Well…it
is hard to know how to start. For those of you who have lived through this
experience, our hearts and thoughts are with you. Given that, I wanted to send
a quick note that most likely reiterates what you have been hearing from public
health and government and public works officials. The topic of disaster
response is a well thought-out one, with a great deal of research behind it.
When I studied disaster response as part of my MPH program, my teacher was
Linda Landesman. She is a thought leader on the subject and wrote a very
important book entitled Public Health
Management of Disasters, a useful resource for people wanting to understand
how to prepare for this sort of situation. The book is published by the APHA.
The way
I think of the topic is very similar to how I think of disease in general. Is
it acute or chronic or an acute flare-up of a chronic situation? Which means
that when the event first occurs, the needs are different than they are a few
weeks or 6 months later. So for where we
are now, here it goes.
At this
point, nearly a week since the event, the most important issues to contend with
are:
- Shelter
- Warmth
- Clean water and Safe food
- Psychological support
I am
going to start by making an incredibly useless, stupid, and what may seem
insensitive comment. It could have been worse. Just when you think that things
cannot get worse, you hear a story that shows you that things really could have
be worse. We know that there are well over a hundred people who have already
died from the direct force of Hurricane Sandy. But it is this number, not
thousands, tens of thousands or hundreds of thousands. This does not help the
person who has passed away nor the parent, partner, child or friend of someone
who has died. That death cannot be changed. And of course, well…I mean what can
you say, except that you understand just how sad it is. However, what I am
writing about is trying to help to make that number stays as small as possible,
and to limit the ongoing effects or threats that exist now, which make it
dangerous or harmful for the people still impacted by the hurricane.
Shelter. Many people have lost homes and need
temporary shelter for the next days. Most of those people should have already
found temporary shelter. But if they have not they can reach out to a variety
of people. If they have a cell phone that sends texts, the easiest way to find
temporary shelter is to text to the following number “43362” with the following
message “shelter (put your zip code here)”. For example, text to 43362, the
following, “shelter 10010.” You will receive a text back within seconds to the
address of a nearby temporary shelter. The location you get will be within
walking distance.
For
those of you reading, this is the time to reach out to friends to invite them
to live with you for a while. They may or may not accept the invitation. But
sometimes, in this situation, people are in shock and they may not have actually
thought of it. Make the offer.
A related
and very important issue to shelter is that some homes are not destroyed.
However, they may be damaged. You have
to make sure that the home is sound enough to inhabit. People will be injured,
people have been killed moving into a house that is not sound. Make sure that
it is sound! If in doubt, get professional advice. Aside from structural
issues, the two big issues are live electric exposures and gas leaks. Both of which
are potentially life threatening and should be treated with the utmost caution
and gravity. Remember, even though you as a human being may have been
displaced, so too are mice, rats, cats, dogs, etc. Look through the house. Make
sure all is as it should be.
Related
to this, throw garbage away from your sleeping locations. No spoiled foods or garbage
near you. Lastly, even though it is not so important now, you should consider
taking pictures of your house and its belonging now. Those will be useful for
insurance claims at a later time.
Warmth. To add insult to injury, there is a storm
coming in the northeast this week. Temperatures are going to drop. People need
heat. So if you have house/shelter but no heat, and you are relatively okay,
you might want to relocate to a better shelter in advance of the storm. If you
do not want to leave your house but it is not safe at night, consider temporary
shelter that is warm. Plan ahead!
Related
to this is that people may want to run some sort of generator to create some
local electricity for heat. ALL GENERATORS SHOULD BE OUTSIDE. NO GENERATORS
SHOULD RUN INSIDE THE HOUSE. PEOPLE DIE FROM CARBON MONOXIDE POISONING. This
happens, and happens often enough that on the generator there are generally warnings
about this. It is not safe to run a generator inside the house. Don’t think
that just because there is no longer a window or a door that there is enough
ventilation. It is not safe. Also, don’t think about running the generator
inside the house while you are gone, and then come back in and turn it off. The
carbon monoxide will still be there and the situation remains dangerous.
Food and Water. At this point, days later, if you live in a
place that has previously lost power, the food and water you are about to
eat/drink may be dangerous to you. Foods that were canned/preserved/jarred and
unopened are safe. However, foods that go bad, even if they were in the refrigerator/freezer,
should be considered as potentially spoiled. If in doubt, get rid of it. At
this point, spoiled foods and water become much more of a health concern than
previously. Don’t get sick from something as simple as this. If the fridge was
off for days, consider everything in there with suspicion. Don’t add to the
medical burden or compromise your safety with something you can control. Make
sure children understand this as well. It turns out that epidemics do not
happen as often as portrayed in movies, but food borne local illnesses do!
Relatedly,
while cleaning up the house, it is easy to get injured with minor cuts and
scrapes. If you have access to gloves or other protective hand wear, use it. Before
you start your cleanup work be sure you know where you have soap, water and
clean cloth. In the event you injure yourself, clean the area carefully, USE
SOAP, for at least 30 seconds on the area. Clean as well as you can, and then
keep the area dry and clean until you can get care. At this point, these
secondary injuries and infections become common and frequent and potentially as
dangerous as anything else.
Make
sure you know that the water you drink is confirmed potable. If possible, let
it run a bit before you capture it. And if you’re not sure, boil it. But ask an
official if the water is safe where you live.
Psychological support. The
psychological shock and dislocation are huge. Luckily this was not a surprise,
and therefore most families were already together. Kids were not at school,
with one parent at one job and another parent at another job. But grief,
sadness, anger, and confusion are all strong emotions. Some have lost loved
ones. Some have lost limbs. Many have lost everything they have worked for
their whole lives. They may have lost their house, which may not have been
insured, and lost all the contents within that home. Their family pictures,
their marriage certificate, the picture of their child being born, work related
documents, etc. All gone. Grief does not begin to describe it.
Increased stress
may lead to angry outbursts. For me, this is very important and something that
is often overlooked. During these times, the potential for domestic violence
rises and often does. You have to make sure that everyone is safe. To help
this, it is important to make sure that people can get psychological support,
some sort of counseling, some sort of talk therapy. Look for caregivers from
the government, but also from churches and synagogues and mosques. Trauma is
trauma, stress is stress, and people need to be able to process this so that
they are better able to move forward. These early days matter. As important is
the need for the caregivers and first responders, who are most likely as
stressed as everyone else, to access this sort of therapy as well. They lived
through the same situation, and may have lost as much as anyone else.
Interestingly enough, there has been research to show that first responders
will most often show up for work even
though, or even when, they themselves have suffered in the same disaster.
We have to make sure that they check in to ensure that they don’t
psychologically ‘crash and burn.’
Lastly, around
this issue, many people’s psychological structure is supported by their family,
job, friends, and in a disaster such as this, they lose their support
structures. When that happens they may become temporarily, understandably, unhinged.
Having crisis teams and counselors available to help deal with the initial
impact and anxiety is crucial, helping the general public and those fire fighters
and police officers process the experiences they are going through. Towards
that, removing anxiety of the unknown can go a long way. Letting people know about
the welfare of their family members, and where food and shelter will be
provided can make a huge difference. Media campaigns to give reliable
information are important here, and they have been great this time around.
Children are very sensitive as they have not had many experiences in life and
will be very vulnerable to psychogenic shock, and need special counseling.
Family counselors would be useful. While a lot of this is acute, work here/now
can help prevent or mitigate PTSD.
There is a lot
more to say about how to prepare and what to do in these situations, but now is
not the time. At this time, we are in an acute situation, and need to be
preparing for the storm that is going to arrive here in the next few days.
To end, I just
wanted to say that our thoughts and prayers are with you all.
Love, Paul
