Jun 19 2013
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Prepared for a Disaster and Building Back Better: Terry Cline on Public Health’s Response to Oklahoma Tornados

Tornadoes that struck Oklahoma just a few weeks ago have left more than 40 people dead, scores injured and billions in losses, including whole neighborhoods wiped out. The devastating weather of the past year—including superstorm Sandy, which wreaked havoc on the Northeast, especially New Jersey and New York City—has called even greater attention to the critical need for public health departments to be ready to respond at all times. Health departments in the communities and states where disasters happen have to be nimble enough to respond to the expected and the unexpected—as you’ll see from three interviews NewPublicHealth recently conducted with the health commissioners of New Jersey and Oklahoma, as well as with the health director of Oklahoma City, the most recent area to be rocked by severe weather.

And because disasters don’t honor state lines and devastated areas may not have the capacity on their own to handle the myriad of disaster health issues, the manpower and equipment of even far-flung health departments can be critical—making preparedness a year-round, 24/7 responsibility for everyone in public health.

Read the first installment in the series, a conversation with Terry Cline, PhD, the Commissioner of Health in Oklahoma. 

NPH: With the recent tornadoes, what were you able to prepare for and what was unexpected?

Terry Cline: Unfortunately, in Oklahoma we have a lot of experience in dealing with disasters and we have what I consider to be a well-oiled machine in place. So overall, I think the response to this tragic situation went very well. The multiple tornados were a bit of a surprise though. It’s not unusual to have several tornados in the same area, but it’s unusual to have two significant tornados and then have one of those go through an urban area. I think a critical impact that was not anticipated was the flooding during the most recent tornado. The bottom line is that you need to have a strong infrastructure in place because Mother Nature has a way of always having the upper hand.

NPH:  Did it benefit your state that other communities are prepared for disasters as well and could come in and help?

Cline: Absolutely. We’re very grateful for the offers of assistance that came from all levels of government. We got offers of help within hours if not minutes and that included my fellow commissioners who were reaching out to me directly from other states, as well as our federal partners who were the top level individuals who reached out personally and individually. Another way in which our colleagues have been generous is that nearby communities may not have been hit directly but may have people coming into their area because they can’t stay at home.

When the tornado hit Joplin, Missouri, several years ago, that was just across the line in Oklahoma. The state boundary is really an artificial boundary. If you live in that area it doesn’t really matter to you what side of the state boundary you’re on, it impacts you. So when your local grocery store is wiped out and you need to travel across that state line and you, for example, get food through the Women, Infants and Children (WIC) program and you need your WIC voucher to work in a different state, officials need to prepare to really cross those lines. The response has been awesome.

NPH: What have the biggest challenges been?

Cline: The biggest challenge has been not trying to get resources; it’s really making sure that those resources are coordinated. That has probably been the biggest public health challenge in this situation­ – making sure that we have the right resources at the right time and the right place. And that’s where the boots on the ground experience is really critical – being able to coordinate that response so we’re maximizing those resources.

A concrete example would be making sure that we don’t have five of the exact same resources from five different areas show up at the same place when we really just need one of those.

People from other states really need to be coordinating through that emergency operations center, and then they then triage that needs and aid. Is this a public health issue? Is this a shelter issue? And then they coordinate that to the respective areas.

NPH: In preparing for disaster, where does public health come in?

Cline: Well, of course, the most immediate need is safety, shelter, food, the basic elemental services that we need just to function and the most immediate aftermath is connecting people with their families and making sure that everyone is accounted for, that people are safe and then have a place to shelter.

Then the cleanup begins. With a tornado of the magnitude we had, where everything is wiped out, you end up with a debris field that looks like entire communities have been put through a shredder and you end up with that rubble. Even getting back into your community requires coordination on the ground from the immediate response team that’s there because the street signs are gone, the trees may be gone, and everything that you used to navigate in the course of a day is gone. At the same time we’re concerned about making sure that people have had recent tetanus shots. We administered literally thousands of tetanus shots on site. We send teams in to make the shots available as people are going through these debris fields. And as they do that they can get puncture wounds from rusty nails and other metal sources. It can be very hazardous. It’s a challenge to get people to do that in a safe way.

Another challenge we found was that people have no food, no money, and couldn’t go to a restaurant or grocery store. There’s a complete absence of all those things it takes to get through a usual day. So you have food vendors showing up and we in public health need to make sure that food is properly prepared and that we’re not inadvertently poisoning all of our families and our first responders who are on site. So we had inspectors at the sites who were giving guidance about the proper handling of food and sometimes that was a challenge because you had a lot of people who were showing up, very well intentioned, but they might be putting people at risk of unsafe food preparation and delivery.

The medical response also has challenges. You have to find out if you have surgical capacity within your hospital systems, but not really knowing what the magnitude of medical need will be. And can you get ambulances in and out of the site when you have nails and other debris that will puncture tires everywhere? And as we saw in this case, if you had a hospital that was hit, do you have capacity in other communities and ability to get people to those hospitals?

We had one hospital that had to evacuate, not because they were hit by the tornado but because without power, the pumping stations weren’t able to pump water to several of the hospitals that were in that area. The hospital that evacuated was one we would have relied on and in close proximity so we had to ripple out to other hospital systems. We were able to do that but it took good communication and the infrastructure in place to make that happen seamlessly.

Another challenge when you have providers pouring in from other states is that we needed to make sure those people are appropriately vetted so we don’t have people who are claiming to be medical providers who may not be. We needed to verify that. So again, it’s about that coordination, not a lack of resources, but making sure we have the right resources where they need to be.

Public health also has a role in terms of vital records such as birth and death certificates. If you lose everything in a disaster you may not even have your wallet and how do you get a hotel room without an ID. So we set up a Vital Records Office in the community that could issue birth and death certificates. We waived the fees if you lived in that vicinity.

NPH: How did budget cuts impact your ability to respond?

Cline: Well, we benefitted after the tornadoes from ten years’ worth of investment through preparedness funding. But the preparedness dollars moving forward are in jeopardy at the federal level, so I have grave concerns about that.

In terms of our response to the tornadoes just a few weeks ago, however, this is the validation about the importance of having and maintaining that infrastructure.

But, I worry about this type of response next year because there’s been very active discussion about cutting the preparedness dollars at the federal level. I think that would be incredibly shortsighted. We’ve made this investment, and you need to continue to maintain those services and that infrastructure, which takes funding to keep that well-oiled machine in place.

NPH: Are there seasonal disaster preparations in your state?

Cline: We are always in a state of preparedness. Again, it’s about having that infrastructure, so it’s an ongoing process. In public health, we need to be prepared year-round and have the flexibility to respond to an unanticipated event.

NPH: In the course of rebuilding, are there ways to build back better? In ways that create the community infrastructure to help improve health, such as bike paths?

Cline: We are beginning those conversations about the rebuild. Governor Fallin is all about population health and while she’s ensuring that individuals and families are getting what they need, she’s also very clear – what can we do to ensure that all boats rise with the tide at the same time and recognize that there is always opportunity for improvement. So she has pushed that population health approach and I would expect that that same approach will be applied here. This is a very early stage but it’s also the right time to be asking that question.

Tags: Community Health, Disasters, Preparedness, Public health, Public health agencies