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Out of the Superstorm, Valuable Lessons for Health Providers

Roundtable gives emergency responders a chance to reflect on what riding out Sandy taught them.

New Jersey healthcare officials and providers are professionally prepared for disasters, but the scale and intensity of Hurricane Sandy should provide lessons in emergency response for years to come.

That's the overall consensus of a roundtable briefing held at Jersey Shore Medical Center in Neptune on Thursday.

“I see this as another opportunity for learning and seeing how we can prepare best for next year’s season, or even the rest of this winter," said state Health Commissioner Mary E. O’Dowd, who attended the session.

High on the list of post-Sandy concerns are coordination and communication. That's critical when dealing with an army of professional and volunteer first responders, many from out of state. In fact, a related issue had to do with when to call in outside assistance.

An equally essential communication challenge is keeping hurricane victims apprised of available services, whether that's a meal, a mobile emergency room, or mental health counseling. What's more, counseling shouldn't be thought of as something solely for victims; healthcare providers out in the storm had their own stresses to deal with.

A basic question, without easy answers, is how do health providers communicate with victims when phones and Internet service are out? Even more down to earth: did state officials underestimate the staggering impact of Sandy?

Perhaps the most surprising lesson, however, had to do with the volunteers themselves, who found that helping victims was a life-affirming experience.

Listing the Lessons

O’Dowd was not alone when she said that she was keeping a running list of lessons that the storm response was teaching state officials. Public health officials across New Jersey have been compiling their own lists, as they prepare for post-event debriefings.

For O'Dowd, the scale of communication required by the storm -- particularly in coordinating food and shelter available to residents -- was unique.

The commissioner has emphasized in her public statements that residents should be better aware of the resources the state has to offer, including separate phone lines dedicated to providing information about water and home safety and mental health support.

She said to hospital officials, “as much as you can echo that those resources exist and are out there to support, we think that that will bring people quicker, faster and more effectively to routine business.”

Emergency response experts said the storm raised a large number of issues, ranging from the ability of healthcare providers to deal with crises of a massive scale to the need for outside support when local providers are facing their own challenges.

Dr. Robert L. Sweeney, emergency department chairman at Jersey Shore Medical Center, said he was concerned with the communication problems that became evident when the power went out.

“Nobody had any way to communicate with anybody,” Sweeney said. “They had no electric, so they had no Internet, they had no TV.”

According to Sweeney, it’s important to think of other ways to spread news to the public.

Dr. Joseph Feldman, chairman of the emergency department at St. Barnabas Medical Center, had a more specific concern. He said that the New Jersey Department of Health needs to further embed the state’s Mobile Satellite Emergency Department (MSED) into its early response.

The MSED includes an emergency room on wheels, carried on a semi trailer. It was deployed in Somerset and Ocean counties during the storm.

“What this storm shows is that the state needs a unified and coordinated response,” that includes the mobile department, Feldman said.

Minimizing Trauma

Dr. Nicole Lurie, assistant director of U.S. Health and Human Services, emphasized that health officials and employers can better prepare for the traumatic events, reducing the need for those under emotional stress to seek emergency aid.

“There are a lot of resources that go under a label of psychological first aid that employers can learn, that teachers can learn, that anybody touching the public in any way can learn, that can take the lid off enough so that nobody will come to the emergency room,” who doesn’t have to, Lurie said.

A system of integrating lessons learned through post-disaster briefings has become a part of state hospitals’ regular emergency process, as a result of the September 11 attacks, according to New Jersey Hospital Association spokeswoman Kerry McKean Kelly.

“Hospitals have always had emergency plans in place, by their very nature -- it’s what they do,” McKean Kelly said. But after September 11, the state saw the “the start of a new, more mature, more sophisticated time in emergency planning.”

That lesson continues to resonate, reflected in the comments of Lurie, who oversees preparedness and response.

“From our perspective, in every one of these events, we seek to do better than the time before,” Lurie said. “I always say that organisms -- and institutions -- that don’t evolve become extinct, and we need to continue to evolve with our evolving world and God only knows what we have to be ready for next.”

Underestimating Sandy?

Dr. Jane Webber, an associate professor of counseling at New Jersey City University, said the biggest lesson is “never underestimate the power of a natural disaster.”

Webber edited a book for mental health counselors about how to respond to terrorism and trauma after chairing the American Counseling Association Foundation following September 11. Webber said that many providers were overwhelmed by a storm that they had underestimated.

Having grown up by the Shore, “we had hurricanes, and they were terrible, but they were never of this power,” she commented.

With so many providers dealing with lost or damaged homes, the state showed a need for more out-of-state mental-health professionals, she said.

“Many of us were living as survivors and contemporaneously we trying to help everyone else,” said Webber, who volunteered in her community of Bernardsville and late last week was recruiting counselors for the state’s Mental Health Helpline.

Webber said the state will benefit from drills that consider a broader scope for natural disasters, and must review how to respond to the needs of elderly residents.

Webber said that Sandy could also teach some positive lessons, citing studies indicating 12 percent to 15 percent of those who undergo crises may experience post-traumatic stress, while 75 percent have “post-traumatic growth” by helping others.

“That is a lesson that we have to use. You see people go out of their way to help each other, reflect on their life, be glad that they’re alive,” she said.

Drew A. Harris, director of the health policy program at Thomas Jefferson University in Philadelphia, said the final step of the post-event process is incorporating the lessons learned into future plans.

Healthcare officials should concentrate on the experience of local providers, said Harris, former assistant director of the University of Medicine and Dentistry of New Jersey’s Center for Public Health Preparedness.

“Talk to the folks at the ground level,” Harris said, asking “What would they have liked to have been different?”

Harris said it's also possible to learn from issues that weren’t a problem, both what went well and where there were “near misses.”

It’s important to ask what kept residents in their homes after evacuation orders were issued, from those who were concerned about the welfare of their pets to those who didn’t receive the urgent communication.

“So often you’re so happy when the disaster is over, you just want to move on from that,” Harris said.

Still, Harris said, "I think everyone has been heartened as a result of this. They realize that they do have resilience”

He added, “If you can survive this, you can survive anything.”

Andrew Kitchenman is the healthcare writer for NJ Spotlight.

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