Recovery Research, Katrina's Fifth Anniversary, and Lessons Relearned

What may be called “disaster science” is a broad field that begins with understanding hazards, risks, and population vulnerabilities and moves on to establishing best-practice models of response, mitigation, and recovery. Gaps abound in our collective knowledge in all of these areas, and it is fair to suggest that we have only begun to scratch the surface in terms of what we need to know. The goal continues to be to learn how to prevent disasters whenever possible and, when prevention is not possible, to at least optimize survival, preserve vital infrastructure, and return rapidly to a state of normalcy

Hurricane Sandy: Lessons Learned, Again

Hurricane Sandy was a sobering reminder to those of us who call New York home that it is a port city and subject to the whims of wind and water. The storm itself was massive: climatologically, a thousand miles wide at its peak; economically, an estimated excess of $50 billion in damages. In the New York metropolitan area, 97 people died in the storm, thousands were displaced from their homes, and 2 major hospitals required perilous evacuations even as the hurricane force winds engulfed the metropolitan region. For those of us in the fields of disaster medicine and public health preparedness, the question is, were we ready? During the past decade considerable public investment has been made in standardizing command and communication, assuring appropriate and rapid supply chains, and training the medical and public health workforces to respond appropriately. And yet, in the week after the storm, persistent reports of widespread gaps in the provision of coordinated relief were received from the Rockaways to Coney Island to Staten Island and New Jersey. The question was not one of capacity and capability as much as it was of communication and coordination. Resources did not always make it the last mile to reach those most in need

School Interventions After the Joplin Tornado

Background/Objective To qualitatively describe interventions by schools to meet children's needs after the May 2011 Joplin, Missouri tornado. METHODS: Qualitative exploratory study conducted six months after the tornado. Key informant interviews with school staff (teachers, psychologists, guidance counselor, nurse, principal), public health official, and physicians. Report After the tornado, school staff immediately worked to contact every enrolled child to provide assistance and coordinate recovery services. Despite severe damage to half of the city's schools, the decision was made to reopen schools at the earliest possible time to provide a safe, reassuring environment and additional services. An expanded summer school session emphasized child safety and emotional wellbeing. The 2011-2012 school year began on time, less than three months after the disaster, using temporary facilities. Displaced children were bused to their usual schools regardless of their new temporary residence locations. In just-in-time training sessions, teachers developed strategies to support students and staff experiencing anxiety or depression. Certified counselors conducted school-based, small-group counseling for students. Selective referrals were made to community mental health providers for children with greatest needs. CONCLUSIONS: Evidence from Joplin adds to a small body of empirical experience demonstrating the important contribution of schools to postdisaster community recovery. Despite timely and proactive services, many families and children struggled after the tornado. Improvements in the effectiveness of postdisaster interventions at schools will follow from future scientific evidence on optimal approaches

Lessons from Katrina – What Went Wrong, What Was Learned, Who’s Most Vulnerable

If humans did not occupy the planet, disasters would never occur. Massive climatic events, earthquakes, volcanic eruptions, and tsunamis would be regular occurrences, of course, and the earth would look like a dynamic cauldron of natural activity, changing the look and the balance of nature and natural events continuously and randomly. What morphs these natural phenomenon into catastrophic events we call “disasters” is simply the presence of human beings who by choice, chance, or necessity find themselves in harm’s way. The “human factors” may be straightforward and benign. For instance, people making their livelihood from the sea are at risk from coastal storms and tsunamis. Similarly, people are found living in areas at considerable risk for mudslides and volcanoes. It could even be said that living in New Orleans, a coastal city actually below sea level, is a gamble, as was so dramatically emphasized by the storms and subsequent flooding of August and September 2005

Assessing the Reliability and Validity of the Evacuation Support Decision Tool

This study examines the reliability and validity of the Evacuation Decision Support Tool (EDST). The EDST is designed to provide healthcare facilities, emergency managers, and other agencies with a systematic process with which to evaluate and guide “evacuation” versus “shelter in place” decision making for a variety of “all hazards” situations. The EDST is comprised of 7 items that assess “threat” and 9 items that measure “consequences” of a situation. The tool was designed to provide users with a decision on whether to remain, prepare, or evacuate from a healthcare facility. To date, there has not been a study that examined psychometric properties of any evacuation decision tool, including the EDST

Analyzing Postdisaster Surveillance Data: The Effect of the Statistical Method

Data from existing administrative databases and ongoing surveys or surveillance methods may prove indispensable after mass traumas as a way of providing information that may be useful to emergency planners and practitioners. The analytic approach, however, may affect exposure prevalence estimates and measures of association. We compare Bayesian hierarchical modeling methods to standard survey analytic techniques for survey data collected in the aftermath of a terrorist attack. Estimates for the prevalence of exposure to the terrorist attacks of September 11, 2001, varied by the method chosen. Bayesian hierarchical modeling returned the lowest estimate for exposure prevalence with a credible interval spanning nearly 3 times the range of the confidence intervals (CIs) associated with both unadjusted and survey procedures. Bayesian hierarchical modeling also returned a smaller point estimate for measures of association, although in this instance the credible interval was tighter than that obtained through survey procedures. Bayesian approaches allow a consideration of preexisting assumptions about survey data, and may offer potential advantages, particularly in the uncertain environment of postterrorism and disaster settings. Additional comparative analyses of existing data are necessary to guide our ability to use these techniques in future incidents

Broadcasting Flu Messages – Citywide Transmission and Community Reception: An Evaluation of Ready New York’s pandemic influenza outreach campaign

Public health risk communication is a central feature of New York City’s pandemic flu preparedness plan. Particularly in the early stages of a pandemic, before effective therapeutic measures are available, non-pharmaceutical interventions such as social distancing, personal protective hygiene, and voluntary isolation are critical strategies for suppressing the spread of a novel viral strain. New York City health and emergency management officials have decided to use the city’s risk communication structure – the Office of Emergency Management’s Ready New York outreach and dissemination capacities – as one of the primary means to communicate pandemic flu health messages. In October 2008, NCDP contracted with Public Health Solutions and the Office of Emergency Management (OEM) to evaluate the reach and effectiveness of its planned Ready NY Pandemic Flu community outreach campaign

Children as Bellwethers of Recovery: Dysfunctional Systems and the Effects of Parents, Households, and Neighborhoods on Serious Emotional Disturbance in Children After Hurricane Katrina

Background: Over 160 000 children were displaced from their homes after Hurricane Katrina. Tens of thousands of these children experienced the ongoing chaos and uncertainty of displacement and transiency, as well as significant social disruptions in their lives. The objectives of this study were to estimate the long-term mental health effects of such exposure among children, and to elucidate the systemic pathways through which the disaster effect operates. Methods: The prevalence of serious emotional disturbance was assessed among 283 school-aged children in Louisiana and Mississippi. These children are part of the Gulf Coast Child & Family Health Study, involving a longitudinal cohort of 1079 randomly sampled households in the two states, encompassing a total of 427 children, who have been interviewed in 4 annual waves of data collection since January 2006. The majority of data for this analysis was drawn from the fourth round of data. Results: Although access to medical care for children has expanded considerably since 2005 in the region affected by Hurricane Katrina, more than 37% of children have received a clinical mental health diagnosis of depression, anxiety, or behavior disorder, according to parent reports. Children exposed to Hurricane Katrina were nearly 5 times as likely as a pre-Katrina cohort to exhibit serious emotional disturbance. Path analyses confirm the roles played by neighborhood social disorder, household stressors, and parental limitations on children's emotional and behavioral functioning. Conclusions: Children and youth are particularly vulnerable to the effects of disasters. They have limited capacity to independently mobilize resources to help them adapt to stressful postdisaster circumstances, and are instead dependent upon others to make choices that will influence their household, neighborhood, school, and larger social environment. Children's mental health recovery in a postdisaster setting can serve as a bellwether indicator of successful recovery or as a lagging indicator of system dysfunction and failed recovery