How Hurricane Ian Led to South Carolina’s New System for Natural Disaster Response

July 28, 2026 | Emma Talkington, Nicholas Porter

Hurricane preparedness, response, and recovery work continues to be a top priority for state and territorial health departments. Damaging winds, historic storm surge, and intense rainfall pose severe risks to those caught in the path of these formidable storms, and the impacts can be felt for far longer than the immediate hazards.

In 2022, Hurricanes Ian, Fiona, and Nicole made landfall in the United States, causing dozens of deaths and billions of dollars in damage. Hurricane Ian alone caused 66 direct and 90 indirect deaths. In late 2023, and again in late 2024, CDC awarded funding from the FY23 Omnibus Disaster Supplemental to ASTHO to assist South Carolina in building capacity to recover from the environmental health impacts brought on by Hurricane Ian and to respond to future hurricanes. ASTHO worked closely with staff from CDC’s National Center for Environmental Health/Agency for Toxic Substances and Disease Registry (NCEH/ATSDR) Office of the Director and staff from the South Carolina Department of Public Health (SC DPH) to implement capacity building projects to bolster environmental health preparedness, response, and recovery capabilities identified as gaps following Hurricane Ian.

Identifying Gaps and Needs from Hurricane Ian

SC DPH’s primary focus for all three project years was developing a Post-Disaster Surveillance System (PDSS) to identify and track disaster-related health issues in hurricane-impacted communities. The PDSS will help SC DPH identify and respond to the health needs of South Carolina residents who have been adversely affected by hurricanes and other natural disasters and fill a necessary health surveillance gap in the state. This need was communicated both through after-action reports and during scoping meetings with ASTHO and NCEH/ATSDR. SC DPH received funding from ASTHO via a sub-award to support the development of the PDSS.

Identifying and Developing the Post-Disaster Surveillance System

During the first year of the project, with the help of two temporary staff, SC DPH began the process of identifying existing PDSS systems in other jurisdictions, identifying the platform that would host the PDSS system, and developing a framework and capability analysis for leadership review. Ultimately, SC DPH decided on REDCap as the platform that would host the PDSS. Prior to the second year of the project, SC DPH lost one of their two temporary staff and ultimately opted to not pursue re-hiring for that position. The remaining temporary staff stayed on through the end of the second year of PDSS-related work.

In the second and third year of the project, SC DPH continued working on the PDSS, which included finalizing standard operating procedures for PDSS activation, developing surveys to capture data associated within the PDSS, and determining how the PDSS would be maintained. They also created an inventory and comparative analysis of different mass communication platforms that would be used in conjunction with the PDSS.

Pilot Testing the PDSS During the 2025-2026 Measles Outbreak

Additionally, SC DPH met with the University of South Carolina’s Patient Engagement Studio and internal community engagement teams to help refine the survey instruments associated with the PDSS. Feedback from these groups included incorporating shorter surveys, providing additional clarification in certain questions/survey language, and limiting free text fields. To pilot test the data gathering and analysis capabilities of the PDSS, as well as the communication capabilities, SC DPH decided to utilize data from the Measles outbreak in South Carolina that occurred from October 2025 through April 2026. SC DPH utilized funds from the sub-award to purchase Twilio, a cloud communications platform that integrates text messages with the REDCap platform. SC DPH first incorporated Twilio to send contact monitoring surveys during the Measles outbreak and will also utilize it to send the PDSS survey to people impacted by hurricanes, other environmental disasters, and large-scale infectious disease outbreaks. The Twilio software provides a cost-effective solution for large and wide-scale reach while maintaining data security and integrating with current SC DPH-developed products and surveys. Despite initial setbacks with procuring the Twilio texting line, Twilio appears to be a solution to widely sharing the PDSS survey throughout the state. SC DPH also plans to incorporate the PDSS as an annex entry for the agency’s Emergency Operations Plan, outlining when and how the PDSS will be operationalized during various disasters. Finally, ASTHO, through the sub-award mentioned above, supported SC DPH staff to attend the National Association of County and City Health Officials' 2026 Preparedness Summit to present a poster on the PDSS.

Conclusion

Through the support provided by ASTHO and NCEH/ATSDR, SC DPH will be better positioned to identify and track health impacts from hurricanes and other disasters via their flexible PDSS. The communications infrastructure, survey instruments, and standard operating procedures developed as part of this project collectively represent an increased capacity to protect the public health of South Carolinians when disaster strikes.

Acknowledgements

Thank you to the staff within SC DPH that worked tirelessly to implement this project, including the temporary staff. Thank you also to CDC’s NCEH/ATSDR staff who oversaw this project. Without their support, none of this work would have been possible.

Thank you especially to Sam Finklea for his tireless work on this project. Sam passed away before the conclusion of this project. May he rest in peace.

This publication is supported by the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $770,915 with 100 percent funded by CDC/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CDC/HHS, or the U.S. Government.