Natural Disasters
Topic Collection
June 6, 2023
Topic Collection: Natural Disasters
Natural disasters and their consequences (e.g., flooding, injuries experienced during clean up) can wreak havoc on healthcare facilities and the communities they serve. It is important for emergency planners to enroll in alert systems, monitor weather forecasts and have a solid natural disaster or all hazards facility response plan that complements their jurisdiction’s plan. The resources in this Topic Collection highlight lessons learned from recent events, communication tools and information, and checklists, plans, tools, and templates that can be modified to suit specific threats and needs. Articles in this Topic Collection address specific natural disasters and hazards and elements of their planning, but do not address all-hazard planning or specifics of clinical care which may be found in other topic collections.
Each resource in this Topic Collection is placed into one or more of the following categories (click on the category name to be taken directly to that set of resources). Resources marked with an asterisk (*) appear in more than one category.
Must Reads
This report shares workshop findings on increasing and improving the resilience of healthcare facilities and services to high-impact weather events. The workshop grouped their findings into three main categories: hardening structures, making incremental adaptations, and implementing innovative practices.
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This design guide can inform and help design professionals, hospital administrators, and facility managers employ sound mitigation measures that will decrease the vulnerability of hospitals to disruptions from natural hazard events (e.g., earthquakes, high wind events, floods).
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This issue of The Exchange highlights lessons learned from recent wildfires, evacuating and receiving patients, and preparing for planned power outages.
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Michael Wargo (HCA Healthcare), Scott Cormier (Medxcel), and Toni Carnie (HCA Houston Healthcare Tomball) share how a rare winter storm, extreme cold, and unplanned power outages affected utilities--particularly water and water pressure--in healthcare facilities throughout Texas. This summary highlights issues that will benefit from additional mitigation and preparedness activities as extreme weather incidents increase in frequency.
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Climate change continues to negatively impact national security, environmental stability, and human health conditions. This document provides an overview of climate trends in the U.S., outlining the impacts of climate-related illness and injury on health system operations, care delivery, and patient surge. It touches on the importance of bolstering healthcare infrastructure resilience, facility hardening, and highlights three areas being affected by various elements of climate change.
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The authors review heat wave plans from 18 cities and list recommendations for overcoming challenges (e.g., targeted outreach geared towards the socially isolated, begin prevention efforts before high temperatures arrive, and collect and use data to determine the effectiveness of interventions).
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The materials on this webpage include a toolkit, web tools, and press release and other templates that can help community leaders develop communication plans for extreme heat events.
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These checklists can help healthcare and other service providers identify residents at highest risk for heat-related illnesses.
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This 86-page document is a guide and toolkit designed to assist healthcare providers, design professionals, policymakers, and others with roles and responsibilities in assuring the continuity of quality health and human care before, during, and after extreme weather events. It is focused on healthcare infrastructure resilience to climate change impacts as manifested primarily by extreme weather events.
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Workshop participants discussed the effects of wildfires on certain populations and human health; challenges associated with recovery; improving operational response; and "the impact of mitigation and preparedness."
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Healthcare facility emergency planners can use this template when developing their emergency operations plan. It features 12 disaster scenarios, including: hurricane, tornadoes, structure fires, earthquakes, and extreme cold.
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The authors conducted a literature review and discovered variance in the tools used in disaster death scene data collection. They formed a work group comprised of medical examiners and coroners, forensic pathologists, death scene investigators, forensic anthropologists, and epidemiologists that developed and pilot tested this toolkit. The toolkit includes templates and checklists by hazard.
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This slide presentation focused on four main areas: the impact of an unexpected natural disaster on healthcare services; how the nation responded to help the Joplin community; how to incorporate lessons learned into planning; and how to design enhancements that can protect against future incidents.
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The authors conducted a literature review to examine health problems following flood and storm disasters. They found that illness mainly occurred within four weeks of these events. Poisonings, wounds, gastrointestinal infections, and skin or soft tissue infections increased after storms; gastrointestinal infections were more likely to occur after flood events.
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This article documents how facility staff from Memorial Hermann Hospital incorporated lessons learned after Tropical Storm Allison flooded the facility with almost 40 feet of water in 2001.
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This one-hour webinar covers the provision of pre-hospital care; the patterns of injury seen after hurricanes and tornadoes, including appropriate initial management; appropriate emergency risk communication messages; and the importance of data collection to improve messaging and response efforts.
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This editorial provides an overview of factors and issues to consider during heatwaves. The article includes links to the report authored by the World Health Organization and World Meteorological Organization, guidance from the Centers for Disease Control and Prevention, and other applicable webpages.
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This report summarizes presentations made at a 2012 workshop organized by the Committee on Public Response to Alerts and Warnings Using Social Media. Chapters cover the fundamentals of alerts, warnings, and social media, how social media has been used in emergencies by local agencies, the dynamics of social media, message credibility, privacy and legal issues, and research gaps and other challenges.
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This report summarizes presentations made at a 2012 workshop organized by the Committee on Public Response to Alerts and Warnings Using Social Media. Chapters cover the fundamentals of alerts, warnings, and social media, how social media has been used in emergencies by local agencies, the dynamics of social media, message credibility, privacy and legal issues, and research gaps and other challenges.
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This book provides a summary of conference proceedings where risk communications experts discussed the public response to mobile alerts. A free PDF download is available or physical copies can be ordered for a fee.
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U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2021).
National Health Security Strategy.
U.S. Department of Health and Human Services.
The goal of the National Health Security Strategy (NHSS) is to strengthen and sustain communities’ abilities to prevent, protect against, mitigate the effects of, respond to, and recover from disasters and emergencies. This webpage includes links to the full text of the strategy, an overview, the NHSS Implementation Plan, the NHSS Evaluation of Progress, and an NHSS Archive.
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This online toolkit can help healthcare facility planners learn more about implementing best practices in climate resilience. It is based on a framework composed of the following five elements: Climate Risks and Community Vulnerability Assessment; Land Use, Building Design, and Regulatory Context; Infrastructure Protection and Resilience Planning; Essential Clinical Care Service Delivery Planning; and Environmental Protection and Ecosystem Adaptations.
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This guidebook identifies best practices that have been implemented to save lives during excessive heat events in various urban areas. It provides critical information needed to help local public health officials, emergency managers, meteorologists, and others assess their community’s vulnerability to excessive heat waves, and develop and implement notification and response programs.
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Alerts, Warnings, and Communications
This study investigated whether non-traditional data (i.e., tweets and news reports) fill a void in traditional data reporting during hurricane response, as well as whether non-traditional data improve the timeliness for reporting identified HHS Essential Elements of Information (EEI).
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The authors examined information sources used for Superstorm Sandy with respect to the storm, evacuation routes, shelters, safety, and health issues in Central New Jersey and Jersey Shore communities. They concluded that the reliance on traditional sources of information (i.e., TV, radio, friends) observed suggests that the extreme power outages made web, cell phones, and social media on cell phones less available.
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The materials on this webpage include a toolkit, web tools, and press release and other templates that can help community leaders develop communication plans for extreme heat events.
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The authors evaluated official New York City tweets related to Superstorm Sandy (2012) and winter storm Nemo (2013) and how often they were re-tweeted. They found that information was shared beyond existing follower bases; official tweets during Sandy had lower lexical diversity, with links to more information, and were retweeted more than unofficial Sandy tweets; and NEMO-related tweets containing more general information were retweeted more often than those containing actionable information.
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The authors describe how they used Twitter for situational awareness during Superstorm Sandy in 2012.
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The HHS emPOWER Map provides monthly de-identified totals of Medicare claims submitted for one or more of the fourteen types of life-maintaining or saving electricity-dependent durable medical and assistive equipment (DME) and certain implanted electricity-dependent cardiac devices, at the national, state, territory, county, and ZIP Code levels. Users have the ability to create unique aggregations by geography and export the data, as well as the ability to access historical HHS emPOWER Map datasets for further analysis. When combined with real-time severe weather and hazard maps, the HHS emPOWER Map gives communities the power to anticipate, plan for, and address the needs of this population prior to, during, and after an incident, emergency, or disaster.
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The National Weather Service provides links to federal and external alert and warning sources.
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The National Weather Service provides links to sources that provide tsunami event messages.
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National Wildfire Coordinating Group. (2015).
InciWeb.
This webpage provides up-to-date information on wildfires across the country. Users can search by state or incident name. Photographs, announcements, and news articles are also included.
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This tool provides central access to federal disaster and public health related natural disaster alerts, warnings, and other resources.
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The U.S. Geological Survey provides this free service that notifies users when earthquakes occur in their area.
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These guidelines provide an overview of the general heat–health problem and describe how an understanding of the biometeorology, epidemiology, and public health and risk communication aspects of heat as a hazard can be used to inform the development of a heat-health warning system (HHWS) as part of a wider heat-health action plan (HHAP).
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Education and Training
The speakers in this webinar discuss the earthquake risk in the Cascadia subduction zone in the Pacific Northwest. Challenges for planners and communication and mitigation strategies are also discussed.
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This 9-hour course covers: weather basics and forecasting; threats analysis and hazards planning; fact sheets for weather and non-weather-related hazards; warning partnership information; and human behavior and community response.
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This 10-hour course is targeted to those involved in the decision making process for hurricanes and includes basic information about: how hurricanes form and the hazards they pose; how the National Weather Service (NWS) forecasts future hurricane behavior; and what tools and guiding principles can help emergency managers prepare their communities.
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This 30-minute course presents basic information on earthquake science, risk, and mitigation. It also discusses techniques for structural and non-structural earthquake mitigation.
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This 6-hour course helps emergency managers prepare their communities for tsunamis. It covers basic tsunami science, hazards produced by tsunamis, regional U.S. tsunami risks, the tsunami warning system, the importance of public education activities, and how to craft good emergency messages and develop tsunami response plans.
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National Center for Disaster Medicine and Public Health. (2020).
Wildfires.
This hour-long webinar features speakers discussing lessons learned from recent wildfires, including the effect of wildfire smoke on air quality and respiratory health.
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National Hurricane Program. (2022).
Hurrevac.
This website contains links to recordings of the 2022 Web-based Hurrevac webinar series organized by the National Hurricane Program (NHP). The courses cover information on hurricanes and evacuation for the emergency management community, including wind forecast features, evacuation timing, storm surge, and other water hazards.
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This presentation addresses the purpose of the tabletop exercise, describes the severe weather scenario that impacts the community health center, and provides discussion questions for participants.
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This document provides guidance for healthcare facilities that wish to participate in a ShakeOut (earthquake) exercise in their community. It includes checklists to guide planning for a drill, a tabletop exercise, and a functional exercise.
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The HHS emPOWER Program Web-Based Training is a free, publicly accessible course designed to help partners better understand the HHS emPOWER Program and integrate its tools into their emergency preparedness, response, recovery, and mitigation activities.
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This course can help physicians, registered nurses, asthma educators and others learn about the negative health effects associated with wildfire smoke. Participants will also learn what to encourage patients to do to prepare for and minimize exposure to smoke during a wildfire.
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Lessons Learned: Earthquakes
The authors describe their experiences and lessons learned working in the emergency department of the only regional acute care hospital following the 2011 New Zealand earthquake. They note that emergency department response plans should account for patients arriving in atypical ways; loss of power; the need for paper registration and tracking systems; volunteer management; and teamwork with clear leadership, among other things.
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This ASPR TRACIE resource provides an overview of the potential significant health and medical response and recovery needs facing areas affected by a major earthquake with or without additional cascading events.
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The authors describe their experiences in a pediatric field hospital in Haiti following the 2010 earthquake. They discuss requirements for equipment, manpower, medical records, and systems addressing volunteer stress, as well as ethical issues. They also note that 93% of casualties initially were surgical admissions with 40% undergoing operations in the first week after the event, mostly for fractures and wound care.
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This report summarizes the Pacific Northwest's multi-state exercise held in June 2016. Findings are listed by core capability; public health and medical services and mass care information can be found beginning on page 13.
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The authors discuss lessons learned from the 2011 Japanese earthquake and tsunami, and present a graphic entitled the "chain of survival for disasters" to help guide decision-makers and emergency response planners during natural disasters.
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The authors present four examples of initiatives that helped communities recover from Japan's earthquake/tsunami "3/11 Disaster." They stress the important role of healthcare providers in ensuring access to care and reducing stressors in survivors.
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The Puerto Rico Department of Health (PRDOH) used the emPOWER Emergency Response Outreach Dataset to identify at-risk individual residences in areas impacted by severe earthquakes and directed community outreach teams comprised of PRDOH officials, Medical Reserve Corps volunteers, local nursing school students, and others to conduct wellness checks across five municipalities. Outreach teams located 166 at-risk individuals and provided them with referrals to behavioral health services, as needed, as well as informational resources and contacts for behavioral health, hygiene, human services and housing services, the Emergency Prescription Assistance Program, and other federal assistance programs.
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The authors conducted a medical analysis of injuries and diseases after an earthquake that struck a remote, high-altitude region. They listed related challenges and suggestions for future healthcare provider training topics.
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The authors describe loss of functions and structural damage experienced by hospitals in Chile following a major earthquake. Loss of communications capability was cited by hospital administrators surveyed as being most problematic.
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The authors analyze the medical response to earthquakes and tsunamis in tropical regions and found that shock, infection, and heat stroke were frequently encountered by survivors.
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The authors discuss how the assumptions and planning for their orthopedic surgery team deployed to assist after the 2010 Haiti earthquake were "naïve," and they present their lessons learned.
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The authors reviewed resources from PubMed, Ovid, and Medline combined with real-life experience treating chronic disease after disasters. They found that the international nephrology community had formed an effective organization (the Renal Disaster Relief Task Force), and emphasize that patients have emergency diet and renal fluid restriction plans and be prepared to modify dialysis schedules and methods. Suggestions for facilities are also provided.
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The authors discuss how lessons learned from the 1995 Hanshin earthquake and effective use of the Internet for communication and coordination assisted with the response to the 2011 earthquake and tsunami. They also describe and compare the injuries and causes of death for the two events.
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This report discusses lessons learned from the immediate and early response in the first three months following the 2010 earthquake in Haiti, with the goal of improving the health response in future sudden-onset disasters.
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The authors discuss lessons learned from recent earthquakes worldwide and explore how resources spent on search and rescue missions may diminish resources available for other needs, including healthcare.
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The authors describe the injuries encountered in the weeks following the Pakistan earthquake in 2005, and the joint efforts by orthopedic and plastic surgeons that were required to treat them.
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The author highlights strategies used by several hospitals to mitigate and prepare for the effects of future earthquakes (e.g., retrofitting buildings, adding communications tools to ensure redundancy, and monitoring seismic activity.
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Early intervention may reduce avoidable hospital admissions for new acute conditions in the months following an area impacted by a natural disaster.
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This article provides a comparison of pre-event and the two years post-event diagnoses of patients seen up to one month post-earthquake in the same location.
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The authors conducted a cross-sectional, records-based study of 2,484 records obtained from a temporary hospital to investigate patterns of healthcare service demand for a rural displaced population following the 2014 Ludian County earthquake. They found that healthcare service demand from younger age groups was higher than that of the older adult group, and observed three major health problems: respiratory disease, skin problems, and ear, eye, and throat (EET) problems.
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The authors incorporate lessons learned from the Fukushima disaster into response recommendations for pediatric surgeons and physicians.
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The authors characterize the bacteria isolated from trauma patients following the 2008 Wenchuan earthquake, and associated antibiotic susceptibilities. They found that the distribution spectrum of pathogens isolated from trauma patients after the earthquake was different from that for non-earthquake trauma patients in the same hospital at the same time.
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Lessons Learned: Extreme Cold
Michael Wargo (HCA Healthcare), Scott Cormier (Medxcel), and Toni Carnie (HCA Houston Healthcare Tomball) share how a rare winter storm, extreme cold, and unplanned power outages affected utilities--particularly water and water pressure--in healthcare facilities throughout Texas. This summary highlights issues that will benefit from additional mitigation and preparedness activities as extreme weather incidents increase in frequency.
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The authors describe a recent snowstorm that exceeded weather forecasts and contributed to 11 deaths in Southern Erie County (NY). Most of these deaths were "potentially preventable," and the Centers for Disease Control and Prevention developed a winter weather checklist to emphasize the importance of preparing for similar weather events.
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Cardiovascular disease (CVD) admissions from four hospitals over 5 years were merged with weather data to determine if temperature affected hospital admissions among elderly people with CVD. The authors found that CVD admissions increased in the elderly during a period of 4-15 days following exposure to extreme cold, peaking at around a week's time after exposure.
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This article highlights lessons learned by healthcare facilities during winter storms. One facility converts exam rooms into overnight accommodations for staff and provides them with cafeteria meal vouchers. Another ensures childcare is available for staff who remain at work during a storm, and others have agreements with local hotels that provide rooms at discounted rates.
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During back-to-back severe blizzards, Goshen County, Wyoming, used the emPOWER Emergency Response Outreach Individual Dataset, along with local electric cooperative and company information, to identify at-risk individuals in areas impacted by prolonged power outages. The county then partnered with the Sheriff’s Office to conduct approximately 25 targeted outreach phone calls and visits to the residences of at-risk individuals without cell phones.
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The authors looked at syndromic surveillance data from England for the 2010-11 and 2011-12 winters to characterize cold weather-related Emergency Department visits. The authors found that the strongest fit with temperature was cold-related fractures in females, and strongest fit for snowfall was cold-related fractures in both sexes.
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The authors looked at 292,666 cardiovascular and 562,738 respiratory disease Emergency Department (ED) visits over an eight-year period in Toronto. They found that: diabetics exposed to extreme heat had more ED visits vs. non-diabetics; respiratory disease ED visits during hot weather were higher for individuals with comorbid respiratory diseases and cancer; exposure to extreme cold temperatures over a 2-week period increased cardiovascular disease ED visits for individuals with comorbid cardiovascular diseases, and kidney diseases.
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This MMWR describes three selected cases of hypothermia-related deaths in Wisconsin, and summarizes risk factors based on all cases that occurred in the state during the period of active surveillance in 2014. A summary of hypothermia-related deaths for the United States during 2003–2013 also is presented for comparison.
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The authors looked at 197,680 deaths from natural causes, air temperature, and air pollution rates from November to April for 9 consecutive years. They found that individuals aged 85 and older, and those with cardiovascular diseases (including hypertensive diseases, stroke, congestive heart failure, chronic obstructive pulmonary disease (COPD), and pneumonia) had the greatest risk of death from exposure to extreme cold temperatures.
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Lessons Learned: Extreme Heat
The authors of this report analyze the results of independent peer-reviewed scientific papers and present the findings of increasing heat-related mortality due to global warming for the 40 largest U.S. cities. Their findings indicate that rising temperatures, driven by persistent climate change, will increase the number of life-threatening excessive heat events.
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The authors applied time-series models to a 14-year dataset featuring 107 U.S. communities to relate cold, heat, and heat wave effect estimates to community-specific variables (e.g., socioeconomic factors and urbanicity).
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Triple digit temperatures are affecting areas of the U.S. that historically never experienced them, including the City of Seattle, where home and facility air conditioning is rare or is not designed for extreme temperatures. This article features health care stakeholders sharing how lessons learned during the 2021 heat dome event and robust regional and local collaboration and communications during the pandemic facilitated connections during the heat wave in the summer of 2022.
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The authors used death certificate data to understand whether and how the 2021 heat wave in Washington state led to excess deaths. They used time series to compare deaths during the dates the heat wave occurred against the number of deaths that historically occurred in the same time period. The authors conclude that the heat wave was associated with an increase in injury deaths.
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The authors examined more than 720,000 daily emergency department hospital admissions in Charlottesville, VA from 2005-2016 and found an overall association between heat waves and increased admissions, “across the entire disease spectrum.”
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This website includes a map of maximum daily temperatures across the U.S., a heat and health tracker to facilitate response to extreme heat, a climate explorer to understand how weather will change in the coming decades, and information on related events and news.
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The researchers studied data on daily temperature and fluid and electrolyte imbalance (FEI) emergency department (ED) visits in Atlanta, GA, between 1993 and 2012. They found that higher ambient temperature was significantly related to FEI ED visits. Analyses indicated higher risks for all populations, but particularly males.
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Climate change is exacerbating hurricanes, extreme heat, and other severe weather events, which requires hospitals to improve their infrastructure to withstand these events and prepare to care for affected patients. This article provides information for Federally Qualified Health Centers and other facilities serving patients who are at risk for health impacts due to climate change-related extreme weather events.
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The authors combined data from emergency medical services (EMS) and emergency department (ED) visits over a period of time in New York City to calculate heat-related mortality. They found a (statistically significant) 7% increase in non-external cause mortality associated with one-day lagged heat-related EMS calls and a 5% mortality increase with one-day lagged ED visits.
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The authors looked at 292,666 cardiovascular and 562,738 respiratory disease Emergency Department (ED) visits over an eight-year period in Toronto. They found that: diabetics exposed to extreme heat had more ED visits vs. non-diabetics; respiratory disease ED visits during hot weather were higher for individuals with comorbid respiratory diseases and cancer; exposure to extreme cold temperatures over a 2-week period increased cardiovascular disease ED visits for individuals with comorbid cardiovascular diseases, and kidney diseases.
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This analysis of 33 studies found that the elderly, males, children, and those with chronic diseases were more vulnerable during heat waves. The authors also found that certain social factors (e.g., lower socioeconomic status) had a relationship to heat susceptibility. They suggest incorporating morbidity indicators into heat wave early warning systems to bolster health response.
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This website aims to help prepare the U.S. for extreme heat events by mapping areas at risk in the next seven days. The map uses a color scale of 0-4 to show whether areas have no elevated risk, moderate risk, high risk, or very high risk for heat waves.
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The author describes how a 2021 heat wave led to the deaths of 112 people in Washington state. The article highlights how a lack of air conditioning statewide was a factor, how the event led to a significant increase in heat-related emergency department visits, and how emissions today will lead to higher temperatures in the future.
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The researchers found that extreme heat events in Maryland increased the risk of same-day hospitalization for asthma by 3 %; higher risk was seen for extreme heat events that occur during summer months. They also found that extreme precipitation events increased the risk of summertime hospitalization by 11 % in Maryland.
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This editorial provides an overview of factors and issues to consider during heatwaves. The article includes links to the report authored by the World Health Organization and World Meteorological Organization, guidance from the Centers for Disease Control and Prevention, and other applicable webpages.
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This guidebook identifies best practices that have been implemented to save lives during excessive heat events in various urban areas. It provides critical information needed to help local public health officials, emergency managers, meteorologists, and others assess their community’s vulnerability to excessive heat waves, and develop and implement notification and response programs.
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This website explains why there were extreme heat-associated deaths during the 2021 heatwave in the Pacific Northwest and provides data tables on heat-related deaths broken down by county, gender, age, and race/ethnicity. They note that people aged 65+, infants and children under 4 years old, and people who are ill or taking certain medications are at higher risk for heat-related illness.
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Lessons Learned: Fire/Wildfire
Staff from Kaiser Hospital Santa Rosa (CA) share their personal experiences with the 2017 wildfire and professional experiences evacuating a hospital in the midst of one.
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This issue of The Exchange highlights lessons learned from recent wildfires, evacuating and receiving patients, and preparing for planned power outages.
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On December 30th, 2021, healthcare workers at Centura Health’s Avista Adventist Hospital were managing a pandemic and planning for a winter storm. The hospital, which includes a large neonatal intensive care unit, was full, with less than 5% capacity. Unbeknownst to the staff working during that holiday weekend, the Marshall Fire was approaching the building, and would cause some of them to lose their homes while forcing the hospital to evacuate in under two hours. ASPR TRACIE met with five subject matter experts to learn more about their experiences, challenges, and lessons learned.
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This document contains information for California’s public health officials, emergency management professionals, and others involved in planning for and responding to wildfire smoke incidents. Information is provided on wildfire smoke and health risks, sensitive populations, strategies to reduce exposure during wildfire smoke incidents, and specific guidance for public health planning and response. Tools and best practices are included, particularly those that emphasize assessing community vulnerabilities and the protection of sensitive populations. Appendices include additional resources and links, organized by topic.
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The information on this webpage can help first responders and community members understand the risk and protect themselves from the effects of wildfire smoke.
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This 2.5-hour recording features speakers from the state and two counties sharing lessons learned from the northern California wildfires of 2017 specific to the medical health response and the need for shelters. The speakers highlight how lessons learned from recent extreme fire behavior can inform healthcare planning.
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This article describes how Southern California’s 2007 wildfires impacted emergency department visits for respiratory issues. Complaints related to dyspnea and asthma increased significantly between pre- and post-fire periods. The authors suggest developing a virtual pack of supplies to save space locally and that can be quickly assembled and sent to sites by the distributor.
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The authors reviewed data over 12 years from Washington State and found “increased odds of mortality in the first few days following wildfire smoke exposure.” The article includes figures and tables that describe subject demographics and their relationship to wildfire smoke-related variables.
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The authors conducted a comprehensive literature review of international research on wildfire-related health effects and led several focus groups with study authors. Results indicated that certain populations are especially vulnerable; wood smoke has high toxicity levels; respiratory morbidity is the leading health effect, wildfire exposure is also associated with burns (and related effects) and cardiovascular, ophthalmic, and psychiatric problems.
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During severe wildfires, Los Angeles County, California, used the emPOWER Emergency Response Outreach Individual Dataset to identify and contact 38 local durable medical equipment and oxygen suppliers serving approximately 600 at-risk individuals to provide information on recovery resources for their clients. LA County also developed a formal multi-agency LA County-City of LA protocol that rapidly operationalizes data and supports integrated situational awareness, decision-making and action prior to, during, and after an emergency.
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This article discusses lessons learned from hospitals in California during the 2017 wildfires. The authors credit following an established command structure for incident management as one of the reasons they were able to remain open. They also note the importance of focusing on capacity and staff care during disaster response.
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This 1.5-hour video is part of a four-video series which details how Mountain View Fire Rescue, EMS, and the Boulder County Sheriff’s Office responded to the Marshall Fire on December 31, 2021. The panel is composed of emergency responders who discuss their experiences during the fire.
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This 1.5-hour video is part of a four-video series in which hospital, EMS, and Mountain View Fire Rescue leaders discuss the hospital evacuation during the Marshall Fire on December 31, 2021. The video includes participants from the responding health care coalition, Boulder County Public Health, and health care facilities which were affected.
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This 1-hour video is part of a four-video series in which stakeholders who supported the emergency response to the December 31, 2021, Marshall Fire discuss regional coordination among public health, disaster management, and the local health care coalition. They discuss emergency sheltering, evacuating residents with access and functional needs, and local coordination structures.
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This 1 hour, 20-minute video is part of a four-video series in which stakeholders from public health and a retirement community discuss evacuation and support for residential care facilities during the Marshall Fire on December 31, 2021. The participants discuss transportation, coordination among partners, and considerations for evacuation during the COVID-19 pandemic.
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Workshop participants discussed the effects of wildfires on certain populations and human health; challenges associated with recovery; improving operational response; and "the impact of mitigation and preparedness."
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Readers can learn about how smoke from wildfires—both near and far—can have an effect on health. Maps that show how smoke from wildfires in 2011 affected many areas of the U.S. are included.
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Lessons Learned: Floods and Landslides
In this article, the authors discuss infection prevention and control experiences related to the reopening of medical facilities after recent disasters in Thailand and the U.S.
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This case study includes lessons learned from record flooding in 2006 and select flood response plan components provided by Our Lady of Lourdes Hospital in Binghamton, NY.
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The authors provide information for clinicians caring for flood victims. They describe the conditions seen in patients following floods, and characterize the causative agents of these conditions. Treatment is also discussed.
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This one-hour webinar features Gary Goldbaum of the Snohomish Health District who shares how his health district worked with partner agencies in response to the Oso, Washington mudslide in March 2014. He also discusses the roles of public health when responding to a mass fatality disaster, key barriers to effective response during a mass fatality disaster, strategies for overcoming those barriers, and key partners for assuring effective response to a mass fatality disaster.
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The Broome County Health Department in New York used the emPOWER Emergency Response Outreach Individual Dataset to quickly identify and conduct outreach to 58 at-risk residents without power during a severe and prolonged power outage and make informed decisions on power restoration.
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Nevada’s state and county health departments, in partnership with the Aging and Disability Services Division, a Tribe Emergency Manager, durable medical equipment suppliers, and others, used emPOWER data to conduct outreach to at-risk individuals during multiple prolonged severe flooding events.
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This article discusses the impact of the Mumbai floods and the provision of shelter-based and community care for over 150,000 cases of diarrhea, many consistent with leptospirosis by hospital staff and medical students, detailing the substantially increased risk of communicable disease during flooding events with poor sanitary conditions.
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The authors provide a review of the health impacts of U.S. coastal storms, with a focus on outcomes relevant to New York City (NYC) and urban coastal areas, and incorporate lessons learned from Superstorm Sandy. Based on the literature reviewed, indicators of health vulnerability were selected and mapped within NYC neighborhoods.
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In January 2018, a 30-foot debris flow inundated Montecito, CA, leading to dozens of injuries and 21 “prehospital deaths.” The authors examined 24 patients’ injury patterns, related procedures performed (and complications), length of stay, and outcomes. They defined “debris flow syndrome…as a pattern of injuries, including soft tissue injuries, hypothermia, craniofacial trauma, corneal abrasions, orthopedic injuries, and mud impaction.”
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The author discusses infectious disease risks associated with extreme weather events, drawing on recent experiences, including Hurricane Katrina in 2005 and the 2010 Pakistan mega-floods. Historical examples from previous centuries of epidemics and "pestilence" associated with extreme weather disasters and climatic changes are also discussed.
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Ms. Quinn, a Medical Reserve Corps (MRC) Coordinator with Snohomish Health District, discusses the MRC response to the 2014 flooding and mudslide in Washington state.
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The authors discuss lessons learned from this flood and landslide event in 2011, with a focus on pre-hospital and hospital organization and management of patients. They also describe the most common injuries treated (injuries were to the extremities, most requiring only wound cleaning, debridement, and suture), and note that the primary cause of death was from asphyxia due to drowning or mud burial.
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The authors conducted a literature review to examine health problems following flood and storm disasters. They found that illness mainly occurred within four weeks of these events. Poisonings, wounds, gastrointestinal infections, and skin or soft tissue infections increased after storms; gastrointestinal infections were more likely to occur after flood events.
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This article documents how facility staff from Memorial Hermann Hospital incorporated lessons learned after Tropical Storm Allison flooded the facility with almost 40 feet of water in 2001.
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Lessons Learned: General
The authors share three case stories from emergency departments (EDs) (a structural collapse, a fire, and a computer system failure) to highlight vulnerabilities and the range of hazards that can affect EDs. Hospital planners and builders are encouraged to incorporate local and other hazards into facility plans and construction.
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Philadelphia County, in collaboration with the Commonwealth of Pennsylvania, used the emPOWER Emergency Response Outreach Individual Dataset to provide targeted public health messaging and direct contact information for support services, including grocery and utility bill paying assistance, to approximately 13,000 at-risk individuals. Philadelphia also leveraged emPOWER data to identify and partner with home health agencies, to reinforce these public health and safety messages and provided additional resources for their staff and patients.
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The Arizona Department of Health Services (ADHS) used the HHS emPOWER Map, the emPOWER Emergency Planning De-identified Dataset, and the emPOWER Emergency Response Outreach Individual Dataset to prepare for, respond to, and work to mitigate severe weather, poor air quality, and power outage threats to at-risk individuals in emergencies. ADHS developed systems, processes and deployable equipment and supply caches to support 1,000 at-risk individuals in a response.
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This report highlights how rural healthcare facilities can prepare for natural and human-caused disasters and the importance of flexibility. The author also shares lessons learned from rural communities and providers who responded to a tornado in Iowa, an earthquake in Alaska, and an armed hostage standoff in South Dakota.
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The authors review wind disaster incidents (including hurricanes and cyclones) worldwide from 1980-2008, including a subcategory of tornados in the U.S. from 1950 to 1994. Results include injury data and descriptions (both prior, during, and after impact) and information on damage to healthcare facilities and infrastructure.
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National Center for Disaster Medicine and Public Health. (2018).
State of Science.
Uniformed Services University of the Health Sciences.
This is the first webinar in a series that discusses the current state and future direction of critical healthcare infrastructure modeling for disaster events including climate change influences. This project focuses on developing a platform that integrates several variables (“extreme event forecasts, health risk/impact assessment and population simulations, critical infrastructure (electrical, water, transportation, communication) impact and response models, healthcare facility-specific vulnerability and failure assessments, and health system/patient flow responses”) to improve regional healthcare system resilience.
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Suneja, A., Chandler, T.E., Schlegelmilch, J., et al. (2018).
Chronic Disease After Natural Disasters: Public Health, Policy, and Provider Perspectives.
Columbia University, Earth Institute, National Center for Disaster Preparedness.
This report provides public and private state and local stakeholders with information to help them better understand and support the post-disaster needs of individuals with chronic conditions. It highlights the strengths and weaknesses that have been experienced, or are anticipated in current approaches to this issue.
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Lessons Learned: Hurricanes
The authors examine the impact of Hurricane Sandy ("the dose") on the health and well-being of New Jersey residents ("the response") exposed to the storm. Primary findings include: the negative effect housing damage had on residents' health is similar to the effect of poverty; some toxins (e.g., mold) had a double negative effect (e.g., clinically-diagnosed asthma and mental health distress); and children living in homes that experienced minor physical damage were more likely to be sad or depressed or having sleeping problems.
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This report summarizes the findings from a research project conducted to evaluate how the healthcare system was negatively affected in preparation for, during, and after Hurricane Sandy. Lessons learned from the hospital, EMS, and ancillary services (i.e., pharmacies, methadone clinics, dialysis/kidney centers, and medical supply companies) sectors are noted to assist healthcare professionals, medical facilities, and public health better prepare for future disasters.
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The authors interviewed 30 key informants (KI), including health and social service providers that provide healthcare to the under- and uninsured along the Mississippi and Alabama Gulf Coast. Pre-disaster issues of importance were patient education and preparedness; evacuation guidance and support; planning for special medical needs shelters; and health care provider preparedness. Post-disaster issues were communication; volunteer coordination/credentialing; and donation management, particularly for medications.
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The authors interviewed 30 key informants, including health and social service providers that provide healthcare to the under- and uninsured along the Mississippi and Alabama Gulf Coast. Respondents indicated that mental health, diabetes mellitus, hypertension, respiratory illness, end-stage renal disease, cardiovascular disease, and cancer were medical management priorities after a disaster. The most frequently mentioned barrier to providing care was maintaining continuity of medications. Inaccessible medical records, poor patient knowledge, and financial constraints also impacted care. Implemented or suggested solutions included better pre-disaster patient education; support for electronic medical records at community health centers; and better management of donated medications/medical supplies.
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Following a number of related technical assistance requests and in anticipation of future information needs from healthcare systems impacted by current and future disasters, ASPR TRACIE developed this white paper to answer the question: “How long does it take the healthcare system to recover from a major hurricane?”
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This Assistant Secretary for Preparedness and Response (ASPR) Technical Resources, Assistance Center, and Information Exchange (TRACIE) document provides numerous hurricane-related resources applicable to a variety of stakeholders and audiences.
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More than 150 direct and indirect deaths and over $112 billion in damage have been attributed to 2022’s Hurricane Ian, which made landfall in southwestern Florida as a Category 4 storm. Dave Kistel (Vice President and Chief Facilities Executive at Lee Health) met with ASPR TRACIE and described how the hospital system prepared
for, responded to, and recovered from Hurricane Ian, which caused $12 million in damage to Lee Health facilities. Access the recording here: https://files.asprtracie.hhs.gov/documents/hurricane-ian-lee-health-wreckage-resilience-recovery.pdf
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The author recounts the challenges associated with providing care in a university hospital’s neonatal intensive care unit before, during, and after Hurricane Katrina made landfall.
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The authors share lessons learned by staff in a Florida hospital that experienced the effects of Hurricane Irma in 2018, including: providing fuel for staff vehicles so they can get to work; having hard copies of plans and contact lists available for all key staff; devising staffing plans in advance of the storm to create three teams to ensure staffing before, during, and after the storm; and having emergency contacts in place with key vendors.
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The author describes her experience in Charity Hospital following Hurricane Katrina, with a focus on the unexpected necessities (e.g., shoes, extra underwear, shift work/sleep, morale-boosting activities, a team of professionals who care about patients and each other, etc.) that arose, and how they were addressed.
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BlueCross BlueShield of Texas reviewed member claims for the 6 months post-Harvey and compared them to the same time period the previous year and found that “many people turned to technology in the form of telemedicine for the first time.” There was a rise in mental and physical health conditions such as post-traumatic stress disorder (PTSD), as well as infectious and parasitic diseases post-Harvey. The claims data also showed an increase in substance abuse, pneumonia and Chronic Obstructive Pulmonary Disease (COPD).
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The authors retrospectively reviewed their hospital's disaster plan and compared it with actual events that occurred after Hurricane Katrina. They evaluated and scored vital support areas as adequate (3 pts), partially adequate (2 pts), or inadequate (1 pt), with the following results: water-3.0, food-2.4, sanitation-1.5, communication-1.4, and power-1.5. The authors concluded that, despite writing and exercising plans, the hospital was still not fully prepared.
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This article demonstrates the usefulness and diverse population base that can be cared for by an emergency department (ED) Observation Unit. The authors examine what happened in the absence of an ED through a retrospective review of such a model created after the destruction of the NYU Langone Medical Center ED during Hurricane Sandy.
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This website contains links to all hurricane-related MMWRs, including valuable epidemiologic information from multiple hurricanes, mold-related and other post-hurricane illnesses and injuries, and longer-term health effects.
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The authors share how lessons learned in patient movement and other planning and response capabilities have been incorporated since Hurricane Katrina struck the Gulf Coast. The authors highlight the development of Mississippi MED-COM, a statewide medical communications center, to serve as a “hub for patient coordination and movement during emergency incidents.”
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This document provides an overview of the status of the recovery in Puerto Rico and the U.S. Virgin islands six months after Hurricanes Irma and Maria, with a focus on the health care systems and health needs of residents. It builds on earlier work that examined how residents in Puerto Rico were faring two months after the hurricanes, and key issues for recovery in Puerto Rico and the U.S. Virgin Islands identified during a Fall 2017 roundtable with key stakeholders.
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The Florida Department of Health used the emPOWER Emergency Response Outreach Individual Dataset and their alert system to perform a reverse phone number look up to conduct rapid robo-dial outreach to over 40,000 at-risk individuals in the path of Hurricane Matthew.
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During Hurricane Matthew, the South Carolina Department of Health and Environmental Control (DHEC) used the emPOWER Emergency Response Outreach Individual Dataset to identify areas with high concentrations of at-risk individuals. Through a partnership with first-responders and FEMA Urban Search and Rescue (USAR), DHEC identified evacuation staging areas that could support a surge in at-risk individuals requiring shelter. DHEC later conducted recovery outreach to 268 at-risk individuals to assess ongoing recovery needs and level of preparedness, and provide informational resources.
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The authors describe a novel approach to reestablishing connectivity with the electronic health records server for a hospital affected by Superstorm Sandy through resource-sharing of a disaster response asset from a hospital in a neighboring state.
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Climate change is exacerbating hurricanes, extreme heat, and other severe weather events, which requires hospitals to improve their infrastructure to withstand these events and prepare to care for affected patients. This article provides information for Federally Qualified Health Centers and other facilities serving patients who are at risk for health impacts due to climate change-related extreme weather events.
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The authors present findings from a qualitative study of participants representing healthcare and social services organizations serving health disparate residents of the Mississippi and Alabama Gulf Coast. They note that participant organizations have implemented changes to ensure continuity of care for the chronically ill in case of disasters (e.g., evacuation planning and assistance; support to find resources in evacuation destinations; equipping patients with prescription information, diagnoses, treatment plans, and advance medications when a disaster is imminent), but that additional solutions are necessary to meet the needs of disparate populations more fully.
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The authors share the experience of a hospital faced with deciding whether to evacuate or shelter in place while in the path of a hurricane (two years in a row). An appendix at the end can be used as a planning tool to help other facilities facing similar challenges.
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This paper addresses the overarching healthcare status of the areas affected by Hurricane Katrina and their potential impact on other locations across the nation. It describes issues related to public health, emergency/trauma care, primary care, medication access, acute hospital care, long term care, and mental health care.
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The authors provide a review of the health impacts of U.S. coastal storms, with a focus on outcomes relevant to New York City (NYC) and urban coastal areas, and incorporate lessons learned from Superstorm Sandy. Based on the literature reviewed, indicators of health vulnerability were selected and mapped within NYC neighborhoods.
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The author discusses infectious disease risks associated with extreme weather events, drawing on recent experiences, including Hurricane Katrina in 2005 and the 2010 Pakistan mega-floods. Historical examples from previous centuries of epidemics and "pestilence" associated with extreme weather disasters and climatic changes are also discussed.
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The authors reviewed resources from PubMed, Ovid, and Medline combined with real-life experience treating chronic disease after disasters. They found that the international nephrology community had formed an effective organization (the Renal Disaster Relief Task Force), and emphasize that patients have emergency diet and renal fluid restriction plans and be prepared to modify dialysis schedules and methods. Suggestions for facilities are also provided.
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The authors describe how their hospital system's response plans were revised after Hurricane Rita in anticipation of Hurricane Ike in 2008. They note that, despite planning and exercising their plan, there were still a number of lessons learned that could be helpful to other hospitals during future disaster responses.
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The authors surveyed 174 Medicare-certified hospitals located in declared disaster areas in Connecticut, New Jersey, and New York during Superstorm Sandy and conducted 10 site visits and collected other types of data. They found that a small percent of hospitals (7%) evacuated during the storm (the rest sheltered in place). The report describes several cases of flooded hospitals and recommends continued community disaster collaboration.
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The author discusses the circumstances surrounding the arrest of a physician and two nurses for allegedly euthanizing four elderly patients at Memorial Hospital in Louisiana after Hurricane Katrina. Issues such as altered standards of care, scarce resource allocation, triage, and indemnification and/or immunity for health professionals are included.
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The authors conducted a retrospective observational analysis of 33.6 million deaths in 1206 counties that experienced tropical cyclone days (i.e., days with a sustained maximal wind speed 34 knots [39 mph] or greater) from 1988-2018. They found that each additional cyclone day was associated with somewhat higher death rates for several months due to the following causes: injuries, infectious and parasitic diseases, cardiovascular diseases, neuropsychiatric conditions, and respiratory diseases.
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The authors describe the challenges associated with evacuation of a morbidly obese patient during Superstorm Sandy, and how those challenges influenced the decision not to evacuate the patient, even in the absence of power and running water.
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This article discusses lessons learned from the evacuation of two NYC area hospitals in response to Hurricane Sandy in 2012.
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The authors discuss the challenges and benefits of transferring their patients to other hospitals along with their care teams in preparation for, and following Hurricane Sandy.
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The authors conducted a literature review to examine health problems following flood and storm disasters. They found that illness mainly occurred within four weeks of these events. Poisonings, wounds, gastrointestinal infections, and skin or soft tissue infections increased after storms; gastrointestinal infections were more likely to occur after flood events.
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Red Cross disaster mental health volunteers used an evidence-based tool called PsySTART to collect data on risk factors for post-traumatic stress disorder (PTSD), depression, and anxiety among survivors at shelters, emergency aid stations, and mobile feeding and community outreach centers. They found 17,979 risk factors, with significant differences across survivors in eight counties. They also found survivors with high risk in areas apart from those with the greatest physical damage.
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This one-hour webinar covers the provision of pre-hospital care; the patterns of injury seen after hurricanes and tornadoes, including appropriate initial management; appropriate emergency risk communication messages; and the importance of data collection to improve messaging and response efforts.
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Just after Hurricane Katrina, the Centers for Disease Control and Prevention collaborated with the Louisiana Department of Health and Hospitals to establish an injury and illness surveillance system in functioning hospitals and medical clinics. The surveillance system recorded more than 7,500 nonfatal injuries in the month after the storm, with the leading "mechanisms of injury" being fall and cut/stab/pierce. Residents were more likely than relief workers to be injured.
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The Texas Hospital Association met with hospital representatives from areas affected by Hurricane Harvey and agency partners to discuss experiences prior to, during, and after the storm. This document highlights identified areas for improvement "to better equip hospitals, governmental agencies and other organizations for the next disaster" and outlines how to incorporate next steps.
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The authors examined syndromic surveillance data for emergency department (ED) visits in New Jersey after Superstorm Sandy in 2012, and compared it to ED visit data during the same time periods the previous year to better understand the effects of the storm on the health of affected individuals. They found that “spikes in overall ED visits were observed immediately after the hurricane for carbon monoxide (CO) poisoning, the 3 disrupted outpatient medical care indicators, asthma, and methadone-related substance use.”
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This document highlights common post-disaster recovery planning challenges for small and medium-sized healthcare facilities; shares strategies for short- and long-term recovery; and identifies support resources. Information is presented in four categories: financial and legal; operational planning; workforce; and training and testing.
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This brief article describes the causes of death associated with Hurricane Matthew in 2016. More than half of all deaths occurred in North Carolina; 18 (69%) of these were drowning deaths associated with a motor vehicle.
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Lessons Learned: Tornadoes
This MMWR describes 13 cases (5 of which were fatal) of cutaneous mucormycosis identified after the 2011 Tornado in Joplin, Missouri. It reminds clinicians to consider fungal infections in individuals presenting with necrotizing soft-tissue infections following tornadoes, and to begin treatment as soon as possible in suspected cases.
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The authors review the clinical courses of 24 patients who suffered cranial, spinal, and peripheral nerve injuries due to the tornadoes that touched down in Alabama in 2011, and the medical responses of the pediatric neurosurgical team they were part of.
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The authors examined the demographics of the 247 decedents from the tornado outbreak in Alabama on April 27, 2011 and found that females and older adults were at highest risk for tornado-related deaths. The authors stressed the importance of local community shelters (and messaging to inform residents of shelter locations); encouragement of word-of-mouth warnings; and personal and family preparedness planning (with a focus on helping vulnerable population members take shelter).
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On May 3, 1999, powerful tornadoes, including a category F5 tornado, swept through Oklahoma. The authors examined all tornado-related deaths, hospital admissions, and emergency department visits to identify important risk factors.
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The author describes pneumonia cases admitted to Freeman Health System in Joplin, Missouri from May 2009 to May 2012. She found a higher incidence of pneumonia cases, particularly those caused by uncommon microbes, in the group of cases that lived or worked in the tornado zone in the year following the Joplin tornado. She concludes that respiratory infections many increase following tornadoes, and should be treated with broad-spectrum antibiotics, not currently standard practice for community-acquired pneumonia.
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Green, J. and Karras, D. (2010).
Commentary.
Annals of Emergency Medicine. 59(1):54-55.
The authors write that disaster-related wounds contaminated with soil or vegetative matter should be monitored for mucormycosis. They provide an overview of treatment strategies and encourage emergency physicians to “maintain a high index of suspicion for cutaneous mucormycosis infections when deep injuries” present.
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This article details how a mobile hospital was created with Hospital Preparedness Program support in Louisville when a local hospital was deemed a structural loss after a tornado.
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The authors review wind disaster incidents (including hurricanes and cyclones) worldwide from 1980-2008, including a subcategory of tornados in the U.S. from 1950 to 1994. Results include injury data and descriptions (both prior, during, and after impact) and information on damage to healthcare facilities and infrastructure.
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The authors review data on 13 patients who developed necrotyzing cutaneous mucormycosis, a rare fungal infection, in addition to other injuries sustained form an F-5 tornado. The authors share risk factors, treatment strategies, and other relevant information that can help healthcare providers work with tornado survivors.
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The authors analyzed tornado-related injuries seen at hospitals and risk factors for tornado injury, and screened for post-traumatic stress following a statewide tornado-emergency in Alabama in April 2011. The majority of injuries were not life-threatening; the most severe injuries affected the head and chest regions.
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This report describes response and recovery operations by several hospitals during the 2011 natural disasters in Missouri, with many implications for COOP planning. It summarizes lessons learned, with a focus on the Joplin tornado.
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This slide presentation focused on four main areas: the impact of an unexpected natural disaster on healthcare services; how the nation responded to help the Joplin community; how to incorporate lessons learned into planning; and how to design enhancements that can protect against future incidents.
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This article describes the planning one health center undertook to secure its data so that it could be accessed after a disaster, and discusses why healthcare information technology must be a priority focus for planning. The authors advocate for increased federal funding and clear guidelines from federal planning partners in support of physical security, data back-up, and redundancy planning, as well as staff training to support these technology needs.
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This one-hour webinar covers the provision of pre-hospital care; the patterns of injury seen after hurricanes and tornadoes, including appropriate initial management; appropriate emergency risk communication messages; and the importance of data collection to improve messaging and response efforts.
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The authors retrospectively reviewed records on 10 pediatric patients in the trauma registry following the 2011 F5 tornado in Joplin, MO to characterize their injuries. They found that traumatic brain injury was the most common diagnosis followed by orthopedic and maxillofacial injuries. Seven patients required surgical procedures in the operating room, and 8 patients were intubated and in the pediatric intensive care unit.
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Lessons Learned: Tsunamis
The authors describe the effects of the 2004 tsunami on medical facilities and systems in 10 countries.
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This article describes the health response to the 2004 tsunami that caused nearly 225,000 deaths in eight countries on two continents. Information on rapid response, conducting health and needs assessments, and public health surveillance is included.
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This webpage includes general information on the health effects of tsunamis, resources on handling human remains, and links to disaster mental health resources.
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The authors present four examples of initiatives that helped communities recover from Japan's earthquake/tsunami "3/11 Disaster." They stress the important role of healthcare providers in ensuring access to care and reducing stressors in survivors.
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The authors analyze the medical response to earthquakes and tsunamis in tropical regions and found that shock, infection, and heat stroke were frequently encountered by survivors.
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The authors discuss how lessons learned from the 1995 Hanshin earthquake and effective use of the Internet for communication and coordination assisted with the response to the 2011 earthquake and tsunami. They also describe and compare the injuries and causes of death for the two events.
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The authors incorporate lessons learned from the Fukushima disaster into response recommendations for pediatric surgeons and physicians.
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Mitigation
This report shares workshop findings on increasing and improving the resilience of healthcare facilities and services to high-impact weather events. The workshop grouped their findings into three main categories: hardening structures, making incremental adaptations, and implementing innovative practices.
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This design guide can inform and help design professionals, hospital administrators, and facility managers employ sound mitigation measures that will decrease the vulnerability of hospitals to disruptions from natural hazard events (e.g., earthquakes, high wind events, floods).
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Climate change continues to negatively impact national security, environmental stability, and human health conditions. This document provides an overview of climate trends in the U.S., outlining the impacts of climate-related illness and injury on health system operations, care delivery, and patient surge. It touches on the importance of bolstering healthcare infrastructure resilience, facility hardening, and highlights three areas being affected by various elements of climate change.
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This vulnerability assessment highlights structural, non-structural, and functional elements that must be considered to ensure that a health facility can withstand and remain operational in emergencies.
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The materials from this workshop can help hospital administrators and facility managers identify opportunities to implement seismic mitigation in their facilities.
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The 2011 Joplin tornado decimated St. John’s Hospital. This article describes how builders designed an addition to a different hospital (Mercy, in Festus, MO) to withstand storm damage. Builders used window glass that can withstand winds greater than 100 miles per hour; encased power sources in the attic; reinforced stairwells; and built a wall around the perimeter to protect the hospital from floodwater.
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This 86-page document is a guide and toolkit designed to assist healthcare providers, design professionals, policymakers, and others with roles and responsibilities in assuring the continuity of quality health and human care before, during, and after extreme weather events. It is focused on healthcare infrastructure resilience to climate change impacts as manifested primarily by extreme weather events.
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This document provides information on the impact of water loss on healthcare facilities, and a series of questions for planners to use to prepare their facilities for water service interruptions.
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This fact sheet summarizes steps a healthcare facility can take to ensure communication during incident response when normal technologies fail.
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The HHS emPOWER Map provides monthly de-identified totals of Medicare claims submitted for one or more of the fourteen types of life-maintaining or saving electricity-dependent durable medical and assistive equipment (DME) and certain implanted electricity-dependent cardiac devices, at the national, state, territory, county, and ZIP Code levels. Users have the ability to create unique aggregations by geography and export the data, as well as the ability to access historical HHS emPOWER Map datasets for further analysis. When combined with real-time severe weather and hazard maps, the HHS emPOWER Map gives communities the power to anticipate, plan for, and address the needs of this population prior to, during, and after an incident, emergency, or disaster.
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The HHS emPOWER REST Service allows users to readily access, consume, and apply de-identified aggregated Medicare beneficiary claims data totals at the state, territory, county, and ZIP code levels (as displayed in the HHS emPOWER Map) in their own geographic information system (GIS) application.
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The authors use models to measure the resilience of different medical building types to excessive heat. They found that masonry and Nightingale wards (a large room without subdivisions) fared better than rooms in light-weight modular buildings.
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This 106-page document provides information about three potential levels of protection for hospitals and health facilities from adverse events such as disasters, or performance objectives: life safety, investment protection, and functional protection.
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This guidance document includes two hospital-specific case studies that illustrate the successful use of floodwalls.
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Healthcare facility emergency planners can use this template when developing their emergency operations plan. It features 12 disaster scenarios, including: hurricane, tornadoes, structure fires, earthquakes, and extreme cold.
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This report summarizes a project that was conducted to determine the state of preparedness of coastal hospitals in response to a Cascadia earthquake and tsunami, and to assess what is needed to reduce earthquake damage in order to provide sufficient healthcare services following the event. The project assessed each hospital’s level of awareness and preparedness for earthquakes and tsunamis and highlighted the information and resources hospitals need to effectively plan for a magnitude 9 Cascadia earthquake and accompanying tsunami.
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This slide presentation focused on four main areas: the impact of an unexpected natural disaster on healthcare services; how the nation responded to help the Joplin community; how to incorporate lessons learned into planning; and how to design enhancements that can protect against future incidents.
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This fact sheet frames water security around the world as a national and global security issue for the United States. The three pillars of the White House policy include leading the international effort to achieve universal, equitable access to water without increasing greenhouse gas emissions; sustainable management of water resources; ensuring collaborative multilateral action to promote water security.
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This tool provides central access to federal disaster and public health related natural disaster alerts, warnings, and other resources.
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This objective, data-driven all hazards risk assessment can be used to inform emergency preparedness planning and risk management activities. The toolkit consists of three self-assessment modules allowing healthcare facilities to: identify site-specific threats and hazards; assess site-specific vulnerabilities; and evaluate criticality and consequences. (A related webinar explains the toolkit in more detail: https://files.asprtracie.hhs.gov/documents/aspr-risc-toolkit-webinar-slides-final-508.pdf.)
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This online toolkit can help healthcare facility planners learn more about implementing best practices in climate resilience. It is based on a framework composed of the following five elements: Climate Risks and Community Vulnerability Assessment; Land Use, Building Design, and Regulatory Context; Infrastructure Protection and Resilience Planning; Essential Clinical Care Service Delivery Planning; and Environmental Protection and Ecosystem Adaptations.
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This document discusses how to safeguard health facilities from natural disasters, how to retrofit existing facilities, and plan and train for emergencies.
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Plans, Tools, and Templates: Earthquakes
This ASPR TRACIE resource provides an overview of the potential significant health and medical response and recovery needs facing areas affected by a major earthquake with or without additional cascading events.
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This fact sheet highlights lessons learned and strategies for building mitigation and resilience by hospitals that experienced recent earthquakes.
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The authors conducted a literature review and discovered variance in the tools used in disaster death scene data collection. They formed a work group comprised of medical examiners and coroners, forensic pathologists, death scene investigators, forensic anthropologists, and epidemiologists that developed and pilot tested this toolkit. The toolkit includes templates and checklists by hazard.
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The goal of this project was to evaluate the risk of hospitals and water systems from earthquakes triggered by the Cascadia subduction zone. The authors used a model and estimated the following results from major earthquake shaking (magnitude 9): "$5.1 billion in building losses, up to 80,000 damaged buildings...up to 12,500 displaced people, and about 1,900 people requiring public shelter. Human suffering in the area is estimated to be up to 2,000 people requiring medical aid, up to 600 people requiring hospital care, up to 90 people with life-threatening injuries, and up to 180 fatalities." Graphics and tables help illustrate the challenges and the author lists hospital and community resilience strategies in Section 4.2.
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This report highlights the risks and prevention and response strategies associated with flood-, earthquake-, and cyclone-related chemical releases.
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Plans, Tools, and Templates: Extreme Cold
This factsheet lists components for healthcare facilities to consider when creating an extreme cold “action plan.” Information is provided under three categories: Get Ready (creating the plan); Get Set (preparing staff for cold weather); and Go! (activating the plan and policies). Additional information and links are provided at the end of the document. This document may have specific value as a starting point for communities that do not frequently experience severe cold weather events.
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This website includes a series of small checklists to guide preparation for winter weather.
Considerations for communication, heating, carbon monoxide and smoke detectors, and car supplies are included.
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This toolkit can help local health authorities develop public messaging during periods of extreme cold weather. It includes key messages, sample press releases, factsheets, links to key resources, and sample social media messages for Twitter and Facebook.
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The authors conducted a literature review and discovered variance in the tools used in disaster death scene data collection. They formed a work group comprised of medical examiners and coroners, forensic pathologists, death scene investigators, forensic anthropologists, and epidemiologists that developed and pilot tested this toolkit. The toolkit includes templates and checklists by hazard.
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This document outlines the hospital's plan for " an anticipated or an actual snow storm, the severity or duration, or any combination in which it is necessary." It includes information on personnel practices, nurse staffing, and the transportation command center.
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Weston, B., Lappe, M., and Hick, J. (2014).
Blizzard Checklist.
Hennepin County Medical Center.
This checklist can help healthcare facility staff plan for and respond to major snowstorms (i.e., 12 or more inches of accumulation).
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Plans, Tools, and Templates: Extreme Heat
This plan was developed by the Arizona Department of Health Services to address and help limit the adverse public health effects from excessive heat. It identifies conditions or events that would trigger activation of the emergency response plan, and provides a framework for coordinating efforts with other agencies that provide services to at-risk populations. The plan also includes a list of prevention and educational resources that can help mitigate heat-health adverse effects and deaths.
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This guide provides local health officials and public information officers with information on health impacts of extreme heat events, decision-support tools, and useful resources for prevention of heat-related illnesses. This document also supports the Arizona Department of Health Services Extreme Heat Incident Annex.
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This ASPR TRACIE TA response includes various municipal heat wave mitigation plans, toolkits, checklists, and related resources. Related Topic Collection: Natural Disasters.
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This extreme heat response plan can be downloaded and tailored by a local jurisdiction. It was provided to ASPR TRACIE by a state representative who requested identifying information be redacted prior to sharing with the field.
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The authors review heat wave plans from 18 cities and list recommendations for overcoming challenges (e.g., targeted outreach geared towards the socially isolated, begin prevention efforts before high temperatures arrive, and collect and use data to determine the effectiveness of interventions).
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The materials on this webpage include a toolkit, web tools, and press release and other templates that can help community leaders develop communication plans for extreme heat events.
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These checklists can help mental health service providers identify consumers and residents at highest risk for heat-related illnesses.
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These checklists can help healthcare and other service providers identify residents at highest risk for heat-related illnesses.
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East Central (GA) Regional Hospital. (2014).
Heat Plan.
This document outlines the East Central Regional Hospital's plans for extreme heat situations. It includes response actions by title (e.g., Safety Manager, Nurse Director) and recovery actions. The plan also includes a list of preventive measures, symptoms and treatment, and a weather index chart that lists steps to follow by temperature level.
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This toolkit can help health communicators charged with developing or updating heat-health communication strategies, and features strategies for reaching specific audiences.
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The authors looked at 292,666 cardiovascular and 562,738 respiratory disease Emergency Department (ED) visits over an eight-year period in Toronto. They found that: diabetics exposed to extreme heat had more ED visits vs. non-diabetics; respiratory disease ED visits during hot weather were higher for individuals with comorbid respiratory diseases and cancer; exposure to extreme cold temperatures over a 2-week period increased cardiovascular disease ED visits for individuals with comorbid cardiovascular diseases, and kidney diseases.
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New Hampshire Department of Health and Human Services. (2014).
Excessive Heat Emergency Response Plan: Appendix 2 to Emergency Services Function 8 Annex of New Hampshire State Emergency Operations Plan.
(Contact the ASPR TRACIE Assistance Center for a copy of this attachment.)
This plan identifies the New Hampshire (NH) Department of Health and Human Services’ role in response to excessive heat emergencies in the state, in collaboration with the NH Public Health Regions and other state agencies, and in accordance with the National Incident Management System. It includes templates for press releases, hotline scripts, and health alert messages, and provides a heat fact sheet.
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This tip sheet can help healthcare organizations and response agencies in their planning and response efforts in the event of anticipated/actual extreme heat events.
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This "outlook" is based on temperature projections from the National Oceanic and Atmospheric Administration and others and highlights areas of the U.S. and populations at higher health risk from extreme heat exposure. It also provides related strategies and resources for individuals, healthcare professionals, and public health officials.
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This toolkit can help local health authorities develop public messaging during periods of extreme heat. It includes key messages, talking points, sample press releases, fact sheets, sample social media messages for Twitter and Facebook, and links to related information in English and Spanish.
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The authors conducted a literature review and discovered variance in the tools used in disaster death scene data collection. They formed a work group comprised of medical examiners and coroners, forensic pathologists, death scene investigators, forensic anthropologists, and epidemiologists that developed and pilot tested this toolkit. The toolkit includes templates and checklists by hazard.
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Weston, B., Lappe, M., and Hick, J. (2014).
Heat Checklist.
Hennepin County Medical Center.
This checklist can help healthcare facility staff plan for and respond to extreme heat events.
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Plans, Tools, and Templates: Fires and Wildfires
This website contains a downloadable template and checklists which can assist healthcare facilities with preparing for wildfire season, especially during the COVID-19 pandemic. It includes checklists for recovery, wildfire preparedness, flood preparedness, and power and generators.
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This document contains information for California’s public health officials, emergency management professionals, and others involved in planning for and responding to wildfire smoke incidents. Information is provided on wildfire smoke and health risks, sensitive populations, strategies to reduce exposure during wildfire smoke incidents, and specific guidance for public health planning and response. Tools and best practices are included, particularly those that emphasize assessing community vulnerabilities and the protection of sensitive populations. Appendices include additional resources and links, organized by topic.
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Centers for Disease Control and Prevention, Emergency Preparedness and Response. (2013).
Wildfires.
This webpage can help users prepare for a wildfire, take proper actions during a wildfire, and prevent injury and address physical and emotional health after a wildfire.
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This resource examines and contains links to resources on how local health departments respond to wildfires, the health impacts of wildfire smoke, emergency communications, shelters, clean up, and recovery.
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Environmental Protection Agency. (n.d.).
AirNow.
(Accessed 5/17/2022)
This website provides air quality data for anywhere in the United States. Users can enter their zip code, state, or city to get local air quality information.
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This guidance document was developed to address the vulnerability of hospitals to fires. It is intended that all possible steps should be taken to minimize the hazard of fires in hospitals and the need for evacuation. The guide is applicable to existing hospitals that can be retrofitted to improve safety against fires, and proposed new-build facilities. It is formatted into four sections: Prevention, Suppression, Evacuation, and Training Drills.
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This document provides essential information on one healthcare facility’s response to a fire. It includes procedures for alarm activation, oxygen shut-off, the emergency response team, the fire department, evacuation, and declaring the facility all clear. The document may serve as a template for other healthcare facilities.
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National Institute of Environmental Health Sciences. (n.d.).
Wildfires.
(Accessed 5/17/2022)
This webpage contains training resources from the National Institute of Environmental Health Sciences’ Worker Training Program on wildfires, including a wildfire response training tool. Links to additional materials from the National Institutes of Health and the U.S. Department of Health and Human Services are also provided.
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National Wildfire Coordinating Group. (2015).
InciWeb.
This webpage provides up-to-date information on wildfires across the country. Users can search by state or incident name. Photographs, announcements, and news articles are also included.
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This website contains information for healthcare organizations on how to stay informed during wildfires, preparedness and response resources for wildfire, information on power outages, and patient care considerations.
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This ASPR webpage provides healthcare and public health-focused resources related to wildfires.
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Oregon Health Authority, Public Health Division Health Security, Preparedness, and Response Program. (n.d.).
Wildfires and Smoke.
(Accessed 3/26/2020.) Oregon Health Authority, Public Health Division Health Security, Preparedness, and Response Program.
This webpage includes information and links to factsheets and other resources that can help users learn about current wildfires, smoke conditions, and how to reduce the health effects of wildfire smoke.
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This toolkit can help local health authorities develop public messaging during a severe wildfire smoke event. It includes key messages, talking points, sample press releases, sample social media messages for Twitter and Facebook, and links to related information.
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The authors conducted a literature review and discovered variance in the tools used in disaster death scene data collection. They formed a work group comprised of medical examiners and coroners, forensic pathologists, death scene investigators, forensic anthropologists, and epidemiologists that developed and pilot tested this toolkit. The toolkit includes templates and checklists by hazard.
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U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (n.d.).
GeoHEALTH Platform.
(Accessed 5/16/22)
This website contains links to resources on natural hazards, incident tracking, counties where FEMA has declared a disaster, and other information related to geographic help for healthcare during wildfires.
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This index can be used to identify areas at higher health risk to wildland fire smoke exposure. Officials can use this information to develop maps of areas at most risk and create related communication strategies.
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This toolbox includes information on the effect of wildfire smoke for individuals and healthcare and public health professionals. Links to sites that provide information on current fires are also provided.
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During a wildfire or prescribed fire, residents may be advised to stay indoors as smoke creates unhealthy air quality. This video highlights strategies for creating a clean room to reduce exposure to wildfire smoke while indoors.
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This guide was developed to help local public health officials prepare for and respond to smoke events. It includes information on protective measures and strategies for communicating with the public about wildfire smoke and health.
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Plans, Tools, and Templates: Floods and Landslides
This case study includes lessons learned from record flooding in 2006 and select flood response plan components provided by Our Lady of Lourdes Hospital in Binghamton, NY.
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This exercise template, while designed for facilities in CA, can be customized by other healthcare facilities interested in designing a statewide exercise to test their flood response.
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This checklist provides guidance for completing building and life safety inspections prior to restoration work, and guidance for infection control review of facilities to be done before the hospital can reopen. Attachment A includes a site specific checklist for selected areas of the facility (e.g., laboratory, pharmacy).
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The information on this webpage can help individuals protect themselves from flood water inside and outside their homes and highlights health risks associated with exposure to flood water.
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This guidance document includes two hospital-specific case studies that illustrate the successful use of floodwalls.
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This toolkit can help local health authorities develop public messaging during a flood event. It includes information relevant to the actual event and the recovery period: key messages, talking points, sample press releases, factsheets, links to key resources, and sample social media messages for Twitter and Facebook.
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The authors conducted a literature review and discovered variance in the tools used in disaster death scene data collection. They formed a work group comprised of medical examiners and coroners, forensic pathologists, death scene investigators, forensic anthropologists, and epidemiologists that developed and pilot tested this toolkit. The toolkit includes templates and checklists by hazard.
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This tool can help local governments, health departments, and residents prepare for and recover from flooding events. It includes checklists and other guidance (e.g., regarding wells and re-entering structures after floods).
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This report highlights the risks and prevention and response strategies associated with flood-, earthquake-, and cyclone-related chemical releases.
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Plans, Tools, and Templates: Hurricanes
This Assistant Secretary for Preparedness and Response (ASPR) Technical Resources, Assistance Center, and Information Exchange (TRACIE) document provides numerous hurricane-related resources applicable to a variety of stakeholders and audiences.
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This ASPR TRACIE resource was developed to provide a short overview of the potential significant public health and medical response and recovery needs facing hurricane- and severe storm-affected areas, based on past experience and lessons learned from Hurricanes Katrina, Sandy, Harvey, and others.
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Damaging floods have increased in frequency, and sometimes occur in non-traditional areas. Community residents, business owners, and healthcare facility executives are often left with the arduous job of cleaning up after floods, to include preventing, identifying, and getting rid of mold. These resources can assist with those efforts.
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This booklet provides guidance that can ensure healthcare providers will be prepared at home and at work before, during, and after a hurricane. The first page describes healthcare facility-specific details (e.g., closure and reporting status, what to bring if working during a storm). The rest of the booklet provides guidance on setting up personal hurricane plans.
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National Institute of Environmental Health Sciences. (n.d.).
Hurricane Worker Podcasts.
(Accessed 2/17/2020.) National Clearinghouse for Worker Safety and Health Training.
These short podcasts were developed to help emergency responders and recovery workers prepare for hurricane-related hazards (e.g., mold, debris, and electrical hazards).
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This toolkit was developed to help state hospitals prepare for, respond to, and recover from hurricanes. The plan focuses on sheltering in place and recovery. Included are a series of assessment checklists, including three specifically focused on recovery (demobilization; patient transfer and discharge; and financial resources).
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ASPR created this webpage after Hurricanes Harvey, Irma and Maria caused major damage across a large swath of the southeastern United States and its territories. These resources can help individuals, families, communities and professionals stay up-to-date and recover from the storms.
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The authors conducted a literature review and discovered variance in the tools used in disaster death scene data collection. They formed a work group comprised of medical examiners and coroners, forensic pathologists, death scene investigators, forensic anthropologists, and epidemiologists that developed and pilot tested this toolkit. The toolkit includes templates and checklists by hazard.
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This plan includes 11 sections, covering four phases (mitigation, preparedness, response, and recovery) and information on staff accommodations, personal preparedness planning, document preparation for FEMA claims, and sample HICS forms.
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The authors incorporated lessons learned from Hurricane Sandy into this checklist of actions for healthcare, public health, nongovernmental organizations, and private entities to strengthen the resilience of their community’s health sector. There is a general checklist of actions for all stakeholders, as well as guidance provided by type of healthcare facility.
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This report highlights the risks and prevention and response strategies associated with flood-, earthquake-, and cyclone-related chemical releases.
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Plans, Tools, and Templates: Tornadoes
The authors conducted a literature review and discovered variance in the tools used in disaster death scene data collection. They formed a work group comprised of medical examiners and coroners, forensic pathologists, death scene investigators, forensic anthropologists, and epidemiologists that developed and pilot tested this toolkit. The toolkit includes templates and checklists by hazard.
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Plans, Tools, and Templates: Tsunamis
The authors conducted a literature review and discovered variance in the tools used in disaster death scene data collection. They formed a work group comprised of medical examiners and coroners, forensic pathologists, death scene investigators, forensic anthropologists, and epidemiologists that developed and pilot tested this toolkit. The toolkit includes templates and checklists by hazard.
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Users can search this digital library for current resources specific to tsunamis.
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Agencies and Organizations
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U.S. Department of Health and Human Services, Office of the Assistant Secretary of Preparedness and Response.
HHS emPOWER Program.
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