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.

Norovirus Illness is Messy – Clean Up Right Away

Hand in pink protective glove wiping tiles with rag in the bathroom.

When norovirus strikes in your own home, you can be prepared by having the supplies you need to immediately clean up after a loved one vomits or has diarrhea.

Norovirus is a tiny germ that spreads quickly and easily. It causes vomiting and diarrhea that come on suddenly. A very small amount of norovirus can make you sick. The number of virus particles that fit on the head of a pin is enough to infect over 1,000 people.

You can get norovirus if poop or vomit from an infected person gets into your mouth. You can get it by:

  • Caring for a person who is infected with norovirus and then touching your hands to your mouth
  • Eating food or drinking liquids that are contaminated with norovirus
  • Touching surfaces or objects with norovirus on them and then putting your hands in your mouth

Clean up the splatter!

Vomiting and diarrhea are messy, especially with norovirus. If you get sick from norovirus, drops of vomit or poop might splatter for many feet in all directions.

It’s extremely important to clean up the entire area immediately after you or someone else vomits or has diarrhea. You must be very thorough so you don’t miss any drops of vomit or poop that you can’t see.

If you find yourself in this situation, follow these steps from start to finish to protect other people from getting sick with norovirus:

Step 1 – Put on disposable plastic gloves and a face maskNorovirus spreads when a person gets poop or vomit from an infected person in their mouth.

Step 2 – Wipe up vomit and poop with paper towels and throw them away

Step 3 – Clean all surfaces thoroughly with a bleach cleaner, or make your own solution (¾ cup of bleach plus 1 gallon of water)

Step 4 – Clean all surfaces again with hot water and soap

Step 5 – Remove your gloves, throw them away, and take out the trash

Step 6 – Wash all laundry that may have vomit or poop on them with hot water and soap

Step 7 – Wash your hands with soap and water

Thorough clean up helps prevent norovirus outbreaks

Cleaning-up immediately after someone with norovirus vomits or has diarrhea protects others from getting sick, and prevents norovirus outbreaks. It’s important for everyone to know the clean-up steps and other ways to prevent norovirus.

CDC and state and local health departments help to raise awareness among healthcare providers and the general public about norovirus and how to prevent it. Learn more about how health departments, CDC, and other agencies work to prevent and stop norovirus outbreaks.

To learn more about norovirus, see CDC’s norovirus website and infographics, videos, and other resources, and state and local health department websites.

Preparing to quit: 10 tips to help you quit smoking

Broken cigarette lies on a calendar sheet. Tobacco wake. On the calendar inscription marker.

Each year, on the third Thursday of November, the American Cancer Society encourages smokers to quit during the Great American Smokeout. Most people who smoke want to quit, but they also know quitting is hard…it can take several attempts to succeed.

Here are some tips to help you quit for good:

  1.  Find Your Reason to Quit
    To get motivated, find your reason to quit. It may be to protect your family from secondhand smoke. Or to lower your chance of getting cancer, heart disease, or some other serious health condition. Find a reason that is strong enough to outweigh the urge to light up.
  2. Set a Date
    Once you’ve made the decision to quit, set a “quit date” within the next month. Most smokers have tried to quit before, and sometimes people get discouraged thinking about previous attempts. Instead, treat them as steps on the road to success. Learn from what worked and what didn’t work, and apply these the next time you try to quit.
  3. Medication can help
    Using nicotine replacement products (such as nicotine gum and nicotine patches) or FDA-approved, non-nicotine cessation medications can help reduce withdrawal symptoms and increase the likelihood that you will quit. Ask your doctor about what option is best for you.It’s more than just tossing your cigarettes out. Cigarettes contain nicotine, which is highly addictive. Nearly all smokers have some feelings of nicotine withdrawal when they try to quit. Knowing this will help you deal with withdrawal symptoms that can occur, such as bad moods and really wanting to smoke.
  4. You don’t have to quit alone
    Telling friends and family that you’re trying to quit and getting their support will help the process. Expert help is available from a number of groups. 1-800-QUIT-NOW offers free telephone support; and Smokefree.gov is an on-line resource. There’s even a quit smoking app for your phone! Check out CDC Tobacco Free on Facebook for on-line support.
  5. Be prepared for challenges
    The urge to smoke doesn’t last long – usually only 3 to 5 minutes, but those moments can feel intense. Before you quit, plan new ways to occupy your time. You can exercise to blow off steam, listen to your favorite music, connect with friends, treat yourself to a massage, or make time for a hobby. Try to avoid stressful situations during the first few weeks after you stop smoking.
  6. Clean house
    Once you’ve smoked your last cigarette, remove any triggers or things that remind you of smoking. For example, throw out all your ashtrays and lighters. Wash any clothes that smell like smoke, and clean your carpets, draperies, and upholstery. If you smoked in your car, clean it out, too. It is best not to see or smell anything that reminds you of smoking.
  7. Get moving
    Some research shows that being active can help ease some withdrawal symptoms. When you feel the urge to reach for a cigarette, get active – try a yoga class or put on your jogging shoes instead. And you can burn calories, too!
  8. Quitting can save money
    In addition to all the health benefits, one of the perks of giving up cigarettes is the money you will save. There are online calculators that can help figure out how much you will save.
  9. It’s never too late to quit
    As soon as you quit, your health can immediately start to improve. After only 20 minutes without smoking, your heart rate drops. Within 12 hours, your blood’s carbon monoxide level falls back to normal. In just two to three months, your chance of having a heart attack starts to go down. In the long run, you will also lower your chance of getting cancer and other serious diseases. While it’s best to quit smoking as early as possible, quitting at any age will improve the length and quality of your life.
  10. Try and try again
    Most people make several attempts before giving up cigarettes for good. If you slip, don’t get discouraged. Instead, think about what led to your relapse. Use it as an opportunity to step up your commitment to quitting. Think about what helped you during those previous tries and what you’ll do differently the next time. Above all, don’t give up.

Remember this good news!

More than half of all adult smokers have quit, and you can, too. Millions of people have learned to live without cigarettes. Quitting smoking is an important step you can take to protect your health and the health of your family.

Resources:

Everyone can be a flu vaccine advocate!

Little girl getting a bandaid.
Children, especially those younger than 5 years, are at higher risk for serious flu-related complications. The flu vaccine offers the best defense against getting the flu and spreading it to others.

With the holidays quickly approaching, there will be more opportunities to spend time with family and friends.  Now is the time to ensure that you and those around you are protected from flu. Now is the time to get your seasonal flu vaccine if you haven’t already gotten it. It takes about two weeks after vaccination for antibodies that protect against flu to develop in the body.—so it’s  important to get vaccinated now, before the flu begins circulating in your community.

Whether you are a doctor, school nurse, grandchild, best friend, or coworker, you can play a role in reminding and encouraging  other people to get their flu vaccine. Get your flu shot and talk to others about the importance of everyone 6 months and older getting a flu shot every year.

Talking to Friends and Family about Flu ShotsGet yourself and your family vaccinated.

Need some tips for talking about the importance of flu vaccine? CDC is a great source of information about the serious risk of flu illness and the benefits of flu vaccination, as well as information to correct myths about the flu vaccine. Below are several examples of the benefits of flu shots and corrections of common flu myths. Find out more about the benefits of getting your annual flu vaccine on CDC’s Vaccine Benefits webpage, here.

  • Flu can be a serious illness, even for otherwise healthy children and adults. While most people will recover from flu without complications, anyone can experience severe illness, hospitalization, or death. Therefore, getting vaccinated is a safer choice than risking serious illness for yourself or those around you.
  • The flu vaccine CANNOT give you the flu. Flu shots do NOT contain flu viruses that could infect you and cause flu illness. Flu shots either contain flu vaccines viruses that have been “inactivated” (or killed) and therefore are not infectious, or they do not contain any flu vaccine viruses at all (recombinant influenza vaccine).
  • Flu vaccination can keep you from getting sick with flu. Flu vaccines can reduce your risk of illness, hospitalization.
  • Getting vaccinated yourself may also help protect people around you, including those who are more vulnerable to serious flu illness, like babies and children, older people, and people with certain chronic health conditions.

Making a Flu Vaccine Recommendation to Your Patients

Woman talking to her doctor
Talking to patients about vaccines can be difficult. CDC has resources to help you make a strong flu vaccine recommendation.

For health care providers, CDC suggests using the SHARE method to make a strong vaccine recommendation and to provide important information to help patients make informed decisions about vaccinations. Remind patients that it is not too late for them to get vaccinated, and follow the SHARE strategies below:

  • S- SHARE the reasons why the influenza vaccine is right for the patient given his or her age, health status, lifestyle, occupation, or other risk factors.
  • H- HIGHLIGHT positive experiences with influenza vaccines (personal or in your practice), as appropriate, to reinforce the benefits and strengthen confidence in flu vaccination.
  • A- ADDRESS patient questions and any concerns about the influenza vaccine, including side effects, safety, and vaccine effectiveness in plain and understandable language.
  • R- REMIND patients that influenza vaccines protect them and their loves ones from serious flu illness and flu-related complications.
  • E- EXPLAIN the potential costs of getting the flu, including serious health effects, time lost (such as missing work or family obligations), and financial costs.

Be an advocate for flu vaccination. Get your flu vaccine and remind those around you to do the same! Visit www.cdc.gov/flu for more information and tips on flu vaccination and prevention.

Interested in learning more about flu? Check out other CDC Flu Blog-a-thon post throughout the week for personal stories, advice, and tips on flu and flu prevention. You can see all the participating blogs here: https://www.cdc.gov/flu/toolkit/blog-a-thon.htm.

Loving Someone With Epilepsy

MRI brain scan

When Zayan first told me that he has epilepsy, I didn’t believe him.  “You mean seizures, right?”  I was embarrassed at how much I didn’t know.

Epilepsy is a disorder of the brain that triggers recurrent seizures. It can be caused by different conditions that affect a person’s brain. A person is diagnosed with epilepsy when they have had two or more seizures that are not caused by another medical condition such as a high fever or low blood sugar.

Zayan was thirteen years old when he had his first seizure in his school computer lab in Dhaka, Bangladesh. “The moments leading up to my seizure are hazy, but when I woke up in the hospital, my mind was wiped clean.  I didn’t recognize my own father, whose tear-strewn face was fixated on mine.  I couldn’t even remember how to talk.”

Photo of Zayan Shamayeen
Zayan Shamayeen, 22, encourages others to not let an illness prevent them from reaching their full potential. Photo credit: Dear World

Following the incident, Zayan took a long break from school to seek medical care.  He was diagnosed with idiopathic epilepsy, which is caused by an unknown factor that may be genetic. Epilepsy can be caused by different conditions, including stroke, brain tumor, brain infection, or traumatic brain injury. Zayan is one of the 60% of people where the cause of epilepsy is unknown.

Caring for someone during a seizure

As my friendship with Zayan grew, I became passionate about understanding how epilepsy impacted his daily life. One morning I witnessed a seizure suddenly take over his body and it was one of the most frightening moments we shared together. That experience made learning seizure first aid a priority for me so that I could take care of Zayan if and when he had another seizure.

If you know someone living with epilepsy, you might have to care for them during or after a seizure. The goal of seizure first aid is to keep the person safe until the seizure stops on its own. Stay with the person until the seizure ends and he or she is fully awake. After it ends, help the person sit in a safe place. Once they are alert and able to communicate, tell them what happened in very simple terms. Comfort the person and speak calmly.

You can take action to help someone during a seizure:

  • Ease the person to the floor.
  • Turn the person gently onto one side.  Loosen ties or anything around the neck that may make it hard to breathe.
  • Clear the area around the person of anything hard or sharp to prevent injury.
  • Put something soft and flat, like a folded jacket, under his or her head.
  • Remove eyeglasses.
  • Time the seizure.
  • Check to see if the person is wearing a medical bracelet or other emergency information.
  • Keep yourself and other people calm.

    In 2015, 1.2% of the U.S. population had, active epilepsy. This is about 3.4 million people with epilepsy nationwide: 3 million adults and 470,000 children.
    Data Source: National and State Estimates of the Numbers of Adults and Children with Active Epilepsy — United States, 2015, Morbidity and Mortality Weekly Report

Call 911 if…

  • The person has never had a seizure before.
  • The person has difficulty breathing or waking after the seizure.
  • The seizure lasts longer than 5 minutes.
  • The person has another seizure soon after the first one.
  • The person is hurt during the seizure.
  • The seizure happens in water.
  • The person has a health condition like diabetes, heart disease, or is pregnant.

Knowing what NOT to do is also very important for keeping a person safe during or after a seizure. Never do any of the following things:

  • Do not hold the person down or try to stop his or her movements.
  • Do not put anything in the person’s mouth. This can injure teeth or the jaw. A person having a seizure cannot swallow his or her tongue.
  • Do not try to give mouth-to-mouth breaths (like CPR). People usually start breathing again on their own after a seizure.
  • Do not offer the person water or food until he or she is fully alert.

Supporting someone with epilepsy

Zayan and Eshita in Chatanooga, Tennessee
Zayan and me enjoying our visit to Chattanooga, Tennessee

After his first seizure, Zayan struggled to understand how epilepsy would affect his life – Can I still play soccer?  Will my friends still like me? Will my friends and family look down on me or look at me differently?  Will the cost of my medicines be a burden to my family?  Will I be a burden to my family?

The first medicine Zayan was prescribed helped his seizures, but caused a lot of side effects, including rapid weight gain. After finding a medicine that worked for him, Zayan spent years learning to overcome the medicine’s effect on his mood and relationships. He is grateful for the support he received and that those close to him were able to come to terms with his condition.

With the support of his family and friends, Zayan has learned to keep his seizures in check and lead a normal life.  Today he has aspirations to become a pharmaceutical researcher who finds effective treatment methods for coping with epilepsy.

Resources for family, friends, and caregivers

If you have a loved one with epilepsy you can:

  • Learn about epilepsy.
  • Learn seizure first aid.
  • Listen. Sometimes this is the best form of support.
  • Ask what you can do to help.

People who take care of someone with epilepsy should learn everything they can about the disorder, and the specific type of seizures their loved one has.  Caregivers can work with their loved one’s healthcare provider to learn about treatment options, manage medicine side effects, and address other medical conditions the person may have. Caregivers may also benefit from connecting to others in their community who also deal with epilepsy.

Learn more

Preparing Your Medicine Cabinet for an Emergency: A Checklist

Closeup view of an eighty year old senior woman's hands as she sorts her prescription medicine.

If you read our blog on a regular basis you can probably recite the mantra “Make a kit. Have a plan. Be informed.” in your sleep. You are probably familiar with the important items you should keep in your emergency kit – water, food, a flashlight, and a battery-powered radio. What you may not think about is personalizing your kit for your unique medical needs or the needs of your family. Particularly, including prescription medications and other medical supplies in your emergency kit and plans.

As a pharmacist whose job is focused on emergency preparedness and response, I want to give you 10 pointers about how to prepare your medications for an emergency so you can decrease the risk of a life-threatening situation.infographic illustrating an emergency kit.

  1. Make a list. Keep a list of all your medications and the dosages in your emergency kit. Make sure you have the phone numbers for your doctors and pharmacies.
  2. Have your card. Keep your health insurance or prescription drug card with you at all times so your pharmacy benefits provider or health insurance plan can help you replace any medication that was lost or damaged in a disaster.
  3. Keep a record. Make copies of your current prescriptions and keep them in your emergency kit and/or go bag. You can also scan and email yourself copies, or save them in the cloud. If you can’t reach your regular doctor or your usual pharmacy is not open, this written proof of your prescriptions make it much easier for another doctor to write you a refill.
  4. Start a stockpile. During and after a disaster you may not be able to get your prescriptions refilled. Make sure you have at least 7 – 10 days of your medications and other medical supplies. Refill your prescription as soon as you are able so you can set aside a few extra days’ worth in your emergency kit to get you through a disaster.
  5. Storage matters. Keep your medications in labeled, child-proof containers in a secure place that does not experience extreme temperature changes or humidity. Don’t forget to also include nonprescription medications you might need, including pain relievers, cold or allergy medications, and antacids.
  6. Rotate the date. Don’t let the medications in your emergency supply kit expire. Check the dates at least twice every year.
  7. Prioritize critical medicines. Certain medications are more important to your health and safety than others. Prioritize your medications, and make sure you plan to have the critical medications available during an emergency.
  8. Communicate a plan. Talk to your doctor about what you should do in case you run out of a medication during an emergency. If you have a child who takes a prescription medication, talk to their daycare provider or school about a plan in case of an emergency.
  9. Plan ahead. Make sure you know the shelf life and optimal storage temperature for your prescriptions, because some medications and supplies cannot be safely stored for long periods of time at room temperature. If you take a medication that needs to be refrigerated or requires electronic equipment plan ahead for temporary storage and administration in an emergency situation.
  10. Check before using. Before using the medication in your emergency kit, check to make sure the look or smell hasn’t changed. If you are unsure about its safety, contact a pharmacist or healthcare provider before using.

Resources

Sickle Cell Disease: Data Saves Lives

Woman receiving care at the new sickle cell clinic in the Martin Luther King, Jr. Outpatient Center in Los Angeles, California.

“One minute I’d be fine, the next minute I’d be in pain. It would just come out of nowhere,” says Tywan Willis. “I would have pain in my lower back, my shoulders, and sometimes in my legs. I can’t describe it. I just know it’s a really bad pain that I get.”

Tywan has sickle cell disease (SCD), an inherited blood disease that can run in families and causes abnormal, sickle-shaped red blood cells. Pain is the most common complication of SCD, and the top reason people with SCD go to the emergency room or hospital.What is sickle cell disease? Healthy red blood cells are round and move through small blood vessels to carry oxygen to all parts of the body. With sickle cell disease (SCD), red blood cells become hard and sticky and look like a C-shaped farm tool called a “sickle.” These cells can block blood flow and keep oxygen from getting to the body’s tissues and organs.

Tywan is a regular patient at a new sickle cell clinic within the Martin Luther King, Jr. (MLK) Outpatient Center in Los Angeles (LA). The Sickle Cell Data Collection (SCDC) program in California, which is funded through the CDC Foundation,* and has been collecting information to monitor the long-term trends in diagnosis, treatment, and access to health care for people with SCD since 2010, provided data that highlighted the strong need for comprehensive care for adults with SCD in LA County.  These data, together with the determination and hard work of many partners, lead to the establishment of the clinic in order to address those needs.

Identifying a Community Need

The SCDC program found that 1 in every 2 adults with SCD in California (about 1500 people) live in LA County. In October 2015, a team of SCD experts used these data to inform LA County’s Department of Health Services about the urgent needs of the SCD community. The data showed no places in the county where adults with SCD could receive quality, comprehensive, and coordinated care. The emergency department was the only option for the many patients who did not have access to doctors who understood the complexities of SCD.

Data on patients with SCD in LA County were mapped by ZIP code. The map showed that most patients with SCD in the county lived within five miles of the MLK Outpatient Center. This new information presented an opportunity to create a clinic that focused on the needs of people with SCD within a medically underserved area.

Providing Comprehensive Care

“The color coded map by ZIP code was the most powerful data. You could easily see at a glance that there was an intensity of adults with SCD living in the MLK geographic region,” said Ellen Rothman, Chief Medical Officer of the MLK Outpatient Center.
“The color coded map by ZIP code was the most powerful data. You could easily see at a glance that there was an intensity of adults with SCD living in the MLK geographic region,” said Ellen Rothman, Chief Medical Officer of the MLK Outpatient Center.

The SCD clinic at the MLK Outpatient Center opened in August 2016, only 10 months after sharing the data from the SCDC program with LA County health officials. The clinic provides comprehensive care to patients with SCD, whom often have other health problems in addition to those related to SCD.

During each visit, clinic patients see both a hematologist (a doctor who specializes in blood disorders) and a primary care provider. The hematologist focuses on SCD-specific needs, helping to reduce health issues and prevent early death. The primary care provider manages health problems unrelated to SCD, such as diabetes and high blood pressure. “We complement each other,” says Susan Claster, the clinic’s hematologist. “Having the primary care provider sitting with me, we cover 90% of what the patient needs and it’s very efficient.”

This combination of expertise effectively addresses the complex health needs of patients with SCD.

The clinic provides access to complementary health services, such as acupuncture, yoga, and exercise classes. Behavioral therapists are available to help with mental health issues related to SCD, such as anxiety and depression. In addition, Patient Navigators guide patients through the clinic process and make their experience as stress-free as possible.

“Since I’ve been going to this clinic, I’ve learned a lot of new things that I didn’t know about sickle cell. They have taught me what to do when I’m in pain and how to treat it. It really works. They’re really good with their patients,” says Tywan. “When I walk in the clinic, they say ‘Hi, Tywan!’ They love me,” he adds with a laugh.

In June 2017, the SCD clinic at the MLK Outpatient Center received the national 100 Brilliant Ideas at Work Award from the National Association of Counties for their new approach to closing the healthcare gap for adults with SCD in South LA.

Tywan is just 1 of about 100,000 people in the United States who have SCD and many of them do not have access to adequate care. The SCD clinic at the MLK Outpatient Center is one example of how public health data and the combined actions of stakeholders can serve the needs of a community and improve the lives of people living with SCD.

The SCDC program is made possible by the CDC Foundation’s partnership with CDC’s Division of Blood Disorders, the California Rare Disease Surveillance Program, the Georgia Health Policy Center, the Association of University Centers on Disability, Pfizer Inc., Bioverativ, and Global Blood Therapeutics.

Learn More

The Power of Us

Evacuteer checking someone in during 2017 full-scale city assisted evacuation exercise.

“I am a Katrina survivor.” These were the first words out of Joan Ellen’s mouth when I spoke with her. And she was one of the lucky ones. She made it out of New Orleans before Hurricane Katrina made landfall on August 29, 2005. But not everyone was so fortunate. One of Joan Ellen’s neighbors did not evacuate because she could not bring her old dog with her to a shelter and would not leave him behind. Her neighbor died in the flooding. Joan Ellen recalls, “If I had known I would have taken her with me.”

Evacuations are more common than you might think. Every year people across the United States are asked to evacuate their homes due to fires, floods, and hurricanes. However, there are many reasons people may not be able to evacuate– including issues that New Orleans’ residents face, like lack of transportation, financial need, homelessness, and medical or mobility issues.

No one left behindJoan Ellen returned to her home in New Orleans 48 days after Hurricane Katrina. She likes to tell people, “I only had a foot of water – but it was a foot over my roof.” The thing she remembers most vividly about going home was not the destruction, but the smell. When Joan Ellen heard a radio announcement that they were recruiting volunteers to help in a mandatory evacuation she signed up. She has been training other Evacuteers since she joined the organization in 2009. She loves the casual definition of family that keeps people together in the event of an evacuation. “Family is anybody we say is family, and we will keep everybody together. In New Orleans we are only two degrees of separation.”

According to FEMA’s Preparedness in America report, people in highly populated areas were more likely to rely on public transportation to evacuate in the event of a disaster. In the event of a mandatory evacuation, approximately 40,000 people living in New Orleans will need assistance to evacuate because they don’t have a safe or alternative option.

After learning from Hurricane Katrina, the City of New Orleans will now call a mandatory evacuation nearly three days in advance of a dangerous or severe storm making landfall on the Louisiana coast. Everyone must leave during a mandatory evacuation until officials declare the city safe for re-entry.

Mobilizing the Evacuteers

The City also started City Assisted Evacuation (CAE) to help people who are unable to evacuate on their own. Through this program, the city provides free transportation for residents, along with their pets, to a safe shelter. CAE counts on volunteers from Evacuteer.org, a local non-profit organization that recruits, trains, and manages 500 evacuation volunteers called “Evacuteers” in New Orleans. As the Executive Director of this organization I tell people, “We are a year-round public health preparedness agency that promotes outreach to members of the community that aren’t always easy to reach, nor trusting of government, about their options and the evacuation process. The goal is to make sure that everyone using CAE is treated with dignity throughout the entire process.”

Lit evacuspot in Arthur Center
Evacuspot outside of Arthur Monday Multipurpose Center

Evacuteers receive a text message if the City of New Orleans calls for a mandatory evacuation. Teams are assigned to seventeen pickup points, called Evacuspots, placed in neighborhoods around the city. The Evacuteers help register people and provide information about the evacuation process. When residents go to an Evacuspot, Evacuteers will give every person a ticket, a wristband, and a luggage tag to help track their information and ensure that families stay together. After the paperwork is filled out, evacuees are transported to the downtown Union Passenger Terminal bus station where they will board a bus, and for a smaller percentage, a plane, to a state or regional shelter. When the city is re-opened after the storm passes, the process will bring residents back home to New Orleans.

An artistic approach to save lives

Each Evacuspot is marked by a statue of a stick figure with his arm in the air, and looks as though he is hailing a safe ride out of the city. Erected by international public artist, Douglas Kornfeld, the statues are a public art initiative led, and fundraised, by Evacuteer.org. Installed at each of the pick-up points in 2013, the stainless steel statues measure 14-feet tall, and stand as a reminder to residents year-round that there is a process to ensure everyone has the opportunity to safely evacuate.

Do you know what to do?

  1. Have a plan. Know where your family will meet, both within and outside of your neighborhood, before a disaster.
  2. Fill ‘er up. Make sure you have a half a tank of gas at all times in case of an unexpected evacuation. If an evacuation seems likely, make sure your tank is full.
  3. Keep your options open. Have alternative routes and other means of transportation out of your area. Choose several destinations in different directions you can go to evacuate.
  4. Leave early. Plan to take one car per family to reduce congestion and delay.
  5. Stay alert. Do NOT drive into flooded areas. Roads and bridges may be washed out and be careful of downed power lines.

Learn more

Read our other National Preparedness Month blogs:

Preparedness and Response in Action: Stories from the States

Celebrating 15 Years of PHEP

CDC’s Public Health Emergency Preparedness (PHEP) cooperative agreement is a critical source of funding, guidance, and technical assistance for state, local, tribal, and territorial public health departments to strengthen their public health preparedness capabilities.  Since 9/11, the PHEP program has saved lives by building and maintaining a nationwide public health emergency management system that enables communities to rapidly respond to public health threats.

The following stories are examples of how PHEP has equipped states for each of the four stages of preparedness: Ready. Steady. Show. Go!

READY: Planning for the inevitable6 domains of preparedness

Often the emergency managers and public health professionals who respond to an emergency are personally impacted by the same event. The ability of emergency response staff to take action during a disaster is limited when they are stranded in their homes due to an ice storm, without power, or unable to make it into the office.

The Connecticut State Department of Health, led by Jonathan Best, took on the challenge to ensure that operations can run smoothly even when their own staff are directly impacted by an emergency. They developed the Red Sheet Program, which trains three people for every key position in the emergency management structure – a primary contact with two back-ups. This means the health department can be fully staffed and ready to respond to a crisis within 20 minutes.

STEADY: Solving two problems at once

As the saying goes, even the best laid plans often go awry. Planning is an essential part of any preparedness program, but it is often difficult to imagine every scenario and obstacle that may arise during an emergency. But we also know that practice is the best way to identify and address those gaps– and practice is exactly what the Oklahoma State Department of Health does to improve its preparedness programs.

In September 2016, the Oklahoma Strategic National Stockpile team prepared to conduct a full-scale exercise of its ability to distribute medical countermeasures – medications and other products used to prevent and treat health conditions that may arise during a public health emergency.  Before the exercise began, the state realized they had shipments of flu vaccines that they needed to distribute around the state and the team distributed the vaccines as part of their regularly scheduled exercise. The team transported 11,960 doses of vaccine to eight local health departments while simultaneously completing this practice exercise.

SHOW: Creating a culture of preparedness

Emergencies impact all sectors of health, and experts from across departments are often asked to weigh in, from epidemiologists, to laboratorians, to mental health experts. However, public health staff in these positions may not often consider their roles in an emergency situation.

To build a culture of preparedness across the entire Oregon Health Authority, the Emergency Operations Division provided all staff with a 72-hour emergency kit, worked to enroll staff in the Health Alert Network, and trained staff on the Incident Management System. Since this initiative, staff personally feel more prepared for an emergency, and more staff are now prepared to respond should the need arise. “The culture has shifted. People are now talking in the elevator about what they would do in the event of a large-scale disaster,” acting PHEP director Akiko Saito said. “If we can build this culture of preparedness here, then we’re better equipped to build community resiliency on a larger scale.”

GO! Putting plans into action

While we all hope that emergencies never occur, they are inevitable and the true test of any preparedness system. Washington experienced an outbreak of mumps that affected more than 800 people of all ages in late 2016 and early 2017.

During this outbreak, the state and local health departments in Washington investigated new cases, advised local school districts on prevention measures, and developed culturally appropriate risk communication materials. Due to a robust preparedness system and the efforts of the health department staff and partners, more than 5,000 more people were vaccinated for measles, mumps, and rubella compared to previous years.

For 15 years, PHEP has been there, from Katrina to SARS; Joplin to H1N1 influenza. To find out more about how the PHEP program has equipped jurisdictions to prepare for, respond to, and recover from public health emergencies, check out our Stories from Field.

Read our other National Preparedness Month blogs:

Preparing for the Worst-case Scenario

"ROTTERDAM, HOLLAND - SEPTEMBER 5, 2010: Demonstration of handling of car crash victim by medics at the annual World Harbor Days in Rotterdam, Holland on September 5"
New York City completed a functional exercise to help the city’s hospital system prepare for emergency medical personnel to treat and transport children, like this young girl, after a catastrophic event.

Setting the Stage

Celia Quinn
Celia Quinn, MD, MPH CDC Career Epidemiology Field Officer assigned to NYC Department of Health and Mental Hygiene

Imagine this: Explosions across New York City target elementary schools. Hundreds of severely injured and traumatized children, teachers, and parents flood hospital emergency departments in the five boroughs. Municipal emergency medical services (EMS) are rushing to respond.

Fortunately this scenario wasn’t really happening – it was part of an exercise conducted on May 25, 2017. The exercise was designed to test the ability of the New York City (NYC) Healthcare System to respond to a massive surge of pediatric trauma patients, exceeding the usual resources of this large and complex healthcare system.

Identifying the Players

As a CDC Career Epidemiology Field Officer assigned to NYC, I worked with the experts in the Pediatric Disaster Coalition and the Fire Department of New York (FDNY). We designed an exercise that reflected the number of injured children who would need to go to the hospital and the type of injuries they might experience if a similar event really happened.

NYC has 62 acute care hospitals that participate in the 911 system. Of these, 16 are level 1 trauma centers designated by the NYC Department of Health  (this includes three pediatric level 1 trauma centers and 4 burn centers). A total of 28 hospitals care for pediatric patients and have, during the past seven years with the assistance of the NYC Pediatric Disaster Coalition, developed pediatric-specific components of their overall disaster plans to prepare them to receive pediatric patients from an incident like the one invented for this exercise. All 28 hospitals participated in the exercise.

Coordinating Resources

Hospitals who participated in the exercise were challenged to rapidly respond to more than 60 simulated patients with a range of injuries and conditions:

  • a 7-year-old boy unresponsive after a traumatic injury to his head

    Hospital nursing leadership reports on the status of nursing staff, while the hospital’s Public Information Officer looks on.
    Hospital nursing leadership reports on the status of nursing staff, while the hospital’s Public Information Officer looks on.
  • A toddler with burns to the face, chest, and abdomen
  • A 12-year-old distraught after witnessing another child lose arms in an explosion

Hospitals had to assess the resources that were available to care for the patients, including

  • What nursing and specialty staff could be made immediately available?
  • What medications and equipment, including imaging equipment and burn supplies, were needed to care for the children?
  • What communications and incident command processes would each hospital use to mobilize staff and other resources in the situation described in the exercise?
  • Which patients needed to be transferred to specialty hospitals to receive care for their injuries?

Coordination between FDNY and hospitals was critical to the success of this exercise – it supported interfacility transfers for patients who required specialty care or to better match hospital resources with patient needs. During the exercise, I met with FDNY leadership from EMS and Office of Medical Affairs physicians, and leaders from NYC Emergency Management and the Health Department at the Fire Department’s Operations Center. There, we tested the communications between hospitals, FDNY, and a volunteer pediatric intensive care physician who was trained to assist FDNY’s Office of Medical Affairs to prioritize patients for urgent interfacility transfers.

Measuring Success

Hospital Incident Command leadership discusses the availability of resources to make more pediatric beds available.
Hospital Incident Command leadership discusses the availability of resources to make more pediatric beds available.

This exercise revealed that 28 NYC hospitals were able to rapidly and dramatically increase their pediatric critical care capacity. It was the largest exercise NYC has done that was focused primarily on caring for injured children. During the exercise, these hospitals:

  • More than doubled the number of beds in pediatric intensive care units (PICUs) and added 1,105 pediatric inpatient beds, so children could stay in the hospital for an extended period of time
  • Opened 203 operating rooms that could treat children who needed surgery

During the exercise, we also identified some challenges, including

  • More than half of the hospitals did not have enough supplies that could be used to treat critically injured children
  • A limited number of pediatric specialists, including doctors who could perform brain surgery on children as well as ear, nose, and throat specialists
  • Hospital resources (beds, supplies, and staff) would have been further strained if the disaster scenario had also included large numbers of adults

We were able to identify ways to improve each hospital’s process and further develop our citywide plans to respond to any emergency that strains our healthcare system. As a pediatrician and a parent of two young New Yorkers, I’m grateful that so many dedicated people are working together to make sure that city and hospital plans account for the unique needs of children in disasters.

The NYC Department of Health and Mental Hygiene receives federal funds used to support state and local public health and healthcare system preparedness through the aligned Hospital Preparedness Program (HPP) – Public Health Emergency Preparedness (PHEP) cooperative agreement. NYC used HPP funds to fund the NYC Pediatric Disaster Coalition to design and conduct the exercise, and coordinate participation of hospitals in the exercise.

Read our other National Preparedness Month blogs: