Partnerships Help Save Lives When Disaster Strikes

Emergency responders gathered in a circle.

Public health emergencies occur every day across the United States. Tornadoes, hurricanes, wildfires, floods, infectious disease outbreaks, terrorist attacks, and other emergencies have all occurred within the past few years and likely will happen again. Communities must be ready in the event of a public health emergency – both those they expect and those that come without warning.

Since 2002, CDC’s Public Health Emergency Preparedness (PHEP) program has provided funding and guidance to 50 states, four cities, and eight territorial health departments across the nation to protect communities. Planning and exercising plans help ensure that health departments are ready to respond and save lives when emergencies occur.

While we all hope that emergencies never happen, they are inevitable and the true test of any preparedness system. The following stories are examples of how CDC’s PHEP program works with states and local communities to ensure they are ready to respond to any emergency. Some of CDC’s partners include health departments, community organizations, national public health organizations, and private companies.

Restoring California Communities after Devastating Wildfires

A fire truck responds to a brush fire.In 2017, nearly 9,000 fires, almost double the average annual number, burned 1.2 million acres in California. The fires destroyed more than 10,800 structures and killed at least 46 people. However, thanks to years of planning for such events and building a public health infrastructure through the PHEP program, state and local health departments were ready to respond immediately and help their communities recover over the following months.

Through partnerships and support provided by the PHEP program in and around Sonoma County, local officials evacuated more than 1,160 patients from area hospitals and many other healthcare facilities. Additionally, because of the relationship the state built with the California National Guard through the PHEP program, more than 100 volunteer troops cleaned the Sonoma Developmental Center in one day. More than 200 patients with disabilities were then able to return safely to the facility.

Ensuring Access to Medication during an Influenza Outbreak in Maine

Package of Oseltamivir (i.e., Tamiflu) capsulesIn March 2017, an influenza outbreak on Vinylhaven, a remote island off the coast of Maine with a population of about 1,165, sickened half of the island’s residents. The outbreak depleted the medical center’s Tamiflu® supply. Tamiflu® can greatly lessen the severity of influenza but it must be taken early in treatment.

Because of a partnership agreement established under PHEP with the Northern New England Poison Center, local pharmacies, and other organizations, and the Maine Department of Health staff quickly delivered 100 treatment courses of Tamiflu®. As a result, the state successfully reduced the impact of the influenza outbreak on the island.

Responding to a Water Contamination Incident in Illinois

Bottles of water on a conveyor belt.On May 2017, a water main break under a river contaminated water in Cumberland County, Illinois, and left some residents without water entirely. Health department staff funded through PHEP established water distribution sites with bottled water donated by private partners such as Walmart, Coca-Cola, and Anheuser-Busch. Staff also went door-to-door to check on residents and distribute materials about safe water.

The PHEP program ensures public health emergency management systems and experts are ready to respond when emergencies occur. Preparedness efforts throughout the years have saved lives and helped communities return to normal operations as quickly as possible.

From natural disasters to infectious diseases, the PHEP program protects America’s health, safety, and security to save lives. Check out the PHEP Stories from the Field to find out more about how the PHEP program has helped communities prepare for, respond to, and recover from public health emergencies.

3 Reasons Why Handwashing Should Matter to You

Unseen woman washing her hands with soap in a sink.

Most of us are familiar with the parental-like voice in the back of our minds that helps guide our decision-making—asking us questions like, “Have you called your grandmother lately?” For many that voice serves as a gentle, yet constant reminder to wash our hands.

Handwashing with soap and water is one of the most important steps you can take to avoid getting sick and spreading germs to loved ones. Many diseases are spread by not cleaning your hands properly after touching contaminated objects or surfaces. And although not all germs are bad, illness can occur when harmful germs enter our bodies through the eyes, nose, and mouth. That’s why it is critical to wash hands at key times, such as after a flood or during a flu pandemic, when germs can be passed from person to person and make others sick.

Washing hands with soap and water is the best way to reduce the number of germs on them, however during a disaster clean, running water may not be available. If soap and water are not available, use an alcohol-based hand sanitizer that contains at least 60% alcohol. Alcohol-based hand sanitizers can quickly reduce the number of germs on hands in some situations, but sanitizers do not eliminate all types of germs.

Here are three key reasons why you should always care about handwashing:Your hands carry germs you can't see. Wash your hands.

  1. Handwashing can keep children healthy and in school. Handwashing education can reduce the number of young children who get sick and help prevent school absenteeism.
  2. Handwashing can help prevent illness. Getting a yearly flu vaccine is the most important action you can take to protect yourself from flu. Besides getting a flu vaccine, CDC recommends everyday preventive actions including frequent handwashing with soap and water.
  3. Handwashing is easy! Effective handwashing is a practical skill that you can easily learn, teach to others, and practice every day to prepare for an emergency. It takes around 20 seconds, and can be done in five simple steps:
    1. Wet your hands with clean, running water, turn off the tap, and apply soap
    2. Lather your hands by rubbing them together with the soap
    3. Scrub your hands for at least 20 seconds. Need a timer? Hum the “Happy Birthday” song from beginning to end twice
    4. Rinse your hands well under clean, running water
    5. Dry your hands using a clean towel or air-dry them

Promote Handwashing in Your Community

Global Handwashing Day is celebrated annually on October 15 to promote handwashing with soap as an easy and affordable way to prevent disease in communities around the world. This year’s theme, “Clean Hands—A Recipe for Health,” calls attention to the importance of handwashing at key times, such as before eating or feeding others, and before, during, and after preparing food.

Learn how you can get involved and promote handwashing at home, your child’s school or daycare, and your local community:

Protecting Our Future: Emergency Preparedness and Children’s Mental Health

Sad boy sitting against a brick wall with his face hidden

Among the many lessons learned during the 2017 Hurricane season, we recognized that addressing children’s mental and behavioral health needs is a major concern in hurricane-affected areas.

CDC’s At Risk Task Force (ARTF) was established in 2017 to ensure identification and prioritization of the mental and physical health needs of at-risk populations, including children. ARTF’s first Emergency Operations Center (EOC) activation was on Aug. 31, 2017, in response to Hurricane Harvey, the first of three consecutive hurricanes to hit the United States and its territories in a five-week period. ARTF’s mission was to address the needs of at-risk populations in affected areas throughout the response and recovery phases.

Early in the response, it became clear that the emotional impact of the storms and the mental health needs of people, particularly children, affected were a critical area of focus. ARTF worked closely with federal and non-government agencies to address these needs so that children and families had the best chance for recovery.

October 10 is World Mental Health Day. The theme this year is Young People and Mental Health in a Changing World. In light of this, we want to share our experiences to inform mental health interventions and improve outcomes for children after public health emergencies and natural disasters. First, let’s talk about what makes children more vulnerable in emergencies.

Why are children more vulnerable in emergencies?

Mental stress from a disaster can be harder on children. Children are more vulnerable in emergencies: Because they breathe in more air for their size than adults, children absorb harmful materials from the air more readily. Because they spend more time outside, are lower to the ground, and put their hands in their mouths more often than do adults. Because they may not be able to communicate their symptoms or feelings. Because they need medicines, and specifically designed equipment for emergency situations that are different from adults.Children are more vulnerable in emergencies because of their physical, developmental, behavioral, and emotional differences from adults. Children may have difficulty or may not be able to communicate symptoms or feelings. They may understand less about the situation and feel less able to control the events around them.

The aftermath of an emergency or disaster is also difficult for children because they have less experience coping with difficult situations.

The emotional impact of an emergency depends on a child’s characteristics and experiences, the social and economic circumstances of the family and their community, and the availability of local resources. Other factors may influence the emotional impact on children, causing them to be more vulnerable in emergencies. These include children with mental, behavioral, or developmental disorders. Children who have experienced trauma in the past may also have more difficulty coping with a disaster.  

What does the At Risk Task Force do for children’s mental health during a hurricane response?

During the 2017 hurricane season, the ARTF collaborated with federal and non-government partners to monitor behavioral health in affected areas and disseminate key messages and coping resources for children in schools and vulnerable populations in other contexts. ARTF coordinated a webinar for primary care physicians that focused on identification of common adjustment difficulties in children, provided strategies to promote effective coping skills in children and their parents, and explained the importance of self-care for professionals. The webinar was attended by more than 300 clinicians and other health care providers on Oct 26, 2017.

Public health professionals also play an important role in addressing short-term and enduring mental health needs of the population. Timely and accurate mental and behavioral health surveillance data, that includes specific information on children, could inform intervention efforts to improve developmental outcomes for children in the longer-term aftermath of disasters. It is important that mental health surveillance be incorporated into preparedness planning so that surveillance systems can be established or leveraged immediately when emergency response begins.

What are next steps for CDC?

Children’s mental health needs are a prominent concern in hurricane-Recommendations to help children cope during and after an emergency: • Share age-appropriate information • Encourage children to ask questions • Limit media exposure • Return to a routine • Reunite children with caregivers as soon as possibleaffected areas. There is still a gap in real-time information on mental health needs to inform intervention efforts and improve child outcomes. CDC is working internally to enhance efforts to monitor health impacts during and after natural disasters, including integrating mental health into standard data collection.

CDC is also working with partners to integrate children’s mental health in preparedness planning. Following the 2017 hurricane season, CDC collaborated with the American Academy of Pediatrics to develop an activity book for children and families, Coping after a Disaster, that focuses on feelings children might have after a disaster and coping strategies that may help. This book is part of a series that follows Ready Wrigley, a dog who helps her family prepare for emergencies and their impacts.

CDC is now partnering with the National Hazard Center to develop mental and behavioral health training modules for researchers conducting field research immediately following an extreme event, such as a hurricane. These free, online trainings will provide background information on mental health in the context of disasters, as well as a list of mental health assessment tools used following a disaster for various vulnerable populations (e.g., children, older adults). The trainings and associated resources will address current research gaps in mental health, help to organize research in this area, and share best practices with researchers.

On Sept. 12, 2018, CDC activated the EOC to respond to Hurricane Florence, which made landfall off the coast of North Carolina on Sept. 13. The ARTF was quickly activated to address the needs of vulnerable populations. As the storm decreased in intensity, North Carolina began reporting increased emergency department visits related to stress and anxiety. Mental health concerns in children, similar to 2017, are expected to remain a prominent focus throughout the response and recovery phases. The ARTF continues to monitor the situation and support the mental and behavioral health needs of children and vulnerable populations in affected areas.

Additional Resources:

The Power of Preparedness: Prepare Your Health

Group of people kneeling around a CPR dummy.

The devastating hurricanes of 2017 reminded us how important it is to prepare for disasters. These potentially life-threatening situations have real impacts on personal and public health. During Hurricane Irma, existing medical conditions and power outages increased the likelihood of death. Being prepared with supplies and an Emergency Action Plan can help you protect the health of your family until help arrives.

September is National Preparedness Month (#NatlPrep), and the perfect time of year to remind people of The Power of Preparedness. This year’s call-to-action of Prepare Your Health (#PrepYourHealth) and four weekly themes highlight the roles that individuals, state and local public health, and CDC play in creating community health resilience. It takes everyone “pulling in the same direction” to create families, communities, and a nation that can withstand, adapt to, and recover from personal and public health emergencies.

The first week focuses on personal preparedness, and the importance of nonperishable food, safe water, basic supplies, and the personal items you need to protect your health until help arrives.

Personal needs

A large-scale disaster or unexpected emergency can limit your access to food, safe water, and medical supplies for days or weeks. However, nearly half of adults in the U.S. do not have an emergency kit for their home; they don’t have the provisions, supplies, and equipment necessary to protect the health of their families in a disaster. This list will get you started:

  • Special foods—such as nutrition drinks—for people with dietary restrictions, food sensitivities and allergies, and medical conditions such as diabetes.
  • Prescription eyeglasses, contacts and lens solution
  • Medical alert identification bracelet or necklace
  • Change of clothes
  • Emergency tools (e.g., manual can opener; multi-use tool; plastic sheeting; etc.)
  • Durable medical equipment (e.g., walkers; nebulizers; glucose meters; etc.)
  • Medical supplies, including first aid kit
  • Pet supplies
  • Baby and childcare supplies

Prescriptions

The hands of an elderly man holding a pill organizer

Many people need daily medications and medical equipment. Nearly half of Americans take at least one prescription drug, and a quarter of Americans take three or more medications. A large-scale natural disaster, like a hurricane, could make it difficult to get prescription and over-the-counter medicines.  You and your family may need to rely on a prepared emergency supply. There are some basics to include:

  • A 7 to 10 day supply of prescription medications stored in a waterproof container.
  • An up-to-date list of all prescription medications, including dosage and the names of their generic equivalents, medical supply needs, and known allergies.
  • Over-the-counter medications, including pain and fever relievers, diuretics, antihistamines, and antidiarrheal medications stored in labeled, childproof containers.
  • A cooler and chemical ice packs for storing and keeping medicines cold in a power outage.

Paperwork

Over half of Americans do not have copies of important personal paperwork. Collect and protect documents such as insurance forms, and medical, vital, and immunization records. Here are some of the basics:

  • Health insurance and prescription cards
  • Shot records
  • Living wills and power of attorney forms
  • Vital records (e.g., birth and death certificates; adoption records)
  • User manuals, model and serial numbers, and contact information for the manufacturer of medical devices (e.g., blood glucose meters; nebulizers)
  • Hardcopies of your Emergency Action Plan

Power sources

A portable generator sitting outside in the snow.

A power outage can close pharmacies, disrupt medical services, and can be life threatening for over 2.5 million people who rely on electricity-dependent medical equipment. Be ready for a lengthy blackout with an emergency power plan and back up. You will need alternative power sources for your cellphone, refrigerator , and medical equipment. Here’s a checklist:

  • Extra batteries, including those for hearing aids, in standards sizes (e.g., AA and AAA)
  • Fully-charged rechargeable batteries for motorized scooters
  • Hand-crank radio with USB ports
  • Car chargers for electronic devices, including cell phones and breast pumps
  • A generator

Practical skills

Finally, it’s important to know some basic do-it-yourself skills to stay healthy and safe until help arrives. Here are the basics to get you started:

  • Call 911 in a life-threatening emergency
  • Get trained in cardiopulmonary resuscitation (CPR). If you do not know CPR, you can give hands-only CPR—uninterrupted chest compressions of 100 to 120 a minute—until help arrives.
  • Learn how to use an automated external defibrillator (AED).
  • Learn Handwashing is one of the best ways to protect yourself, your family, and others from getting sick.

The good news is that it is never too late to prepare for a public health emergency. You can take actions, make healthy choices, and download free resources to help you prepare for, adapt to, and cope with adversity.

Arizona’s ERIC Program Works to Improve Access to Emergency Information

Emergency Response Interpreters Credentialing (ERIC) program interpreter, Beth Kovatch, works with the Operations Section of the Southwest Incident Management Team 1 on the Tinder Fire to record an accessible video updating the public on the the status of the wildfire.

Vicki Bond is not surprised at how hot, but at how cold the temperatures can get out on a wildfire. “I’ve worked on responses to more wildfires in freezing temperatures than in extreme heat,” she says.

Coincidentally, making sure people aren’t left out in the cold in an emergency is why she has so much experience with the weather.

Bond works for the Arizona Department of Emergency and Military Affairs (DEMA) as a licensed American Sign Language (ASL) interpreter and deployment coordinator for the Emergency Response Interpreters Credentialing (ERIC) program. She helps prepare licensed ASL interpreters and Communication Access Realtime Translation (CART) captioners to deploy for emergencies throughout the state.

ERIC interpreters and captioners work alongside communicators to interpret and transcribe information presented at community meetings and media briefings, on websites and social media, and in evacuation shelters for people who are deaf and hard of hearing.

“The goal of the ERIC program,” said Bond, “is to ensure deaf and hard of hearing community members have access to critical information during emergencies and disasters in the State of Arizona.”

People in Arizona are at risk from a variety of hazards, including extreme heat, floods, and wildfire. More than 1,500 wildfires occur in Arizona each year.

Trial by Fire

Group photo of participants in the Emergency Response Interpreters Credentialing Program
The ERIC team is made up of American Sign Language Interpreters, Certified Deaf Interpreters, and Communication Access Real-time Translation captioners.

The pilot of the ERIC program was a literal trial by fire. In 2017, ERIC interpreters and CART providers deployed in response to one flood and nine wildfires, where long hours, limited supplies, and sleeping in tents are the rule, not the exception.

The ERIC staff of five captioners, 15 interpreters, and three certified deaf interpreters deployed to two major fires this season–the Tinder Fire and the Rattlesnake Fire in April—and, most recently, supported Coconino County’s response to flooding east of the City of Flagstaff.

ERIC staff have not worked with a public health department on an exercise or real-life emergency, such as a Point of Distribution (or POD) drill or activation as of yet, but Bond anticipates “many more” deployments with the recent enactment of State of Arizona Senate Bill 1296, which is meant to improve the accessbility of emergency communication.

Bond hopes the early success of the ERIC progam will help highlight the need for ASL translators and CART captioners on all emergencies.

Know Your Community

It is not a matter of if you will need an interpreter and captioner, but when you will need them. In Arizona, an estimated 1.1 million people are hard of hearing, and over 20,000 people are culturally deaf and use ASL as their primary language.

Public health and emergency management agencies can use tools like Community Assessment for Public Health Emergency Response (CASPER) surveys to assess local health and communication needs, and collect data that can help emergency planners know when to request resources like interpreters and captioners. The earlier the better in most cases.

Think Accessibility

In today’s “digital first” world, where half of visitors to CDC.gov come on mobile devices first, it is important to think about accessibility throughout the process of creating content, from conceptualization to publication.

Small print, videos without captions, and the use of long and technical language in printed materials and on websites are barriers to communication and possible violations of federal and state laws. Section 508 of the Rehabilitation Act and other laws like it help protect people who have disabilities that affect their ability to hear, speak, read, write, and understand information.

Here are 5 ways to create web and social media content that is useful, usable, and accessible:

  1. Add alternate text (or AltText) to images.
  2. Caption social media video and web video.
  3. Provide transcripts for videos and podcasts, and interpreters for livestreams.
  4. Improve the readability of print materials with large text.
  5. Write in plain language to increase understanding of your message.

Related resources:

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Using Trauma-Informed Care to Guide Emergency Preparedness and Response

Exposure to a traumatic event or set of circumstances can negatively affect a person’s mental, physical, social, emotional or spiritual well-being for a long time after the initial incident. We know that not all individuals respond to trauma in the same way and we know that individuals with a history of trauma, especially childhood trauma, are more likely to experience psychological distress and are at increased risk for the development of Post-traumatic Stress Disorder (PTSD) with future exposure to trauma.

The chemicals in our bodies change during stressful or traumatic situationsEmergency responders are vulnerable to trauma during or after a disaster the same as survivors. Hazardous work conditions, being away from family, and exposure to human suffering can cause new and intensify existing feelings of stress, anxiety, grief, and worry in responders.

When the body is threatened, stress hormones are released to help you survive (fight or flight response). These hormones cause our bodies to minimize non-essential tasks, including growth, reproduction, and immune function and to maximize body functions that are necessary to prepare the body to fight or flee from a stressor.  Functions such as breathing, heart rate and alertness are useful for the body to survive the stress.   If someone is regularly exposed to trauma, stress hormones are repeatedly released and the brain can become exposed to these powerful stress hormones that would normally be present in the body for short periods of time. Over time repeated exposure to stress may cause your body’s natural stress response system to malfunction and can result in potentially unhealthy mental and physical responses to current or future stress.  These responses can include irritability, emotional reactivity, intrusive thoughts about the event, emotional numbing and avoidance, loss of one’s sense of safety, or diminished capacity to trust others.

Exposure to trauma can affect a person’s normal coping and stress management skills.  A person’s mental health during an emergency may be impacted by:

  • Direct exposure to the disaster, such as being evacuated or witnessing others (including family members) in life-threatening situations
  • Prior experience with and exposure to trauma
  • Pre-existing conditions, such as mental health conditions
  • Socioeconomic factors, such as family resources available
  • Family variables, for example, how parents react

Take trauma into account when responding to emergencies

When someone has experienced trauma, he or she can be re-traumatized if emergency medical service providers, healthcare professionals, and community service providers are not aware of and sensitive to the possibility of re-traumatization. Emergency responders should be aware that individuals and communities may have experienced a variety of traumas in their lives and need to consider a survivor’s physical, psychological, and emotional safety and well-being after a disaster.

Trauma-informed organizations and emergency responders need to be sensitive to the potential impact that widespread trauma can have on individuals. An essential underpinning of trauma informed care and approach is the awareness that procedures and interactions can be re-traumatizing.

Training emergency responders in trauma-informed care

The CDC’s Office of Public Health Preparedness and Response (OPHPR) collaborated with SAMHSA to develop a trauma-informed care training for CDC. Working with Mary Blake (SAMHSA) and the Technical Assistance Center, SAMHSA’s National Center for Trauma-Informed Care (NCTIC) developed and led a new training for OPHPR employees about the role of trauma-informed care during public health emergencies. The training aimed to increase responder awareness of the impact that trauma can have in the communities where they work. Participants learned the six principles that guide a trauma-informed approach, including:

  1. Safety
  2. Trustworthiness and transparency
  3. Peer support
  4. Collaboration and mutuality
  5. Empowerment, voice and choice
  6. Cultural, historical, and gender issues

Adopting a trauma-informed approach is not accomplished through any single particular technique or checklist. It requires constant attention, caring awareness, sensitivity and it may require a cultural change at an organizational level. On-going internal organizational assessment and quality improvement, as well as engagement with community stakeholders, will help to imbed this approach which can be augmented with organizational development and practice improvement. The training provided by OPHPR and NCTIC was the first step for CDC to view emergency preparedness and response through a trauma-informed lens.

Resources:

5 Communication Lessons Learned from Hurricane Maria

Over-the-shoulder photo of two older women looking down at health communication materials in their hands.

When Category 4 Hurricane Maria made landfall in Puerto Rico, CDC assembled a team of experienced communicators who were flexible, bilingual, and culturally sensitive communicators. This group of experts prepared to deploy to Puerto Rico on short notice to support the communication needs of the Puerto Rico Health Department. I was asked to lead content development, and as a native Puerto Rican I did not hesitate to go home and help in any way I could.The 2018 hurricane season began on June 1 and will last until November 30. Learn more about hurricanes from the National Hurricane Center at the National Oceanic and Atmospheric Administration.

I was part of the first team of four health communications specialists who arrived on the island just three weeks after the hurricane. We knew our job was not going to be easy— severe electrical power outage meant that residents had no access to internet, social media, or television. Antennas had fallen during the storm, so there was very limited radio coverage and almost no cell phone connectivity. Large billboards were literally on the ground and newspapers were not circulating widely because there was no way to publish and transport them for delivery.

Hurricane Maria was an unprecedented disaster, exposing residents to an increased risk for foodborne, waterborne, infectious and non-infectious diseases, and other public health risks. We had to figure out how to communicate about multiple health risks to the public, especially to those in rural and isolated communities, when basic resources and services were not available.

We met this challenge head on, and I took away five key lessons that I hope can help other communication responders prepare for the 2018 hurricane season and any future emergency events:

1. Develop Key Messages in Advance

Every natural disaster is unique and emergency responders have to quickly adapt to the ever-changing nature of a crisis. Nonetheless, many key messages can be written before disaster strikes so they can be quickly disseminated before an event, during the response, and in the recovery stages. In disaster planning this is known as a phased approach, and it can save valuable time when in the midst of a crisis response. Before the 2017 hurricane season started, CDC developed a key message reference document for partners to have the most up-to-date science about multiple hurricane-related health threats. The key message document helped us on the ground so we could quickly create and adapt health communication products for Puerto Rican audiences.

2. Identify New Communication Channels

When all primary communication systems and technology fail, communicators must think creatively and adapt to the crisis by identifying new communication channels. In Puerto Rico, we realized that mass producing printed materials was our best bet to get important health messages to the most vulnerable communities. As the response evolved, we identified alternate channels, such as using FEMA’s text messaging capability to disseminate health messages to their subscribers, or using outdoor speakers to run public service announcements in rural areas. We also posted targeted and relevant messages on the CDC en Español Facebook channel. We knew Puerto Ricans on the United States mainland, known as “la diáspora,” were heavily using technology to connect with family and help people on the island, so we posted targeted and relevant digital messages that could be relayed to people in Puerto Rico by word of mouth.

3. Create Culturally Appropriate Materials

Cultural norms influence how people behave, so culture has important implications for emergency communication. For the Puerto Rico response, we translated materials to Spanish and made sure to linguistically and culturally tailor our health prevention messages so they would be relevant with the Puerto Rican audience. Our team made sure to use widely understood terminology in the island to provide clear and localized language, particularly for audiences with low literacy. For example, in Puerto Rico the term “hongos” is widely understood as a translation for “mold” as opposed to “moho,” which is used in other Spanish speaking countries but has a dual-meaning in Puerto Rico. We also implemented a streamlined process for the Puerto Rico Department of Health, and CDC scientists and communication experts to vet, approve, and co-brand the communication materials.

4. Partner Up

We collaborated with the Puerto Rico Health Department to determine our number one priority, which was reaching the most vulnerable communities, including those with no access to clean water, and people who were still in isolated and rural areas. When we heard about military partners who were delivering food and water supplies to isolated communities by helicopter, we gave them boxes of our fact sheets so they could be distributed in these areas. We delivered materials to federal and local government agencies who were doing health assessments in hospitals and shelters. We also provided copies to grassroot and non-profit organizations, and religious and community leaders who went door-to-door to assist residents and organize community events. Through our commitment to partnerships, we distributed over 1.6 million copies of printed materials in a 3-month period. Topics ranged from food and water safety, to carbon monoxide, vector control, mold, leptospirosis, mental health, among others. This included fact sheets, posters, palm cards, and children’s coloring books.

5. Boots on the Ground

Once we started mass producing printed materials, we organized and attended more than 30 community events with partners to disseminate information to the public. We visited hospitals, shelters, disaster recovery centers, schools, and provided information door-to-door in rural communities. Talking with people face-to-face gave us a better understanding of the realities survivors were facing and helped identify public health information gaps in our materials so we could make adjustments.

Learn more

Shouting in the Dark: Emergency Communication in USVI After Irma and Maria

Nykole Tyson, Director of Public Relations for the US Virgin Islands Department of Health, speaking into a radio microphone.

Communication experts often say, “When you’re communicating during an emergency, always think about what you’d say to your mom. What information would she need the most? How would you explain it to her? What would you need to know for sure before you told her? And just how far would you go to reach her?”

When Hurricanes Irma and Maria hit the U.S. Virgin Islands (USVI) in September 2017, this wasn’t just advice for Nykole Tyson. Nykole is the USVI Department of Health’s (DOH’s) Director of Public Relations. She serves as the DOH spokesperson and emergency communicator. Like all of USVI’s responders and government officials, she is a survivor who was impacted by the storms. Nykole’s home had water and roof damage and she was without water or power for four months. “I caught rain water in barrels and used solar lights sent to me by friends living stateside,” Nykole said. She lived on a cot in her office in the DOH for several weeks between and after both storms. .

The storms destroyed most of the territory’s communication infrastructure, making both personal and mass communication nearly impossible. Nykole was unable to reach her own family for four days after the second hurricane. However, within hours of both storms, she was on the radio talking to her community about how to stay safe, find shelter, and stay strong. Nykole wasn’t just talking to the public, she was talking to her neighbors, her community, her family, and even her mom.

Hurricane Irma

Just hours before Hurricane Irma hit USVI, Nykole was a spokesperson on local radio stations and distributed press releases, public service announcements (PSAs), and social media messages with critical information about how to prepare for the storm. When the storm hit on September 6, electricity, cell, and Internet access was cut off across most of the territory. People sought resources, shelter, and safety, and many struggled to locate friends and loved ones. Virgin Islanders needed to know how to stay safe around downed power lines, debris, mold, and floodwaters.  There was only one working radio station after the storm and Nykole immediately went on the air to give safety tips and updates about available services. She also realized that some people were still able to access Facebook, and the social network became one of the primary means of communication throughout the response. The USVI DOH Facebook posts from September provide a glimpse into how events unfolded and demonstrate the DOH’s commitment to responding to the public’s concerns.

Hurricane Maria

Just 12 days after Irma, USVI was preparing for another major hurricane—Maria. Only this time there were limited ways to alert the public and provide health and safety information. Virgin Islanders, Nykole included, needed to find shelter or prepare their homes, many of which were already damaged, for the impact of another hurricane. Nykole did a PSA on the local radio station from her own home as she was securing her furniture and checking her emergency supplies. “We will get through this,” she repeated over the radio. Unbeknownst to the listeners, Nykole’s family had lost phone service after Irma. She had been unable to reach them so she was driving to her mom’s house to give her family the same safety information she was sharing on the air.

When the storm hit, Nykole and about one hundred other DOH staff took care of special needs patients sheltered in the DOH building. As the wind battered and shook the concrete building, they thought of their communities, homes, and families on the islands. “We were all scared,” she recalls. As soon as the clouds cleared, Nykole was back on the radio, “We survived two category fives. We lost property but we still have our lives. All is not lost. It is time for us to rebuild.”

Resourcefulness and Resilience

USVI DOH staff had to be creative and resourceful after the storms because the typical means of communication were down. The best ways to share information immediately after the storms was through paper flyers, radio, and in-person outreach. CDC and the U.S. Postal Service assisted with printing and distributing a flyer on key health tips to every mailbox on all four islands. CDC health communicators deployed to USVI to support outreach efforts started conversations the islands at churches, stores, disaster recovery centers, radio stations, and schools.

When asked about lessons learned, Nykole reflected, “Do not underestimate the power of radio.” She is still making radio appearances to engage the community, repeat the key messages, answer questions, and encourage community members. While she is running errands, people stop to thank her and comment on her energy. “There were so many times I wanted to cry when I was on the radio, but the listeners didn’t know that,” she says. People tell her how she kept them calm during the worst of the storms, and, hearing her now, still on the radio, lets them know that their government officials are still working hard for them.

Nykole’s experience shows how a talented spokesperson who is also a survivor can be the best voice to engage and reassure a community after a disaster. All responses could benefit from people who care for and communication with the public as if they are family.

After the Storm: Helping Kids Cope

A boy and his mother wait to cross the street on their way to school.

Changing schools is hard for any kid. Imagine picking up without any notice and moving to a new school in a brand new place with a different climate, culture, and maybe even a different primary language.  Harder still is the thought of moving because your home and community have been devastated by a major hurricane. The truth is, this is the reality for the tens of thousands of students from Puerto Rico and the U.S. Virgin Islands (USVI) who moved to the continental U.S. after Hurricane Irma and Hurricane Maria.

Recognizing a need

As a Massachusetts native, I subscribe to news alerts from the Boston area. One morning before heading to work in CDC’s Joint Information Center, I saw a news article about the influx of PuertoCDC's Joint Information Center (JIC): The JIC Outreach Team is responsible for reaching hard-to-reach and at-risk audiences with important health and safety information during and after a public health emergency. Rican children displaced by the hurricanes who were relocating to the cities of Springfield and Holyoke in western Massachusetts.  Both cities have large Puerto Rican populations, and many residents were taking in relatives and friends from the devastated island. Schools in the territories would be closed for months after the storm, so many families were coming to the continental U.S. so their kids could keep going to school.

Children who were displaced as a result of the hurricanes faced the challenges of leaving behind their homes, communities, and schools, family and friends, and even their pets.  Kids in middle and high school were old enough to understand the uncertainty facing their families. They had to stay strong to support their parents and siblings, while finding a routine at a new school and keeping up with their academics.

Understanding the issue

During my meeting with the Hurricane Emergency Response Communication Teams, I brought up the article I had read that morning. Dr. Melissa Mercado-Crespo, a behavioral health scientist at CDC’s National Center for Injury Prevention and Control, took a special interest in the well-being of the families who had been displaced by the hurricanes. Dr. Mercado serves on the StopBullying.gov Editorial Board, and grew up in Puerto Rico. Most of her family and loved ones still live there, and when the storms hit, her husband was deployed to the island with the U.S. Army Reserves.

In collaboration with the CDC At-Risk Task Force, Dr. Mercado and I reached out to federal and local partners to find out how many hurricane-displaced students from Puerto Rico and USVI had enrolled in the middle of the semester. Through media and local sources, we learned that most of the students had enrolled at schools in Florida and New York, as well as cities in western Massachusetts. The Center for Puerto Rican Studies at Hunter College, City University of New York, confirmed our findings. They estimated that after September 20, 2017 – the day Hurricane Maria hit Puerto Rico – 10,324 Puerto Rican students enrolled in Florida schools. The Puerto Rico Department of Education reported that nearly 25,000 students have left the island and are no longer enrolled in the Puerto Rico public school system.

Taking action

My former colleagues in Boston put me in touch with José Claudio of the New North Citizens’ Council, a community organization that provides public and human services to residents in the Springfield area. He mentioned that many of the students were struggling to adapt to their new setting and that there were misunderstandings between the permanent students and their new peers. We wanted to provide teachers and youth organizations with tools and resources that could help make the transition easier for everyone.

To help address these challenges, we pulled together a list of resources to help teachers and youth organization leaders plan activities to prevent and reduce the emotional challenges new students may face and help them cope with the trauma following hurricanes. We published the list in a Spotlight issue of the CDC Emergency Partners Newsletter that was reviewed by CDC behavioral health experts and representatives from StopBullying.gov, SAMHSA, and the National Child Traumatic Stress Network (NCTSN). The newsletter went out to partners, and we received positive feedback from teachers, school counselors, and organizations that serve Hispanic populations in the U.S.

The messaging needs and target audiences change before, during, and after every emergency. We identified a new target audience during the 2017 Hurricane Response – children from Puerto Rico and USVI who left their schools and homes behind after the storms. Our hope is this is the first step in concrete efforts to help ensure they are no longer left behind.

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Educating Children After Hurricane Maria

In September 2017, Hurricanes Irma and Maria roared through the Caribbean just 12 days apart. The schools on St. Croix and St. Thomas in the U.S. Virgin Islands (USVI) did not re-open until October 24. Teachers talked about how many of the books and materials in their classrooms were moldy and how teachers and staff had to help the janitorial staff clean up classrooms. Parents shared stories of their children coming home from school with mosquito bites all over their arms and legs. Schools could not always run the air-conditioning because they were operating using generators.

Finding a natural fit

As a team lead in the Division of Adolescent and School Health, I have expertise in how health departments and federal agencies should work with schools. So when I was deployed to support health communication activities in the US Virgin Islands after Hurricane Maria, I offered to support the USVI Department of Health doing health communication outreach to schools. We worked quickly to connect with schools and distribute materials to students and their families about how to stay safe and healthy after a hurricane.

Making a vision a realityChildren are the key to primary prevention because they are the drivers of the health behaviors we hope to change. -Malaika Washington

I worked with Director of Public Relations, Nykole Tyson, at the USVI Department of Health and the USVI Department of Education to determine how many children were enrolled on St. Croix, St. Thomas, and St. John and which educational materials from CDC to distribute. With support from the CDC Foundation, we printed and distributed flyer packets for over 16,000 K-12 students on the three islands to take home to their families. The packets contained CDC-developed materials about how to stay safe after a hurricane, including tips for food and water safety, how to prevent mosquito bites, the health risks from mold, how to avoid carbon monoxide poisoning, and mental health. Since 35% of the children on St. Croix speak Spanish, we made the messages available in both English and Spanish.

Each child was also given a copy of the Ready Wrigley Flooding and Mold Activity Book as part of the flyer packet. Ready Wrigley is a series of CDC-developed activity books for children 5-9 years old and their families to help them talk about and prepare for emergencies. There are nine Ready Wrigley books that provide tips, activities and a story about disaster preparedness. The flooding and mold activity book talks specifically about safe mold clean-up after a flood and how kids should never touch mold and always tell a grown-up if they see mold.

Giving children a voice

Malaika Washington reading the Ready Wrigley Flooding and Mold activity book to students in USVI.
Sharing the Ready Wrigley Flooding and Mold activity book with students in USVI.

American Education Week takes place every November. The USVI Department of Education contacted Director Tyson and asked her to read to elementary school students on St. Croix. She asked me if I would like to join her visits to kindergarten and first grade classrooms. I jumped at the chance to interact with students in-person and suggested we read the Ready Wrigley Flooding and Mold Activity Book. I even colored the pictures in the book and completed the activities so the children could follow along. We shared the Ready Wrigley books with the teachers at each school we visited, giving teachers enough copies of the book for every student to take one home.

All of the students really wanted their stories heard. One first grader recounted how his mother and grandparents told him to stay far away from the cleaning products while they cleaned up the mold in their home. Another little girl shared how she was personally impacted by mold. She had to sleep on the sofa in her home because there was mold all over her bed and the other furniture in her bedroom. Several other children described the mold they found on the front door of their homes after the hurricane.

Fulfilling a passion

Working with school-aged children is so rewarding. This deployment experience was the best I could have hoped for. The time I spent in the USVI made me realize my personal and professional goal to provide public health education materials to children and their families. I have always believed that public health prevention work should begin with school-aged youth and it is my lifelong public health mission to ensure that they have a voice.

Malaika Washington has been a Commissioned Corps Officer in the United Stated Public Health Service since October 2009. She is a team lead in the Division of Adolescent and School Health, the only division at CDC that funds education agencies directly. Her deployment to the U.S. Virgin Islands for the 2017 HHS Hurricane Response was the first time she deployed for a public health emergency.