Building Back Better: New Jersey as a Case Study for Improving Preparedness

Nov 11, 2014, 1:12 PM

In recent years, the state of New Jersey has found itself at the center of high-profile emergencies and public health scares—from the disaster wrought by Superstorm Sandy in 2012 to a controversial plan in recent weeks to quarantine individuals identified as at risk for contracting Ebola. As the 11th-most populous state—and a major hub of international travel and commerce—New Jersey’s public health leadership serves as a case study for the nation.

NewPublicHealth recently spoke with New Jersey Health Commissioner Mary O’Dowd. She has been sharing New Jersey’s preparedness and recovery lessons nationally as a member of the preparedness policy committee of the Association of State and Territorial Health Officials and implementing them as the state addresses potential exposure to Ebola in returning volunteers.

NewPublicHealth: Looking back, what worked well in the health department’s response before, during and after Sandy?

Mary O’Dowd: I think one of the things that really worked well in that immediate response phase was that we employed our lessons learned from Hurricane Irene the year before, in 2011. For example, we used the Emergency Management Assistance Compact, which is an agreement among states to assist each other in times of crisis or emergency, and we specifically used it to bring additional ambulances into New Jersey for our EMS system to enhance our capability, but we didn’t make the request until after the storm. So for the first day or two, we didn’t have the resources on hand.

We learned from that shortfall. The next year, before Sandy made its way to New Jersey, we had already put out the request via the EMAC system and had ambulances from Indiana on the ground before the storm hit. And that was really critical in our ability to immediately respond in particular with Sandy, because with the flooding we had several areas of the state where ambulances actually were flooded out and were no longer available for us. We were very lucky that we had learned that lesson from the year before. 

Watch a NewPublicHealth video about the public health response to Hurricane Sandy featurining Mary O'Dowd and other public health officials.

We also got a lot of very positive feedback on making modifications and actually issuing waivers in advance of the storm hitting. We issued waivers, for example, to health care facilities that would allow them to add extra beds exceeding their capacity license, and to accept patients from other facilities as well as allowing hospitals to shelter patients who no longer needed acute care services but couldn’t return home to their communities. And those two were extraordinarily important because in some of our harder hit communities, the power outages lasted days to weeks.

Some hospitals were actually sheltering individuals who needed electricity to plug in their oxygen compressors because they couldn’t do that at home. We also issued waivers for home health and hospice agencies that allowed them, for example, to provide services beyond their geographic area and that allowed them to follow patients to where they were sheltering if they were relocated in a shelter or in a family member’s home in another part of the state which allowed for continuity of care.

NPH: What aided the department’s response during the storm?

O’Dowd: Something that we really did well was data surveillance and using that data to immediately react to providing services where needed. We monitored the emergency departments of hospitals which helped us react to the increased number of visits because of carbon monoxide poisoning linked to power outages and improper use of generators. We also worked with the CDC and the American Red Cross to assess the medical needs in shelters and because of information we gathered then, there is now a national conversation between ASTHO, the Association for State and Territorial Health Officers, as well as the American Red Cross to integrate that more consistently in response to emergencies. I think that was a lesson learned that we’re now trying to make a national standard.

NPH: Do you have examples of collaboration that sped up or improved the post-storm response?

O’Dowd: In the recovery phase, one of the things that worked really well was the comprehensive approach that New Jersey’s Departments of Health, Human Services, and Department of Children and Families use to develop a comprehensive recovery plan, making sure that we had one plan collectively, that we assigned the projects to the most appropriate agency depending on how we were going to manage it, and really created an effective complement of programs for the short and long-term recovery.

NPH: Are you still addressing after-storm mental health issues two years on?

O’Dowd: Yes, I would say one key issue that continues to linger from a public health perspective is the ongoing stress and related behavioral health challenges for the community. When we originally put together our recovery plan, we had looked at some of the research that existed from Hurricane Katrina and Hurricane Floyd that showed that the impact of stress post-storm led to households breaking up, domestic abuse, traumatic brain injury in children as a result of abuse. And so the three agencies—Health, Human Services, and Children and Families—made this a particular point in our recovery initiative, and we continue to see the lingering impact of that. We provided additional support for case management, we provided support to our county health departments so that they could evaluate the needs of their community, and we also had a number of behavioral health programs. The Department of Health specifically focused on the integration of behavioral health screening in the primary care setting because we know that stress and behavioral health can be expressed in physical health needs, and so individuals who may not recognize they’re in need of behavioral health support may actually go to their doctor or provider because of a physical health need, so we provided nearly $3.5 million in funding to 10 healthcare agencies in the most impacted areas so that they can provide routine and regular screening for behavioral health issues in the primary care setting.

This is an ongoing initiative, and we know that some of these effects, you may see a year or two afterwards when individuals felt they should or anticipated a full recovery and are still challenged by ongoing impacts of the storm. And so, this was something that we continue to fund and support and anticipated, and are still working to try to support our communities so that individual still dealing with the aftermath can make a full recovery and fundamentally be a more resilient community in the end.

NPH: How has your planning and recovery work improved the evidence base for responding to disasters?

O’Dowd: One of the things that we struggled with is the lack of real research and data on which long-term-recovery-oriented programs are effective, and so when we were trying to put together our recovery plan, the research was scarce. There was not a toolkit that the federal government was able to provide us with. One of the things that I felt was very important incorporate into our recovery plan was a strategic approach to evaluating our programs to see how effective they were and supporting research on recovery in general so that New Jersey and the nation as well as the rest of the world would benefit from that moving forward.

I’m very proud of the work we’ve done here in New Jersey to really roll up our sleeves and work collectively as a state, as well as with our federal partners to put that together, but it was a challenge to find research out there that would validate or inspire some of these programs. We’re working with Rutgers University and Columbia University on some very specific research initiatives, including work related to occupational health as well as community health, and so I think that we have made a very focused and concerted effect to enhance the knowledge and understanding base for the country on what does long-term recovery really mean relative to programs that can enhance the resiliency of your community after multiple years, because I think in New Jersey and in many other areas of the country, recovery has been “the lights are back on, we can get back to work.”

And, I think that what we have learned and we anticipated from the extraordinary damage that Superstorm Sandy caused was that this was going to be a much longer-term recovery period and would require a much longer time period of investment and forethought, and so we now have an obligation to share that kind of learning with our colleagues around the country. Toward that end, I’m a member of the ASTHO policy committee on emergency preparedness.

I really see that New Jersey has an obligation based on our experience to better prepare our nation as we move forward.

NPH: How has the work better prepared you to respond to volunteers in West Africa coming back to the United States, at least one recently to New Jersey, who have been exposed to the Ebola virus?

O’Dowd: We continue to use a lot of different vehicles for communication. Twitter is one tool, but we’ve also been working for months to be sensitive to the very diverse community here in New Jersey, go out to community meetings and interact with Liberian organizations of the Liberian-American community in New Jersey to specifically give them feedback, because they’re extraordinarily concerned about their family and loved ones back in the affected countries of West Africa and worry about family from affected countries visiting their homes in New Jersey.

We have to continue to be wide in our perspective for providing some conference calls, the opportunity for conversation and interaction with our stakeholders. We’ve had some conference calls with almost 800 participants to talk about what the changing dynamics are, the policies in New Jersey, and respond very specifically to questions among health care, public health and EMS partners. We’ve gone to community organizations to meet with the Liberian and other West African communities here in the state in order to provide them with more education and information, and have also used Twitter when updates must be given quickly.

Questions we’ve gotten include: If a family member who has been in West Africa is sick, how do we address that? Who do we call? How do we get help? And we need to address those issues in a way that is culturally competent and reflective of the very real, personal, and emotional concerns that the community has. Sometimes that can be lost in a Twitter feed, but it can be better communicated in a community meeting. I know there are a variety of different tools that we need to be able to continue to use so that we can effectively meet the needs of our community and also be better informed about what their concerns are so that we can improve our response moving forward.

This commentary originally appeared on the RWJF New Public Health blog.