How Do Health Professionals Protect Patients After Extreme Events like Hurricane Harvey and Maria?

Scientists agree that global climate change is increasing the frequency and severity of extreme weather events. In just the past month, our country witnessed the immense destruction of Hurricanes Harvey, Irma, and Maria, and we have observed the complex public health crises that followed. It is now more important than ever for health professionals to understand the potential health implications from climate change and extreme storms in order to provide the best care to those impacted. In this guest blog, Dr. Carl Baum discusses resources available through the Pediatric Environmental Health Specialty Unit (PEHSU) that health professionals can use to prepare and protect their patients and clients following extreme weather events. The Center for Climate Change and Health extends its sincere gratitude to Dr. Baum and his team at PEHSU for these important resources.

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A 35-year-old mother brings her 2-year-old to their pediatric nurse practitioner with concerns about the health effects of flooding in the aftermath of Hurricane Irma. The mother, who is currently pregnant, has just moved with her husband and toddler back to their home in Florida, which has had extensive flood damage. The waters have receded, but they are still dependent on generator power.

This fictitious but imaginable scenario illustrates a number of issues that families may face in the wake of flooding or other natural disasters. But many healthcare providers may feel insecure about their training and experience in environmental health, and search for authoritative resources to answer questions posed by the families of their patients.

Fortunately, the Pediatric Environmental Health Specialty Unit (PEHSU) Program can provide answers. Established in 1998 and federally funded by the Agency for Toxic Substances and Disease Registry (ATSDR) and the Environmental Protection Agency (EPA), the PEHSU Program is intended for healthcare providers and members of the public, and maintains a network for education, consultation, and referral to experts in pediatric and reproductive environmental health, available on the PEHSU website. Two national organizations share the management of the PEHSU Program: the American College of Medical Toxicology, and the American Academy of Pediatrics.

So how would the nurse practitioner answer these questions? The PEHSU Program, which funds teams based in each of the 10 federal regions around the US, has developed webinars, electronic learning modules, and fact sheets about a variety of environmental health problems that are commonly encountered. In the above scenario, for example, a top priority would be to confirm with the mother that the generator is set up outdoors, and is positioned properly to prevent accumulation of potentially lethal carbon monoxide (CO) exhaust inside the garage or the home itself. Does anyone in the family complain of headaches, malaise, or vague gastrointestinal symptoms that might suggest CO poisoning? Portable generators may not be capable of powering every circuit in the home, and a UL-approved CO detector should be installed on a working outlet if not battery-powered.

The nurse practitioner would also want to ask about the family’s water supply—whether from a private well or a public system—and whether that supply has been deemed safe by local health agencies. If not yet safe, is the family following recommendations to boil water or use bottled water? Similarly, discussions about food safety are important if flood waters contaminated food and utensils, or if any spoilage occurred during the power outage. Flood waters may have damaged the home, promoting mold growth and mosquito breeding. Although mold is not an immediate threat to those with intact immune systems, removal of damaged drywall, furniture, clothing, and toys may be necessary. The mother should be reminded that children and pregnant women should not participate in cleaning or removal of damaged items, and that anyone who does so should have personal protective equipment. Mosquito control begins with elimination of standing water, and repellants should be used carefully, according to directions.

More information about hurricane and flooding resources is available here.