Hurricane Response and Recovery

VERONICA BRYANT:
North Carolina may not be one of the states that you necessarily think about when you think hurricanes. You may think Texas or Louisiana or Florida, but we've had lots of impacts over the years and particularly in 2022 with Ian, we had multiple tornadoes associated with that hurricane.

And Wake County, which is where Raleigh is, had close to 100,000 people without power at one point. And then more recently we are about a year out from the devastating Hurricane Helene incident that we had.

Right now in North Carolina, it specifically is pretty young. We have about a third of our workforce, I think, with less than five years experience. So until Hurricane Helene most of our folks had never been through a disaster. And I think if any of you are in emergency preparedness, you know that preparedness is difficult because of the competing priorities.

It gets really hard to work on preparedness-related projects during blue sky days when there's lots of other things that have to be handled right now and, emergencies don't, they're not happening, so it's hard to focus on those. And we also, besides myself, don't have dedicated environmental health preparedness staff.

I say myself is dedicated, but I have lots of other things that I'm doing too. So we don't really have a group that can spend their time working on preparedness. And there's also a need for this information. We understand that our environmental health specialists may not have been trained because we don't have the training materials or the training resources.

And then there's a lot of preparedness topics that we just didn't feel like there was a lot of guidance that was available. And so in order to kind of overcome some of these challenges with this project Emma mentioned the temporary staff that we were able to hire. So we had two temporary staff that were with us until I think September of this year.

And they had two kind of separate jobs. There was one that focused on training and exercises and so, they were someone with a emergency management background that kind of went through and collected a lot of training materials so that we knew what was out there and then helped us develop some exercises and trainings specific to North Carolina so that our folks can be better trained for emergencies.

Our training and exercise specialists worked with us to create a water emergency tabletop. We found that during Hurricane Helene, like I said, we had a lot of water issues. In going through that, we learned a lot, and I think, during Ian and Fiona, we had some of these issues, and they were just magnified by Helene and the scale that it hit us.

And so we realized we had a lot of knowledge gaps and training gaps when it came to things like loss of water or boil water advisories. And so we developed a specific tabletop related to water emergencies that we were able to provide in April, and we did that in conjunction with our Food Safety and Defense task force here in North Carolina and the conference.

Also, in July, we gave a hurricane-specific training that was during hurricane season, and we wanted to give people some updated information and provide them with some kind of exercises to work. And in that training, we have specific discussions on, planning for events, on ICS, which is really important, and then again, emergency shelters, which is something that we've had to work hard on here in North Carolina because we've had, issues with just assessing them and also outbreaks and like the role of environmental health and lots of different things related to shelters.

We also developed a new preparedness website. We were able to provide all of the guidance documents and handouts and toolkits and everything that we developed during this project. This is our community meal events class that we developed. And so just to give you a little bit of background on this, we have a lot of, as everyone does, a lot of people who prepare food and they, that's not their primary job.

They're doing it as a volunteer either in a religious organization or at a shelter or during an emergency, folks just decide, "Hey, I'm gonna try to feed my community." And so they wanna serve food, and because they don't do it for a living they don't have any food safety training.

And trying to tell those folks, in the middle of a disaster like, "Hey, ServSafe would be really good for you," isn't really feasible. Plus, ServSafe is written, or the other food safety courses are written for food workers, and these people are, food workers for a day. And so we were trying to come up with something that was in real plain language that gave just the basics of what folks need to know about food safety, and then give them specific information about food safety during a disaster.

So if you're going to serve food in a shelter or, prepare meals for your community obviously, water would be an issue, and power, and other things. And so these are just a couple of pages out of the book that we created. We have a full kind of book. Instead of printing slides for the participants, they got the information that was on the slides in book form, hoping that folks would continue to use that after the course.

And then we also have some stickers and magnets that were printed with this project funding. And so we're able to provide these during the course that are good reminders of the major things that we're interested in getting people to learn if they're gonna serve food for a day.

And if you're interested in, how we did the course in person and if you have other questions, it's really designed so that anyone with any sort of food safety knowledge, like a communicable disease nurse, or an extension specialist, or an environmental health specialist should be able to pick up the course material and teach it just because it's so plain language and straightforward.

So I'll say, and this is not an internal partnership, but the Community of Practice which Emma mentioned a little bit, having the four states available to talk to one another was incredibly helpful during Helene, for example. We would have questions about do you have guidance on playgrounds or, like, how did you hand- how do you handle water issues?

And we were able to reach out specifically to the folks associated with this project, which I think before this project, we wouldn't have we wouldn't have had those relationships. And then also not that Nick set it up this way, but the ASTHO partnership has been incredible in having them available to get us information and again, have somebody who can help, during a disaster go looking for links or helping with that.

But, more internally, like I said, there's been a lot of very local connections made during the Community Meals course. Organizations like the Salvation Army or local Meals on Wheels or other people that because they're not regulated didn't really talk to the health department very much came to the course and, there was a lot of, "Oh," "Call me when you have questions," and that kind of stuff that was I think really important.

And, we have really good relationships with our in-state preparedness and emergency management. And, through the task force specifically when we did the tabletop, we were able to use all of those partnerships during that exercise and strengthen those as well.

I think that with our training and exercise person she went out and found a lot of resources. So I'll say, there's probably a lot of the stuff that you need that's already out there if you can find it, trainings and, stuff from other states and, so I would just say before you start spending a lot of time, precious time on projects, go look and see if it already exists through some other partner. And having relationships with other folks too help because they may have already been through this, I think really helps to build the capacity as well.

So I think that's really important. And then, spending some time thinking about your specific jurisdiction and what you need. If you don't have a lot of resources, so you don't have a lot of time we don't spend a lot of emergency preparedness time on earthquakes in North Carolina because we don't have earthquakes.

There are things that you can do to focus on what you need. We had a lot of water emergencies, and so we were able to focus a lot of our time on that issue specifically, and you may have a jurisdiction with your own set of unique things. And so focus on those because you may not be able to go out and find what you need if you're a specific jurisdiction with a specific issue. The bigger stuff may already be out there. So focus on, what's individual to your jurisdiction.

CECE GEORGE:
But a little bit of background. We sought to create a system to perform essentially long-term health monitoring in South Carolina post-disaster. So we noticed that there were gaps in data collection, specifically health information, after disasters occur. And within South Carolina, we are impacted by hurricanes not only on our coast, but as seen by Helene there are impacts across the state as well.

The goal of the system was to help identify and respond to health needs of South Carolina residents who have been adversely affected by hurricanes and other disasters. So including other natural disasters along with any type of no-notice disaster such as chemical releases, any radiologic or any other disasters that occur in our state.

So overall goals and objectives as we started to create this, as mentioned, developing a system to address gaps in data collection in relation to disasters and health information. And then also trying to incorp- or the goal to, is to incorporate an annex into our emergency operations plan.

So we have been working to integrate that as a part of our EOP. And then creating a set of standard operating procedures to create surveys that will collect the information and then execute these surveys along with analyzing data within REDCap. And I'll go a little further into REDCap, but that was our chosen surveillance system and platform that we will be using.

And then piloting the post-disaster surveillance system. So I'll talk a little bit further about our focus groups and how we've piloted this along the way, and then how we hope to pilot it next year as well through series of exercises.

So initially in 2024 we created an inventory of post-disaster surveillance systems and really just looked at different state plans that had disaster surveillance systems available. And we really saw a mix of systems plans, annexes, and they really included hazard mitigations plans, disaster recovery frameworks, disaster recovery plans.

And then we also looked to determine the platform or third-party vendor to establish the post-disaster surveillance system, and that was REDCap. And we developed a framework and capability analysis. So we presented this to leadership, all of our projected activities that we plan to do, the timeline, and the platform to establish the post-disaster surveillance system or PDSS.

So like I mentioned, the survey, we have a series of surveys that have a mix of disaster-related questions and health-related questions. So these are geared towards essentially allowing us to capture information to track over time. And these include general disaster questions. They have specific disaster type questions, so whether it's a hurricane, a flood, a no-notice disaster and then along with previous medical history.

So the overall process of the post-disaster surveillance system. So right now, we have it where a disaster takes place, and then we will activate the post-disaster surveillance system, so within REDCap, and that really depends on the type of disaster that takes place. So, for a hurricane, for example, we will deploy the primary survey that contains all the disaster-specific hurricane questions, all the general disaster-related questions, and then the health questions as well.

So after that, we will collect data within REDCap. Based on those answers, we'll perform our data analysis. And then timeline-wise, we are hoping to send another survey, follow-up survey, six months later. So right now, it's scheduled for six months and has a series of essentially the same questions, but a little more follow-up on, since you've taken the previous survey, what health issues are you experiencing now? Are you still, do you have any sustained damages to your place of living? And then we repeat the process to have essentially a long-term surveillance system. With this, there's also a component for a no-notice disaster event. So this is when a survey will be deployed within twenty-four hours of an event, rather than, we have the primary survey set for three weeks after just to collect that information.

So to present, we've been presenting our work to various groups. I mentioned a work group previously. But in order to receive more feedback, we took the post-disaster surveillance system to the University of South Carolina Patient Engagement Studio. So this is a studio that essentially, description here is brings together patients and caregivers, community groups, health system innovators, and clinicians, and academic researchers to provide meaningful research and innovation that advances health and research outcomes.

Essentially, we shared our surveys with them, and a group of individuals with various backgrounds who lived in different parts of the state were able to give us feedback on these surveys, and it just so happened that a lot of them were in the upstate of South Carolina who were impacted by Helene. So we were able to receive a lot of really great feedback and valuable feedback for our system. So we were able to incorporate a lot of that and change some of our questions and really just narrow focus on certain areas that maybe we hadn't seen prior. So, this was something that was super valuable and really helpful for us and moving forward with our surveillance system.

I mentioned them before, but the South Carolina Department of Public Health Community Engagement Directors. This team works with local communities to help them take charge of their own health. This includes informing public health policy, systems, environmental changes, facilitating community needs assessments, providing local public health data, providing technical assistance to communities to develop community health improvement plans, and providing outreach and education on a variety of health-related topics and disease risk factors.

So we presented this to the directors themselves, and they were able to assist with, similarly to the Patient Engagement Studio, they've had a lot of experience with these communities who have been impacted by disasters previously. They have had a lot of experience with sending out surveys, receiving feedback on surveys, and participation.

So, we have been able to incorporate some of their feedback as well. That is a major goal of ours for 2025 is to work with these community engagement directors more, and specifically the communities they work with just to see how we need to maybe narrow down some of the surveys themselves.

Being public health agency, you know, having that environmental perspective has been very impactful and helping me at least. I come from Bureau of Emergency Preparedness and Response, but I'm bridging that gap of public health, environmental health, and then, internally, with our more of our disaster and disease epidemiologists.

Yes, I think that mostly answered your question, Nick, but it's just been extremely impactful to have a lot of individuals and different experiences to learn from over this course of the project.

Taking an inventory at the beginning was really helpful for us of, different states, jurisdictions that had the resource that we were looking for and just notating maybe of the gaps that we had within our state in terms of, for us it was more data collection surrounding hurricanes and after disasters.

So that initial, we did a comparative analysis of as well of just different systems for surveillance platforms. But really, yeah, working with looking at different, taking inventory, looking at different states and what they had was really helpful for us, and then reaching out to those states, so making partnerships with them.

Particularly for us, Minnesota, just making sure that we were establishing, those relationships and then also utilizing the information that they were able to give us.

CHAD BAILEY:
Hurricanes are the most well-known natural disaster affecting Florida. State faces these risks of storms each year during hurricane season, which spans six months of the year, June 1st through November 30th. And the number and strength of storms vary each season depending on atmospheric patterns such as El Niño or La Niña.

Florida's geographic location and subtropical climate makes it especially vulnerable. Hurricanes can contaminate food and water sources, cause coastal storm surge and saltwater intrusion, and lead to inland flooding, which can cause, which can affect wells and increase the spread of bacteria. Mold growth is also an important major concern following the flooding of homes and can significantly impact indoor air quality. Flooding and storm damage may also lead to wastewater releases, whether from overwhelmed stormwater systems or lift stations affected by power loss.

And power outages also raise a risk of carbon monoxide poisoning due to the misuse of portable generators. Impacts on buildings and homes from high wind speeds create hazardous debris and can shelter rodents, contributing to the spread of disease. Prolonged rainfall results in standing water that can become prime habitat for mosquitoes to breed, increasing the potential for vector-borne disease outbreaks.

So these are just some of the potential impacts Florida faces during each hurricane season.

So at the onset of our relationship with ASTHO, when I first got into my role here back in 2022, their initial goal was to aid us in supporting communities impacted by Hurricane Ian. After the major devastation brought upon Ian, and as a form of help and education, ASTHO provided FDOH with thousands of laminated copies of CDC's Homeowners and Renters' Guide to Mold Cleanup After Disasters, as you can see pictured here on the far right-hand side.

They also assisted with printing numerous copies of our internal guidance document, which DOH created, which is Health and Safety Emergency Preparedness and Response. That booklet has been distributed alongside our mold guide, is what we call that, and, we provided those to our local environmental public health teams, and our strike teams during deployments for community outreach, and they're distributed as a form of health communication and education on safe practices for those who were, who were impacted by the hurricane. And to this day, these materials are continually utilized by county health departments for ongoing community preparedness and public health outreach efforts, evidence of the long-lasting impact of ASTHO and CDC support.

In ASTHO's effort to minimize our workload, three temporary remote contractors were hired. ASTHO provided invaluable support by handling the bulk of the hiring process. They advertised the positions, assisted with the initial review of the applicants, and scheduled interviews. In addition, they coordinated with a labor management company to cover the HR functions like, issuing paychecks and approving time sheets.

They also provided office equipment and funded travel, for a site visit to FDOH headquarters here in Tallahassee for a meet and greet with my team, my bureau leadership, and SMEs, or subject matter experts. So this opportunity solidified the working relationship between our temporary staff and FDOH.

The temporary staff team, which was led by an experienced emergency manager, was eager to learn environmental public health and expand their skills. And this, to be honest with you, this was my first experience managing multiple people remotely, many without prior environmental public health experience, which allowed me to grow in my supervisory and leadership skills.

But nonetheless, it was definitely a nuance for me to supervise a few remote staff, right out of the gate. The contract was conducted a gap analysis of our unit's inventory to prioritize development of guidance documents, training courses, and resources in areas where the needs and gaps were the greatest. They assisted in a initial development phase of our All-Hazards Water Incident Response guide.

They also helped create a food safety poster intended for strike team deployments. They also reviewed our SharePoint, platform to identify gaps, any broken links, or additional areas for improvement. All right, moving on. As part of, their ongoing support efforts, ASTHO conducted, I'm sorry, coordinated the course delivery of topics identified from the gap analysis, such as mental health and disaster behavioral health awareness for responders, risk and crisis communication, and stress management and resilience.

So through HCC or Health Communication Consultants and their certified, subject matter expert instructors, they were able to provide this. The program included four sessions over a six-week period. It included workbooks, physical printed workbooks for them to, for the participants to actually utilize, both during the training and after the training, or as a refresher to pick up maybe the next year if they forgot some things. So like I said, the first two sessions were held in person.

There was two additional sessions that were virtually held afterwards. So the first two sessions were held in person during, the 2025 Florida Environmental Health Association conference, or FEHA conference. And the evaluation results from all four of those, indicate that there, the trainings were, helped them improved the overall awareness of responders, their resilience and preparedness for mental health and disaster behavioral health challenges that they may face when deployed to the field.

So within Florida, it has enabled us to strengthen existing relationships, with both internal and external partners, and expand or bridge the gap between emergency management and environmental public health by highlighting the importance of environmental public health in emergency response. I would say this was quite evident, especially during Hurricane Ian, when we were activated for, I would say, over three months, with response activities and deploying team after team to assist counties that were in need.

So we're very much, we're the talk of the town, I guess, internally here as far as, okay, we need another strike team, we need another strike team. So I think that definitely did strengthen our relationship with our internal partners. But in addition, I will say that we've benefited greatly from being a member of the ASTHO and CDC Community of Practice.

Like you said at the beginning, Nick, it does provide a great opportunity for us for, interstate collaboration and assistance of environmental public health emergency response objectives, whether it's just sharing guidance documents, kind of talking through, scenarios or incidents or issues. I think that has also been a very big, helpful, key item for us.

So that's a great question, Nick. So I'm gonna preface that with a brief quote, by Benjamin Franklin, "An ounce of prevention is worth a pound of cure," right? So I've got some advice for other jurisdictions, if they're interested in building capacity to address hurricane impacts or potential hurricane impacts, whether, environmental health-focused or not.

I would say first would be trying to leverage federal funding and technical assistance, so basically look to see if there's any grants available, focus on emergency preparedness and response. I know there are some several opportunities available. Typically throughout the year there could be others that do pop up, but this, it's usually a good time to do this before hurricane season, obviously, or planning for next year, 'cause it does take a little bit of time.

Along with that, I would say utilizing internal and external technical support, right? Look at your colleagues, internally. Look across different bureaus or divisions, with your agency, and see if there's anything maybe they're working on, their team's working on something similar that you are. I'd also go ahead and say, to jump off what I just mentioned, building robust interagency and cross-sector coordination.

I know I mentioned not too long ago bridging environmental health with emergency management. Sometimes it may not, it's not very clear sometimes, that environmental health does play a pretty large role, in emergency management. So just make sure that you can speak to your emergency support function or ESF8 colleagues, before hurricane season or before you're actually needed. Just introduce yourself and kind of get to the lunch table and have discussions with them, right?

Prepare before hurricane season. That's always, the big part for us here in Florida, always. Meet with your local partners, develop a response.

Next I would say regularly train and exercise staff on emergency response activities. This could include conducting trainings, tabletop exercises virtually, and real-world drills with internal, external partners, and stakeholders. Let's see, I would also suggest utilizing all available resources, like I said, technical assistance earlier, but there are additional available resources.

What I mean by that, the guides. There are SOPs, SOBs, SOGs, standard operating procedures or guides. There are trainings. There are exercise templates, communities of practice. Those can be found through a myriad of different places, but some of the main, places to look, that where I look is ASTHO, CDC, NEHA or National Environmental Health Association, FEMA, and EPA, just to name a few.

In addition, even look at other states. See what they've developed. Don't try to create the wheel yourself. See what's been created and try to tailor it to your jurisdiction, your state or region, and go from there so you have a kind of a jumping-off point.

Next I would say after trainings, things like that, conduct hot washes, evaluations, and AARs or after action reports.

So the goal of those are to improve the overall process, right? These types, of critical review identify areas for improvement and areas that worked well, so it's good and bad. Finally, I would say if the need does arise, identify mutual aid opportunities. Referencing back to Hurricane Ian here in Florida, we were running very thin after deploying 11 strike teams, right?

So we had to make the call for an EMAC or an Emergency Management Assistant Compact to come, and actually a full team to come down to Florida and assist us, after Hurricane Ian. And lastly, I would say with, mutual aid opportunities, look at FEMA. They do have emergency funding opportunities, after emergencies, so they typically do have that both for community and businesses, but also for state and local jurisdictions as well.