The 2018 hurricane season began Friday, a stressful time for communities most likely to be affected. In recent years, southeastern U.S. cities, like Houston and New Orleans, and Caribbean islands such as the U.S. Virgin Islands and Dominica have seen their infrastructure, economies and public health majorly affected by the high winds and heavy flooding that can accompany a major storm.
The new season also puts in sharp relief the ways in which Puerto Rico has yet to recover from a cascade of natural disasters last year, culminating in the devastating Hurricane Maria on Sept. 20, 2017.
A recent Harvard study estimated that nearly 5,000 people died in Puerto Rico in the aftermath of Maria ― 70 times higher than the government’s official count. The study also showed how dangerous a loss of infrastructure can be for individuals who depend on routine medical care to live.
According to the report, around one-third of households surveyed reported having issues that threatened their health and safety after the hurricane, including not being able to access medication, having no open medical facilities nearby and not being able to reach 911 services.
These challenges were often caused or exacerbated by the island’s near total loss of power. Eight months after the storm’s landfall, power has yet to be fully restored.
As the new season begins, experts are eager to help lessen the number of lives lost after a major storm. HuffPost spoke to public health and disaster preparedness experts about what medical professionals and facilities can do to prepare for a major hurricane in Puerto Rico and other regions at risk during this time.
There are federal guidelines in place that require many medical facilities to have a comprehensive emergency plan in case of a disaster. But Dr. Sarah Nafziger, co-chair of The University of Alabama at Birmingham’s emergency management committee, told HuffPost that while these guidelines say that facilities must prepare for certain scenarios, they don’t “dictate what is a good plan, because different facilities have different needs.”
Nafziger said the following points are fundamental in terms of emergency preparedness and aren’t always overly costly or time-consuming, especially if facilities pool resources or collaborate with community organizations. Still, she said implementing some of these will require investing a significant amount of manpower.
“I don’t think disaster preparedness necessarily has to be incredibly expensive. What it does take is a lot of effort,” she said.
And this short list of strategies could be lifesaving for the many residents who survive a storm, only to have their health threatened by a lack of medical attention in its aftermath.
Protect emergency equipment and medical supplies from possible flooding.
Ahead of a major hurricane, hospitals and other medical facilities should prepare for possible structural damage or flooding.
Dr. Irwin Redlener, the director of the National Center for Disaster Preparedness at Columbia University in New York, told HuffPost this means making sure medical supplies and equipment are in proper protective storage.
He notes it is also essential that hospitals and facilities have a backup generator and a stockpile of fuel for the generator in case of a power outage. Both must be be stored in a safe and dry place.
“What we learned after Hurricane Katrina in 2005 is that there were hospitals who had generators in the basement, which of course flooded out,” Redlener said. He added that when Superstorm Sandy hit the Northeast in 2012, several hospitals had placed generators on high floors, but left the fuel pump system in basements that ultimately flooded.
Identify and create a plan of action for people at high risk based on previously diagnosed chronic medical conditions.
Several experts advised that medical professionals should identify people who will be the most vulnerable in the aftermath of a storm, namely those with a previously diagnosed chronic medical condition. Compiling a list of patient names, conditions and needs can facilitate providing emergency services to them during and immediately after the storm.
Dr. José Cordero, a professor of public health at the University of Georgia who grew up in Puerto Rico, said moving these people to a safe place before the storm is essential. Cordero spent almost three decades working for the U.S. Centers for Disease Control and Prevention, including in the aftermath of 2005′s Hurricane Katrina.
“One of the things we learned in Katrina was that many of the people that have disabilities of different kinds or who were medically vulnerable were not moved in time because there was no such a list,” he said.
“Since that time, the need to move the medically vulnerable is something that is known,” he added. “And it was very sad to hear people from Puerto Rico saying, ‘No, we didn’t have a plan for doing that.’ They should have had a plan. And we need to have a plan for the next time.”
Redlener emphasized that some of the most at-risk are those on very specific chemotherapy or radiation treatments, and people with a chronic kidney disease who require hemodialysis several times a week.
“Let’s say there are 50 people getting dialysis in a particular center, those 50 people will need to be ― in my view ― contacted as soon as possible to make sure they are able to continue on their treatment regiment.” Without proactive outreach, he added, these patients could die.
Dr. Linda Young Landesman, a public health preparedness expert at The University of Massachusetts Amherst, added pregnant women to the list. She said doctors “need to discuss with the patient what the plan would be if they go into labor and there’s a storm” to prevent them from having to deliver their child at home.
Make mental health professionals available to survivors.
Special focus should be placed on communities’ mental health resilience in the aftermath of a disaster. Spikes in suicide are seen in many places after a major storm, including Puerto Rico; making mental health professionals immediately available can help save lives.
“There’s something called ‘psychological first aid’, where the whole concept is to make sure there are mental health professionals who are trained and specifically focus on this area of trauma,” Redlener said. “People who are trained to help folks in the immediate and long-term aftermath of a big disaster.”
In Puerto Rico, Cordero said, the sustained loss of infrastructure ― including power and water ― created a particularly desperate situation for citizens.
“A lot of the mental health issues we’re seeing is not only in terms of the shock of what happened, but also the sense of not knowing what to do or [not] getting any help,” he said. “When weeks go into months and months go into more months, and six months later we still don’t have power or water ― I think that’s a different type of mental health issue that comes up.”
This prolonged feeling of helplessness can lead to depression or suicide. Dr. Cordero said the solution is to identify survivors who need mental health assistance as soon as possible and provide them with the help they need.
Set up an effective way to communicate with other facilities and patients.
Immediately after a storm, cell service and power may be compromised due to fallen debris and wind gusts. Landesman recommends that every medical facility thus set up a way to communicate important information.
“They have to have a way to communicate to their staff and to their patients about whether or not they’re open,” she said. “But this assumes that there’s still some existing infrastructure in place.”
She suggested setting up a telephone tree or an online patient portal, “but if you don’t have Internet, that isn’t going to work.” In Puerto Rico, where power was down for months and remains fragile at best, shortwave radios have proved to be an important lifeline for many.
“What worked in Puerto Rico, that actually helped in many communities, were the shortwave radios. They actually go long distances,” Cordero said. “You can go to one side of the island and be able to talk to people on the other side with no problem whatsoever.”
Cordero said they worked better on the island than satellite phones. He said if medical facilities can buy a shortwave radio and train employees on how to use it, the device could come in handy when reaching out to other facilities or government entities to check in or ask for help.
Back up patients’ medical records to find information quickly after the storm.
Health care facilities, ambulatory care clinics and private doctors should also back up their patients’ records, according to Landesman.
“They have to make sure that they have a portable backup of all their patient records so that if a patient comes in [after the storm] and is on multiple medications and doesn’t know their dose ― they can find the information in the medical records,” she said, adding that redundancy is key and having multiple backups is best.
She recommends that large facilities make permanent backups in locations out of state. An island like Puerto Rico, for example, should store backup data somewhere like Florida, Landesman suggested.
“An individual doctor’s office or a small clinic could back their records up to a portable hard drive because it isn’t so big,” she added.