A call for experts to work collaboratively on the public health response to disaster — one of COEH’s strengths — was at the heart of a keynote presentation by John Howard at the Lela Morris Symposium held on March 2 in Oakland, California. “Every public health school in the United States needs to have a presence in emergency preparedness and response,” says NIOSH Director John Howard.
Howard, the director for the National Institute for Occupational Safety and Health, confirmed the United States set a new record for the number of disaster events in 2010. “We are either getting better at counting disasters, or they are actually increasing,” he noted. “That suggests that we, as public health professionals, need to establish a knowledge base from the research, intervention, and training perspectives to put disaster response into the public health profile.”
Howard’s keynote address offered first-hand accounts of the most significant U.S. disasters over the last decade, from the Word Trade Center collapse to the Gulf Coast oil spill. “Each one of these disasters has its own signature,” he acknowledged.
From a public health perspective, the aftermath of the World Trade Center collapse was a disaster in its own right, with major mental and respiratory health impacts, according to Howard. An estimated half a million people were directly affected including approximately 90,000 responders in Lower Manhattan. Only a small portion of the air pollution particles generated by the twin towers’ collapse were respirable. “But there were so many of them, they overwhelmed peoples’ defense systems,” he explained. “Even large particles reached the lower airways and, hence, caused problems for our responders ever since.”
Summarizing key lessons from 9/11, Howard emphasized the need for a cadre of toxicologists, epidemiologists, and industrial hygienists who can identify real-time exposures during disasters to improve the public health response.
Learning from 9/11
Robyn R.M. Gershon, a professor in UCSF’s School of Medicine, revealed findings of her 9/11 disaster management study. Fire codes in New York at the time were among the best in the nation, Gershon highlighted. The tragedy, therefore, was shaped by poor safety behaviors and insufficient communication rather than engineering failures.
Fifty percent of the survivors she surveyed said they did not know how to evacuate their building, other than the way they normally came in or out. Many of the floor wardens, who could have helped with the evacuations, had not reached their desks when the first plane hit at 8:46 a.m., Gershon noted. And although 81% of those surveyed had participated in fire drills, most had never practiced exited the building as part of the exercise.
Worse, emergency preparedness for persons with disabilities scored 0.32 on a 4 point scale. “Basically, nobody knew anything about preparedness for people with disabilities or medical conditions,” reported Gershon. Their evacuation time averaged three times slower than non-disabled workers, a significant factor in light of the aging U.S. population.
Gershon also reviewed victims’ calls to 911 operators. “People were told repeatedly to stay in place. Help will be on its way. And that led to the deaths of many people who may have been safely evacuated.”
Still, Gershon emphasized that her message is one of hope. “Change may come in increments, but we do learn.” Last year, she began teaching a course in public health emergency preparedness. Half her students were subsequently hired by government and non-profits. “I can’t believe the transformations I’ve seen in this field,” said Gershon. “It has become a specialty science within public health.”
Paths of Pandemic Infectious Disease
Tomás J. Aragón presented the role of statistical models in risk management communication, using the recent norovirus outbreak in a San Francisco high school to underscore the potential of infectious disease threats. The incident began on a busy basketball court. From one player, roughly 100 others became ill in 24 hours. In a matter of days, 900 out of 1,400 students were also affected. Aragón, director of Cal PREPARE Research Center, used the case as well as the SARS crisis in 2003 to demonstrate “just how impressive an infectious disease can be.”
Lessons from Katrina
Reviewing the results of her environmental assessment investigations post-Katrina, Gina Solomon described problems of soil contamination and indoor and outdoor mold concentrations and their health effects on the community. The next ‘New Orleans’ may be in California, Solomon warned, citing the Sacramento-San Joaquin Delta for its risk of flooding Sacramento with up to 17 feet of water.
A recent study co-authored by Solomon in the February 2012 issue of Environmental Health Perspectives reviews the health effects of seafood contamination resulting from the BP oil spill off the Gulf Coast in 2010. The study’s authors suggest the U.S. Environmental Protection Agency’s Food and Drug Administration’s risk assessment of seafood safety is failing to protect vulnerable populations including pregnant women, the developing fetus, and young children.
Revelations from Japan’s Nuclear Disaster
Thomas McKone reflected on lessons from the Fukushima nuclear disaster in Japan one year after the tragedy on March 11, 2011. Ignoring historical earthquake and tsunami data, Tokyo Electric Power Company, owners of the nuclear power plant, failed to construct containment walls high enough to prevent flooding from the forty foot wall of water that followed the 9.0 earthquake off the coast, he concluded.
Emergency diesel tanks located perilously on the waterfront, back-up batteries falling short of their design specifications, and lax regulatory oversight were some of obstacles described by McKone, a professor from the UC Berkeley School of Public Health.
Placing the effects of the disaster in perspective, he predicted, “The health risks, though they vary with distance from the plant, will be much lower than what people now fear.”
Expert Panel Shares Stories of Emergency Preparedness
Broader themes of the public health response to disaster planning emerged during the Symposium’s panel discussion. Local, state and federal government experts relayed facts of search and rescue deployment during 9/11 in addition to smaller scale public health investigations, including cases of occupational and environmental contamination from chemical hazards.
“As we heard today, there is a hair’s breadth between surviving and not surviving a disaster,” Solomon said at the conclusion of the symposium, as she called attention to COEH’s opportunity to develop the public health response to natural and human disasters.
The 2012 Lela Morris Symposium was made possible by course directors Gina Solomon, co-director of the UCSF Occupational and Environmental Medicine Residency Program, associate clinical professor of medicine and associate director of the UCSF Pediatric Environmental Health Specialty Unit and senior scientist at the Natural Resources Defense Council, and Patty Quinlan, deputy director of COEH. Other committee members included Michael Wilson, director of LOHP, and John Balmes, director of COEH and division chief of Occupational and Environmental Medicine at San Francisco General Hospital.
To view and download the 2012 speaker presentations, visit: http://coeh.berkeley.edu/symposium.
Remembering Lela Morris
COEH renamed its annual symposium in 2011 to honor the late Lela Morris, who became the Center’s first director of Continuing Education (C.E.) in 1982. “Lela Morris touched everyone she met,” said John Balmes, director of COEH. “I’m sure she is smiling down on us today as this is the type of event she would have liked to organize.” Barbara Plog, the current C.E. director noted, “She started the COEH Summer Institute, which has continued for 25 years.”
Morris’ family members were on hand to kick-off the inaugural symposium honoring her legacy. Dr. Walter Morris personally thanked attendees for dedicating their lives to public health, as his wife had.
“Good health is a right,” said Dr. Morris. “And you are on the fighting edge of making this a reality.”
Find this article and others online at http://coeh.berkeley.edu/bridges