Oct 28 2012

Getting Ready for Hurricane Sandy: A Conversation on the Role of Public Health in Preparedness

file Image courtesy of NOAA

Hurricane Sandy could be the biggest storm to hit the United States mainland in recent history, and some are calling the storm unprecedented. The storm poses a major threat to portions of the Mid-Atlantic and Northeast, and residents from New England to New York, Pennsylvania, New Jersey, Delaware, Maryland, Virginia, West Virginia and eastern Ohio are being urged to prepare.

Public health departments play a critical role in preparing and responding to disasters, particularly in galvanizing work across sectors. Earlier this Fall, NewPublicHealth spoke with Umair Shah, MD, Deputy Director of Harris County Public Health and Environmental Services in the Houston, Texas area, about partnerships for preparedness, including how public health and medical and response teams can work together. His experiences preparing for Hurricanes Ike, Rita and Katrina, as well as other emergencies such as H1N1, are more critical to share now than ever and just as relevant as the nation prepares for another emerging threat.

NewPublicHealth: What is your preparedness role for the health department?

Dr. Shah: As the deputy director of the health department, I work with our executive team that takes preparedness efforts very seriously. We wear two hats—our day job and then as a preparedness team, always ready. We have an incident command structure in place to use for any emergency—anything from a hepatitis scare to a rabies death, as well as identifying other citizens who may have been exposed. Some of the larger scale emergencies have included looking after 27,000 people housed in the Houston astrodome after Hurricane Katrina. And when Hurricane Rita hit just a short time later, we moved the Katrina evacuees and prepared for a potential landfall. During Hurricane Ike, three years later, we dealt with long power outages. And during H1N1, we worked with multiple partners. My role is really to work with our executive team and our response team to manage the health department’s responses, regardless of number of people affected.

NewPublicHealth: What kinds of partnerships are critical to ensure all efforts are coordinated and effective in the event of an emergency?

Umair Shah, Harris County Public Health and Environmental Services Umair Shah, Harris County Public Health and Environmental Services

Dr. Shah: I’ve been at the department now for a little bit over eight and a half years, and I have actually seen such a tremendous growth in our partnerships and our collaborative relationships with different agencies across the spectrum. During Tropical Storm Allison, the Texas Medical Center, which is the largest in the world, was flooded quite significantly. Our health care institutions and our community learned very quickly that a significant flooding event could have significant consequences for our [public health] system, and we improved both our response activities and our collaborative relationships. Then when we responded to Hurricane Katrina a while later, several dozens of agencies worked together on a daily basis over several weeks to determine how to handle the 27,000 people housed in the Astrodome. What we have really seen is that partnership is the key.

And when you have the kinds of budget restrictions we’ve been facing over the last few years, you have to be really creative. You have to also be very mindful of  your partners strengths and limitations because in the midst of an emergency response you want to be able to play to their strengths. When you are aware of their potential limitations, you can fill gaps.

The school system is another example of a critical partnership. During H1N1 we worked very closely with the schools and the administrators and were able to use school facilities to provide vaccines. Other successful partnering efforts have included the private sector and the faith-based communities. One key reason these groups are helpful is because some residents might not be as mindful of messaging that comes from “government." Faith-based or community leaders are trusted and often have a real good pulse of what’s happening within their specific communities.

Emergency response is very similar to a sporting event in the sense that on game day, you don’t just show up at a game and say, “Okay,  I’m going to go play today.” You have to practice it; you have to build upon the previous games you have played.

NPH: What is the role of the community in preparedness and response?

Dr. Shah: We’ve seen that our community is actually a responsive partner. When we communicate that through the media—another key partner—and deliver messages, such as to shelter in place or evacuate, or risks related to some infectious disease, we have felt that the public actually heeds the messages.

Public engagement is really something we should embrace. Our residents have a wealth of knowledge. But it’s also so important to remember the most vulnerable in the populations that oftentimes may not have the resources and may be especially adversely impacted by an emergency. So, as an agency, we really need to be mindful to provide for the entire community.

NPH: How else have budget cuts impacted how you do your work?

Dr. Shah: This is really a challenging time for local government but also specifically for public health departments across the country. Funding has been reduced, but not the expectations of a community or the responsibilities of a department.

And it’s not just funding cuts to the Centers for Disease Control [and Prevention] (CDC) that impact us. Budgets cuts to other agencies such as Environmental Protection Agency (EPA) and the U.S. Department of Agriculture impact us as well because they provide funding streams that come through states to local communities and local health departments like ours.

Those cuts have direct impact on our ability to respond. Oftentimes, at the local level, we take on the roles of a CDC or an EPA or a Department of Agriculture. Our department has lost about 30 percent of our personnel over the last couple of years. That impacts emergency response because during an emergency, you pull personnel from other parts of the department to help. When you don’t have as many people in other areas of the department to be part of our emergency infrastructure and response our capacity is reduced. Our real concern is whether we have enough resources and enough personnel to handle the myriad of every day responsibilities that continue in addition to an emergency response that might come up.

NPH: And despite that, you remain prepared for disasters. What have you done to remain prepared in the face of budget cuts?

Dr. Shah: It is important to highlight that Texas has had a number of emergency responses, really large scale responses. We’ve not just had to practice but we’ve actually had to respond. Whether they’re smaller storms or larger emergencies, we have over time really built up a very strong, robust communication system, collaborative activities and strong protocols to really understand  the emergency response role is at the local level. How does the state support what’s happening at the local level? How does the federal government come in to help support a local response, if they need to?

It’s also important to remember that emergencies happen in local communities. When the states come or the federal government comes in, they are there to help support the local response. At the end of the day, when the state and federal agencies that have helped  leave and respond somewhere else, the measure of success is really going to depend on how well the local agencies responded. If we do it well, our communities continue to have trust in government structure and our response agencies.

Preparedness is an iterative process, and just because you have actually had one successful response, you cannot rest on your laurels. You really have to continue to stay vigilant, to stay prepared, and be ready for the next emergency.

>>NewPublicHealth is on the ground in San Francisco, Calif., this week at the American Public Health Association Annual Meeting. Follow our coverage here.

Tags: APHA, Emergency Preparedness and Response, Hurricane Sandy, Partnerships, Preparedness, Public Health Departments, Public and Community Health, Q&A