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.

CDC, SAMHSA and Red Cross Resources Help Individuals and Communities Cope with Disaster
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. CDC’s “Tips for Self Care” includes advice on dealing with stress and suggestions for connecting socially after a traumatic event, avoiding drugs and alcohol, as well as links to SAMHSA’s disaster distress helpline  which can be accessed by phone, text, twitter and Facebook. SAMHSA’s site also includes resources for students, parents, teachers, caregivers, children, first responders and health professionals.

Following the explosions, families and friends found that cell phone and in some cases even texting communication was jammed, making it difficult for people to know whereabouts of those involved in the explosion. The American Red Cross offers a free service called the Safe and Well website which is a central site for people in disaster areas in the United States to register their current status, and for their loved ones to access that information. The Red Cross says the site helps provide displaced families with relief and comfort during a stressful time. The site is easy to use:

• If you are currently being affected by a disaster somewhere in the United States, click List Myself as Safe and Well, enter your pre-disaster address and phone number, and select any of the standard message options.
• If you are concerned about a loved one in the United States, click Search Registrants and enter the person’s name and pre-disaster phone number OR address. If they have registered, you will be able to view the messages they have posted.

The site is available 24 hours a day, 365 days a year and is accessible in both English and Spanish. Read more on preparedness.

Mortality Rates Highest at Small Rural Hospitals
A new study by researchers at the Harvard School of Public Health (HSPH) finds that a failure to stay up to date in the treatments they provide may be a factor in climbing death rates at rural hospitals. The study appeared in the JAMA. The HSPH researchers reviewed data from small, rural hospitals that receive government reimbursements and are exempt from participation in national quality improvement programs. The researchers looked at data on 10 million Medicare patients who were admitted to these small rural hospitals or other hospitals with a heart attack, congestive heart failure, or pneumonia—and compared 30-day mortality rates for each of the three conditions over a nine-year period. While ten years ago, mortality rates for each of these conditions were about the same at hospitals, the researchers found that between 2002 and 2010, mortality rates at CAHs increased at a rate of 0.1% per year, while at non-CAHs they decreased 0.2% per year. By 2010, CAHs had higher overall mortality rates—13.3% versus 11.4% at non-CAHs. “Small rural hospitals are being left behind,” says Karen Joynt, MD, MPH, the lead author on the study. “By creating a separate category for these hospitals, we’ve really left them out of many of the advances in medical care over the past decade, and we need systems-level solutions to help improve healthcare in these rural areas.” Read more on health disparities.

High Resting Heart Rate Indicates Increased Risk of Early Death
Faster than normal heart rates—even in men who exercise—could indicate a higher risk of early death, according to a new study in the journal Heart. While previous studies have shown a connection between heart rate and life expectancy, this study looked specifically at whether that was also true for healthy people who got regular exercise; the results indicate that resting heart rate is a risk factor independent of other health markers. Each 10-beat-per-minute resting heart rate increase corresponded to a 16 percent increase in the likelihood of death. Gregg Fonarow, MD, a professor of cardiology at the University of California, Los Angeles, said there are ways to improve resting hear rate. "Increasing physical activity and decreasing periods of sitting can lower heart rate and lower cardiovascular risk," he said, adding that stopping smoking can also lower heart rate. Read more on heart health.

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.

NOAA Report Helps U.S. Regions Prepare for Spring Droughts, Floods
The National Oceanic and Atmospheric Association’s (NOAA) new three-month U.S. Spring Outlook predicts above-average temperatures will strike areas already afflicted by drought—such as Texas, the Southwest and the Great Plains—while places such as North Dakota can expect significant river flooding. The report looks at the likelihood of flooding and predicts temperature, precipitation and drought across the country. "We produce this outlook to help communities prepare for what's likely to come in the next few months and minimize weather's impacts on lives and livelihoods,” said Laura Furgione, deputy director of NOAA's National Weather Service. “A Weather-Ready Nation hopes for the best, but prepares for the worst." Read more on preparedness.

CDC Ad Campaign to Continue to Share the Stories, Troubles of Former Smokers
The U.S. Centers for Disease Control and Prevention (CDC) has re-launched last year's successful national ad campaign with a second series of ads telling the true stories of former smokers now living with the effects of their addiction—such as chronic obstructive pulmonary disease, severe adult asthma and heart disease. The campaign will run on television, radio, billboards and online, as well as in theaters, magazines and newspapers. "The Tips from Former Smokers campaign shows the painful effects of smoking through former smokers, in a way that numbers alone cannot," said CDC Director Tom Frieden, MD, MPH. "These are the kinds of ads that smokers tell us help motivate them to quit, saving lives and money." The ads are funded by the Affordable Care Act’s Prevention and Public Health Fund. Read more on the campaign.

Experts Expect More Severe, Lengthy Spring Allergies
Springtime means allergies for many across the United States, and higher pollen counts means the people who suffer from seasonal allergies can expect this year’s to be more severe and last longer, according to Kevin McGrath, MD, of the American College of Allergy, Asthma and Immunology. That means more sneezing, itchiness and fatigue. "We've seen record pollen counts for trees and ragweed [the most common fall allergy trigger] for the past few years, and the seasons may be a bit longer—about six to seven more days in the Midwest and a few more days in the Northeast," said McGrath, according to HealthDay. David Lang, MD, section head of allergy and immunology at the Cleveland Clinic in Ohio, recommends beginning medication early and avoiding the triggers as much as possible. Read more on environment.

At this month’s Public Health Preparedness Summit, John Lumpkin, MD, MPH, senior vice president and the director of the Health Care Group at the Robert Wood Johnson Foundation, presented about the National Health Security Preparedness Index. The Index, when completed, will be a single annual measure of health security and preparedness at the national and state levels. The Index will help inform decisions about how to prioritize investments and continual quality improvement of public health preparedness, and will also identify and highlight strengths and novel approaches. With input from many stakeholders, the Association of State and Territorial Health Officials, in partnership with the Centers for Disease Control and Prevention, is coordinating development of the Index.

Prior to joining the Foundation in 2003, Dr. Lumpkin served as director of the Illinois Department of Public Health for 12 years. In an interview at the Summit, Dr. Lumpkin described how the Index will help improve the quality of public health preparedness. He also shared his insights from his first-hand experience in coordinating a sustained response to public health emergencies that extends well beyond the initial response.

NPH: In the aftermath of a disaster such as Hurricane Sandy, how can public health agencies balance their focus on immediate needs such as shelter, food and emergency services, with longer-term challenges such as mental health, housing solutions and resilience?

Dr. John Lumpkin: While the immediate impact of homes being destroyed, people being forced to relocate and lives being lost, is devastating—there is also an ongoing public health impact of a disaster such as Hurricane Sandy, which is tremendous.

>>Watch a video on the ongoing public health response to Hurricane Sandy.

Study: Most Intend to Comply With Mandatory Hurricane Evacuation
Most residents of areas most likely to be hit by hurricanes—no matter their income level—intend to comply with mandatory evacuation orders, according to a new study in the journal Disaster Medicine and Public Health Preparedness. Researchers at The University of Texas School of Public Health did find variations with other demographic differences, such as age, ethnicity and education level. The findings indicate that disaster preparedness should focus more on how to best evacuate the most vulnerable residents, which could include targeted messaging and education. Read more on preparedness.

Breath Test May Identify People Prone to Obesity
A breath test that measures bacterial overgrowth in the stomach could be used to determine whether a person will become overweight, according to a new study in the Journal of Clinical Endocrinology & Metabolism. Researchers found that higher levels of methane and hydrogen from the bacteria Methanobrevibacter smithii were associated with higher BMIs and more body fat. Overgrowth of “bad” bacteria can also lead to bloating, constipation and diarrhea. While noting that obesity is “not a one-size-fits-all disease," study author Ruchi Mathur, MD, director of the outpatient diabetes treatment center at Cedars-Sinai Medical Center in Los Angeles, said this could help identify people who would respond best to particular weight loss methods. Read more on obesity.

Study Finds Most Major Restaurants Post Accurate Nutrition Info
A new study from Consumer Reports found that most major chain restaurants post accurate nutritional information about their food. Shoppers purchased and tested 17 menu items from restaurants and fast-food chains, comparing the results for each item to the same items purchased at other restaurants in the chain. They determined that only two items had higher fat or calorie content than advertised: Olive Garden’s Lasagna Primavera with Grilled Chicken and Outback Steakhouse’s Chicken on the Barbie. “We found that you can usually trust the figures you see,” said editor Leslie Ware. “On average, most of them were telling the truth.” The U.S. Food and Drug Administration is slated to release new regulations regarding nutrition labeling later this year. Read more on nutrition.

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.