Category Archives: Preparedness
In the wake of disasters communities often share stories of resiliency, not just to show how far they have come, but to model for others the critical need for an infrastructure of planning and preparedness when disaster hits. When the bombs went off at the Boston Marathon last year, Achilles International, a non-profit group that pairs able-bodied runners with disabled people, already had a chapter in place in the Boston area.
The group reached out using social media, as well as bright yellow banners and shirts during twice-weekly training sessions along the Charles River, to help attract attention and encourage Bostonian volunteers and potential athletes to join up. One survivor did. Thirty-one-year old Mery Daniel, a single mother of a five-year-old, who is close to completing her medical boards to become a general practitioner physician, lost one leg and suffered damage to the other during the blast. She joined up with Achilles and ran its 5K Hope and Possibility race—her first race ever—using a hand cycle last June.
The community rallying around the Boston Marathon over the last year has resulted in several new competitors joining up to compete in the Boston Marathon. A team of thirty differently abled Achilles runners, each with at least one guide for the race, will be wearing yellow Achilles shirts in today’s marathon. Their disabilities—ranging from Dwarfism and scoliosis to visual impairment—have not held them back.
“The stories about the survivors’ recoveries brought attention to the fact that people with disabilities have opportunities to do things they enjoy and learn new skills,” said Eleanor Cox, director of chapter development for Achilles. “So when the chapter put extra effort this past year into outreach through social media, word of mouth and the bright yellow banners on the Charles—matched up with people wanting to volunteer and people with disabilities wondering what was possible—it turned a previously quieter Achilles chapter into a strong one. Boston Strong.”
>>Bonus Link: Read more from Boston Marathon Survivor Adrianne Haslet-Davis on Recovery, Care, and Collaboration on the RWJF Culture of Health blog.
The U.S. Food and Drug Administration (FDA) was a partner agency for last week’s Preparedness Summit in Atlanta. NewPublicHealth spoke with Brooke Courtney, Senior Regulatory Counsel in the FDA Office of Counterterrorism and Emerging Threats, about how the agency plans for disasters it hopes never occur. Previously, Courtney was the Preparedness Director at the Baltimore City Health Department and in that role oversaw all of the public health preparedness and response activities for Baltimore City.
NewPublicHealth: What did you speak about at the Summit last week?
Brooke Courtney: FDA views the summit as an unparalleled opportunity each year to engage with stakeholders at the state, local and federal levels—to share with them updates from the federal side and also for us to get feedback from them about challenges and successes. We engage with stakeholders on a regular basis, but this is really the meeting where the largest number of people involved in preparedness come together, and it’s a great opportunity to see people face-to-face.
We feel really fortunate to have been able to take part in the summit for the past few years. For this year’s summit FDA served on the Planning Committee and also participated in the medical countermeasure policy town hall with federal colleagues from the Office of the Assistant Secretary for Preparedness and Response, the U.S. Department of Homeland Security and the national security staff, all of whom we work with closely.
Another thing that we like to do at the summit each year is to give a more in-depth update through a session with the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department for Health and Human Services (HHS) legal counsel on the authorities that we have that we use related to the emergency use of medical countermeasures during emergencies. This year’s session was especially exciting for us because it was an opportunity for us to discuss with stakeholders some new authorities that were established in 2013 to enhance preparedness and response flexibility.
For example, we can now clearly issue emergency use authorizations in advance of emergencies, which is really a critical medical countermeasure tool for preparedness purposes. Through these flexibilities, for example, we’ve issued three emergency use authorizations in the past year for three different in-vitro diagnostic tests to address the emerging threats of H7 and 9 influenza and MERS-CoV.
NPH: What are the key responsibilities the FDA has in helping to prepare the United States for possible disasters?
Courtney: As an agency of the U.S. Department of Health and Human Services, the FDA, at its core, is a public health agency. FDA’s mission is to protect and promote public health in a number of critical ways. We’re responsible for regulating more than $1 trillion in consumer goods annually, ranging from medical products such as drugs and vaccines to tobacco and food products.
At this year’s Preparedness Summit, which met last week in Atlanta, the American Red Cross was a first-time partner for the annual event which brings together more than 1,000 preparedness experts from around the country.
“It was important for us to partner with the American Red Cross because they have a major role and responsibility in disasters,” said Jack Herrmann, the Summit chair and Chief of Public Health Preparedness at the National Association of County and City Health Officials (NACCHO), the lead partner for the Summit. “We felt that it was important that the public health and health care communities understand the Red Cross’ role and authority during a disaster and look for ways to foster and build partnerships [among] local health departments, state health departments and American Red Cross chapters across the country.”
Just prior to the Summit, NewPublicHealth conducted an interview by email with Russ Paulsen, Executive Director, Community Preparedness and Resilience Services of the American Red Cross.
NewPublicHealth: What are the key issues that communities should focus on now to get themselves better prepared for a disaster should it occur?
Russ Paulsen: Everyone has a role to play in getting communities better prepared for disasters.
As a first step, individuals, organizations and communities should understand the problem: What hazards are in their area? How likely are any of these hazards to become actual disasters? What have people already put in place to deal with them? Local Red Cross chapters can help with this assessment.
Once people understand the problem, the next step is to make a plan. Plan what to do in case you are separated from your family or household members during an emergency, and plan what to do if you must evacuate your home. Coordinate your household plan with your household members’ schools, daycare facilities, workplaces and with your community’s emergency plans.
Behavioral health was a frequent topic at this year’s Preparedness Summit in Atlanta for both presenters and attendees, who focus on helping people cope with stress during a disaster as well as on mental health conditions which can be exacerbated by the stress of an emergency. Thomas Bornemann, EdD, has been the director of mental health programs at the Carter Center in Atlanta since 2002. The Carter Center is the philanthropic foundation of former president Jimmy Carter and his wife, and focuses primarily on peace and health initiatives globally and in the United States.
NewPublicHealth spoke with Bornemann about the Center’s mental health programs and challenges that lie ahead. We spoke with Bornemann several days before the shooting this week at Fort Hood.
NewPublicHealth: What are the key mental health projects underway at the Carter Center?
Thomas Bornemann: We’re involved in a number of issues at the local level, national level and globally. One of our major global programs is a program in Liberia, West Africa, where we’ve been working on scaling up services in this post-conflict, low-income country. We are in our fourth year of five, and we’re providing three services: We’re training mental health workers because their mental health system was decimated after the war; we have helped them develop a national mental health policy plan and a national mental health law that will go to the legislature for approval this year we hope; and we’ve been working on the issues of stigma and discrimination against people with mental illnesses and helping to develop support for family caregivers who provide the lion’s share of the care.
In the United States we’ve been working for years on Mrs. Carter’s number one healthy policy priority, which has been the implementation of mental health parity legislation which passed in 2008. The U.S. Department of Health and Human Services has been working on final regulations since then which spell out the terms and conditions of parity. We’ve been working on monitoring that through the years, and we were very proud that in November Secretary Kathleen Sebelius came here to announce the release of the regulations out of respect for Mrs. Carter’s long commitment to parity legislation. We’ll continue to monitor the parity efforts as they become implemented through the Affordable Care Act.
Disaster experts at this week’s Preparedness Summit underscored the importance of meeting the specific needs of children and young adults in a disaster, who often react not only to their own response to a crisis but also to how adults around them are responding and dealing with the situation.
The Federal Emergency Management Agency (FEMA) has a program called Teen CERT (Community Emergency Response Team) which teaches readiness and response skills and includes practice and exercises. A California fourteen-year-old Teen CERT member, for example, has 17,000 Twitter followers for a weekly feed she updates with disaster preparedness tips.
Teen CERT Training takes 20-30 hours; more if teens are also certified in CPR, First Aid and the use of automatic defibrillators. Training includes:
- Keeping the teen volunteer safe while helping others
- Identifying and anticipate hazards
- Reducing fire hazards in the home and workplace
- Using fire extinguishers to put out small fires
- Assisting emergency responders
- Conducting light search and rescue
- Setting up medical treatment areas
- Applying basic first aid techniques and helping reduce survivor stress
Teen CERT members are also eligible for community credits which many high schools require for graduation.
And Columbia University’s National Center for Disaster Preparedness spearheads a program called SHOREline, which has a pilot program at five high schools in the Gulf Coast. Students work on organizational and leadership skills; meet and practice preparedness drills with local and national experts; and attend youth preparedness summits, said David Abramson, PHD, MPH, the deputy director of the Center who spoke about the SHOREline program at the Preparedness Summit this morning.
Abramson told attendees about the work of one group of SHOREline members at a Gulf Coast high school who took the lead on a disaster recently when a student at the school was killed by in a shooting. Seeing that the school had not planned a memorial service, the students raised $500 and bought all the helium balloons they could find for a service they planned and carried out that Abramson said was very critical for community recovery.
“Two or three years ago we were urging you to ask your health directors for social media tools, and now we’re talking about how it’s making a difference,” said Tom Hipper, MSPH, MA, Public Health Planner at the Center for Public Health Readiness and Communication at Drexel University, who helped lead a session on social media and public health response at the Preparedness Summit on Tuesday. He was joined by Jim Garrow, MPH, Operations and Logistics Manager at the Philadelphia Department of Public Health.
While many in the audience of a couple of hundred attendees are still in the early days of using social media, the benefit of adding social media to communications channels for routine and emergency communication is clear said the presenters.
Examples included the use of Twitter by public health officials in Edmonton, Alberta last year after flooding covered the downtown area. So many users accessed the feed that it looked like spam and Twitter shut down the feed, forcing the health department to move to the police Twitter account and then to a private constable’s account when the second feed was also shut down. Despite the switches, a survey after the flooding showed that 98 percent of responders were satisfied with the health department’s responsiveness on social media.
There is also the Verification Handbook for digital content to help verify digital images on social media. One example of an altered report was a shark moving alongside a car in New Jersey just after Hurricane Sandy hit.
Hipper had strong advice for both novice and seasoned health department social media users:
- During disasters, retweet important information from credible agencies, such as street closings from the Office of Emergency Management
- Use Twitter message libraries when available. Drexel is creating one that includes messaging for all sorts of public health emergencies such, as an active shooting or a ricin attack. The value of the messages includes faster response in an emergency even if some tweaking is needed, and many of the preset messages are based on feedback to messaging used previously.
- Engage your audience before an emergency so they will turn to your social media platforms if an emergency strikes. Hipper gave the examples of Chicago, which held an immunization Twitter chat last fall and had 180,000 followers, as well as the Boston Police Department, which already had 40,000 followers before the Marathon bombing last year and saw that number rise to 300,000 as the search for the bombers unfolded.
Hipper and Garrow also advised repeating information during a disaster because people join the conversation at different points; to announce when to expect next updates and what hashtags are being use; to point to other credible agencies for information; and to ask users to send questions which can help improve the information they provide.
“Disasters pose questions of who [is helped] first and who...last,” said Sheri Fink, MD, PhD, a correspondent for The New York Times and Pulitzer Prize-winning author, to more than 1,000 attendees of the 2014 Preparedness Summit in Atlanta this week. Fink is the author of Five Days at Memorial: Life and Death in a Storm Ravaged Hospital, about the response by health providers, first responders, volunteers, patients and family members who rode out the storm in a hospital that lost power in the early hours of the hurricane. Fink was the headline speaker for the first plenary session of the Summit.
Fink’s book—which Umair Shah, deputy director of Harris County Public Health and Environmental Health Services in Texas and a panelist for the plenary discussion, urged the audience to read even if they only had time to skim—takes a close up look at the response from what may have been mercy killings to heroics by family members who commandeered boats to help evacuate patients.
Questions posed during the emergency in New Orleans, said Fink, included whether the hospital should be taking in new patients during the storm at a time when it was trying to evacuate the patients there, and whether criteria for first evacuees should be maximizing numbers of lives saved or maximum number of years of life saved.
“And because there is no right answer, we need to develop better evidence to [rely on] when difficult decision are needed,” said Fink, who had been a disaster and conflict first responder.
In response to the deaths and delays of Katrina, Fink and other panelists including Shah, Paul Biddinger, MD, FACEP, director, emergency preparedness and response exercise program at the Harvard School of Public Health, and Nicole Lurie, MD, MSPH, Assistant Secretary for Preparedness and Response in the U.S. Department of Health and Human Services, ticked off disaster response improvements including the creation of Lurie’s office, and the development of new partnerships—in particular public and private ones such as with hospitals and health departments. One key change—mapped data from the Centers for Medicare and Medicaid Services—helps responders identify people in the community whose medical conditions require them to shelter in place.
Fink shared some recommendations for additional preparedness needs:
- A need to update infrastructure that is vulnerable to collapse or breakdown across the country
- Engage the public so that they will show their support for preparedness funding
- Face the fact that all power can be lost and respond in that way
- Promote research
- Maintain flexibility and creativity
Fink shared some examples of creativity at Memorial Hospital in New Orleans, including hospital workers who used a truck to transport patients to another side of the building and then carried them up rickety stairs to the helipad since it could not be reached by elevator; workers who hotwired boats to aid in evacuation; and workers who found that neonatal incubators would not fit on some of the evacuation helicopters and so kept babies warm by tucking their heads under their own clothing and continued to ventilate them manually.
>>Bonus Content: Read a NewPublicHealth interview with Paul Biddinger.
Paul Biddinger, MD, FACEP, director of the Emergency Preparedness and Response Exercise Program at the Harvard School of Public Health, was a member of this morning’s opening panel on disaster preparedness at the 2014 Preparedness Summit. NewPublicHealth spoke with Biddinger ahead of the conference on what students and communities need to know and do to be best prepared for a disaster.
NewPublicHealth: Is it a requirement for students in graduate school for public health degrees to take at least one class in disaster preparedness?
Paul Biddinger: It is not. They have the option, but it is not a required element of what they have to take.
NPH: How do you think recent disasters have informed what students and public health staff members need to know about response?
Paul Biddinger: I think some of what students need to know has always been the case—but maybe has been underscored by recent events—which is that no matter what you do in public health you may be needed as part of the response, and whether you're working in maternal and child health or smoking cessation or HIV/AIDS, when a disaster happens it’s all hands on deck. And I think the hurricanes, the pandemic and other events have showed that often we need to reach well outside the traditional emergency response or preparedness work staff in public health, and so everyone has to be flexible, has to be able to participate in the response. I think in order to participate in the response you have to know that there is an emergency operations plan, what your role in it would be, how you would get information, to whom you would be responsible or to whom you would report. And those are things that you should know ahead of time.
I think the other thing we see when we see these wide-area disasters like we saw in Sandy, like we saw in Katrina, is the central role that public health can play in coordinating the health response—that multiple hospitals, long-term care facilities, out-patient facilities such as dialysis centers all need to be coordinated in their response to achieve the best possible health outcomes for the community. And public health is in a particularly strong place in the community to be able to help make sure that each of those individual participants is pointed in the same direction and is leveraging the community resources as best they can.
Study Finds Many Older Adults Often Not Prepared for Disasters
A recent University of Iowa study finds that, compared to younger adults, older adults are more vulnerable when natural disasters, hit yet most U.S. adults ages 50 and older may not be prepared for a serious flood, earthquake, tornado, or other natural disaster. The report is based on a 2010 survey that was part of the Health and Retirement Study, which collects social, economic, and health information on adults age 50 and older in the United States. The survey did not include older adults living in nursing homes or other institutional settings. Among the findings:
- Only about one-third of the 1,304 adults interviewed said they had participated in an educational program or read information on how to prepare for a disaster.
- Fewer than 25 percent had an emergency plan in place, although the same percentage lived alone.
- Almost one-third reported being disabled or in fair or poor health.
“Our analysis underscores that older adults living at home often have special needs and situations that put their health and safety at risk in the face of natural disasters,” said Tala Al-Rousan, MD, the study’s primary author and a graduate student in epidemiology at the UI College of Public Health. “The oldest respondents, 80- to 90-year-olds, were significantly less prepared than 65- to 79-year-olds.”
>>NewPublicHealth will be on the ground at the 2014 Preparedness Coverage this week. Follow our coverage here.
Healthy Foods Can Increase Concession Stand Sales A new small study by researchers at the University of Iowa found that adding healthy foods to a football game concession stand appears to increase sales. The researchers asked a college club to add healthy foods such as apples and string cheese to its concession stand menu open during football season, as well as put healthier ingredients into other items including nachos and popcorn. Sales rose four percent over the previous year, and the healthier foods making up almost ten percent of sales. The study was published in the Journal of Public Health. Read more on nutrition.
Study: Gastric-Bypass Surgery Linked to Remission of Type 2 Diabetes
People who undergo gastric-bypass surgery to deal with their weight are more likely to see their type 2 diabetes go into remission without medication that are people who undergo a sleeve gastrectomy, according to a new study in the New England Journal of Medicine. "One-third [of patients] in the gastric bypass group had remission of diabetes—meaning they had normal blood sugar control—and a quarter of the people in the sleeve gastrectomy group had remission of type 2 diabetes," said study co-author Sangeeta Kashyap, MD, an endocrinologist at the Cleveland Clinic's Endocrinology & Metabolism Institute, according to HealthDay. "These effects are real, and they're persistent for at least three years. Essentially, these patients have had a vacation from diabetes for three years." The study included 150 people with type 2 diabetes, with an average age of 49 and two-thirds female. Read more on obesity.
FEMA Issues Advisories as Severe Weather Hits Parts of the U.S.
The Federal Emergency Management Agency (FEMA) has begun issuing advisories for states across the Southern United States expected to be impacted by severe weather.
According to the National Weather Service, a major winter storm is impacting the South and Southeast ahead of moving up the Eastern Seaboard on Wednesday.
FEMA is encouraging both residents and visitors in the track of the storms to follow the instructions of state, local and tribal officials, and monitor NOAA Weather Radio and their local news for updates and directions provided by local officials. Residents can find trusted sources for weather and preparedness information via Twitter on FEMA’s social hub.
Weather Emergency Alerts (WEA) are currently being sent directly to many cell phones on participating wireless carrier networks. These alerts are sent by public safety offices such as the National Weather Service about imminent threats like severe weather. They look like a text message and show the type and time of the alert, any action you should take and the agency issuing the alert. Check your cellular carrier to determine if your phone or wireless device is WEA-enabled. Read more on preparedness.
Dozens of Bills Introduced in Recent Years to Increase School Vaccine Exemptions
From 2009 to 2012, 36 bills were introduced in 18 states to change school immunization mandates, with the majority aimed at expanding exemptions, according to a recent review in JAMA by researchers from Emory University. None of the bills passed, but the researchers say continued efforts to change state vaccine rules are concerning. Among 36 bills introduced, 15 contained no administrative requirements, seven bills had one or two administrative requirements, and the remaining 14 contained between up to five administrative requirements in order for parents to exempt their children from school vaccine rules in a given state.
"Exemptions to school immunization requirements continue to be an issue for discussion and debate in many state legislatures," according to the study authors. Read more on vaccines.
Being in a Good Mood Can Lead to Safer Sex
HIV-positive men are more likely to have save sex when their mood improves, according to a new study by researchers at the Mailman School of Public Health at Columbia University. The study, published in the journal Psychology, included 106 sexually active, HIV-positive men who have sex with men who completed weekly surveys over six weeks that asked about their sexual behavior, depression, and wellbeing during the prior week. Overall, 66 percent of study participants reported having unprotected intercourse in the prior two months; 81 percent had multiple partners. Three-quarters of the study participants were black and Latino men, a group disproportionately affected by HIV.
The researchers found that the men who reported an increase in their wellbeing in a given week were more likely to have safe sex (66%), while those who reported higher-than-usual levels of depression were more likely to engage in the risk behaviors (69%). The researchers are now studying potential interventions that might help address risky behaviors during depressive phases. Read more on sexual health.