PUBLIC HEALTH RISKS OF DISASTERS

Communication, Infrastructure, and Preparedness

Workshop Summary

William H. Hooke and Paul G. Rogers, Editors

Roundtable on Environmental Health Sciences, Research, and Medicine

Board on Health Sciences Policy

Institute of Medicine and

Disasters Roundtable

National Research Council

INSTITUTE OF MEDICINE AND NATIONAL RESEARCH COUNCIL OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS
Washington, D.C.
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Public Health Risks of Disasters: Communication, Infrastructure, and Preparedness - Workshop Summary PUBLIC HEALTH RISKS OF DISASTERS Communication, Infrastructure, and Preparedness Workshop Summary William H. Hooke and Paul G. Rogers, Editors Roundtable on Environmental Health Sciences, Research, and Medicine Board on Health Sciences Policy Institute of Medicine and Disasters Roundtable National Research Council INSTITUTE OF MEDICINE AND NATIONAL RESEARCH COUNCIL OF THE NATIONAL ACADEMIES THE NATIONAL ACADEMIES PRESS Washington, D.C. www.nap.edu

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Public Health Risks of Disasters: Communication, Infrastructure, and Preparedness - Workshop Summary THE NATIONAL ACADEMIES PRESS 500 FIFTH STREET, N.W. WASHINGTON, DC 20001 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. Support for the Roundtable on Environmental Health Sciences, Research, and Medicine was provided by the National Institute of Environmental Health Sciences, National Institutes of Health (Contract No. 282-99-0045, TO#5); National Center for Environmental Health and Agency for Toxic Substances and Disease Registry, Centers for Disease Control and Prevention (Contract No. 200-2000-00629, TO#7); National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention (Contract No. 0000166930); National Health and Environment Effects Research Laboratory and National Center for Environmental Research, Environmental Protection Agency (Contract No. 282-99-0045, TO#5); American Chemistry Council (unnumbered grant); and Exxon-Mobil Corporation (unnumbered grant). The Disasters Roundtable is supported by the National Oceanic and Atmospheric Administration (Task order 56-DKNA-0-95111); Federal Emergency Management Agency (EMW-20022003-SA-0175246); National Aeronautics and Space Administration (W-24245679); National Science Foundation (under Grant No. CMS-0335360226189); U.S. Geological Survey, Department of the Interior (under Assistance Award No. 030HQAAG000410), Pacific Gas and Electric, Institute for Business and Home Safety, and PB Alltech, Inc. The views expressed herein are those of the authors and do not necessarily reflect the views, official policies, either expressed or implied, of any of the above mentioned sponsors, the Institute of Medicine, or the National Research Council. This summary is based on the proceedings of a workshop that was sponsored by the Roundtable on Environmental Health Sciences, Research, and Medicine and the Disasters Roundtable. It is prepared in the form of a workshop summary by and in the names of the editors, with the assistance of staff and consultants, as an individually authored document. International Standard Book Number 0-309-09542-5 (Book) International Standard Book Number 0-309-54703-2 (PDF) Additional copies of this report are available for sale from the National Academies Press, 500 Fifth Street, N.W., Box 285, Washington, DC 20055. Call (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area), Internet, http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. For more information on the National Research Council, visit the NRC homepage at national-academies.org. Copyright 2005 by the National Academy of Sciences. All rights reserved. Printed in the United States of America.

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Public Health Risks of Disasters: Communication, Infrastructure, and Preparedness - Workshop Summary THE NATIONAL ACADEMIES Advisers to the Nation on Science, Engineering, and Medicine The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Bruce M. Alberts is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Wm. A. Wulf is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Bruce M. Alberts and Dr. Wm. A. Wulf are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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Public Health Risks of Disasters: Communication, Infrastructure, and Preparedness - Workshop Summary ROUNDTABLE ON ENVIRONMENTAL HEALTH SCIENCES, RESEARCH, AND MEDICINE Paul Grant Rogers (Chair), Partner, Hogan & Hartson, Washington, DC Lynn Goldman (Vice Chair), Professor, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MD Jacqueline Agnew, Professor, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MD Jack Azar, Vice President, Environment, Health and Safety, Xerox Corporation, Webster, NY Roger Bulger, President and Chief Executive Officer, Association of Academic Health Centers, Washington, DC Yank D. Coble, Immediate Past President, American Medical Association, Neptune Beach, FL Henry Falk, Assistant Administrator, Agency for Toxic Substance and Disease Registry, Atlanta, GA Baruch Fischhoff, Professor, Department of Engineering and Public Policy, Carnegie Mellon University, Pittsburgh, PA John Froines, Professor and Director, Center for Occupational and Environmental Health, Southern California Particle Center and Supersite, University of California, Los Angeles, CA Howard Frumkin, Professor and Chair of the Department of Environmental and Occupational Medicine at the Rollins School of Public Health, Emory University, Atlanta, GA Michael Gallo, Professor of Environmental and Community Medicine, University of Medicine and Dentistry, New Jersey–Robert Wood Johnson Medical School, Piscataway, NJ Paul Glover, Director General, Safe Environments Programme, Health Canada, Ottawa, Ontario, Canada Bernard Goldstein, Dean, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA Charles Groat, Director, U.S. Geological Survey, Reston, VA Myron Harrison, Senior Health Advisor, Exxon-Mobil, Inc., Irving, TX Carol Henry, Vice President for Science and Research, American Chemistry Council, Arlington, VA John Howard, Director, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Washington, DC Richard Jackson, Senior Advisor to the Director, Centers for Disease Control and Prevention, Atlanta, GA Lovell Jones, Director, Center for Research on Minority Health; Professor, Gynecologic Oncology, University of Texas, M.D. Anderson Cancer Center, Houston, TX

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Public Health Risks of Disasters: Communication, Infrastructure, and Preparedness - Workshop Summary Alexis Karolides, Senior Research Associate, Rocky Mountain Institute, Snowmass, CO Fred Krupp, Executive Director, Environmental Defense, New York, NY Donald Mattison, Senior Advisor to the Directors of National Institute of Child Health and Human Development and Center for Research for Mothers and Children, National Institutes of Health, Bethesda, MD Michael McGinnis, Senior Vice President and Director of the Health Group, Robert Wood Johnson Foundation, Princeton, NJ James Melius, Administrator, New York State Laborers’ Health and Safety Fund, Albany, NY James Merchant, Professor and Dean, College of Public Health, Iowa University, Iowa City, IA Sanford Miller, Senior Fellow, Center for Food and Nutrition Policy, Virginia Polytechnic Institute and State University, Alexandria, VA Alan R. Nelson, Special Advisor to the Chief Executive Officer, American College of Physicians–American Society of Internal Medicine, Fairfax, VA Kenneth Olden, Director, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC John Porretto, Chief Business Officer, Health Science Center, University of Texas Houston, Houston, TX Peter Preuss, Director, National Center for Environmental Research, U.S. Environmental Protection Agency, Washington, DC Lawrence Reiter, Director, National Health and Environmental Effects Research Laboratory, U.S. Environmental Protection Agency, Research Triangle Park, NC Carlos Santos-Burgoa, General Director, Equity and Health, Secretaria de Salud de México, México D.F., México Michael Shannon, Chair of the Committee of Environmental Health, Associate Professor of Pediatrics, Children’s Hospital, Boston, MA Samuel Wilson, Deputy Director, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC IOM Health Sciences Policy Board Liaisons Lynn R. Goldman, Professor, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MD Bernard D. Goldstein, Dean of the University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA

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Public Health Risks of Disasters: Communication, Infrastructure, and Preparedness - Workshop Summary Roundtable Staff Christine M. Coussens, Study Director Ricardo Molins, Senior Program Officer Dalia Gilbert, Research Associate Erin McCarville, Senior Project Assistant Victoria Blaho, Christine Mirzayan Science and Technology Policy Graduate Fellowship Program Intern LaTeya Foxx, Anderson Intern Division Staff Andrew Pope, Division Director Troy Prince, Administrative Assistant Carlos Gabriel, Financial Associate

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Public Health Risks of Disasters: Communication, Infrastructure, and Preparedness - Workshop Summary DISASTERS ROUNDTABLE Appointed Members William H. Hooke (Chair), Senior Policy Fellow and Director of the Atmospheric Policy Program, American Meteorological Society, Washington, DC Ross B. Corotis, Professor, Department of Civil Engineering, University of Colorado at Boulder, Boulder, CO Ann-Margaret Esnard, Associate Professor, Director of GEDDeS GIS Lab, Department of City and Regional Planning, Cornell University, Ithaca, NY Ellis M. Stanley, Sr., General Manager, City of Los Angeles Emergency Preparedness Department, Los Angeles, CA Richard T. Sylves, Professor, Department of Political Science and International Relations, University of Delaware, Newark, DE Susan Tubbesing, Executive Director, Earthquake Engineering Research Institute, Oakland, CA Ex Officio Members Stephen Ambrose, Physical Scientist, Earth Science Enterprise, National Aeronautics and Space Administration, Washington, DC David Applegate, Ph.D., Senior Science Advisor for Earthquake and Geologic Hazards, U.S. Geological Survey, Reston, VA Frank Best, Vice President, Alltech, Inc., Fairfax, VA Lloyd S. Cluff, Manager, Geosciences, Pacific Gas and Electric, San Francisco, CA Elizabeth Lemersal, Physical Scientist, Risk Assessment Branch, Mitigation Division, Federal Emergency Management Agency, Department of Homeland Security, Washington, DC Dennis Wenger, Ph.D., Program Director, Infrastructure Management and Hazard Response, National Science Foundation, Arlington, VA Helen Wood, Senior Advisor, Satellite and Information Services, National Oceanic and Atmospheric Administration, Washington, DC Roundtable Staff William A. Anderson, Associate Executive Director, Division on Earth and Life Studies, and Director, Disasters Roundtable Patricia Jones Kershaw, Senior Program Associate, Disasters Roundtable Byron Mason, Senior Project Assistant, Disasters Roundtable Melissa Cole, Christine Mirzayan Science and Technology Policy Graduate Fellowship Program Intern, Disasters Roundtable

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Public Health Risks of Disasters: Communication, Infrastructure, and Preparedness - Workshop Summary REVIEWERS This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report: John Godleski, Harvard University, Boston, MA John Harrald, George Washington University, Washington, DC Havidán Rodríguez, University of Delaware, Newark, DE Nate Szejniuk, University of North Carolina, Chapel Hill, NC Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the final draft of the report before its release. The review of this report was overseen by Melvin Worth, Scholar-in-Residence, Institute of Medicine, who was responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

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Public Health Risks of Disasters: Communication, Infrastructure, and Preparedness - Workshop Summary Preface The National Research Council’s Disasters Roundtable and the Institute of Medicine’s Roundtable on Environmental Health Sciences, Research, and Medicine were established as mechanisms for bringing various stakeholders together to discuss timely issues in a neutral setting. The goal was not to resolve these issues, but to create an environment conducive to scientific debate. The members of the respective Roundtables comprise representatives from academia, industry, nongovernmental agencies, and government, whose perspectives range widely and represent the diverse viewpoints of researchers, federal officials, and public interest. This workshop was convened by the two Roundtables as a contribution to the debate on the health risks of disasters and the related need to build capacity to deal with them. The meeting was strengthened by integrating perspectives from these two fields, so that the agenda represented information from both communities and provided an opportunity to look at some of the most pressing research and preparedness needs for health risks of disasters. Disasters, almost by definition, involve health risks, and have frequently been associated with first responders saving lives in the face of extreme events such as hurricanes, earthquakes, or flooding by transporting injured victims to hospitals to receive care. Life then continues until the next disaster arrives. Perceptions changed, however, with the terrorist attacks of September 11 and the subsequent anthrax attacks, when the government and the public realized the need for more attention to the complex health risks associated with disasters. More emphasis has also been placed on long-term needs after disasters as recovery continues long after release from the hospital or the burying of the dead. In short, what is clear is that preparing for health risks must occur long before disasters strike, and addressing health problems continues long after the initial “search and rescue” and other emergency period activities. Since 2001, there has been a greater need for integrated, up-to-date scientific information to respond to the rapidly changing circumstances that occur with

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Public Health Risks of Disasters: Communication, Infrastructure, and Preparedness - Workshop Summary disasters. Significant strides toward integration have occurred, but it is clear that additional planning, research, and integration are needed. Unlike many scientific subjects, where the practitioner’s knowledge is solid, but public awareness lags, this is one area where professional understanding, capabilities, and approaches are evolving rapidly and substantially. Current discussions of disasters tend to center on terrorist attacks and health risks. It is important to remember, however, that disasters are a multi-faceted challenge and include the public health consequences of geophysical hazards, industrial/technological accidents, terrorist events, and biological disasters, such as SARS outbreaks and E. coli contamination. In addition, on the international scale, disasters include the complex disasters resulting from war, government collapse, and famine. While September 11 caught the United States offguard, it is important that not all of our resources go into one area. We need to continue to have the ability to respond to a variety of threats. Risk communication has become increasingly important as individuals receive information from various media (e.g., newspaper, television, radios, internet), and may seek to validate their knowledge with local experts, trusted friends, and personal experience. With the advent of 24-hour news coverage and the desire for up-to-date information, there are new challenges for risk communication. While it is important that messages from the government be consistent across agencies, it is also important that the messages be clear and honest, while not understating the risks. Scientists and policy makers need to build on the strength of the established literature of risk communication to fill in the gaps that are important for disasters. Personnel needs were discussed by many speakers throughout the day. The issues ranged from providing responders with ongoing training and information on health risks to replacing an aging workforce. Training will continue to be important as the disasters that we are likely to face on a national scale will involve many complex problems. Training will need to be both general and specific, because the type, the magnitude, and the timing of the threats are unknown. How to prepare for integration in a climate of uncertainty is an area of ongoing discussion. This workshop summary captures the discussions and presentations by the speakers and participants, who identified the areas in which additional research is needed, the processes by which changes can occur, and the gaps in our knowledge. The views expressed here do not necessarily reflect those of the National Research Council, the Institute of Medicine, the Roundtables, or their sponsors. Paul G. Rogers Chair Roundtable on Environmental Health Sciences, Research, and Medicine William H. Hooke Chair Disasters Roundtable

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Public Health Risks of Disasters: Communication, Infrastructure, and Preparedness - Workshop Summary Contents     SUMMARY   1      Interdisciplinary Preparedness and Response Plans,   1      Communicating Prevention and Preparedness to the Public,   3      Vulnerable Populations,   4 1   LINKING HAZARDS AND PUBLIC HEALTH: COMMUNICATION AND ENVIROMENTAL HEALTH   7      Public Health Risks Associated with Disasters,   7      The Role of Environmental Health in Understanding Terrorism,   8      Injury Prevention,   10      Emergency Risk Communication,   11      The Emergency Risk Communication Audience,   12      Emergency Risk Communication Spokesperson,   13      Working with the Media to Communicate Risk,   16      Emergency Risk Communication at the Centers for Disease Control and Prevention,   16 2   LINKING HAZARDS AND PUBLIC HEALTH: CASE STUDIES IN DISASTERS   19      Social and Health Effects of a Disaster—The Heat Wave,   19      The Furnace—The Dynamics of a Heat Wave,   20      The Role of Socioeconomic Factors,   20      A Public Health Policy Example: Recent Heat Waves,   21      The “Social Autopsy” of the 1995 Chicago Heat Wave,   22      Bringing New Life to Disaster Response,   22      The Role of Infrastructure During a Disaster,   23      Infrastructure Under Non-Disaster Conditions,   24      Infrastructure in the Short and Long Term,   24

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Public Health Risks of Disasters: Communication, Infrastructure, and Preparedness - Workshop Summary      Infrastructure Organization and Management,   25      Infrastructure: Choices and Trade-Offs,   27      Complex Disasters and Public Health,   27      The Risks of International Assistance,   28      Public Health Needs,   29      NGOs and Complex Disasters: Challenges,   30      If You Don’t Know, Don’t Go,   31 3   PREPAREDNESS AND RESPONSE: SYSTEMS, SUPPLIES, STAFF, AND SPACE   33      Systems,   34      Funding Preparedness Efforts Through Cooperative Agreements,   35      The National Response Plan,   36      National Disaster Medical System,   37      Communication at the Department of Homeland Security,   39      Supplies,   40      Rapid Needs Assessment,   40      Strategic National Stockpile,   41      CDC’s Chempak Program,   42      CDC’s Cities Readiness Initiative,   43      Future DHHS and DHS Preparedness Plans,   44      Staff,   45      Education and Training for Emergency Responders,   45      Management of Staff,   47      Space,   47 4   PRACTICAL CONSIDERATIONS OF EMERGENCY PREPAREDNESS   49      Practical Look at Emergency Preparedness and Crisis Management: Protecting Workers and Continuing Essential Services,   49      Modifying Disaster Planning as a Result of the 2001 Terrorist Acts,   51      Shelter in Place,   51      Need for Additional Coordination,   52      NGO’s Role in Public Capacity Building: The American Red Cross,   52      Displaced Children and the Community,   54      Medical Issues,   55      Physical Issues,   55      Legal Issues,   55      Psychological Issues,   56      Wrap-Up,   56

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Public Health Risks of Disasters: Communication, Infrastructure, and Preparedness - Workshop Summary     REFERENCES   58     APPENDIXES     A   Workshop Agenda   61 B   Speakers and Panelists   64 C   Workshop Participants   66

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