Category Archives: Preparedness
“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.
CDC Report Details Support of State, Local Health Responses
The U.S. Centers for Disease Control and Prevention (CDC) has released a new report detailing its support of state and local public health responses from 2012 to 2013, as well as assessments of all state and select local public health preparedness. The 2013-2014 National Snapshot of Public Health Preparedness is the sixth annual report from CDC’s Office of Public Health Preparedness and Response. “The lives protected by the public health response to Hurricane Sandy, the fungal meningitis outbreak, and the tornadoes in Joplin are just a few examples of how communities and CDC can work together to protect the public's health when its needed most,” said CDC Director Tom Frieden, MD, MPH.
Among the report’s highlights:
- During outbreaks and emergencies, response time is essential. In 2012, lead state responders reported for immediate duty within 27 minutes of receiving notification of a potential public health emergency—9 minutes faster than the 2011 national average.
- In 2012, across the 62 Public Health Emergency Preparedness (PHEP) cooperative agreement awardees, Emergence Management Program (EMP) activities included 185 engagements and 204 exercises. Internationally, EMP activities across 35 countries included 15 activations, 19 engagements, and 12 exercises.
- The percentage of E. coli-positive tests analyzed and entered into the PulseNet database within four working days increased from 90 percent to 94 percent and timely testing and reporting of Listeria-positive results increased from 88 percent to 92 percent.
“The ability of our local and state health departments to be innovative and maintain a steady level of preparedness despite extensive budget cuts is reassuring,” said Ali Khan, M.D., M. P. H., director CDC’s Office of Public Health Preparedness and Response. “However, preventing an erosion of our nation’s health security will be difficult in the current fiscal environment.” Read more on preparedness.
Study: Overweight Kindergarteners Four Times as Likely to Be Overweight Teens
Children who are overweight at the age of five are four times as likely to be obese by the age of 14 than are children who start their school years at an average weight, according to a new study in the New England Journal of Medicine. Approximately 27 percent of the five-year-olds in the study were overweight. Using data on almost 8,000 children gathered by the Early Childhood Longitudinal Study conducted by the U.S. National Center for Education Statistics, researchers determined that:
- Approximately 32 percent of kids who were overweight when they entered kindergarten had become obese by age 14, compared to 8 percent of normal-weight kindergarteners.
- The obesity rate rose most rapidly between first and third grades—from 13 percent to almost 19 percent—but not significantly between fifth and eighth grades.
- Between kindergarten and eighth grade, the prevalence of obesity rose by 65 percent among white children, 50 percent among Hispanic children and more than doubled among black children.
"If we're just focused on improving weight when kids are adolescents, it may not have as much of an impact as focusing on the preschool-age years," said lead researcher Solveig Cunningham of Emory University, adding that the study "doesn't tell us what to do about it, but it helps tell us when we need to think creatively about what to do." Read more on obesity.
Study: One-third of Americans, Two-Thirds of University Students Have Used Indoor Tanning
Despite clear and widespread data on their link to skin cancer risk, more than a third of Americans and nearly two-thirds of U.S. university students have used indoor tanning, according to a new study in the journal JAMA Dermatology. Approximately 19 percent of teens had also used the machines. Researchers at the University of California, San Francisco based their conclusions on an analysis of 88 surveys covering more than 406,000 people in the United States, Europe and Australia. "It is appalling how often exposure to indoor tanning takes place in presumably educated populations and particularly worrisome that we allow adolescents to be exposed to this carcinogen," said Mark Lebwohl, MD, chairman of the department of dermatology at Mount Sinai Hospital in New York City. "We must do a much better job at educating people of all ages about the risks of indoor tanning.” Read more on cancer.
Tips on Staying Warm During the ‘Polar Vortex’
As much of the country faces record lows due to a polar vortex, with many areas suffering through below-zero temperatures, experts are offering advice on how to stay warm and healthy. The first tip is staying indoors. "It's best to limit your outdoor activity as much as possible, since prolonged exposure can lead to frostbite and hypothermia," said John Marshall, MD, chair of emergency medicine at Maimonides Medical Center in New York City. "Both of these conditions can become serious, and even life-threatening if untreated." However, when you must go outside, follow these tips:
- Dress warmly — Layer clothing to retain body heat, and a non-permeable outer layer will help against strong winds.
- Protect your extremities — Wear extra socks. Also go with mittens over gloves, since fingers stay warmer when they’re next to each other.
- Wear a hat — And cover the ears and nose if possible.
- Wear properly fitted winter boots — If they’re too tight they can cut off circulation. Also go for a pair that’s insulated with treads.
- Stay hydrated — Drink fluids to replenish the energy your body spends to stay warm.
- Stay dry — Get out of wet clothing as soon as possible.
Read more on preparedness.
Study: Health Care Spending Remained Low as Economy Struggled
Health care spending has now stayed relatively steady—and low—for four consecutive years, rising by 3.7 percent in 2012 to $2.8 trillion. according to a new analysis from the Office of the Actuary at the Centers for Medicare and Medicaid Services (CMS). The study, published in Health Affairs, found that faster growth in hospital, physician and clinical services was somewhat offset by slower growth in prescription drug and nursing home services prices. Spending growth and growth in private health insurance for Medicaid were also near historic lows. "The low rates of national health spending growth and relative stability since 2009 primarily reflect the lagged impacts of the recent severe economic recession," said Anne B. Martin, an economist in the Office of the Actuary at CMS and the study’s lead author. "Additionally, 2012 was impacted by the mostly one-time effects of a large number of blockbuster prescription drugs losing patent protection and a Medicare payment reduction to skilled nursing facilities." Read more on budgets.
Study: Newer Antidepressant Drugs All Carry About Equal Risk of Suicidal Thoughts
New antidepressants all come with about the same level of risk for suicidal thoughts and behaviors in children, according to a new study in the journal Pediatrics. Previous studies identified the increased risk, especially within the first few weeks of treatment, but there were still questions of whether some drugs came with higher risks. The study analyzed the medical histories of almost 37,000 children, average age 14, enrolled in Tennessee's Medicaid program between 1995 and 2006. Each child was a new user of one of six antidepressants: Prozac, Zoloft, Paxil, Celexa, Lexapro or Effexor. The study found little difference in the rate of suicidal thoughts and attempts before and after they began the medications. However, they did note that children on multiple medications were at higher risk, though that could also be a result of more severe depression. Read more on mental health.
Study: State Car Seat, Seatbelt Laws Leave Children Vulnerable to Injury, Death
Many state laws on car seats and seatbelts are not current with regards to modern research or are inconsistent from state to state, leaving children vulnerable to injuries or even death, according to a new study in the journal Social Science and Medicine. Researchers look at child passenger safety laws from 1978-2010 across all 50 states [Editor’s note: Go here for an interactive map]. “These laws do not keep up with the published evidence, and even when they do, there are some cases where the laws are unclear,” said Jin Yung Bae, JD, MPH, the study’s lead author, and associate research scientist at the Steinhardt School of Culture, Education and Human Development at New York University. Approximately 250,000 children are injured and 2,000 are killed each year in the United States because of vehicle crashes, which many of these preventable, according to the study authors. The study was conducted by a team from New York University in collaboration with Temple University, and supported by the Robert Wood Johnson Foundation through its Public Health Law Research. The National Institutes of Health’s National Institute on Alcohol Abuse and Alcoholism also funded the study. Read more on injury prevention.
USDA Announces Grants to Improve Rural Housing
The U.S. Department of Agriculture (USDA) has announced that organizations in 45 states, the Western Pacific and the Commonwealth of Puerto Rico will receive grants to make housing repairs and improve housing conditions for limited-income rural residents. The funding is through the USDA Rural Development's Housing Preservation Grant program and will be provided to intermediaries such as local governments; public agencies; federally-recognized Indian Tribes; and non-profit, faith-based and community organizations. The organizations distribute the grants to homeowners and owners of multi-family rental properties or cooperative dwellings who rent to low- and very-low-income residents. Grants may be used to make general repairs, such as installing or improving plumbing, providing or enhancing access to people with disabilities and making homes more energy efficient. Read more on housing.
CDC’s Emergency Management Program Receives Full EMAP Accreditation
The U.S. Centers for Disease Control and Prevention (CDC) has become the first federal agency to achieve full accreditation of its emergency management program from the Emergency Management Accreditation Program (EMAP). “Accreditation is a serious accomplishment for CDC and the emergency management community we support,” said Ali S. Khan, MD, MPH, director of the Office of Public Health Preparedness and Response. “Preparing for and responding to emergencies of any kind—natural disasters, bioterrorism events, chemical terrorism or pandemics—is a core function of public health. Everyone at CDC has a hand, at one point in time, in emergency management and execution.” EMAP’s six steps to accreditation are subscription, self assessment, application, on-site assessment, committee review and accreditation decision. Thirty one states; the District of Columbia; and 14 U.S. cities and counties are accredited. Read more on preparedness and accreditation.
Severe weather is expected to impact at least four regions of the U.S. this weekend including a tropical storm in the Gulf Coast, a tornado threat in the Midwest, snow in the West and spreading fires in California fueled by dry weather. The Federal Emergency Management Agency (FEMA) has already recalled some furloughed staff to prepare for the storms expected on the Gulf Coast.
Because there is an exception during the shutdown for agencies that help protect against loss of life and property, the National Hurricane Center and the National Weather Service (NWS) are regularly updating their websites, and the NWS site has an option to search by state at the bottom of the map on the Service’s home page at weather.gov.
Other federal sites, including ready.gov, the federal disaster preparedness site, and the Centers for Disease Control and Prevention (CDC), currently say they are not adding new information, though government sites already have excellent general disaster preparedness information consumers and health departments can access. The U.S. government has a web page explaining what’s up and running and what is not, during the shutdown. If any of the weather threats become disaster situations, some of the sites may be permitted to update with specific information for individual disasters. The Weather Channel, a commercial site, is updating its information regularly.
Many agency social media feeds, including CDC’s, are not updating during the shutdown, however FEMA is updating its Twitter feed for the severe weather in the Gulf. Yesterday FEMA tweeted:
Four U.S. Regions on Alert for Severe Weather this Weekend
Severe weather is expected to impact at least four regions of the United States this weekend. That includes a tropical storm—downgraded from a hurricane for now—in the Gulf Coast; a tornado threat in the Midwest; early snow in the West that, in part because trees still have leaves that can be weighed down by wet snow, could lead to power outages; and spreading fires in California fueled by dry weather. The Federal Emergency Management Agency (FEMA) has already recalled some furloughed staff to prepare for the storms expected on the Gulf Coast. Read more on preparedness.
Study: Unnecessary Antibiotic Prescriptions Remain High, Endanger Public Health
Despite ongoing efforts by the U.S. Centers for Disease Control and Prevention (CDC) and other public health organizations, doctors continue to overprescribe antibiotics for sore throats, increasing the risk of the development of antibiotic-resistant bacteria, according to a new study in JAMA Internal Medicine. “Our research shows that while only 10 percent of adults with sore throat have strep, the only common cause of sore throat requiring antibiotics, the national antibiotic prescribing rate for adults with sore throat has remained at 60 percent,” said senior author Jeffrey A. Linder, MD, MPH, a physician and researcher in the Division of General Medicine and Primary Care at Brigham and Women’s Hospital. “For acute bronchitis, the right antibiotic prescribing rate should be near zero percent and the national antibiotic prescribing rate was 73 percent.” The researchers said the findings demonstrate the need to study and implement new interventions to reduce unnecessary antibiotic prescriptions. Read more on infectious disease.
Daily Walks Can Reduce Breast Cancer Risk for Older Women
Post-menopausal women can reduce their risk of developing breast cancer through physical activity as simple as a daily walk, according to a new study in Cancer Epidemiology, Biomarkers & Prevention. More intense exercise may have an even more profound impact. "The nice message here is, you don't have to go out and run a marathon to lower your breast cancer risk," said study researcher Alpa Patel, senior epidemiologist at the American Cancer Society, which funded the study. "Go for a nice, leisurely walk an hour a day to lower risk.” However, the study authors noted that they found only a correlation, not a causation, so further study is needed. Experts believe the reason exercise reduces breast cancer risk is related to hormones; they also recommend maintaining a healthy body weight and minimizing the consumption of alcohol as ways to reduce the risk of breast cancer. Read more on cancer.
“I’ll pack the dead batteries.”
“I’ll only put what I don’t need into a duffle bag.”
“I’ll try to get the generator going without any gas.”
Not exactly smart moves in the event of a natural disaster or other emergency…but maybe not far from reality for many families. Six out of 10 Americans don't have a disaster plan and only 19 percent said they were very prepared for a disaster. A new PSA campaign from the U.S. Department of Homeland Security’s Federal Emergency Management Agency (FEMA) and the Ad Council hopes to change that.
The campaign is designed to educate and empower families with children in the household to take steps to get everyone prepared for emergencies. That means giving everyone a role and ensuring everyone knows the plan. Unfortunately, because the subject matter is difficult and weighty, some parents hesitate to even bring it up.
By showing exactly how not to approach the discussion of preparedness—the above quotes are from family members sitting around a table—the new campaign encourages parents to have honest conversations with their kids about disaster preparedness, which can inspire a sense of confidence, control and calm when an actual emergency strikes.
“Humor is important because people get their guard down when they’re engaged in message,” said Priscilla Natkins, Ad Council’s executive vice president and director of client services. “They’re laughing, they’re smiling—yet they’re listening to the content. They’re listening to what these people are saying.”
>>Read More: Go to CNN.com to read the full story and watch a video on the new PSA campaign.
>>Bonus Link: Learn more about how families can prepare for disasters at Ready.gov/kids.