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Objectives: Hurricane Harvey left a path of destruction in its wake, resulting in over 100 deaths and damaging critical infrastructure. During a disaster, public health surveillance is necessary to track emerging illnesses and injuries, identify at-risk populations, and assess the effectiveness of response efforts. The Centers for Disease Control and Prevention (CDC) and American Red Cross collaborate on shelter surveillance to monitor the health of the sheltered population and help guide response efforts., Methods: We analyzed data collected from 24 Red Cross shelters between August 25, 2017, and September 14, 2017. We described the aggregate morbidity data collected during Harvey compared with previous hurricanes (Gustav, Ike, and Sandy)., Results: Over one-third (38%) of reasons for visit were for health care maintenance; 33% for acute illnesses, which includes respiratory conditions, gastrointestinal symptoms, and pain; 19% for exacerbation of chronic disease; 7% for mental health; and 4% for injury. The Red Cross treated 41% of clients within the shelters; however, reporting of disposition was often missed. These results are comparable to previous hurricanes., Conclusion: The capacity of Red Cross shelter staff to address the acute health needs of shelter residents is a critical resource for local public health agencies overwhelmed by the disaster. However, there remains room for improvement because reporting remained inconsistent.

Hurricane Michael made landfall in Florida's northwest Gulf Coast on October 10, 2018, causing massive destruction. It was the first Category 5 storm in recorded history to make landfall in the northeast Gulf Coast and the third most destructive hurricane to hit the continental United States. The health care infrastructure collapsed due to the severe damage to two main acute care hospitals, several heath care facilities, and clinics, resulting in large staff layoffs with many physicians relocating out of the area due to lack or support. With many schools and business destroyed, nearly 3,000 children left the school system along with their families. Ultimately, there were not enough living spaces for first responders and recovery crews, so posthurricane recovery efforts were gravely affected. Here are the stories of four nurse practitioners (NPs) who stepped up and recreated themselves to provide needed health care to several communities ravaged by Hurricane Michael. NPs, as skilled and trusted health care providers, are well-prepared to address the pressing life-threatening needs often associated with disasters such as hurricanes, thus ultimately making a difference in health outcomes in affected communities. It is a testimony for NPs across the state of Florida to be able to practice to their full extent of their education and preparation.

In August 2017, Hurricane Harvey struck the US Gulf Coast and caused more than US $125 billion in damages in Texas. The loss of lives and the economic damages resulted in an outpouring of support for the recovery efforts in the form of federal assistance and private donations. The latter has supported more creative approaches to recovery. Organizations that normally would not receive funding were able to obtain resources to use in novel manners. Using the framework of Dynes typology to identify groups and their respective structures and tasks, this report from the field analyzes Hurricane Harvey and the financial support mechanisms used to support recovery efforts in Texas, what organizations were funded to do, and where they fit into Dynes typology. The authors close by noting the importance of these emerging organizations and the need to support diversity in funding disaster response and recovery efforts beyond large nonprofit organizations.

In September 2019, the northwest Bahamas suffered unparalleled damages due to Hurricane Dorian. The storm disrupted all the essential community services, including water, electricity, and medicine. Heart to Heart International provided medical support in a very austere environment to the people of Abaco island. This article examines the challenges faced by the response team from Heart to Heart International in the immediate aftermath of Hurricane Dorian.

Hurricane Dorian's impact on Eastern North Carolina and the Bahamas islands demonstrate the devastation and public health needs that can be left in the wake of a catastrophic event. The hurricane created a range of public health and healthcare challenges, strained further by the damage to infrastructure on which critical services, including the medical supply chain, depend. The recovery process is long, but offers an opportunity to build back better, more resilient communities that can withstand today's threats.

Hurricane Irma made landfall in Southwest Florida on September 10, 2017, causing significant property damage, flooding, and power outages that lasted days to weeks during high heat and humidity. This created significant challenges for residents and businesses, as well as office-based surgical facilities in the area. Preparations in advance of hurricanes and other natural disasters for businesses should focus on staff, surroundings, space, systems, structure, and service. In the aftermath of a hurricane, assessment of the extent of the damage and the ability to perform restoration and mold remediation postflooding are the immediate goals. With the return of utility services, additional cleanup and assessment of equipment, medications, and sterile supplies with subsequent repair/recertification, replacement and reprocessing, as required, are necessary to bring operations back to normal.

ABSTRACTThe intensely active 2017 Atlantic basin hurricane season provided an opportunity to examine how climate drivers, including warming oceans and rising seas, exacerbated tropical cyclone hazards. The season also highlighted the unique vulnerabilities of populations residing on Small Island Developing States (SIDS) to the catastrophic potential of these storms. During 2017, 22 of the 29 Caribbean SIDS were affected by at least one named storm, and multiple SIDS experienced extreme damage. This paper aims to review the multiplicity of storm impacts on Caribbean SIDS throughout the 2017 season, to explicate the influences of climate drivers on storm formation and intensity, to explore the propensity of SIDS to sustain severe damage and prolonged disruption of essential services, to document the spectrum of public health consequences, and to delineate the daunting hurdles that challenged emergency response and recovery operations for island-based, disaster-affected populations. (Disaster Med Public Health Preparedness. 2019;13:5-17).

Objectives: Two category 5 storms hit the US Virgin Islands (USVI) within 13 days of each other in September 2017. This caused an almost complete loss of power and devastated critical infrastructure such as the hospitals and airports METHODS: The USVI Department of Health conducted 2 response Community Assessments for Public Health Emergency Response (CASPERs) in November 2017 and a recovery CASPER in February 2018. CASPER is a 2-stage cluster sampling method designed to provide household-based information about a community's needs in a timely, inexpensive, and representative manner., Results: Almost 70% of homes were damaged or destroyed, 81.2% of homes still needed repair, and 10.4% of respondents felt their home was unsafe to live in approximately 5 months after the storms. Eighteen percent of individual respondents indicated that their mental health was "not good" for 14 or more days in the past month, a significant increase from 2016., Conclusion: The CASPERs helped characterize the status and needs of residents after the devastating hurricanes and illustrate the evolving needs of the community and the progression of the recovery process. CASPER findings were shared with response and recovery partners to promote data-driven recovery efforts, improve the efficiency of the current response and recovery efforts, and strengthen emergency preparedness in USVI. (Disaster Med Public Health Preparedness. 2019;13:53-62).

Objective: To summarize ways that networks of community-based organizations (CBO), in partnership with public health departments, contribute to community recovery from disaster., Methods: The study was conducted using an online survey administered one and 2 years after Hurricane Sandy to the partnership networks of 369 CBO and the New York Department of Health and Mental Hygiene. The survey assessed the structure and durability of networks, how they were influenced by storm damage, and whether more connected networks were associated with better recovery outcomes., Results: During response and recovery, CBOs provide an array of critical public health services often outside their usual scope. New CBO partnerships were formed to support recovery, particularly in severely impacted areas. CBOs that were more connected to other CBOs and were part of a long-term recovery committee reported greater impacts on the community; however, a partnership with the local health department was not associated with recovery impacts., Conclusion: CBO partners are flexible in their scope of services, and CBO partnerships often emerge in areas with the greatest storm damage, and subsequently the greatest community needs. National policies will advance if they account for the dynamic and emergent nature of these partnerships and their contributions, and clarify the role of government partners. (Disaster Med Public Health Preparedness. 2018;12:635-643).

Public health risks from urban floods are a global concern. A typhoon is a devastating natural hazard that is often accompanied by heavy rainfall and high storm surges and causes serious floods in coastal cities. Affected by the same meteorological systems, typhoons, rainfall, and storm surges are three variables with significant correlations. In the study, the joint risk of rainfall and storm surges during typhoons was investigated based on principal component analysis, copula-based probability analysis, urban flood inundation model, and flood risk model methods. First, a typhoon was characterized by principal component analysis, integrating the maximum sustained wind (MSW), center pressure, and distance between the typhoon center and the study area. Following this, the Gumbel copula was selected as the best-fit copula function for the joint probability distribution of typhoons, rainfall, and storm surges. Finally, the impact of typhoons on the joint risk of rainfall and storm surges was investigated. The results indicate the following: (1) Typhoons can be well quantified by the principal component analysis method. (2) Ignoring the dependence between these flood drivers can inappropriately underestimate the flood risk in coastal regions. (3) The co-occurrence probability of rainfall and storm surges increases by at least 200% during typhoons. Therefore, coastal urban flood management should pay more attention to the joint impact of rainfall and storm surges on flood risk when a typhoon has occurred. (4) The expected annual damage is 0.82 million dollars when there is no typhoon, and it rises to 3.27 million dollars when typhoons have occurred. This indicates that typhoons greatly increase the flood risk in coastal zones. The obtained results may provide a scientific basis for urban flood risk assessment and management in the study area.

Background: Hurricanes Irene and Sandy heavily impacted New Jersey. Investigating EMS dispatch trends during these storms may allow us to prepare for future disasters., Objectives: Our objectives to characterize the types of EMS dispatches immediately before, during, and after landfall compared to a control period., Methods: This retrospective study was conducted at a large EMS dispatch center that provides first responders, Basic Life Support (BLS), Advanced Life Support (ALS), and critical care transport services to an area with approximately 20 receiving hospitals including a Level I Trauma Center. At peak staffing, there are 8-10 ALS vehicles, 25 BLS vehicles, and 3 critical care transport vehicles deployed. We included of the day of landfall and seven days before and after. We compared dispatch data to a control period in 2010 that mirrored Hurricane Sandy the dates of. Descriptive statistics and two way ANOVA were used to assess dispatch, gender and age differences., Results: We found Hurricane Sandy dispatches peaked 2 days after landfall. Both ALS and BLS had an increase in age in the post-Sandy period compared to the pre-Sandy (ALS 58.5 to 64.2, p = 0.005, ANOVA p = 0.078; BLS 47.4 to 56.3, p < 0.001, ANOVA p = 0.001). There were 17 "hurricane related" (loss of power related issues, oxygen supply depleted, evacuation) and 15 carbon monoxide dispatches in the post-Sandy period and none in the others, including peri-Irene. The average age of cardiac arrest dispatches was lower in the post-Irene group compared to pre-Irene (74.3 to 47.8, p = 0.023). There were no critical care requests before or after Hurricane Sandy, but there were 14 around Hurricane Irene and 10 surrounding the control period., Conclusions: Dispatch data can inform natural disaster planning. Education efforts can focus on geriatric patients, as well as resource distribution planning for an increase in geriatric populations. However, pattern variability between storms shows further study is needed to clarify exactly which resources should be utilized in order to maintain an ideal response to a natural disaster.

Analysis of response and recovery efforts to disasters over the past 2 decades has identified a consistent gap that plagues the nation in regard to persons with access and functional needs. This gap can be highlighted by Hurricane Katrina, where the majority of those killed were a part of the access and functional needs population. After a disaster, many individuals with access and functional needs require assistance recovering but often have difficulty accessing services and resources. These difficulties are due to a combination of issues, such as health problems and the disruption of community support services. We sought to help bridge this gap by focusing on strategic and operational methods used while planning for the whole community. This article highlights the many partnerships that must be fostered for successful whole-community planning. These partnerships include, but are not limited to, local government departments, health agencies, nonprofit and nongovernmental organizations, and other volunteer organizations. We showcase these methods by using a developmental Post-Disaster Canvassing Plan to highlight planning methods that may aid jurisdictions across the United States in disaster planning for the whole community. (Disaster Med Public Health Preparedness. 2017;11:741-746).

Health care coalitions play an increasingly important role in both preparedness for, response to, and recovery from large scale disaster events occurring across the United States. The actions taken by the South East Texas Regional Advisory Council (SETRAC) in response to the landfall of Hurricane Harvey, and the consequential flooding that ensued, serve as an excellent example of how health care coalitions are increasingly needed to play a unifying role in response. This paper highlights a number of the strategic planning, operational planning and response, information sharing, and resource coordination and management activities that were undertaken for the response to Hurricane Harvey. The successful response to this devastating storm in the Houston, Texas area serves as an example to other regions across the country as they work to implement the 2017-2022 health care capabilities articulated by the Department of Health and Human Services Office of the Assistant Secretary for Preparedness and Response. (Disaster Med Public Health Preparedness. 2017;11:637-639).

Objective: To determine if there has been a measureable improvement in disaster preparedness among older adults affected by Hurricane Sandy in the NYC Rockaways and to identify if there are any characteristics among this sample that might be factors for vulnerability., Design: A 16-item self-reported survey compromised of demographics and needs assessment questions., Subjects: Senior citizens who are members of a local senior center and live in the Rockaways., Main Outcome Measures: Three hypotheses were tested. (1) H 1 : That there is a positive difference in level of the Pre- and Post- Sandy Storm Preparedness. (2) H 0 : That the level of Storm Preparedness is not related to relative advanced age factor in older adults. (3) H 0 : That the level of Storm Preparedness is not related to living arrangement, income level, and/or access to transportation RESULTS: The alternative hypothesis was accepted for hypothesis one. The null hypotheses were accepted for hypotheses two and three., Conclusions: It was found that the level of disaster preparedness has significantly improved. The age of the participants when analyzed as two groups, those under and those over age 70, is not related to storm preparedness. Also, demographic factors are not significantly related to disaster preparedness. These findings may be a result of older adult psychological development as discussed by Erikson or the participants may be homogeneous due to their shared traumatic experience of Hurricane Sandy.

Objective: After Hurricane Sandy flooded Bellevue Hospital in New York City, its opiate maintenance patients were displaced and Bellevue's outpatient program was temporarily merged with the program at Metropolitan Hospital for continuation of care. The merger forced Metropolitan to accommodate a program twice as large as its own and required special staff coordination and adjustments in clinical care., Methods: Physicians, clinicians, and administrators from both institutions participated in interviews regarding the merger., Results: Issues that emerged in the interviews fell into 4 major themes: (1) organization and meshing of professional cultures, (2) regulation, (3) communication, and (4) accommodations., Conclusions: Despite these barriers, data collected after the merger showed high retention rates and low rates of positive urine toxicology results. (Disaster Med Public Health Preparedness. 2017;11:531-537).

Objective: The mainstay of India's disaster management policy until the early 2000s had been relief and rescue operations. The Odisha Super Cyclone (1999) with 10,000 deaths and US $3 billion economic damage provided a rude awakening. Recognizing the importance of preemptive preparedness, the government initiated systematic steps to implement a national framework interlinking economic, environmental, and overall developmental issues for efficient response to and mitigation of disasters., Methods: We attempted a critical analysis of this paradigm shift in India's disaster management policy through the prism of 2 cyclones, 14 years apart in time., Results: With improved preparedness and response measures, the death toll in 2013 Cyclone Phailin was 0.5% and the economic loss was about one-third of that during 1999. Concomitant improvements in the technological expertise of the early warning system, an integrated approach at all levels of administration including joint planning with major nongovernmental organizations, and improved community participation were identified as game-changers. An unbelievable 1 million people were evacuated to safety., Conclusions: Our essay aims to highlight key steps in this success and calls for futuristic approaches like insurance programs and gender-sensitive recovery plans. With thorough scrutiny, India's model may well stand to be replicated in resource-restricted settings.

Objective: This study sought to identify how humanitarian actors in natural disasters coordinate (or communicate) with the military to identify the needs of disaster-affected populations, identify how coordination should be undertaken for the delivery of relief goods, perceive the effectiveness of such coordination, perceive the role that training played in preparation for coordinating with the military and the effectiveness of this training, and view the overall civil-military engagement and its implications for the independence of the humanitarian sector., Methods: A survey instrument focused on participant perceptions of the civil-military engagement in response to Typhoon Haiyan in the Philippines was sent to country directors and agency leads who played a role in the response., Results: Although the data supported anecdotal accounts that the coordination between civilian and military actors during the disaster relief efforts in Typhoon Haiyan worked well, they also revealed that fewer than half of the respondents were familiar with the Guidelines on the Use of Foreign Military and Civil Defence Assets in Disaster Relief (the "Oslo Guidelines") and only 12% of respondents thought that the Oslo Guidelines were used to develop organizational policy on humanitarian aid agency engagement with military actors., Conclusions: Humanitarians felt that international militaries and the Philippines Armed Forces played an important role in ensuring that aid reached people in need, particularly in the early days of the response. However, less than half of the respondents were familiar with the Oslo Guidelines.

Super-Typhoon Haiyan struck the Philippines on 7 November 2013. The initial reports estimated 10 000 fatalities and four million displaced persons. As the United Kingdom's initial response to this disaster, HMS DARING was diverted from her deployment to take part in humanitarian aid, named Operation PATWIN. This article will outline the medical aspects of the relief effort undertaken and aim to identify any lessons that may inform future operations.

Background: On September 13, 2008, Hurricane Ike, a category 2 storm with maximum sustained winds of 110 mph, made landfall near Galveston, Texas. Ike produced a damaging, destructive, and deadly storm surge across the upper Texas and southwestern Louisiana coasts. Thirty-four Texas counties were declared disaster areas by the Federal Emergency Management Agency; 15 counties were under mandatory evacuation orders. To describe causes of death associated with this hurricane and identify prevention strategies during the response and recovery phases, the Texas Department of State Health Services (DSHS) monitored mortality data in 44 counties throughout the state. This report summarizes Ike-related deaths reported by Texas medical examiners, justices of the peace (coroners), forensic centers, public health officials, and hospitals., Methods: Based on the Centers for Disease Control and Prevention (CDC) disaster-related mortality surveillance form, DSHS developed a state-specific 1-page form and collected (optimally daily) data on demographic, date and place of death, and cause and circumstance of deaths. A case was defined as any death that was directly or indirectly related to Ike among evacuees, residents, nonresidents, or rescue personnel in the declared disaster counties, counties along the Texas Gulf coast or counties known to have evacuation shelters occurring September 8, 2008, through October 13, 2008. Analyzed data were shared with the state emergency operation center and the CDC on a daily basis., Results: The surveillance identified 74 deaths in Texas as directly (10 [14%]), indirectly (49 [66%]), or possibly (15 [20%]) related to Ike. The majority of deaths (n=57) were reported by medical examiners. Deaths occurred in 16 counties of the 44 counties covered by the surveillance. The majority of deaths occurred in Harris and Galveston (28 [38%] and 17 [23%]), respectively. The deceased ranged in age from younger than 1 year to 85 years, with an average age of 46 years (median 50 years); 70% were male. Of the 74 deaths, 47 (64%) resulted from injuries, 23 (31%) from illnesses, and 4 (5%) were undetermined. Among the injuries, carbon monoxide poisoning (13 [18%]) and drowning (8 [11%]) were the leading causes of injury-related deaths. Cardiovascular failure (12 [16%]) was the leading cause of illness-related deaths., Conclusions: Defining the relation of death to hurricane using an active mortality surveillance system is possible. The active mortality surveillance form used in Ike provided valuable daily information to DSHS, state emergency management officials, and the CDC regarding the characteristics of deaths in the state. Most of the Ike-related deaths were caused by injury (direct and indirectly related) such as carbon monoxide poisonings and drowning and may have been preventable by educating the public., (©2011 American Medical Association. All rights reserved.)

Despite previous efforts and expenditure of tremendous resources on creating and simulating disaster response scenarios, true disaster response, specifically for healthcare, has been inadequate. In addition, none of the >200 local and statewide telemedicine programs in the United States has ever responded to a large-scale disaster, let alone, experienced one directly. Based on its experience with hurricanes Rita and, most recently, Ike, the University of Texas Medical Branch (UTMB) experienced its most challenging trials. Although there were significant disruptions to a majority of UTMB's physical and operational infrastructures, its telemedicine services were able to resume near normal activities within the first week of the post-Ike recovery period, an unimaginable feat in the face of such remarkable devastation. This was primarily due in part to the flexibility of its data network, the rapid response, and plasticity of its telemedicine program. UTMB's experiences in providing rapid and effective medical services in the face of such a disaster offer valuable lessons for local, state, and national disaster preparations, policy, and remote medical delivery models and programs.

This qualitative descriptive study explored the experiences of school nurses in coastal Louisiana, who were affected by Hurricanes Gustav and Ike in 2008 and who had also been in the path of destruction caused by Hurricanes Katrina and Rita in 2005. The purpose of the study was to describe the experiences of school nurses affected by repeated natural disasters in relation to their professional practice. The researchers conducted interviews with five school nurses, using the constant comparative method of data analysis to analyze transcripts for recurrent themes. Findings revealed a common process of developing resilience among participants. As a result of their experiences, participants described the ability to recover and adapt in the face of adversity. Various factors affected this resilience, including preparedness, support from others, both personally and professionally, and commitment to the communities in which they live.

Context: Concerns about mental health recovery persist after the 2005 Gulf storms. We propose a recovery model and estimate costs and outcomes., Objective: To estimate the costs and outcomes of enhanced mental health response to large-scale disasters using the 2005 Gulf storms as a case study., Design: Decision analysis using state-transition Markov models for 6-month periods from 7 to 30 months after disasters. Simulated movements between health states were based on probabilities drawn from the clinical literature and expert input., Setting: A total of 117 counties/parishes across Louisiana, Mississippi, Alabama, and Texas that the Federal Emergency Management Agency designated as eligible for individual relief following hurricanes Katrina and Rita., Participants: Hypothetical cohort, based on the size and characteristics of the population affected by the Gulf storms. Intervention Enhanced mental health care consisting of evidence-based screening, assessment, treatment, and care coordination., Main Outcome Measures: Morbidity in 6-month episodes of mild/moderate or severe mental health problems through 30 months after the disasters; units of service (eg, office visits, prescriptions, hospital nights); intervention costs; and use of human resources., Results: Full implementation would cost $1133 per capita, or more than $12.5 billion for the affected population, and yield 94.8% to 96.1% recovered by 30 months, but exceed available provider capacity. Partial implementation would lower costs and recovery proportionately., Conclusions: Evidence-based mental health response is feasible, but requires targeted resources, increased provider capacity, and advanced planning.

Objective: Hurricane Katrina struck the US Gulf Coast on August 29, 2005, causing unprecedented damage to numerous communities in Louisiana and Mississippi. Our objectives were to verify, document, and characterize Katrina-related mortality in Louisiana and help identify strategies to reduce mortality in future disasters., Methods: We assessed Hurricane Katrina mortality data sources received in 2007, including Louisiana and out-of-state death certificates for deaths occurring from August 27 to October 31, 2005, and the Disaster Mortuary Operational Response Team's confirmed victims' database. We calculated age-, race-, and sex-specific mortality rates for Orleans, St Bernard, and Jefferson Parishes, where 95% of Katrina victims resided and conducted stratified analyses by parish of residence to compare differences between observed proportions of victim demographic characteristics and expected values based on 2000 US Census data, using Pearson chi square and Fisher exact tests., Results: We identified 971 Katrina-related deaths in Louisiana and 15 deaths among Katrina evacuees in other states. Drowning (40%), injury and trauma (25%), and heart conditions (11%) were the major causes of death among Louisiana victims. Forty-nine percent of victims were people 75 years old and older. Fifty-three percent of victims were men; 51% were black; and 42% were white. In Orleans Parish, the mortality rate among blacks was 1.7 to 4 times higher than that among whites for all people 18 years old and older. People 75 years old and older were significantly more likely to be storm victims (P < .0001)., Conclusions: Hurricane Katrina was the deadliest hurricane to strike the US Gulf Coast since 1928. Drowning was the major cause of death and people 75 years old and older were the most affected population cohort. Future disaster preparedness efforts must focus on evacuating and caring for vulnerable populations, including those in hospitals, long-term care facilities, and personal residences. Improving mortality reporting timeliness will enable response teams to provide appropriate interventions to these populations and to prepare and implement preventive measures before the next disaster.