Hurricane Florence is poised to make landfall on the Carolina coast tonight, marking the first landfall on the U.S. mainland this hurricane season. Secretary of HHS Alex Azar declared a public health emergency for North Carolina and South Carolina to provide Medicare and Medicaid beneficiaries and health care providers greater flexibility in meeting emergency health needs, as well as readying personnel from the National Disaster Medical System. As we all watch Florence and her impact on millions of Americans, we thought it would be a good to take a quick look at the inexorable connection between emergency preparedness, weather, and medical care. [No discussion of hurricanes and health would be complete without addressing Hurricane Maria and the devastation it wrought on Puerto Rico, but that is a longer post for another day.]
- People still need access to health care, especially primary care, after a storm. Individuals with diabetes need insulin prescriptions, patients with high blood pressure or heart conditions need to be monitored (especially with the added stress of the storm), and infections need to be treated. After Hurricane Katrina and the catastrophic flooding it precipitated incapacitated the major health care infrastructure of New Orleans, makeshift clinics were set up around the city in whatever dry, solid space was available by doctors and nurses to treat storm survivors in different neighborhoods. Many of these temporary post-storm neighborhood clinics became have permanent and now serve over 160,000 people in New Orleans, many who are low-income.
- Mental health care must be integrated into health care, particularly primary care. The stresses of storm preparation, evacuation, rising flood waters, loss of homes and worldly possessions, and worrying about where to live or how to feed ones family after a storm can exacerbate previous conditions or result in a new diagnosis of anxiety, depression, or PTSD.
- Electronic medical records can be instrumental for providing patient care during and after a storm. Compared to paper records (which can be lost to flood waters), EMRs allow for more seamless care during and after a storm. The HITECH Act allowed for the creation of health information exchanges, which let providers access patient records remotely. The Greater Houston Healthconnect HIE and Healthcare Access San Antonio HIE–and the interoperability between them–were instrumental for clinicians to provide proper patient care during Hurricane Harvey.
- The flooding from Hurricane Sandy swamped the basement of Bellevue Hospital in New York City, resulting in a loss of power. Thankfully, a National Guard Unit was able to get to the hospital with fuel before their generator died, but the incident provided a stark reminder that modern medicine runs on electricity–from ventilators and IV pumps to NICU incubators and computers with access to patient records. The experiences of Hurricane Katrina helped inspire the creation of the emPOWER system, a pilot program between the City of New Orleans Health Department and HHS to use Medicare claims data to identify individuals with electricity-dependent equipment and securely provide those names to the local health department prior to an adverse weather event.
Our environment and climate impact our health every day–from an increased risk of melanoma in sunny locales to icy roads that result in tragic accidents. Thanks to modern technology, we have a greater, though not absolute, ability to predict the impact of hurricanes. With prediction power comes responsibility–emergency preparedness, along with learning from past storms, is key.