Medical Monday Special Edition : Hurricanes and Health

After the Flood.jpg

I have lived through two hurricanes, Camille, and Agnes. I was a child, and when I lived for time in St. Petersburg, Florida, hurricanes were nothing but fun and games. We skipped school, had no power, and ate snacks. When it cleared, we rowed, paddled and boated all over the streets and the bayous which had become one. Harvey and Irma are another matter entirely. 

I encourage everyone everywhere to explore the internet or other news media to understand the gravity and breadth of the situation. See the radar, see the satellite video, see the webcams, news and personal videos, the photos, and hear the personal accounts. 

Put yourself in these people’s shoes. And then consider the ramifications of all of this on health. I will present some data and recommendations gathered by the CDC (Centers for Disease Control) in the wake of Hurricane Katrina. It is hard to say exactly how much of this could be generalized to other areas such as Houston or the Florida area, but I would suppose it is a reasonable starting place. 

Here are some key points from the CDC: 

  • Illnesses in the wake of a hurricane are predictable.
  • Long term displacement ( homelessness) poses treatment challenges. 
  • Medical system disruption poses treatment challenges. 

Here is a key recommendation: 

  • Unified registration for evacuees complete with medical history, treatment and vaccination records would assist with care. 

Consider that structures and infrastructure are damaged. This means not only homes and public buildings, but power plants, power lines, sewage treatment plants, and water lines. It means chemical plants and damaged. It also means that people in shelter are in close quarters with out adequate food or sanitation. Telecommunications are disrupted. Finally it means that hospitals, clinics and the movement of medical personnel are all disrupted. 

What illnesses are to be expected ? In the above described setting, infectious rashes are common, with near universal exposure to polluted floodwaters. Respiratory infections come next, followed by Gastrointestinal illness. Vibrio cholera played a large role in GI illness, and other forms of the waterborne vibrio bacteria accounted for the serious skin infections. 

Viruses also entered the picture, particularly the mosquito borne type. Remember that mosquitos reproduce in standing water. Human West Nile Virus had an uptake, but this year, officials anticipate Zika virus will be the major player. 

Trauma of all kinds counts for most presentations to hospitals. Cardiovascular causes are a far second, with medication refills being a third. These three accounted for the vast majority of presentations to hospitals in the wake of Katrina. 

Evacuees in the aftermath of hurricanes are at the most risk. Vaccinations are a key aspect of care for evacuees. For those evacuees in a group setting, the following are recommended: Influenza, varicella, MMR and Hepatitis A. 

Emergency responders are another special group requiring care. Vaccination recommendations for this group include Tetanus if not up to date, Hepatitis B, and the same vaccinations as are given to evacuees if responders are working in large group settings. 

reference : 

https://depts.washington.edu/einet/symposium/USA031210.pdf

For critical additional reading : 

https://www.cdc.gov/disasters/hurricanes/index.html

http://www.weather.gov

 

Please familiarize yourself with what is going on. Figure out how you can help. 

I have lived through two hurricanes, Camille, and Agnes. I was a child, and when I lived for time in St. Petersburg, Florida, hurricanes were nothing but fun and games. We skipped school, had no power, and ate snacks. When it cleared, we rowed, paddled and boated all over the streets and the bayous which had become one. Harvey and Irma are another matter entirely. 

I encourage everyone everywhere to explore the internet or other news media to understand the gravity and breadth of the situation. See the radar, see the satellite video, see the webcams, news and personal videos, the photos, and hear the personal accounts. 

Put yourself in these people’s shoes. And then consider the ramifications of all of this on health. I will present some data and recommendations gathered by the CDC (Centers for Disease Control) in the wake of Hurricane Katrina. It is hard to say exactly how much of this could be generalized to other areas such as Houston or the Florida area, but I would suppose it is a reasonable starting place. 

Here are some key points: 

  • Illnesses in the wake of a hurricane are predictable. 
  • Long term displacement ( homelessness) poses treatment challenges. 
  • Medical system disruption poses treatment challenges. 

Here is a key recommendation: 

  • Unified registration for evacuees complete with medical history, treatment and vaccination records would assist with care. 

A brief search on the Apple App store reveals several useful apps. Check out the ones from the Red Cross, FEMA, and the National Weather Service. As of yet there is no comprehensive evacuee app. 

Consider that structures and infrastructure are damaged. This means not only homes and public buildings, but power plants, power lines, sewage treatment plants, and water lines. It means chemical plants and damaged. It also means that people in shelter are in close quarters with out adequate food or sanitation. Telecommunications are disrupted. Finally it means that hospitals, clinics and the movement of medical personnel are all disrupted. 

What illnesses are to be expected ? In the above described setting, infectious rashes are common, with near universal exposure to polluted floodwaters. Respiratory infections come next, followed by Gastrointestinal illness. Vibrio cholera played a large role in GI illness, and other forms of the waterborne vibrio bacteria accounted for the serious skin infections. 

Viruses also enter the picture, particularly the mosquito borne type. Human West Nile Virus had an uptick in Katrina, but this year, officials anticipate Zika virus will be the major player. 

Trauma of all kinds counts for most presentations to hospitals. Cardiovascular causes are a far second, with medication refills being a third. These three accounted for the vast majority of presentations to hospitals in the wake of Katrina. 

Evacuees in the aftermath of hurricanes are at the most risk. Vaccinations are a key aspect of care for evacuees. For those evacuees in a group setting, the following are recommended: Influenza, varicella, MMR and Hepatitis A. 

Emergency responders are another special group requiring care. Vaccination recommendations for this group include Tetanus if not up to date, Hepatitis B, and the same vaccinations as are given to evacuees if responders are working in large group settings. 

reference : 

https://depts.washington.edu/einet/symposium/USA031210.pdf

For critical additional reading : 

https://www.cdc.gov/disasters/hurricanes/index.html

http://www.weather.gov

 

Please familiarize yourself with what is going on. Figure out how you can help. Click on the up to date radar image below to help. 

 

 https://radar.weather.gov/Conus/full.php

https://radar.weather.gov/Conus/full.php