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Mobilizing Mobile Medical Units for Hurricane Relief: The United States Public Health Service and Broward County Health Department Response to Hurricane Wilma, Broward County, Florida


Abstract and Figures

To describe the outcomes of a collaborative response of federal, state, county, and local agencies in conducting syndromic surveillance and delivering medical care to persons affected by the storm through the use of mobile medical units. Nine mobile medical vans were staffed with medical personnel to deliver care in communities affected by the storm. Individual patient encounter information was collected. A total of 14,033 housing units were approached and checked for occupants. Of residents with whom contact was made, approximately 10 percent required medical assessment in their homes; 3,218 clients were medically evaluated on the mobile medical vans. Sixty-two percent of clients were female. The most common presenting complaints included normal health maintenance (59%), upper respiratory tract illness (10%), and other illness (10%). Injuries occurred in 9 percent. A total of 1,531 doses of medications were dispensed from the mobile medical units during the response. Mobile medical units provided an efficient means to conduct syndromic surveillance and to reach populations in need of medical care who were unable to access fixed local medical facilities.
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Mobilizing Mobile Medical Units for Hurricane
Relief: The United States Public Health Service and
Broward County Health Department Response to
Hurricane Wilma, Broward County, Florida
Melanie M. Taylor, William S. Stokes, Ronald Bajuscak, Mary Serdula, Karen L. Siegel, Brian Griffin, Jeffrey
Keiser, Lisa Agate, Aaron Kite-Powell, David Roach, Nancy Humbert, Kristin Brusuelas, and Sam S. Shekar
Objectives: To describe the outcomes of a collaborative
response of federal, state, county, and local agencies in
conducting syndromic surveillance and delivering medical care to
persons affected by the storm through the use of mobile medical
units. Methods: Nine mobile medical vans were staffed with
medical personnel to deliver care in communities affected by the
storm. Individual patient encounter information was collected.
Results: A total of 14 033 housing units were approached and
checked for occupants. Of residents with whom contact was
made, approximately 10 percent required medical assessment in
their homes; 3 218 clients were medically evaluated on the
mobile medical vans. Sixty-two percent of clients were female.
The most common presenting complaints included normal health
maintenance (59%), upper respiratory tract illness (10%), and
other illness (10%). Injuries occurred in 9 percent. A total of
1 531 doses of medications were dispensed from the mobile
medical units during the response. Conclusion: Mobile medical
units provided an efficient means to conduct syndromic
surveillance and to reach populations in need of medical care
who were unable to access fixed local medical facilities.
KEY WORDS: disaster relief, hurricane, mobile medical units,
syndromic surveillance
Hurricane Wilma, the 21st named storm of the 2005
Atlantic hurricane season, struck the southwest coast
of Florida on Monday, October 24, as a category 3
storm. Hurricane force winds more than 110 miles per
hour and rain caused widespread damage to homes
J Public Health Management Practice, 2007, 13(5), 447–452
Copyright C
2007 Wolters Kluwer Health |Lippincott Williams & Wilkins
Corresponding Author: LCDR Melanie Taylor, MD, MPH, United States Pub-
lic Health Services, Arizona Department of Health Services, Office of Infectious
Disease Services, 150 N 18th Ave, Suite 140, Phoenix, AZ 85007 (taylorm@
LCDR Melanie M. Taylor, MD, MPH, is a Medical Epidemiologist, United States
Public Health Services Commissioned Corps, Rockville, Maryland, and Division of
STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention,
Centers for Disease Control and Prevention, Atlanta, Georgia.
RADM William S. Stokes, DVM, is Deputy Team Commander, Assistant Surgeon
General, United States Public Health Services Commissioned Corps, and Director,
National Toxicology Program Interagency for the Evaluation of Alternative
Toxicological Methods, National Institute of Environmental Health Sciences, National
Institutes of Health, Research Triangle Park, North Carolina.
CAPT Ronald Bajuscak, DMD, MS, is Response Team Commander, National
Consultant for Oral Medicine/Pathology, United States Public Health Services
Commissioned Corps, Rockville, Maryland.
CAPT Mary Serdula, MD, MPH, is a Medical Epidemiologist, United States Public
Health Services Commissioned Corps, Nutrition Branch, Division of Nutrition, Physical
Activity and Obesity, National Center for Chronic Disease Prevention and Health
Promotion, Division of Nutrition and Physical Activity, Centers for Disease Control and
Prevention, Atlanta, Georgia.
CAPT Karen L. Siegel, MA, PT, is Team Leader, United States Public Health Services
Commissioned Corps, and Senior Staff Specialist, National Institutes of Health,
Physical Disabilities Branch (a collaboration between the National Institute of Child
Health and Human Development and the NIH Clinical Center), Bethesda, Maryland.
LCDR Brian Griffin, BSN, RN, is Ready Responder, United States Public Health
Services Commissioned Corps, National Health Service Corps, Health Resources and
Services Administration, Philadelphia, Pennsylvania.
Jeffrey Keiser, BBA, BHS, is Deputy Administrator, Broward County Health
Department, Florida Department of Health, Ft Lauderdale, Florida.
Lisa Agate, MSW, is HIV/AIDS Program Director, Broward County Health
Department, Florida Department of Health, Ft Lauderdale.
Aaron Kite-Powell, MS, is Surveillance Epidemiologist, Bureau of Epidemiology,
Florida, Department of Health, Tallahassee.
David Roach, BA, is Administrator, Broward County Health Department, Florida
Department of Health, Ft Lauderdale.
Nancy Humbert, MSN, ARNP, is Deputy Secretary for Health, Florida Department of
Health, Tallahassee.
Kristin Brusuelas, MPH, is Senior Management Official, Office of the Director,
Centers for Disease Control and Prevention, Atlanta, Georgia.
RADM Sam S. Shekar, MD, MPH, is Assistant Surgeon General, United States Public
Health Services Commissioned Corps, and Director of Clinical Research Grants,
Office of Extramural Research, National Institutes of Health, Bethesda, Maryland.
448 Journal of Public Health Management and Practice
and power lines, and temporarily displaced thousands
of residents. Initial estimates indicated that the most
severe damage occurred along the southeastern coast
of Florida.1In Broward County, the hurricane caused
widespread extended power outages affecting approx-
imately 900 000 homes and businesses and lasting over
3 weeks in some neighborhoods.2,3 This effectively shut
down routine services and impeded daily operation
of health and social services for the approximately 1.7
million residents. Hurricane Wilma resulted in an esti-
mated 41 deaths (9 in Broward County)4and was de-
termined to be the third costliest storm in US history,
with damages estimated at $14.4 billion.5
On October 28, 2005, United States Public Health Ser-
vice (USPHS) officers were deployed at the request of
state and local health authorities to the Broward County
Health Department (BCHD) to staff mobile medical
clinics in order to augment local relief efforts and to de-
liver medical services to the areas most heavily affected
by Hurricane Wilma. Nine mobile medical vans were
staffed with USPHS, local health department, and De-
partment of Veterans’ Affairs (DVA) personnel, as well
as Centers for Disease Control and Prevention (CDC)
Public Health Advisors (PHAs) stationed within the
state of Florida. These mobile teams were dispatched
to multistory retirement communities, mobile home
parks, low-income housing facilities, and other areas
that experienced significant structural damage and/or
that requested medical assistance due to the inability of
residents to leave their premises and access local medi-
cal facilities. Because of the widespread power outages
lasting up to 3 weeks in Broward County, many res-
idents with limited mobility living above the ground
level were trapped in their homes with limited supplies
due to inoperable elevators. This was compounded by
the disruption of telephone communications necessi-
tating door-to-door assessment of medical need. Many
of these communities as well as other low-income com-
munities heavily affected by the storm were identified
as priority areas needing medical assistance. The out-
comes of the collaborative efforts of the USPHS, the
CDC, Florida Department of Health, the BCHD, and
the DVA, in delivering medical relief services and con-
ducting syndromic surveillance in response to Hurri-
cane Wilma, are summarized here.
Areas of need were identified by preassessment teams
comprising experienced outreach workers, health ed-
ucators, and case managers employed by the BCHD.
These teams conducted assessments of communities af-
fected by the storm. Environmental health workers and
community nurses reported additional areas of medical
need to the BCHD. Priority for mobile van deployment
was given to areas without electricity, areas with homes
blocked by fallen debris, and communities where citi-
zens with known medical needs resided such as devel-
opments housing elderly persons. In addition, teams
consisting of staff from the CDC, the North Carolina
Department of Health, and the Florida Department of
Health conducted a rapid needs assessment that in-
cluded 210 interviews within 42 individual county cen-
sus blocks that represented the approximately 375 580
households in northeastern Broward County on the ba-
sis of 2000 US Census estimates. The assessments indi-
cated that 5 percent to 15 percent of the households
had members with one or more medical needs. From
this information, public health department officials and
the county Emergency Operations Center prioritized
additional areas of potential medical need and iden-
tified locations for mobile medical van deployment.
These locations consisted of retirement communities,
mobile home parks, low-income housing facilities/
apartments, churches, and other areas heavily affected
by the storm. Advanced notice of mobile van deploy-
ment to local communities was performed by distribu-
tion of flyers in the communities, contact with commu-
nity leaders or association presidents, and notification
of local law enforcement officials 1 to 2 days prior to
the planned arrival of the medical unit.
Nine mobile medical vans provided by local hospital
and clinic organizations and the DVA were staffed with
USPHS officers, BCHD staff, CDC PHAs, and DVA per-
sonnel. Each mobile van unit was typically staffed with
9 to 10 personnel that included a team leader, one med-
ical doctor, one mid-level provider (nurse practitioner
or physician’s assistant), one pharmacist, two nurses
and a medical assistant, one to two staff members from
the Broward County Health Department, a CDC PHA,
a county social worker, and one or two members of
the Florida Department of Elder and Veterans Affairs.
Broward County provided nurses that assisted in pa-
tient care needs and in the advance site inspections to
identify high-need areas for the mobile units. Services
provided on the mobile medical vans included health
maintenance assessments, primary medical care, moni-
toring oxygen and respiratory tract therapy, dispensing
medications, and arranging for continued services. The
BCHD coordinated the procurement of the mobile med-
ical vans, medical supplies, pharmaceuticals, staffing,
and transportation logistics. Advance agreements for
use of mobile medical units were not obtained prior to
the storm.
Data collection and analyses
Individual patient encounter information including
gender, age, race, ethnicity, zip code, and presenting
Mobilizing Mobile Medical Units for Hurricane Relief 449
medical complaint was collected using a standardized
surveillance form developed by the Florida Depart-
ment of Health for use in disaster response. A conve-
nience sampling method was used. Persons who sought
care on the mobile vans or were approached in their
homes were included in the analysis of reasons for visit.
Separate data analyses were not conducted on the ba-
sis of client self-presentation to the mobile vans versus
door-to-door visits by mobile unit staff. Client identi-
fiers were not collected. Data were compiled and en-
tered daily into an Excel database. Data analyses were
performed using Excel (Version 2000, Microsoft, Red-
mond, Washington).
Definitions of reason for visit to the mobile medi-
cal unit were defined on the standardized surveillance
form and included 15 syndrome categories: animal bite,
asthma, carbon monoxide poisoning, dermatologic dis-
order (rashes, sores insect bite, sunburn), febrile ill-
ness, gastrointestinal illness, heat-related injury, other
injury, lower respiratory tract illness (cough, shortness
of breath, pneumonia), mental health (stress, anxiety),
musculoskeletal system trauma (fracture, sprain, dis-
location), minor wound/injury (abrasion, laceration,
puncture, foreign body removal), normal health main-
tenance (blood pressure and blood glucose monitoring,
prescription refills), other (not fitting into other cate-
gories), poisoning (pesticides, gas fumes, ingestions),
and upper respiratory tract illness (cold, sore throat).
For analysis purposes, some definitions were combined
into larger categories including respiratory complaints
(asthma, upper and lower respiratory tract complaints),
and injuries (animal bite, heat-related injury, muscu-
loskeletal trauma, minor wound).
Diagnostic procedures such as sputum or nasopha-
ryngeal bacterial and viral cultures were not performed
on the mobile vans. Thus, tracking of diagnostic trends
was not available for purposes of epidemic detection.
Patients requiring more intensive care weretransported
by ambulance to functioning emergency care centers.
Clinical criteria for emergency referral were clinician
dependent and not defined by the mobile unit response.
During the period, October 28 to November 9, 2005,
mobile medical van units visited 51 housing develop-
ments. A total of 140 33 housing units were approached
and checked for occupants. Of these, approximately
40 percent (n=5 646) were occupied. Of residents
with whom contact was made, an estimated 10 percent
needed medical assessment in their homes. Most resi-
dents needing medical assessment in their homes were
not able to ambulate to mobile medical units due to
physical limitations. Health issues encountered among
these clients were similar, per staff reports, to those of
clients presenting as “walk-ins” to the mobile medical
A total of 3 218 clients self-presented for medical
evaluation on the mobile medical vans or were med-
ically evaluated in their homes. The majority of these
clients (approximately 85%) presented as walk-ins to
the mobile medical units. Sixty-two percent of clients
were female (n=2 009); 67 percent (n=2 153) of
clients were White and 19 percent were Black (n=901).
Twenty-one percent (n=673) of clients reported being
of Hispanic ethnicity (Table 1).
The most common presenting syndromes included
normal health maintenance (59%, n=1 898), upper res-
piratory tract illness (10%, n=319), and other illness
(10%, n=310). The most frequent reasons for catego-
rization as normal health maintenance (N=1 898) in-
cluded blood pressure check (64%, n=1 215), medica-
tion refill (17%, n=325), supportive reassurance (6%,
n=118), and glucose check (4%, n=79). There were no
presentations of suspected carbon monoxide poisoning
(see Table 1). Current diagnosis of hypertension was re-
ported by 26 percent (n=836), diabetes by 10 percent
(n=328), and chronic obstructive pulmonary disease
by 3 percent (n=92) of clients. (see Table 1). The most
frequently dispensed prescription and nonprescription
medication types included pulmonary (15%, n=231),
pain relief (15%, n=229), antibiotics (13%, n=192),
and hypertension (12%, n=167). Forty-two tetanus
vaccines were administered (Table 2).
Evaluation of the reason for visit to the mobile med-
ical vans by date revealed an increasing proportion of
acute care needs emerging during the period of the re-
sponse (Figure 1). The proportion of visits for respira-
tory tract complaints, injuries, and mental health issues
increased gradually, with peaks in these complaints 4
to 6 days after the initiation of the medical response.
The most common reasons for emergency transport in-
cluded severe hypertension and hyperglycemia. The es-
timated number of persons transported for emergency
care for the above conditions during the response was
Hurricane Wilma followed hurricanes Katrina and Rita
in the unforgettable storm season of 2005. Less attention
was given to this storm despite it being one of the most
costly storms in history. In part, this may be owing to
the minimal mortality caused by the storm; only an esti-
mated 41 fatalities were reported in comparison to the 1
200 plus deaths attributed to Hurricane Katrina.4Rapid
response by local and state governments to the needs of
citizens affected by the storm is likely to have prevented
450 Journal of Public Health Management and Practice
TABLE 1 Demographics of clients presenting for medical
care in mobile van units or in homes visited by United
States Public Health Service personnel during the
Hurricane Wilma response (N=3 218)
0–18 334 (10)
19–30 201 (6)
31–50 773 (24)
51–65 766 (24)
>65 1 109 (35)
Unknown 35 (1.1)
Male 1 204 (37)
Female 2 009 (62)
Unknown 5 (0.2)
White 2 153 (67)
Black 901 (28)
Other/unknown 164 (5)
Hispanic 673 (21)
Non-Hispanic 2 446 (76)
History of chronic disease
Hypertension 836 (26)
Diabetes 328 (10)
Chronic obstructive pulmonary disease 92 (3)
Clinical syndrome category
Animal bite 4 (0.2)
Asthma 76 (2)
Carbon monoxide poisoning 0 (0)
Dermatologic disorder 112 (3)
Febrile illness 0 (0)
Gastrointestinal tract illness 80 (2)
Heat related 0 (0)
Injury, other 95 (3)
Lower respiratory tract illness 29 (9)
Mental health 122 (4)
Musculoskeletal system trauma 124 (4)
Minor wound injury 62 (2)
Normal health maintenance 1 898 (59)
Other 310 (10)
Poisoning, other 0 (0)
Upper respiratory tract illness 319 (10)
Values given are number (percentage).
some morbidity and psychological stress. Mobile med-
ical units staffed by local health department person-
nel, DVA personnel, CDC PHAs, and USPHS officers
played an integral role in finding and providing care to
persons with medical conditions who were unable to
access medical care locally caused by or exacerbated as
a result of conditions produced by the storm. Interven-
TABLE 2 Medication types dispensed from mobile
medical units during the Hurricane Wilma response
Medication type
Diabetes 74 (5)
Hypertension 167 (11)
Cardiac 97 (6)
Antibiotic 192 (13)
Dermatologic 63 (4)
Wound care 108 (7)
Eye 30 (2)
Pulmonary 231 (15)
Pain 229 (15)
Immunization 42 (3)
Gastrointestinal 110 (7)
Other 188 (12)
Values given are number (percentage).
tion likely minimized the number of patients whose
condition may have otherwise deteriorated to a life-
threatening or fatal situation. Collaboration between
federal, state, and local agencies facilitated the delivery
of care to thousands of persons affected by Hurricane
The active illness and injury surveillance imple-
mented on the mobile medical units was similar to
that used in responses to hurricanes Katrina and Rita.6
These surveillance activities served multiple functions
during this response that included prompt evaluation
of trends in diagnoses, assessing unmet needs related
to medication refills, and informing mobile van de-
ployment or redeployment. It has been demonstrated
that less than 10 percent of persons arriving at a hous-
ing shelter following a disaster are in need of medi-
cal care.7This was also true for our convenience sam-
ple; most of the health issues encountered were not re-
lated to Wilma and although acute care needs were ad-
dressed in some patients, far more presented for normal
health maintenance needs (blood pressure checks, glu-
cose checks, medication refills) that might have been
prepared for prehurricane relief. A large percentage of
patients had chronic diseases. Following disasters, it is
these groups of persons that become unable to manage
their chronic conditions due to disruptions in the med-
ical care system.8For example, many health-related fa-
cilities such as clinics and pharmacies remained closed
for 1 to 2 weeks after Hurricane Wilma, and home
healthcare services were also disrupted. Indeed, sev-
eral cases of severe hypertension and hyperglycemia
were identified on the mobile units following Wilma.
Telephone service was also interrupted for extended
periods, which made it difficult or impossible for many
individuals to request needed medical or social as-
sistance. Social services personnel working with the
medical units were able to link persons to temporary
Mobilizing Mobile Medical Units for Hurricane Relief 451
FIGURE 1 Reasons for Mobile Medical Unit Visit by Day of Response
housing, elderly care services, and mental health ser-
vices. Mobile unit staff participating in the Hurricane
Wilma response were able to reach a large number of
persons with acute and chronic medical, mental health,
and social services needs as they arose in the days af-
ter the event. Without these interventions, it is likely
that many of the chronic medical conditions would
have progressed to more severe conditions requiring
emergency department visits or even hospitalization,
resulting in further stress on limited medical resources
already overwhelmed by the disaster.
Priority was given to developments housing elderly
persons owing to the concern regarding limited mobil-
ity due to the loss of electricity resulting in inoperable
elevators, limited lighting, and the inability to recharge
power-assisted wheelchairs and other devices. Door-
to-door visits conducted by mobile van staff concur-
rent with the provision of medical care on the mobile
vans identified persons in medical need who were not
otherwise able to present for care. Other health needs
such as the need for food, water, medication refills,
and assistance with ambulating were identified and
fulfilled through these visits as well. The needs of the
elderly during this and another disasters differ from
those of younger populations and require specialized
attention and response that may include door-to-door
This is one of few reports to describe the use of
mobile medical units to provide medical care and to
gather medical surveillance information during hur-
ricane relief efforts in the United States. Provision of
medical care and medical surveillance using a mobile
medical response effort should be considered for nat-
ural or manmade disasters where there is limited abil-
ity of individuals to access centralized facilities due to
physical disabilities, fuel shortages, limitations in pub-
lic transportation, or medical quarantine. These results
are based on a convenience sample of persons who pre-
sented to or were contacted by the staff of the mobile
medical units, and thus the findings may not represent
other populations affected by this hurricane. Despite
the sampling method used, the race/ethnicity distribu-
tion of this sample mirrors that of the US Census Bureau
2004 Community Survey for Broward County.8This
disaster response relied upon the functioning infras-
tructure of the local health department and emergency
medical services. These activities may be difficult to co-
ordinate in situations where a breakdown in the public
health infrastructure occurs, such as was demonstrated
after Hurricane Katrina.8,10
The Hurricane Wilma response demonstrated the
critical role of the state and local health departments
in organizing the disaster response effort. Equipped
with knowledge of health, socioeconomic, and social
demographics of their communities, the BCHD was
able to coordinate with the county Emergency Op-
erations Center to identify the highest priority areas
for mobile medical unit deployments. The BCHD ex-
pended considerable effort in trying to locate, in this
emergency situation, the proper persons to arrange for-
mal agreements for use of the mobile medical units.
Ideally, advance agreements should be made with or-
ganizations that operate and maintain mobile medical
units for their use during disaster response. This type of
452 Journal of Public Health Management and Practice
coordination will prove critical in future disaster events
that may threaten the health of communities such as
pandemic influenza, bioterrorist events, or additional
natural disasters. The use of properly staffed mobile
medical van units may facilitate dispensing methods,
such mass vaccination, and antibiotic stockpile distri-
bution. Local, state, and federal public health agencies
should consider the use of mobile medical clinics in
their disaster preparedness planning and emergency
1. National Oceanic and Atmospheric Administration’s Na-
tional Weather Service.
events/?id=Wilma. Published December 1, 2005. Accessed
February 28, 2006.
2. Broward County Board of County Commissioners. Com-
munity update, November 2005. Broward County con-
tinues to recover from Hurricane Wilma. http://www.
Published November 2005. Accessed March 15, 2006.
3. Office of Electricity Delivery and Energy Reliability (OE).
U.S. Department of Energy. Gulf Coast Hurricanes Situa-
tion Report #34, November 2, 2005. http://www.oe.netl. coast/gulf 110205-1500.pdf. Published
November 2, 2005. Accessed March 15, 2006.
4. Ragan P, Schulte J, Nelson S. 2004–2005 Florida hurricane
mortality [abstract]. Presented at: Council of State and Ter-
ritorial Epidemiologists 2006 Annual Conference; June 4–8,
2006; Anaheim, California.
5. National Oceanic and Atmospheric Administration’s Na-
tional Weather Service.
NHC/TWSAT. Published October 30, 2005. Accessed Febru-
ary 28, 2006.
6. Centers for Disease Control and Prevention. Injury and ill-
ness surveillance in hospitals and acute-care facilities after
hurricanes Katrina and Rita—New Orleans area, Louisiana,
September 25–October 15, 2005. MMWR. 2006;55:35–38.
7. Mattox K. Hurricanes Katrina and Rita: role of individuals
and collaborative networks in mobilizing/coordinating soci-
etal and professional resources for major disasters. Crit Care.
8. Greenough PG, Kirsch TD. Public health response-assessing
needs. N Engl J Med. 2005;353:1544–1546.
9. United States Census Bureau. American Community Survey.
Broward County, Florida. Pub-
lished 2005. Accessed May 19, 2006.
10. Centers for Disease Control and Prevention. Surveillance for
Illness and Injury After Hurricane Katrina—New Orleans,
Louisiana, MMWR. September 8–25, 2005. 2005;54:1018–
... Each theme was analyzed across the articles and then used to interpret the findings and to understand the results. An overview of the themes is provided in the following: 27 Describe the outcomes of a response of federal, state, county, and local agencies in delivering medical care to persons affected by Hurricane Wilma through the use of mobile medical units. ...
... Economic. 27 To address this issue in the future, it has been recommended that communication strategies be targeted at patients with diabetes, rheumatic diseases, chronic respiratory diseases, and renal diseases. 28 A common link was the need to ensure that patient information was transferred and coordinated. ...
... 32 This situation was not unique: following Hurricane Andrew (Florida USA; 1992), insulin supplies were also exhausted within one day; insulin-loaded syringes were among the most needed supplies following Hurricane Marilyn (US Virgin Islands) in 1993; and Hurricane Wilma in 2005 shut down health and social services (including home-based and elderly services) for 1.7 million people. 27,33,34 Overall, in the future, there is a need to have a ready supply of medicine, personal protective equipment, and power generators for maintaining health services. 29,30,35 3. Evacuation: the management of NCDs at evacuation shelters was a significant issue after Hurricane Katrina. ...
Full-text available
Introduction: Traditionally, post disaster response activities have focused on immediate trauma and communicable diseases. In developed countries such as Australia, the post disaster risk for communicable disease is low. However, a "disease transition" is now recognized at the population level where noncommunicable diseases (NCDs) are increasingly documented as a post disaster issue. This potentially places an extra burden on health care resources and may have implications for disaster-management systems. With increasing likelihood of major disasters for all sectors of global society, there is a need to ensure that health systems, including public health infrastructure (PHI), can respond properly. Problem There is limited peer-reviewed literature on the impact of disasters on NCDs. Research is required to better determine both the impact of NCDs post disaster and their impact on PHI and disaster-management systems. Methods: A literature review was used to collect and analyze data on the impact of the index case event, Australia's Severe Tropical Cyclone Yasi (STC Yasi), on PHI and the management of NCDs. The findings were compared with data from other world cyclone events. The databases searched were MEDLINE, CINAHL, Google Scholar, and Google. The date range for the STC Yasi search was January 26, 2011 through May 2, 2013. No time limits were applied to the search from other cyclone events. The variables compared were tropical cyclones and their impacts on PHI and NCDs. The outcome of interest was to identify if there were trends across similar world events and to determine if this could be extrapolated for future crises. Results: This research showed a tropical cyclone (including a hurricane and typhoon) can impact PHI, for instance, equipment (oxygen, syringes, and medications), services (treatment and care), and clean water availability/access that would impact both the treatment and management of NCDs. The comparison between STC Yasi and worldwide tropical cyclones found the challenges faced were linked closely. These relate to communication, equipment and services, evacuation, medication, planning, and water supplies. Conclusion: This research demonstrated that a negative trend pattern existed between the impact of STC Yasi and other similar world cyclone events on PHI and the management of NCDs. This research provides an insight for disaster planners to address concerns of people with NCDs. While further research is needed, this study provides an understanding of areas for improvement, specifically enhancing protective PHI and the development of strategies for maintaining treatment and alternative care options, such as maintaining safe water for dialysis patients.
... High winds can also impact health through indirect pathways. Damage to infrastructure, for example, can make it harder to meet medical needs, including medical visits and medications [31,[36][37][38][39][40][41][42], and power outages increase exposure to other hazards like heat [11,43], make it harder to safely access food and water [39,44,45], and create risk of carbon monoxide poisoning from generators [5][6][7][8][9][10][11]. ...
... High winds can also impact health through indirect pathways. Damage to infrastructure, for example, can make it harder to meet medical needs, including medical visits and medications [31,[36][37][38][39][40][41][42], and power outages increase exposure to other hazards like heat [11,43], make it harder to safely access food and water [39,44,45], and create risk of carbon monoxide poisoning from generators [5][6][7][8][9][10][11]. ...
Full-text available
Purpose of Review Tropical cyclones impact human health, sometimes catastrophically. Epidemiological research characterizes these health impacts and uncovers pathways between storm hazards and health, helping to mitigate the health impacts of future storms. These studies, however, require researchers to identify people and areas exposed to tropical cyclones, which is often challenging. Here we review approaches, tools, and data products that can be useful in this exposure assessment. Recent Findings Epidemiological studies have used various operational measures to characterize exposure to tropical cyclones, including measures of physical hazards (e.g., wind, rain, flooding), measures related to human impacts (e.g., damage, stressors from the storm), and proxy measures of distance from the storm’s central track. The choice of metric depends on the research question asked by the study, but there are numerous resources available that can help in capturing any of these metrics of exposure. Each has strengths and weaknesses that may influence their utility for a specific study. Summary Here we have highlighted key tools and data products that can be useful for exposure assessment for tropical cyclone epidemiology. These results can guide epidemiologists as they design studies to explore how tropical cyclones influence human health.
... Studies on this theme found relating to PHEP research indicate the utility of specific emergency plans to inform public health strategies such as vaccination and examining the role of interventions such as school closure as mitigating measures in responding to a public health incident [36,37]. Communication [38][39][40][41][42][43][44][45]: The third highest number of studies was identified in this theme. Sub-themes noted for this theme relate to the focus of communication as externally-facing (to the public), internally-facing (within the system), and high-risk populations. ...
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Background: Effective public health emergency preparedness and response systems are important in mitigating the impact of all-hazards emergencies on population health. The evidence base for public health emergency preparedness (PHEP) is weak, however, and previous reviews have noted a substantial proportion of anecdotal event reports. To investigate the body of research excluding the anecdotal reports and better understand primary and analytical research for PHEP, a scoping review was conducted with two objectives: first, to develop a thematic map focused on primary research; and second, to use this map to inform and guide an understanding of knowledge gaps relevant to research and practice in PHEP. Methods: A scoping review was conducted based on established methodology. Multiple databases of indexed and grey literature were searched based on concepts of public health, emergency, emergency management/preparedness and evaluation/evidence. Inclusion and exclusion criteria were applied iteratively. Primary research studies that were evidence-based or evaluative in nature were included in the final group of selected studies. Thematic analysis was conducted for this group. Stakeholder consultation was undertaken for the purpose of validating themes and identifying knowledge gaps. To accomplish this, a purposive sample of researchers and practicing professionals in PHEP or closely related fields was asked to complete an online survey and participate in an in-person meeting. Final themes and knowledge gaps were synthesized after stakeholder consultation. Results: Database searching yielded 3015 citations and article selection resulted in a final group of 58 articles. A list of ten themes from this group of articles was disseminated to stakeholders with the survey questions. Survey findings resulted in four cross-cutting themes and twelve stand-alone themes. Several key knowledge gaps were identified in the following themes: attitudes and beliefs; collaboration and system integration; communication; quality improvement and performance standards; and resilience. Resilience emerged as both a gap and a cross-cutting theme. Additional cross-cutting themes included equity, gender considerations, and high risk or at-risk populations. Conclusions: In this scoping review of the literature enhanced by stakeholder consultation, key themes and knowledge gaps in the PHEP evidence base were identified which can be used to inform future practice-oriented research in PHEP.
... Mobile medical vans have historically provided a way to reach disaster victims. These vans represent a successful collaborative response effort among local, county, state, and federal agencies, and have been determined an efficient method to provide medical care to populations who could not access existing facilities (Fisher, 1977;Taylor et al., 2007). ...
The coronavirus disease 2019 (COVID-19) pandemic has magnified disparities in care, including within reproductive health. There has been limited research on the implications of the financial calamity COVID-19 has precipitated on reproductive health, including restricted access to contraception and prenatal care, as well as adverse perinatal outcomes resulting from economic contracture. We therefore examined the Great Recession (the period of economic downturn from 2007–2009 also referred to as the 2008 recession) to discuss how the current financial difficulties may influence reproductive health now and in the years to come. The existing literature examining the impacts of economic downturn on reproductive health provides a resounding body of evidence supporting the need for state and federal investment in comprehensive reproductive health care. Policies directed at expanding access to programs such as Special Supplemental Nutrition Program for Women, Infants, and Children and Medicaid (WIC), extending Medicaid coverage to 12 months’ postpartum, continuing coverage for telehealth services, and lowering barriers to access through mobile care units would help mitigate anticipated effects of a recession on reproductive health.
Objective This study aimed to characterize ophthalmology consultations ordered after Hurricane Harvey compared to consultations ordered during the same time period of the prior year. Methods A retrospective chart review was performed at an urban, level 1 trauma center of a county hospital. All patients were included who received an electronic health record, documented ophthalmology consultation order between September 2017 and October 2017 (the time period immediately following Hurricane Harvey) or September 2016 and October 2016. Patient demographic risk factors were collected. Patient ICD10 clinical diagnoses were categorized as extraocular, intraocular, infectious, physiological, or other, and then subcategorized as trauma or non-trauma-related. A geographical heat map was generated to compare the changes in diagnosis volume by zip code to the magnitude of rainfall in the county. Results Following Hurricane Harvey, ophthalmology consultation volume decreased, number of infectious ophthalmology diagnoses increased ( P < 0.001), percentage of patients on immunosuppression increased ( P < 0.001), and the number of private insurance payers increased while the number of county-funded insurance payers decreased ( P = 0.003). Conclusions The risk of infectious eye diagnosis was double the risk of traumatic eye diagnosis from Hurricane Harvey flooding. During public disaster planning, different ophthalmological medical resources and responses should be considered for flooding versus high-wind events.
Purpose: To evaluate the Rural Medical Scholars (RMS) Program's effectiveness to produce rural physicians for Alabama. Methods: A nonrandomized intervention study compared RMS (1997-2002) with control groups in usual medical education (1991-2002) at the University of Alabama School of Medicine's main and regional campuses. Participants were RMS and others admitted to regular medical education, and the intervention was the RMS Program. Measures assessed the percentage of graduates practicing in rural areas. Odds ratios compared effectiveness of producing rural Alabama physicians. Findings: The RMS Program (N = 54), regional campuses (N = 182), and main campus (N = 649) produced 48.1% (odds ratio 6.4, P < .001), 23.8% (odds ratio 2.5, P < .001), and 11.2% (odds ratio 1.0) rural physicians, respectively. Conclusions: The RMS Program, contrasted to other local programs of medical education, was effective in producing rural physicians. These results were comparable to benchmark programs in the Northeast and Midwest USA on which the RMS Program was modeled, justifying the assumption that model programs can be replicated in different regions. However, this positive effect was not shared by a disparate rural minority population, suggesting that models for rural medical education must be adjusted to meet the challenge of such communities for physicians.
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The aim of this systematic literature review was to identify the extent and implications of medication loss and the burden of prescription refill on medical relief teams following extreme weather events and other natural hazards. The search strategy followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Key health journal databases (Medline, Embase, PsycINFO, Maternity and Infant Care, and Health Management Information Consortium (HMIC)) were searched via the OvidSP search engine. Search terms were identified by consulting MeSH terms. The inclusion criteria comprised articles published from January 2003 to August 2013, written in English and containing an abstract. The exclusion criteria included abstracts for conferences or dissertations, book chapters and articles written in a language other than English. A total of 70 articles which fulfilled the inclusion criteria were included in this systematic review. All relevant information was collated regarding medication loss, prescription loss and refills, and medical aids loss which indicated a significant burden on the medical relief teams. Data also showed the difficulty in filling prescriptions due to lack of information from the evacuees. People with chronic conditions are most at risk when their medication is not available. This systematic review also showed that medical aids such as eye glasses, hearing aids as well as dental treatment are a high necessity among evacuees. This systematic review revealed that a considerable number of patients lose their medication during evacuation, many lose essential medical aids such as insulin pens and many do not bring prescriptions with them when evacuated.. Since medication loss is partly a responsibility of evacuees, understanding the impact of medication loss may lead to raising awareness and better preparations among the patients and health care professionals. People who are not prepared could have worse outcomes and many risk dying when their medication is not available.
Extreme weather events, unpredictable and often far-reaching, constitute a persistent challenge for public health preparedness. The goal of this research is to inform public health systems improvement through examination of extreme weather events, comparing across cases to identify recurring patterns in event and response characteristics. Structured telephone-based interviews were conducted with representatives from health departments to assess characteristics of recent extreme weather events and agencies' responses. Response activities were assessed using the Centers for Disease Control and Prevention Public Health Emergency Preparedness Capabilities framework. Challenges that are typical of this response environment are reported. Forty-five local health departments in 20 US states. Respondents described public health system responses to 45 events involving tornadoes, flooding, wildfires, winter weather, hurricanes, and other storms. Events of similar scale were infrequent for a majority (62%) of the communities involved; disruption to critical infrastructure was universal. Public Health Emergency Preparedness Capabilities considered most essential involved environmental health investigations, mass care and sheltering, surveillance and epidemiology, information sharing, and public information and warning. Unanticipated response activities or operational constraints were common. We characterize extreme weather events as a "quadruple threat" because (1) direct threats to population health are accompanied by damage to public health protective and community infrastructure, (2) event characteristics often impose novel and pervasive burdens on communities, (3) responses rely on critical infrastructures whose failure both creates new burdens and diminishes response capacity, and (4) their infrequency and scale further compromise response capacity. Given the challenges associated with extreme weather events, we suggest opportunities for organizational learning and preparedness improvements.
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To create a framework and methodology for organizing relevant disaster epidemiology literature. The target audience for the framework is local public health practitioners conducting emergency surveillance in the setting of preparedness or response to natural disasters. The approach to developing the framework involved utilizing the public health and emergency management literature. It was created along four axes. The first was the type of natural disaster; second was according to phase of disaster cycle; third was the impact of the disaster (health, infrastructure, economic); and fourth was related to the main outcome of the study (ie. injuries or infectious diseases). A literature review was conducted and subsequently the current literature was utilized to perform a reliability test of the established framework, using two independent reviewers. Using existing disaster classification systems and risk analysis tools, a framework was developed along the four axes. The final literature search resulted in 85 articles on surveillance in natural disaster settings. The majority of studies are on the subject of hurricanes with a catastrophic impact rating. The phase of testing reliability of the framework resulted in percent agreement of 74%. A reliable framework was developed that enables local public health practitioners to easily access appropriate and previously utilized surveillance methods for a natural disaster emergency. This framework contributes to an evidence-informed approach to surveillance in natural disasters with public health impacts.
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Never before Hurricane Katrina has a disaster caused such a massive displacement of a U.S. population. Never before has the country seen so vividly the exposure and vulnerability of displaced persons — primarily the poor, the infirm, and the elderly. We know from experience that disasters take their greatest toll on the disenfranchised, but the distressing television images of our citizens stranded without basic human necessities and exposed to human waste, toxins, and physical violence awakened the public health community to a frightening realization: given the ineffective response mechanisms that were in place, Katrina could become a public health catastrophe. . . .
The medical support for the coordinated effort for Harris County Texas (Houston) to rescue evacuees from New Orleans following Hurricane Katrina was part of an integrated collaborative network. Both public health and operational health care was structured to custom meet the needs of the evacuees and to create an exit strategy for the clinic and shelter. Integrating local hospital and physician resources into the Joint Incident Command was essential. Outside assistance, including federal and national resources must be coordinated through the local incident command.
During July 9--14, 2004, an outbreak of gastroenteritis occurred among workers at an electronics factory in Huizhou, Guangdong Province, China; 199 cases were reported. A case-control investigation was initiated to identify the agent and the mode of transmission. Stool samples were collected from 142 workers and food handlers and cultured for enteric pathogens. A questionnaire concerning meals and foods eaten in the factory cafeteria during July 11--13 was administered to 92 ill workers and 100 controls. Of approximately 2,000 workers who worked during the outbreak, 197 (10%) had illness consistent with the case definition. Salmonella enteritidis was identified from 44 (31%) of 142 stool samples collected from ill workers. Ill workers were more likely than controls to have eaten breakfast in the factory cafeteria during July 11--13. Of eight foods served at breakfast in the factory cafeteria, three were associated with illness: cake, bread (on July 12 only), and congee (i.e., rice porridge). Stratification of bread and congee exposure by cake consumption indicated that only bread eaten on July 12 was associated with gastroenteritis. The cake was baked on July 11, and a mixture that included raw eggs was poured on top; the cake was then stored at room temperature and served for breakfast on 3 consecutive days (July 11--13). The bread was stored together with the cake on July 11 and 12. No leftover food was tested. The investigation indicated that an outbreak of S. enterica serotype Enteritidis resulted from consumption of an unusual food vehicle (i.e., cake) that had been contaminated from a more typical source (i.e., raw eggs). The bread was stored at room temperature together with cake on which a mixture made from raw eggs had been poured. The bread was probably contaminated by contact with the cake. Food handlers should be instructed that intact fresh eggs can harbor S. enteritidis, foods made from eggs must be cooked, and prepared food must be stored under refrigeration.
Injury and illness surveillance in hospitals and acute-care facilities after hurricanes Katrina and Rita-New Orleans area
Centers for Disease Control and Prevention. Injury and illness surveillance in hospitals and acute-care facilities after hurricanes Katrina and Rita-New Orleans area, Louisiana, September 25-October 15, 2005. MMWR. 2006;55:35-38.
2004–2005 Florida hurricane mortality [abstract] Presented at: Council of State and Ter-ritorial Epidemiologists
  • P Ragan
  • J Schulte
  • Nelson
Ragan P, Schulte J, Nelson S. 2004–2005 Florida hurricane mortality [abstract]. Presented at: Council of State and Ter-ritorial Epidemiologists 2006 Annual Conference; June 4–8, 2006; Anaheim, California
Presented at: Council of State and Territorial Epidemiologists
  • P Ragan
  • J Schulte
  • S Nelson
Ragan P, Schulte J, Nelson S. 2004-2005 Florida hurricane mortality [abstract]. Presented at: Council of State and Territorial Epidemiologists 2006 Annual Conference; June 4-8, 2006; Anaheim, California.