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.

Though temperatures early this week in New York City have climbed to nearly 60 degrees, by Wednesday the overnight low is expected to drop below freezing. That’s why the city’s health department has issued a hypothermia warning to people in homes still without heat. As of last week, according to the Mayor’s Office, 11,000 people in the region still had not had their power restored. Some families have power but still no heat because pipes damaged by the storm have not yet been fixed.

“The weather is getting colder,” Health Commissioner Thomas Farley, MD, MPH, told New Yorkers. “Living in cold buildings is not good for your health. If your building heat is not going to be restored very soon, look for another warm place to live until it is. And check on your family, friends and neighbors, especially those who are vulnerable, to see if they need help getting to a warm place. Hypothermia, or very low body temperature is a life-threatening condition. It occurs when your body loses heat faster than it can produce it. Hypothermia can happen gradually and without the person realizing how serious it is.”

According to Farley, the symptoms of hypothermia include uncontrollable shivering, weakness, sleepiness, confusion, and lack of coordination. In infants, signs of hypothermia may include cold, bright red skin, or very low energy. A body temperature below 95°F (35°C) is a medical emergency and 911 should be called immediately.

A new Census Bureau tool, OnTheMap for Emergency Management, was created to help prepare communities for an emergency. The tool provides information about the potential affected population size and characteristics of the people, such as age, occupation, and place of residence.  In an event like Hurricane Sandy, the tool was able to trace the path of the hurricane and update data predictions of potential impacts as the storm's path changed. Communities can use these statistics to know how many people live and work in an area where there is a disaster. Knowing these numbers and related demographics helps communities set aside resources and identify vulnerable populations that will need additional assistance, such as the elderly or disabled.

>>Read more about the OnTheMap for Emergency Management tool.

Concerned by reports that volunteers and New Jersey residents are frequently unaware of environmental dangers when cleaning up homes and communities, the New Jersey Department of Health released an advisory earlier this week with advice on staying safe while scrubbing and rehabbing. Mold and materials containing asbestos and lead-based paint are examples of potential hazards in storm-damaged buildings and the advisory urged those tackling the heavy jobs to wear protective equipment appropriate for the work they are doing such as waterproof boots, gloves, goggles, and face masks.

"Homeowners doing cleanup work and the volunteers assisting them are critical assets in New Jersey's recovery efforts, but making sure they protect themselves is equally important," said New Jersey Health Commissioner Mary O'Dowd.

NewPublicHeatlh recently spoke about Hurricane Sandy clean-up safety with Donna Leusner, director of communications for the New Jersey Department of Health; Tina Tan, MD, state epidemiologist and assistant commissioner for epidemiology, environmental and occupational health and Joe Eldridge, director of New Jersey’s Consumer, Environmental and Occupational Health Service.

NewPublicHealth: What kind of environmental concerns specifically are there for those cleaning up the community after the storm?

Dr. Tan: There are concerns about individuals coming into contact with contaminated materials, whether contaminated with chemicals or infectious agents—residuals from flood waters as well as the general debris that might be around. We encourage individuals to take the appropriate precautions to try to avoid any sort of injuries or potential illnesses that could result from contact with these contaminated materials.

NPH: Are people aware of the critical basic information for safe cleanup, such as getting a tetanus shot if they’re injured during the cleanup in such terrible conditions? 

Last Friday Governor Chris Christie of New Jersey released an estimate of the economic losses caused by Superstorm Sandy— close to $30 billion. That estimate includes the devastating loss of homes and businesses for tens of thousands of individuals, damage to transportation and utilities infrastructure, and impact on local tourism. The economic consequences are critical, but the hurricane also posed a blow to the mental and physical health of many as well. Throughout the New York and New Jersey area, mobile health clinics remain in place, operated by the local and state health departments to help provide care for people displaced from their homes, neighborhoods and regular medical care.

Recovery continues. Today, for example, additional route sections of the PATH commuter rail service, which connects tens of thousands of New Jersey residents to their jobs in New York City, reopened.

And many states, even as they continue to send aid through funds and manpower to the affected areas, are trying to shore up their own communities against storms and other natural disasters yet to come. In an editorial this weekend, the Boston Globe asked whether the city of Boston will be able to respond and adapt quickly in the event of such a devastating storm. “The short answer is: Not yet, but there’s still time to get it right.”

Getting it right is the focus of the Public Health Preparedness Summit sponsored each year by key organizations including the Association of State and Territorial Health Officers, the National Association of County and City Health Officials and the Centers for Disease Control and Prevention, to be held in Atlanta March 13 to March 15.

Follow NewPublicHealth for stories on health department recovery and resilience efforts in the wake of Hurricane Sandy.

>>Read the Boston Globe editorial.

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.

Critical responses by the health department have included:

• A Department of Health hotline, opened within days of the storm, and staffed with public health experts who answer questions on mold cleanup, food safety, and drinking water concerns. The public can reach the hotline either through the state's 2-1-1 system or by calling 1-866-234-0964. 
• The New Jersey Department of Mental Health and Addiction Services is coordinating statewide efforts to help individuals and communities manage the emotional impact of the storm, and offers assistance through a toll-free Disaster Mental Health Helpline: 1-877-294-HELP (4357); a TTY line is available for persons who are deaf and hearing impaired at 1-877-294-4356.
• The New Jersey Medical Reserve Corps (NJMRC) program is comprised of health care professionals and community health volunteers from across the state. "In the aftermath of Hurricane Sandy, the Department has received many inquiries from people looking to volunteer in New Jersey's response and recovery efforts," says O'Dowd. Every county is the state has at least one MRC unit, and all 25 NJMRC units have been active during the response and recovery efforts, according to O’Dowd. Volunteers have been serving at shelters across the state, have helped staff hotlines and have distributed food and water in local communities. New Jersey was the first state to have an MRC in every county. 
• The U.S. Department of Health and Human Services (HHS) approved the New Jersey health department’s request to ensure access to prescription medications to uninsured residents affected by the storm through its Emergency Prescription Assistance Program.  The program provides access, at any enrolled pharmacy, to necessary prescription drugs and some medical equipment for individuals in a federally-identified disaster area who don’t have health insurance.
• The Department has also assisted local and county health departments who were impacted by the storm. Many health department offices and facilities faced flooding, power outages, water shortages, wastewater concerns and communication difficulties. The state health department’s field staff has assisted with, among other issues, shelter and retail food inspections, in the weeks after the storm. 

As the recovery efforts continue in the aftermath of Hurricane Sandy, NewPublicHealth is following the work of local and state health departments in the areas affected by the storm as they help their citizens regroup, recover and build community resilience. Read more on public health preparedness and response.

Three weeks after the storm the New York City Health Department has meaningful storm-related health use data that is valuable for both current health services delivery and future disaster planning:

• Emergency room visits for both mental and physical health concerns in New York City dropped on the day of the storm but have now returned to typical levels.  
• There was a brief increase in cases of hypothermia immediately after the storm but no sustained increase since then.  
• There is a continuing modest increase in visits for prescription medicine refills.
• There has not been an increase in injuries or illnesses overall.  
• There has been a modest increase in asthma emergencies in the Rockaway section of New York, which was especially hard hit by flooding and storm debris during the period immediately following the storm, but rates seem to have returned to baseline. According to the health department, the increases likely were caused by people living in cold temperatures, using their stoves to heat their homes, dust from storm clean-up and reduced access to prescription medication for some people during the first days of the storm.  

Among the impacts of the East Coast’s Hurricane Sandy have been tens of thousands of uprooted trees, contaminated water and tons of compromised food. A recent article in the Journal of Environmental Health Natural recommends that environmental health become an integral part of emergency preparedness and that community stakeholders take a role in merging the two.

David Dyjack, DrPH, associate executive director of the National Association of County and City Health Officials, and a co-author of the study, spoke with NewPublicHealth about building momentum to include environmental health in disaster emergency preparedness.

NewPublicHealth: What does the article address?

David Dyjack: The article is the first step in a series of research steps looking at how best to integrate environmental health and emergency preparedness so that communities are more resilient and take greater responsibility for their own health and safety in the event of an environmental disaster.

NPH: What is distinct about environmental health emergency preparedness? 

As recovery efforts following Hurricane Sandy continue, homeowners who lost their homes are filing insurance claims or hoping for federal help to rebuild. But there are also calls to require those rebuilding in coastal areas to make changes to the structures, and the seaside, to reduce the potential damage—and its cost—if disaster strikes again. People with ocean view homes, however, typically resist suggestions such as sand dunes or rebuilding homes on higher ground or on raised platforms to reduce flooding, according to a recent article in the New York Times.

Expect the debate to continue. Most flood insurance is issued by the U.S. government because private insurers don’t want to absorb the risk. And the money needed to pay out claims exceeds the premiums collected.

>>Read the full article.

Last week, a member of the NewPublicHealth staff had the opportunity to witness on the ground efforts in Brooklyn, N.Y., to help those affected by Hurricane Sandy. To follow is a brief account of the incredible response and community resilience in the face of a major disaster.

“How ya doin’ buddy,” the National Guard officer asked the elderly, weary man waiting in line for some food and a blanket late last week in Brighton Beach, Brooklyn. The old man, a Russian immigrant, spoke no English and the National Guard solider spoke no Russian, but they locked eyes, and shared a sigh as the man accepted the soldier’s arm around his shoulder. Together they entered a cavernous community center gym with lights, but no heat, a full ten days after the storm. Volunteers stood by tables heaped with supplies: gallon jugs of water, ready-to-eat meals, fleece ponchos that double as blankets, small bags of snacks from the Mayor’s office, and baby formula, diapers and wipes. Volunteers asked the residents their home situation: some had nothing, others had lights but no heat, some had heat but no hot water. Some had it all and lost it again, when an additional storm hit the coast and knocked out more transformers.

Brighton Beach was hit particularly hard during the storm. The community has a significant older Russian immigrant population, many of them on fixed incomes and government benefits, with a poverty rate of close to 30 percent, according to recent surveys. The National Guard soldiers deployed to patrol and search for victims described the conditions they saw: residents drowned in homes closer to the water, homes vandalized, windows smashed, and possessions looted.

Subway service only returned to the area last week, which let volunteers get in to canvass the neighborhoods. The Metropolitan Council on Jewish Poverty, a city-wide agency that has partnered with the New York City Mayor’s Office on response efforts, dispatched volunteers to check the conditions in apartments throughout the neighborhood. The check-list they carry includes questions such as “does your toilet flush?” Frozen pipes are wreaking havoc with water and heating.