Preserving Health in the Face of Disaster

by Samantha Stainburn

Planning for Disasters

Kenneth C. Rondello, M.D., M.P.H., the academic director of Adelphi’s emergency management program and an assistant professor in the College of Nursing and Public Health, knows that responding to disasters is an unpredictable business.

Dr. Rondello is always on call as a member of one of the federal government’s Disaster Medical Assistance Teams (DMAT), groups of 35 physicians, nurses and support personnel who are flown to regions of the country that are overwhelmed by disaster. DMATs, which can operate for 72 hours without support, provide primary and acute care and triage of mass casualties until local medical workers regain control of the situation. Dr. Rondello was deployed with his team to help after Hurricanes Gustav, Hanna and Ike in 2008 and a record-breaking flood in Tennessee in 2010. (Dr. Rondello’s team was not activated to respond to Sandy, since the storm occurred in its home region.)

“Disasters require you to adapt on the fly; it’s never routine,” he says. For nurses in a hospital, that might mean going to a different area of the building and doing work they don’t usually do. For emergency responders, that could mean transforming a gutted store into a temporary hospital, as Dr. Rondello’s team did in Texas after Hurricane Gustav.

But planning for disasters is still essential, he says. Dr. Rondello’s research interests include disaster epidemiology (using epidemiologic methods to assess the adverse health effects of disasters and predict consequences of future disasters), alternate medical treatment sites and distribution points, and epidemic and pandemic planning and response. To mitigate the consequences of any disaster, he says, it helps to map out the likely scenarios of different types of disasters and identify the people, property and environments that are most at risk in each scenario. “You can’t foretell all possibilities,” he says, “but for those you do identify, you need to be specific enough that you can plan for concrete action.”

Caring For Our Most Vulnerable Citizens

Who can forget the stories of elderly people trapped on high floors of low-income buildings, unable to walk down flights of stairs to get the food, water and medication they needed following Sandy? It’s no coincidence that some of the most heart-wrenching tales of despair after the storm featured the elderly as well as the chronically ill, children, pregnant women and ethnic minorities, according to Joan Valas, R.N., Ph.D., chair of graduate studies and an associate professor at the College of Nursing and Public Health. “Things happen more extensively to vulnerable populations because they don’t have the ability to prepare, and they don’t have the social network [to help them],” she says.

Much of Dr. Valas’ scholarly research focuses on care for vulnerable and diverse populations during and after disasters. Her work indicates that one way to mitigate the suffering of vulnerable people during disasters is to provide better services for them during normal times.

Disasters expose ongoing suffering that’s usually hidden from view during calmer periods, she notes. “A disaster is a setting where vulnerabilities become very prominent,” she says. “Things that never get talked about, things that live in the shadows and are not discussed, all are on the front page of The New York Times and CNN after a disaster.”

Dr. Valas has certainly seen her fair share of disasters. As the emergency management director of Park Ridge, New Jersey, the town in which she lives, she has coordinated her community’s disaster response during five federally declared emergencies in the past six years, including Sandy, Hurricane Irene and several major snowstorms. She also treated injured people and patients with chronic illnesses in Mississippi and Louisiana after Hurricanes Katrina and Rita in 2005 as a volunteer supervisory nurse specialist/nurse practitioner with a DMAT.

While in the Gulf, she traveled with an armed guard after being attacked by a man desperate for the medical team’s drugs and visiting a neighborhood where a resident was shooting at strangers. “When you go into a disaster area like this, you’ve got to understand the amount of stress the people are under who’ve lost their homes,” she says. “You can’t imagine what it does to people inside when they’ve lost everything.”

Public Health in a Changing Climate

Sandy was a devastating storm but ultimately not an unusual one, says Philip Alcabes, Ph.D., director of public health programs and a professor in the College of Nursing and Public Health. “That we face a new normal is suddenly self-evident,” he says. “Extreme weather is no longer unlikely, the once-in-a-blue-moon kind of thing, no longer extreme. The new environment portends big changes for the nation, of course, and especially for Long Island.”

Dr. Alcabes studies history, policy and ethics in public health, and believes that government officials and medical experts now need to consider climate change when designing public health systems. “If extreme weather threatens the energy supply, hospitals might run on generators, but what will happen to the increasing numbers of people with chronic conditions who are under treatment in their own homes—the so-called patient-centered medical home, advocated by family physicians and home healthcare, increasingly offered to older Americans?” Dr. Alcabes asks. “What will become of patients who are no longer in need of acute medical care but are marooned in medical centers because their homes— or entire neighborhoods—are uninhabitable?”

Global warming also creates two new tasks for academics, he says. The first is investigating how changing ecosystems, agriculture and transportation might impact human health. “How will specific alterations in the balance of potentially harmful and potentially helpful microbes translate into health and illness?” he says. “How will altered food supplies change our nutritional fortitude and thus our defenses against illness?”

The second task is training health professionals for a new era. “Sandy revealed that if we continue to devote resources to managing emergencies but fail to think more comprehensively about persistent community management problems, more people will suffer without heat or light or elevators or running water, and their misery will go on longer,” Dr. Alcabes says.

“Public health is not just about providing services to the vulnerable in the moment when they’re vulnerable,” he adds. “It’s about changing the social structures and having more responsible government officials so that people aren’t suffering all the time, and the people who are suffering most don’t end up suffering even more when there’s a disaster.”

How best to prepare students for a health career in a world where the environment is changing? Dr. Alcabes is working on one idea. He and colleagues in the environmental studies department at Adelphi are looking at developing an environmental health concentration within the Master’s of Public Health program.

This piece appeared in the Erudition 2013 edition.