North Carolina Department of Health and Human Services

Public Health Response Post Hurricane Floyd

September 30, 1999

Background

Hurricane Floyd caused flooding, environmental destruction, and human suffering unlike any other natural disaster in North Carolina history. While it will take years for the families in all the counties in Eastern North Carolina affected by the hurricane to fully recover, there are a significant number of immediate public health needs that must be addressed as these people return to their work and homes. This document provides an overview of how the state public health system is responding to these citizen needs.

Coordination

The State Emergency Response Team through the Emergency Operations Center (EOC) in Raleigh has been operational since the beginning of Hurricane Floyd and will remain in operation as long as necessary. In addition, 30 local Emergency Operation Centers were activated to coordinate local emergency response efforts. Public Health, including Environmental Health, is an active component of the emergency response at both the state and local level. All public health emergency response activities are coordinated with the State EOC.

Public Health Service Philosophy

• Consumer, customer, patient, person, family, citizen oriented.
• Cut red tape and bureaucracy.
• Actions grounded in evidence-based health science.

Regionalization

Certain counties within the disaster area were harder hit than others. Also, the capacity of individual counties to respond varies widely county to county. Requests for assistance will be accepted from any and all counties. However, there is a need to focus time and attention on the 13 hardest hit counties that have been grouped into 7 zones for the purpose of organizing the public health response. A Public Health Zone Coordinator has been assigned to each zone that in turn will report to the Public Health Zone Manager.

View the zones.

COUNTY COORDINATOR

Zone 1: Nash, Edgecombe Bart Campbell

Zone 2: Pitt, Beaufort Paul Webb

Zone 3: Wilson, Greene Worth Heath

Zone 4: Wayne, Lenoir Wayne Jones

Zone 5: Duplin Pat Curran

Zone 6: Craven, Pamlico, Jones Kathleen Buckheit

Zone 7: Halifax M.L. Tanner

Public Health Zone Manager: Steve Cline

Public Health Zone Coordinator for each zone will:

• Work with the local health directors, local environmental health directors, local EOC directors, local cooperative extension agencies, local building inspectors, and others
• Identify the high priority areas of public health concern
• Establish an implementation plan tailored to the zone with public health priorities, time frames, and desired outcomes
• Act as the point person coordinating public health response for that zone
• Assist in acquiring state and federal assistance.
• Monitor and report progress
• Evaluate and recommend strategies for recovery

Service Approach

• Multidisciplinary teams based on the identified need
• On the spot service

Community involvement and education

• Enlist and involve community leaders and groups (e.g. elected and other local government officials, non-profit groups, and churches).
• Sensitivity to physical and mental disabilities, cultural and language issues.
• Strong emphasis on communication and education through media, printed materials, and conversations with key individuals.

Public Health Focus Areas

Based on previous disaster experience, there are two areas where public health must take immediate and concerted action, environmental health and surveillance of disease/injury.

1. Environmental Health

Goal: All residential units in the impacted areas will have an inspection by a qualified professional for habitation, potable water and waste system within two weeks.

a) Housing

• Assure Safe Housing
• Classification of housing/building status is being managed through local Building Inspections Programs. Houses may be legally condemned for a variety of conditions when they are deemed to be unsafe for human habitation including health risk. State Insurance Commissioner Jim Long issued an order that homes with significant flooding shall have the electricity cut to those buildings until an assessment can be made.
• Local Building Inspection Programs may call on public health expertise in assessing the extent of the health risk of flooded buildings by contacting their local health department.
• Houses that have been submerged in flood water to depths above the electrical outlets for a period of longer than 72 hours should be considered uninhabitable and not subject to immediate health inspection unless occupied. If these flooded homes are occupied, then inspections should be performed as a high priority and occupants informed of the health risk associated with living in the dwelling.
• In owner occupied homes, owners live at their own risk. Thus there is not a compelling public health cause to take action to remove or otherwise demolish the uninhabitable home.
• In cases of rented single family or multifamily dwellings, there is a cause for public concern and the office of the State Health Director may take measures to protect citizens from houses deemed unfit for human habitation.
• Houses with lesser degrees of damage will be evaluated and all owners and/or occupants will be appropriately educated regarding appropriate remediation methods to ensure the safety of the housing
• b) Assure Safe Water Supply for all residents
  • All flooded wells and water supplies servicing habitable areas and residences will be inspected and tested. Samples should not be collected from community water supplies by individual users.
  • Samples for coliform bacteria will be collected from all flooded wells.
  • Nitrate samples will be collected from flooded wells in intensive livestock areas and where the well is used by pregnant women and infants.
  • Homeowners should be informed to disinfect their wells as per instructions available from the local health departments/local cooperative extension agents prior to requesting a sample. When practical, samples from disinfected wells should be sent to the State Laboratory of Public Health. This will enable us to maintain a central data base.
  • Other certified drinking water labs such as the Shellfish Sanitation Section labs, local health department labs, and water plant labs may supplement the State Lab. Local health departments and other laboratories are asked to report to the zone coordinator the number of samples analyzed by other labs.
  • Order water supply sampling supplies from State Lab mail room, (919) 733-7656.
  • EPA and Public Water Supply staff will work with transient water systems to bring them back on line.
  • Public Water Supply staff will work with community water systems to assure that their water is safe and that the boil water notices can be lifted. The Public Water Supply staff will report daily the community water systems that are ok and request assistance if needed for "problem" systems.
• c) Assure Properly Functioning Septic Systems
• Property owners need to contact the local health department regarding damaged or malfunctioning septic systems before they begin repairing systems
• Local health departments will provide septic system evaluations and issue permits for repairs
• State toll-free hotline for Septic System Questions is 1-800-973-9243 or 1-800-9-SEWAGE
  
  
d) Assure Safe Food
• Adequate supplies and availability and access to nutritious and safe food
• Guidelines for reopening of restaurants and food service institutions

 

2. Epidemiologic Surveillance

View the ongoing compilation of epidemiologic data.

Goal: Active surveillance will be conducted daily with selected hospital emergency departments to monitor and respond to reports of communicable diseases, injuries, and other health issues of public health importance.

• Active surveillance sites identified and reporting mechanism established
• Surveillance contact for flood shelters established
• "Epi" response teams are prepared to investigate all identified outbreaks/incidences. Local health departments should contact the Division of Public Health, Epidemiology Section to report a potential outbreak, (919) 733-3419.
• Preventive measures identified and communicated to affected communities
• Surveillance reports submitted daily

 

3. Other Public Health Concerns

a) Laboratory Support

• Drinking water supply testing including private wells
• Communicable disease reporting
• Food and lodging
  
  

b) Health Care

• Assure continuity of medical needs
• Begin to reconnect patients back into systems of care.
• Continue interim care
• Institute preventive health measures
  
  

c) Mental Health

• Attend to psychological needs
• Crisis counseling
• Pre-existing conditions


d) Animal Control

• Domestic Animals separated from their owners are being collected and kept in temporary boarding arragements until they can be safely returned to their owners. This effort is being coordinated by state and local Humane Society volunteers.
• Domestic animals with special care needs are receiving care from local vets or transported to the NCSU Vet School in Raleigh.
• Wild animals have been forced out of their natural habitats due to flood waters. As a result, the potential for increased contact with humans is increased. Educational messages regarding contact with wild animals has been distributed.
• To date, there have been no reports of increased rabies activity in the flooded counties nor is a rabies problem expected. Normal rabies precautions are advised including regular vaccination of pets. If you have questions call the local Animal Control Program at the local health department or the State Vetinary Public Health Program at (919)715-6421.
• The tremendous death toll of Farm Animals (hogs, turkeys, chickens, and cattle) has been widely reported. Actual numbers are still being collected but estimates are in the millions. The Department of Agriculture is the lead agency for farm animal disposal including statutory authority over rendering, burial, incineration, or other approved methods. Activities have been coordinated with state and local public health agencies to assure environmental and human health safety.
• Burial of animal carcasses must be at least 3 feet deep in a dry hole and at least 300 feet from any flowing stream or public body of water. A drinking water well is considered a public body of water. For questions or concerns contact the local cooperative extension agency or representative of the NC Department of Agriculture.

 

e) Vector Control

• Currently, there is no identified communicable disease risk associated with the mosquitoes in Eastern North Carolina, however I feel that the spraying is warranted for a variety of reasons.
• The quantity of mosquitoes has become a significant nuisance and is hampering the recovery effort by workers in the field and families trying to clean up after the floods.
• The recent, well-publicized experience in New York City with encephalitis from West Nile Virus (WNV) being transmitted from infected mosquitoes to humans has North Carolina citizens very anxious about the threat of communicable disease. I am concerned for the mental health of these citizens who have already experienced such psychological and emotional trauma from the floods.
• We know the cold weather that will control the mosquito population in Eastern North Carolina will occur for some time. It seems both timely and appropriate to spray now in an effort to prevent future problems that could arise. ·
• The least toxic but effective pesticide agent is recommended for this type of spraying to minimize the human and environmental health impact. Pyrethrum is the first agent of choice followed by Malathion. For questions or concerns contact the NC Public Health Pest Management Program at (919)733-6407 or (919)733-1066. · Removal of the potential breeding grounds for mosquitoes is recommended to prevent population growth.

 

f) Chemical Pollution Hazards

• Identification of sources of ground, water and air pollution that could have occurred as a result of the flood
  
  

Reporting

• Communications
• Briefing Reports
• Documentation of efforts
• Evaluation