medical care, shelter, clean water and even a safe place for pets.

As part of its coverage on the public health response to Hurricane Sandy, the Robert Wood Johnson Foundation created a series of videos featuring public health officials and those touched by the disaster.

>> Go here to read more about Hurricane Sandy and watched the RWJF video "Unwavering: Public Health's Dedication in the Wake of Hurricane Sandy."

In this first video, Daniel Regenye, Coordinator for the Ocean County Health Department, describes how the state of emergency brought government agencies, non-profit organizations and for-profit organizations together to meet the needs of the community in new ways. Medical needs shelters opened their doors for 24-hour-a-day service for weeks following the storm, with staff members showing incredible dedication by prioritizing the community over their own needs.

Clear, effective communication before and during a major natural disaster plays a major role in saving lives. In this video, Leslie Terjesen, Public Information Officer for the Ocean County Health Department, describes how the department shared information regarding flood preparedness; food and water safety; and keeping medical devices and equipment safe was shared in creative ways given power outages across the county.

Read more of our coverage of Hurricane Sandy.

Communities and people are at their most vulnerable during a disaster. In a crisis, the public looks to government officials to take command, provide answers and restore normalcy. Media—and increasingly social media—play a vital role in influencing public expectations in response and recovery efforts. But, are these expectations realistic? How can public health preparedness leaders and other partners shape public expectations prior to a disaster and encourage personal responsibility? How can they instill confidence in response and recovery efforts while assuring the public that activities being undertaken are in the public’s best interest?

Richard Besser, MD, is ABC News’ Chief Health and Medical Editor and previously served as acting director of the U.S. Centers for Disease Control and Prevention (CDC), where he led the agency’s response to the H1N1 influenza outbreak. He also served as director of the Coordinating Office for Terrorism Preparedness and Emergency Response at CDC. He recently moderated the session “Great Expectations: Maintaining Public Trust and Instilling Confidence Before, During, and After a Disaster,” at the Public Health Preparedness Summit 2013 in Atlanta, Ga.

>>Read more NewPublicHealth coverage from the Public Health Preparedness Summit.

NewPublicHealth spoke with Dr. Besser about how public officials should balance the needs to be both fast and correct during a disaster.

NewPublicHealth: What is most important for public health to know about communicating effectively before, during and after an emergency?

Richard Besser: It’s really important to realize that the needs in each of those different phases are very different. It’s extremely hard to get people’s attention before an event. Once there’s a signal that an event is coming, like you’ll often get with a weather event, people are interested. Using that time as a teachable moment—not just for those in the path of the event, but for everyone—is critical. The Israelis are a model for doing that. They have a lot of prepackaged messages and PSAs that they know people will be interested in when an event comes. They’ll use it as a time to teach.

During the event, you’ve got several different communication objectives. There’s what you want to achieve for people who are facing the disaster. The messages for them are messages that help them get through—safely accessing food, water and heat. In surrounding areas there are those who want to contribute and do something to help people. But then it’s also the time for those people to be prepared. The statistics on U.S. preparedness are pretty dreadful. Fewer than 10 percent of Americans have an emergency kit. That’s because people don’t believe an emergency is something that can happen to them. The statistics would say that that’s not at all true. Every state has had a natural disaster in the past 25 years. So they’re more common than people realize, but it’s easy for people to say this is something that is happening elsewhere.

Hurricane Sandy devastated much of the East Coast last fall, with sea communities in New York and New Jersey such as Ocean County bearing a disproportionate share of the damage. In Ocean County alone, 40,000 buildings were damaged by the storm’s monstrous gusts and floodwaters and the county suffered nearly half the damage recorded throughout New Jersey, according to the Federal Emergency Management Agency.

>>A new video produced by the Robert Wood Johnson Foundation about the public health response to Hurricane Sandy features health department officials including Dan Regenye, coordinator of the Ocean County Public Health Department, and New Jersey Health Commissioner Mary O’Dowd. Watch the video:

For more than a week after the storm ended, more than 250 employees of the public health department worked day and night to help the county’s 576,000 residents. The county provided medical needs sheltering for more than 1,000 residents, three times the number expected. And many shelters that housed displaced residents were also able to shelter their pets­–a critical need for many people who might not have evacuated otherwise.

This week at the annual Public Health Preparedness Summit hosted by the Centers for Disease Control and Prevention and the National Association of County and City Health Officials, the Ocean County Health Department will present a poster on response to and recovery from disaster. Follow NewPublicHealth coverage of the conference and other preparedness news.

In advance of the conference, NewPublicHealth spoke with Dan Regenye.

NewPublicHealth: How is your community doing?

Dan Regenye: I think it’s going to take a long time for total recovery to happen, and the reality is that it’s never going to be what it was. Some things will be better, some things will be worse. Our residents are dealing with their own personal issues and circumstances on a case-by-case basis. I think it’s the navigation part that’s so difficult for so many people between all the different agencies—local, state and federal—and private organizations. They need to look at FEMA (Federal Emergency Management Agency) maps and have to interact with insurers, contractors and others. It’s challenging.

NPH: What is the health department’s role in the recovery?

Three years after a devastating earthquake took the lives of 200,000 Haitians, displaced millions more and disrupted the public health infrastructure of the country, two new public health buildings opened yesterday in the country’s capital city of Port-Au-Prince with funding by the CDC Foundation and several partners including the Robert Wood Johnson Foundation, the GE Foundation and Kaiser Permanente. The CDC Foundation was established by Congress to forge partnerships between the Centers for Disease Control and Prevention (CDC) and corporations, foundations and individuals to support CDC's work in the U.S. and abroad.

“‘Building back better’ isn't just a slogan, it's a reality in public health. These buildings represent an important step forward to save lives in Haiti,” said CDC director Thomas Frieden, MD, MPH, at the opening in Port-Au-Prince. "These new buildings have an importance far beyond their physical presence—they will serve as a basis and catalyst for programs that will save literally tens of thousands of lives,” Frieden said.

One building replaces the Haiti Health Ministry, which was destroyed in the earthquake. The second building will house some of the ministry’s surveillance, epidemiology and laboratory staff as well as Haiti-based CDC staff, who are now working side-by-side in the country.

Representatives of the partners critical to the funding of the new buildings were on hand in Port-Au-Prince for the buildings’ ribbon cutting ceremony, including Susan Mende, senior program officer at the Robert Wood Johnson Foundation. “The earthquake in Haiti wrought great destruction and suffering to some of the most vulnerable in society as well as to the health and public health infrastructure so critical to the nation’s health,” said Mende. “The Robert Wood Johnson Foundation made a $500,000 grant to help build a public health laboratory research center to be used by Haiti’s Ministry of Public Health and Population. The Foundation recognizes that a stronger public health system is the network that protects communities, saves lives and directly improves people’s health and well being.”

To learn about the significance of the new buildings and the continuing efforts to improve public health in Haiti, NewPublicHealth spoke with Charles Stokes, president of the CDC Foundation, and Justin Tappero, MD, MPH, Director for the Health Systems Reconstruction Office in the Center for Global Health at CDC. Both were on hand for the ceremonies this week.

Preparing for disasters like Hurricane Sandy is critical, even more so because of the massive devastation this storm has brought to Staten Island, New York, where hundreds are still without power, and thousands must rebuild their homes and businesses. Thanks to some critical partnerships that have developed among non-profits and businesses in Staten Island in the last few years, some vital relationships that help to facilitate rapid response were already in place when the super storm hit.

NewPublicHealth spoke with David Sorkin, executive director of the Jewish Community Center of Staten Island, who is a also a founding board member and past president of the Staten Island Not-For-Profit Association and former chairman of the Staten Island Economic Development Corporation Business Council.

NewPublicHealth: How did prior relationships help you serve the community when the hurricane hit?

David Sorkin: The Staten Island Not-For-Profit Association is a collective of about 150 not-for-profits on Staten Island who have been networking, training, and learning together over the past four or five years. We already had relationships and interconnections, which allowed us all to react very, very quickly to issues and concerns as well as emergencies because we have emergencies almost every day, though different from a super storm.

A “normal” emergency not related to a storm is when we have a family or an individual who’s in crisis and needs a variety of support such as economic, legal, financial, counseling or a combination of all of them. So, we work together on a regular basis. The other avenue we work through is the Staten Island Economic Development Corporation, which is a coalition of businesses on Staten Island. Because we’re a part of that, I was able to access quality services from businesses and corporations on Staten Island with good relationships already built in. So, I don’t have to worry about vetting these companies and organizations during an emergency and I know that they can come to our assistance very, very quickly.

The Trust for America’s Health (TFAH) has released the 2012 edition of its Ready or Not? report. The annual report details and analyzes state and federal public health preparedness. This year’s entry focuses on emergency preparedness, looking at 10 indicators that help reveal the strengths and vulnerabilities in each state’s emergency preparedness status. TFAH’s hope is that policymakers, taxpayers and other groups can utilize the data to shore up their programs and policies—and help ensure they are ready to support public health in the event of a natural disaster or other emergency.

Among the key findings:

• 29 states cut funding for public health from FY 2010-11 to FY 2011-12
• 35 states and Washington, D.C. do not currently have climate change adaptation plans, which include planning for the health threats posed by extreme weather events
• 21 states have not been accredited by the Emergency Management Accreditation Program (EMAP)
• 13 state public health laboratories report they do not have sufficient capacity to work five, 12-hour days for six to eight weeks in response to an infectious disease outbreak, such as novel influenza A H1N1

This emphasis on analyzing emergency preparedness is especially meaningful now, with many in the Northeast still working to recover from the devastation of Hurricane Sandy. NewPublicHealth had been closely following public health’s role in responding to and recovering from Hurricane Sandy, and will continue to take an in-depth look at how this disaster continues to affect public health.

Here’s a look at some of the many ways NewPublicHealth has covered the intersection of public health and emergency preparedness:

Hurricane Sandy Recovery: New Jersey’s Health Commissioner Helms Response Roundtable
Just two weeks after Hurricane Sandy hit, the State of New Jersey held a Response Roundtable at the Jersey Shore University Medical Center in Neptune Township, N.J., to begin a review of the health department’s response to the storm. The site was an appropriate one: in the first few days of the Sandy, the medical center’s emergency room treated close to 2,000 patients with storm-related medical and mental health emergencies. A key roundtable participant was Nicole Lurie, the U.S. Department of Health and Human Services Assistant Secretary for Preparedness and Response. Leading the discussion was New Jersey’s Health Commissioner Mary E. O'Dowd.