Monday, November 5, 2012

Hurricane Sandy: the 1st week - Paul Herscu ND, MPH

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:
  1.           Shelter
  2.         Warmth
  3.        Clean water and Safe food
  4.        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