How Puerto Rico Leveraged Data in Recovery from Hurricane Fiona

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 Fiona alone caused seven direct and 22 indirect deaths. In late 2023, and again in late 2024, CDC awarded funding from the FY23 Omnibus Disaster Supplemental to ASTHO to assist Puerto Rico in building capacity to recover from the environmental health impacts brought on by Hurricane Fiona and to better 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 Puerto Rico Department of Health (PRDOH) to implement capacity building projects to bolster environmental health preparedness, response, and recovery capabilities identified as gaps following Hurricane Fiona.

Identifying Gaps and Needs from Hurricane Fiona

PRDOH strategically leveraged NCEH/ATSDR and ASTHO support to launch a foundational data modernization initiative designed to strengthen hurricane preparedness and response capabilities across multiple environmental health programs. This initiative directly addressed a key need communicated by PRDOH to ASTHO and NCEH/ATSDR in the wake of Hurricane Fiona: modernize data collection and storage processes to facilitate faster data queries and improved data sharing before, during, and after hurricanes.

Digitizing Inspection Forms

Rather than pursue isolated technology improvements within individual service areas, PRDOH intentionally selected its Radiological Health Section as a pilot program to develop and test a scalable digital infrastructure that could ultimately be expanded across their environmental health portfolio. PRDOH staff first analyzed the needs of their Radiological Health Section and worked with their five ASTHO-supported temporary staff to digitize various inspection forms for the Section within REDCap to allow inspectors to collect data via a tablet computer instead of paper forms. This change would allow for rapid data queries during emergencies that support decision making and data sharing among key partners. PRDOH and the temporary staff also utilized GIS software to create an interactive map that integrates geospatial data from the Radiological Health Section’s inspections, allowing for better response planning and inspection prioritization for future storms. The success of the Radiological Health Section work formed the basis of a broader effort within PRDOH’s Environmental Health Division. By establishing common tools, workflows, and data management practices, PRDOH created a framework that could be adapted to other environmental health programs. This work continued into the second year of the project with staff focusing on digitizing inspection forms for the Vector Control Section, further advancing PRDOH’s vision of an integrated, data-driven approach to environmental health preparedness, response, and recovery. This work proved timely as PRDOH responded to a major dengue outbreak that began in 2024 and continued through 2025.

For the second year of support, PRDOH was interested in hiring additional temporary staff to help support their Vector Control Section work as only two remained after the first year. However, due to the short timeline listed in the job postings, ASTHO and their staffing support partner were unable to identify any additional temporary staff who were qualified and willing to take on the short-term role.

Utilizing REDCap Technical Expertise

The two remaining temporary staff expressed interest in receiving technical support within REDCap. ASTHO identified a REDCap technical expert from the Tennessee Department of Health who could offer guidance on using the platform and answer any questions. ASTHO organized two technical assistance calls between the REDCap expert and PRDOH to discuss questions, share best practices, and provide guidance on utilizing REDCap for their data modernization work. The questions were technical in nature and included inquiries about survey auto-save functionality, integration with other applications, and language translation issues. The calls included interpreters who ensured questions and responses were provided in both English and Spanish to facilitate understanding between all involved parties. The REDCap support, along with the remaining temporary staff support, allowed PRDOH to complete their work in digitizing inspection forms for the Vector Control Section in the second year of this project. The two temporary staff transitioned to contract staff within PRDOH and were able to continue working during the third year of this project. They focused on digitizing their Milk Hygiene inspection forms for the Food Safety Section.

Developing and Hosting a Food Safety Training for PRDOH Staff

During the third and final year of support, PRDOH’s Environmental Health Division identified the need to strengthen the emergency response capacities of its food safety workforce. Recognizing that inspectors required targeted training and practical tools for disaster scenarios, the Division communicated this need to ASTHO, who in turn undertook the task of identifying subject matter experts in food safety emergency response. As a result, PRDOH hosted a food safety training, ER310: Food Safety Issues in the Event of Disasters: A Practical Application, in San Juan in June 2026. Over the course of the two-day training, 31 environmental health professionals from across all regional offices, including directors, supervisors, inspectors, and management staff were educated on the unique food safety hazards that occur post-disaster and were better prepared to conduct post-hurricane investigations of food facilities. ASTHO worked closely with subject matter experts from the University of Tennessee’s Center for Agriculture and Food Security and Preparedness to update and adapt the training for PRDOH’s needs. A key requirement for the training was that all materials be updated to conform with the most recent edition of the U.S. FDA’s Food Code. All course content was translated into Spanish, and the in-person component was delivered in Spanish using simultaneous interpretation services. ASTHO also worked to procure supplies needed by PRDOH to assist in future hurricane preparedness and response efforts.

Conclusion

The work described above developed a solid foundation for additional data modernization work within PRDOH’s Environmental Health Division. By transitioning to a modern digital data collection and storage process, PRDOH’s Environmental Health Division will be better prepared to respond to requests for information from partners, prioritize critical facility assessments after a storm, and provide important information to hurricane-impacted communities. Additionally, PRDOH will be ready to provide critical food safety support to individuals and businesses before and after a storm.

Acknowledgements

Thank you to the staff within PRDOH 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.

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 $850,000 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.