This pilot study aimed to assess the community needs and population health status for the low-income town of Punta Santiago, situated on the southeastern coast of Puerto Rico at the point where Hurricane Maria made landfall on September 20, 2017.

A cross-sectional, interviewer-administered survey was conducted 6 months after the storm with a representative random sample of 74 households. The survey characterized population demographics and resident needs in relation to storm damage and disruption. The survey also assessed prevalence and symptom severity of major depression, generalized anxiety, and posttraumatic stress disorder.

Most of Punta Santiago was without electrical power and more than half of households sustained severe damage. Residents reported loss of jobs, decreased productivity, school closures, dependency on aid for basic necessities, increased risk for vector-borne diseases, unrelenting exposure to heat and humidity, and diminished health status. Two-thirds (66.2%) of the respondents had clinically significant symptom elevations for at least 1 of the 3 common mental disorders assessed: major depression, generalized anxiety, or posttraumatic stress disorder.

Pilot survey results, along with other studies conducted in Punta Santiago, can be used to provide guidance for interventions with this community as well as with other low-income, storm-affected areas. (Disaster Med Public Health Preparedness. 2019;13:18–23)

The aim of this study was to compare the effect of Hurricane Maria on internalizing and posttraumatic stress disorders (PTSD) among Puerto Ricans who moved to Florida after the storm versus those who stayed on the island.

In March through April 2018 (6 months after Hurricane Maria), an online survey was used to assess the effects of the storm on mental health. A sample of 213 displaced Puerto Ricans living in urban and rural/suburban areas in Florida, as well as urban and rural areas of Puerto Rico, participated in the study.

Rates of PTSD were high in both sites (Florida, 65.7%; Puerto Rico, 43.6%); however, participants in Florida were far more likely than those in Puerto Rico to meet diagnostic criteria for PTSD (OR, 2.94; 95% CI, 1.67-5.26). Among participants in both Florida and Puerto Rico, those living in urban areas were more likely than those in rural/suburban areas to meet criteria for PTSD and generalized anxiety disorder.

Results suggest that post-Hurricane Maria adjustment and adaptation may have been more psychologically taxing for Puerto Ricans who moved to Florida than it was for those who remained on the island, and more difficult for those in urban areas than it was for those in suburban or rural areas. (Disaster Med Public Health Preparedness. 2019;13:24–27)

Investigate short- and long-term effects of Superstorm Sandy on multiple morbidities among the elderly.

We examined emergency department visits; outpatient visits; and hospital admissions for cardiovascular disease (CVD), respiratory disease, and injury among residents residing in 8 affected counties immediately, 4 months, and 12 months following Superstorm Sandy. Control groups were defined as visits/admissions during the identical time window in the 5 years before (2007-2011) and 1 year after (2013-2014) the storm in affected and nonaffected counties in New York. We performed Poisson regression to test whether there was an association of increased visits/admissions for periods following Superstorm Sandy while controlling for covariates.

We found that the risk for CVD, respiratory disease, and injury visits/admissions was more than twice as high immediately, 4 months, and 12 months after the storm than it was in the control periods. Women were at greater risk at all time periods for CVD (risk ratio [RR], 2.04) and respiratory disease (RRs: 1.89 to 1.92). Whites had higher risk for CVD, respiratory disease, and injury than other racial groups during each period.

We observed increases in CVD, respiratory disease, and injury up to a year following Superstorm Sandy. Findings demonstrate the need to incorporate short- and long-term health effects into public health recovery. (Disaster Med Public Health Preparedness. 2019;13:28-32)

The purpose of this study was to evaluate role conflict between professional and familial responsibilities among obstetric health care providers during a natural disaster between those required to stay in the hospital versus those who were at home during a catastrophic weather event.

A survey was used of obstetric attending and resident physicians in the Baylor College of Medicine, Department of Obstetrics and Gynecology following Hurricane Harvey on August 26, 2017.

Ninety one of 103 physicians (88%) completed the survey. Survey responses were compared between physicians who worked in the hospital (n = 47) versus those who were at home (n = 44) during the storm and its immediate aftermath. Physicians in the hospital and at home agreed (47% and 48%, respectively, P = 0.94) that professional duties conflicted with family obligations and felt torn (49% and 55%, respectively, P = 0.48) regarding family obligations. A majority of homebound health care providers disagreed with the statement that professional duties override family responsibilities, whereas less than half of in-hospital providers felt the same (68% at-home versus 47% of the hospital-team, P = 0.10).

As organizations prepare for possible catastrophic situations, institutions must realize that obstetric health care providers will experience role conflict between professional and family responsibilities. (Disaster Med Public Health Preparedness. 2019;13:33–37)

Two Category 5 storms, Hurricane Irma and Hurricane Maria, hit the U.S. Virgin Islands (USVI) within 13 days of each other in September 2017. These storms caused catastrophic damage across the territory, including widespread loss of power, destruction of homes, and devastation of critical infrastructure. During large scale disasters such as Hurricanes Irma and Maria, public health surveillance is an important tool to track emerging illnesses and injuries, identify at-risk populations, and assess the effectiveness of response efforts. The USVI Department of Health (DoH) partnered with shelter staff volunteers to monitor the health of the sheltered population and help guide response efforts.

Shelter volunteers collect data on the American Red Cross Aggregate Morbidity Report form that tallies the number of client visits at a shelter’s health services every 24 hours. Morbidity data were collected at all 5 shelters on St. Thomas and St. Croix between September and October 2017. This article describes the health surveillance data collected in response to Hurricanes Irma and Maria.

Following Hurricanes Irma and Maria, 1130 health-related client visits were reported, accounting for 1655 reasons for the visits (each client may have more than 1 reason for a single visit). Only 1 shelter reported data daily. Over half of visits (51.2%) were for health care management; 17.7% for acute illnesses, which include respiratory conditions, gastrointestinal symptoms, and pain; 14.6% for exacerbation of chronic disease; 9.8% for mental health; and 6.7% for injury. Shelter volunteers treated many clients within the shelters; however, reporting of the disposition (eg, referred to physician, pharmacist) was often missed (78.1%).

Shelter surveillance is an efficient means of quickly identifying and characterizing health issues and concerns in sheltered populations following disasters, allowing for the development of evidence-based strategies to address identified needs. When incorporated into broader surveillance strategies using multiple data sources, shelter data can enable disaster epidemiologists to paint a more comprehensive picture of community health, thereby planning and responding to health issues both within and outside of shelters. The findings from this report illustrated that managing chronic conditions presented a more notable resource demand than acute injuries and illnesses. Although there remains room for improvement because reporting was inconsistent throughout the response, the capacity of shelter staff to address the health needs of shelter residents and the ability to monitor the health needs in the sheltered population were critical resources for the USVI DoH overwhelmed by the disaster. (Disaster Med Public Health Preparedness. 2019;13:38-43)

Community characteristics, such as perceived collective efficacy, a measure of community strength, can affect mental health outcomes following disasters. We examined the association of perceived collective efficacy with posttraumatic stress disorder (PTSD) and frequent mental distress (14 or more mentally unhealthy days in the past month) following exposure to the 2004 and 2005 hurricane seasons.

Participants were 1486 Florida Department of Health workers who completed anonymous questionnaires that were distributed electronically 9 months after the 2005 hurricane season. Participant ages ranged from 20 to 79 years (mean, 48; SD, 10.7), and the majority were female (79%), white (75%), and currently married (64%). Fifty percent had a BA/BS degree or higher.

In 2 separate logistic regression models, each adjusted for individual sociodemographics, community socioeconomic characteristics, individual injury/damage, and community storm damage, lower perceived collective efficacy was significantly associated with a greater likelihood of having PTSD (OR, 0.93; 95% CI, 0.90-0.96), and lower collective efficacy was significantly associated with frequent mental distress (OR, 0.94; 95% CI, 0.92-0.96).

Programs enhancing community collective efficacy may be a significant part of prevention practices and possibly lead to a reduction in the rate of PTSD and persistent distress postdisaster. (Disaster Med Public Health Preparedness. 2019;13:44–52).

Two category 5 storms hit the US Virgin Islands (USVI) within 13 days of each other in September 2017. This caused an almost complete loss of power and devastated critical infrastructure such as the hospitals and airports

The USVI Department of Health conducted 2 response Community Assessments for Public Health Emergency Response (CASPERs) in November 2017 and a recovery CASPER in February 2018. CASPER is a 2-stage cluster sampling method designed to provide household-based information about a community’s needs in a timely, inexpensive, and representative manner.

Almost 70% of homes were damaged or destroyed, 81.2% of homes still needed repair, and 10.4% of respondents felt their home was unsafe to live in approximately 5 months after the storms. Eighteen percent of individual respondents indicated that their mental health was “not good” for 14 or more days in the past month, a significant increase from 2016.

The CASPERs helped characterize the status and needs of residents after the devastating hurricanes and illustrate the evolving needs of the community and the progression of the recovery process. CASPER findings were shared with response and recovery partners to promote data-driven recovery efforts, improve the efficiency of the current response and recovery efforts, and strengthen emergency preparedness in USVI. (Disaster Med Public Health Preparedness. 2019;13:53-62)

Parents and children are vulnerable populations following hurricanes, and evacuation is an important safety strategy. Yet, little is known about “before the storm” stressors, particularly the surrounding evacuation, affecting families. Thus, following Hurricane Irma, we evaluated both stressful and positive aspects of the evacuation process for families, and we compared perceived safety and stress before, during, and after the hurricane across evacuating and non-evacuating families.

South Florida parents of children under age 18 years (N=554; 97% mothers) completed an online survey in the months following Hurricane Irma, assessing perceptions of stress, safety, and evacuation experiences. Quantitative data and open-ended responses were gathered.

Most families (82%) residing in mandatory evacuation zones evacuated, although many not in mandatory zones (46%) also evacuated. Parents who evacuated felt significantly safer during the storm, but more stressed before and during the storm, than non-evacuees. Evacuation-related travel and multiple family issues were rated as most stressful, although some positive aspects of evacuation were offered.

Findings have implications for emergency planners (eg, pre-/post-storm traffic flow needs, emotional needs of parents arriving at shelters) and for families (eg, importance of developing family disaster plans, controlling media exposure) to reduce evacuation stress for future storms. (Disaster Med Public Health Preparedness. 2019;13:63-73)

The aim of this study was the construction and validation of a novel research instrument to quantify the degree of post-hurricane trauma and distress in an affected population. The Post-Hurricane Distress Scale (PHDS) has quantitative measures of both acute and prolonged distress, attributable to meteorological and hydrological disasters.

A careful evaluation of existing questionnaires, as well as extensive canvasing of the post-Maria population of Puerto Rico, availed the construction of the PHDS. The PHDS consists of 20 items, organized into 4 subscales. The PHDS was pre-validated (n=79), revised, and then distributed to a broad sampling of the post-Hurricane Maria Puerto Rican population (n=597). Validation, including factor analysis, analyses of concurrent validity, discriminant validity, and internal reliability, was performed.

After comparing various scales, factor loading profiles, concurrent validities, and models of fit, we show that the PHDS is best scored as a single 0–6 distress scale. When compared with the Traumatic Exposure Severity Scale, the PHDS shows superior concurrent validity, more accurately predicting scores for the Peritraumatic Distress Inventory, Impact of Event Scale – Revised, and Generalized Anxiety Disorder 7 Scale. The PHDS shows good internal reliability and discriminant validity.

The PHDS represents a novel, useful instrument for disaster first-responders and researchers. The prompt identification of high-risk populations is possible using this instrument. (Disaster Med Public Health Preparedness. 2019;13:82-89)

The Florida Department of Health in Miami-Dade County (DOH-Miami-Dade) investigated 106 reported carbon monoxide (CO) exposures over a 9-day timeframe after Hurricane Irma. This report evaluates risk factors for CO poisoning and the importance of heightened surveillance following natural disasters.

Data on CO poisoning cases from September 9 to 18, 2017 were extracted from Merlin, the Florida Department of Health Surveillance System. Medical records were obtained and follow-up interviews were conducted to collect data on the confirmed CO poisoning cases. Data were analyzed using SAS v9.4.

Ninety-one of the 106 people exposed to CO met the case definition for CO poisoning: 64 confirmed, 7 probable, and 20 suspect cases. Eighty-eight percent of the affected individuals were evaluated in emergency departments and 11.7% received hyperbaric oxygen treatment. The most frequently reported symptoms included headache (53.3%), dizziness (50.7%), and nausea (46.7%). Three patients expired due to their exposure to CO.

Post Hurricane Irma, the DOH-Miami-Dade investigated numerous cases for CO exposure. By understanding who is most likely to be impacted by CO and the impact of generators’ location on people’s health, education efforts can be tailored to the population most at risk and further CO exposures and related mortalities following natural disasters can be reduced. (Disaster Med Public Health Preparedness. 2019;13:94–96)