background

Public Safety Power Shutoffs (PSPS) are planned power outages designed to reduce wildfire risk during heightened fire-risk conditions. The public health impacts of prolonged power outages are not well described. We examined visit patterns and reasons for seeking care (chief complaints) in emergency departments (ED) during an extended PSPS in October 2019.

methods

ED census data from Marin County’s three hospitals were used to examine patient age, visit frequency, and proportion of visits attributed to chief complaint categories during October 27-29 (days one to three). Daily proportions of visits in categories of interest were compared to the two-year daily average using the chi-squared test. Average daily visitor age was compared to the two-year average using t-tests. Chief complaint text fields were used to create PSPS related diagnostic categories.

results

Visits increased on days one to three compared to the average, with the greatest increase on day one (33%). The average visitor age increased significantly on days one (p=0.002) and two (p<0.001), as did the proportion of accident-related visits (p<0.001). The proportion of medical device-related visits increased on day one (p<0.001), while gastrointestinal-related visits increased on days two (p=0.03) and three (p=0.02).

conclusions

Increases in total visits, average age, and the frequency of conditions potentially related to power loss suggests increased risk during an outage, particularly among older adults. Increases in certain complaint categories on different days point to evolving health risks over the course of an event. These findings suggest a need for evaluation of PSPS risks and benefits.

Families in the perinatal period are vulnerable to disasters and have specific needs which may be disregarded in emergency planning and literature. As part of a larger project evaluating the impact of recent hurricanes on families in Florida, this project investigates the extent to which the needs of pregnant women, infants under one year, and their families are considered in 67 county Comprehensive Emergency Management Plans (CEMPs) throughout the state. A total of 46 CEMPs were analyzed using a MAXQDA lexical search for 21 terms pertaining to the target population (e.g., infant, pregnant, parent, breastfeeding, etc.). The terms of interest were mentioned 1828 times.

After removing non-applicable results, a total of 99 passages from 28 counties were found that pertain to infants and their families in emergency situations. The topics most commonly discussed family reunification after a disaster (12 counties), disaster preparation (i.e. preparing supplies for a disaster; eight counties), and Emergency Support Function #6 (which involves mass care and family reunification; eight counties).

Few plans discussed the unique needs of these populations in a disaster situation. Pregnant women, infants, and children are less often represented in emergency management guidelines and research than other vulnerable groups, such as the elderly and those with physical disabilities. The health implications of this exclusion could be serious but are still unknown. This study highlights an opportunity for agencies to address the needs of a large and important population.

Background: The Georgia Hurricane Response Hub (GA HRH) is one of five technical assistance centers funded by the CDC to enhance disaster-related surveillance, environmental, and occupational health recovery efforts in areas impacted by the 2017 Hurricanes Harvey, Irma, and Maria. The Rollins School of PH at Emory University serves as the coordinating body of the GA HRH and partners with the Georgia Department of PH and the Georgia Hospital Association to provide PH workforce capacity building activities in Georgia.

Methodology: The GA HRH uses a cross-sector workgroup structure to identify training and technical assistance needs; prioritize needs; develop and implement plans; and evaluate successes. Over 50 individuals from the regional healthcare coalitions and preparedness staff from the state PH agency and local PH districts throughout the state are active members of the following workgroups: Strategic Communications, Disaster Epidemiology, Surge Management, Resilience, and Incident Management. Each workgroup has identified its own strategic agenda and workplan based on group members’ expertise/experience and a rapid needs assessment.

Outcomes: The training/resources developed through this initiative are designed to help health departments, PH institutes, emergency management, law enforcement, health care providers, government entities, and other organizations build workforce capacity and institutional knowledge that improves disaster-related recovery efforts.

Conclusion/Summary: Using a multi-sector approach, the GA HRH has developed trainings/resources to improve the capacity to prepare for – and respond to – hurricane events. This session will provide an overview of the GA HRH and showcase some of the trainings/resources that have been developed.

Background

Today’s young people are unduly burdened and impacted physically and mentally by consequences of climate change and disasters. Physical impacts include effects from air pollution, unclean drinking water, increased disease, food insecurity and trauma. Negative impacts from disasters and climate change disproportionately affect children, seniors and people of color. The health and mental wellbeing of future generations is expected to become an increasing concern.

Education programs that address climate and environmental justice are now available to students. With a focus on skills needed for future leaders, this presentation will focus on approaches to improving education in environmental justice and climate change while students are becoming knowledgeable leaders for the future.

Methods

Young people are becoming active in the climate change field while the importance of education about climate change, environmental justice and disasters is being recognized and is studied. The U. N. estimates that “half a million youth around the world have taken action on climate change through small grants programs, projects in homes, schools and communities.” Funding for environmental programs and training for green jobs is responding to student increased interest.

Based on information from a student at Georgetown University’s climate change, environmental program, this presentation summarizes, compares and evaluates several climate change and environmental justice programs.

Outcomes

Summary of climate change and environmental programs described by region, content, learning objectives and recommended improvements.

Conclusion

Climate change and environmental justice education program are critically important to adequately equip people to combat the negative effects from climate change.

Background

There is an inextricable link between natural disasters, extreme weather events, climate change and the increasingly negative impacts to public health that can include disease and loss of life. The climate crisis creates the perfect conditions of complexity in terms of preparedness and response. As one community may be more capable to plan and prepare for a natural disaster than another, other communities may respond to an extreme weather event based on only the very limited resources available. The field of public health has a responsibility to level the playing field for communities and help build resiliency in the face of reoccurring events that are becoming more frequent and more severe with terrifying results. These disastrous climate events impact communities across the United States and globally and the impending crisis requires urgent action.

Methods

This talk will focus on outlining the challenges and successes of disaster planning and response related to natural disasters exacerbated by climate change and the negative impacts on public health.

Outcome

Compilation of mitigation strategies so that particpants can understand the urgency and opportunities to reduce the health effects from climate change and to build resilience in communities in an equitable manner.

Conclusion

Public health communities can work together to address the challenges from disasters due to climate change that increase mitigation strategies and resilience.

California Welfare and Institutional Code (WIC) 5150 enables law enforcement and designated medical professionals to place individuals posing imminent risk to self or others on involuntary 72-hour hold. These holds are intended for psychiatric evaluation at a designated mental health facility; however, many of these patients are transported to emergency departments (ED) based on proximity and lack of alternative resources.

Between January 1^st, 2019 and December 31^st, 2019 Riverside County Emergency Medical Services (EMS) providers responded to approximately 1,200 WIC-5150 emergency and non-emergency transport calls each month. In Riverside County alone, this amounts to thousands of 5150 responses by EMS providers each year at a conservatively estimated cost of $1.5 million annually.

While many WIC-5150 patients require immediate behavioral health intervention to ensure safety and transport, many are not experiencing an imminent medical risk consistent with the aid EMS was designed to provide. As a result, WIC-5150 responses can over-utilize complex and costly emergency services.

Alternative behavioral health response and transport strategies would reduce the current impact of WIC-5150 on the EMS system, deploy more suitable care for this patient population, and help ensure emergency services are more rapidly available for those experiencing life-threatening medical conditions.

Background: Following disasters, healthcare organizations make decisions about evacuation, closure, reentry and reopening. These decisions have substantial impacts on access to healthcare for communities, particularly rural communities with limited infrastructure. There, the closure of a single facility can disrupt access for hundreds of miles. On July 4^th, 2019, Ridgecrest, CA was hit with a 6.4 magnitude earthquake with a second 7.1 magnitude mainshock 34 hours later. The purpose of this study is to examine post-disaster healthcare decision-making.

Methods: Health care facilities in Ridgecrest were identified through the Office of Statewide Health Planning and Development (OSHPD) website and contact information verified. Identified facilities were contacted for an in-person key informant interview. Interviews were recorded, transcribed, and coded. Analytic memos were developed in response to the proposed research questions.

Results: Seven key informant interviews were conducted. Most of facilities had an easily accessible disaster plan to guide their response. Because the first earthquake happened on July 4, the majority of facilities were closed or operating with a skeleton staff. The hospital made the decision to evacuate 15 patients from their main facility due to damage from the first earthquake. Once the immediate danger had passed, all facilities were faced with the decision of when to reopen. Building safety inspections, operational capabilities, and adequate staffing all played a major role in the final decisions.

Conclusions: The experience of Ridgecrest provides understanding of preparedness and information needs of healthcare facility administrator decision-making and information needs related to closure, evacuation, reopening and reentry following disasters.