Ten lessons we learned about how to deploy teams into post-hurricane settings

By Mitch Stripling, MPA, Assistant Commissioner, Bureau of Agency Preparedness and Response; Colin Stimmler, MA, Senior Director for Agency Preparedness and Response at the New York City Department of Health and Mental Hygiene

This blog contains highlights from a new article we wrote for the latest edition of the public health journal, Health Security’s “From the Field” column. Entitled, The NYC Health Department’s Reflections on First-Ever Public Health Deployments in Support of Puerto Rico and the US Virgin Islands After the 2017 Hurricane Season, the article breaks down exactly how experts from our city’s health department deployed teams to storm ravaged Puerto Rico. This sort of content is usually placed behind a paywall, but it will temporarily remain open for public use until November 5, 2018. 

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Disasters like Hurricane Michael show how severe the public health impacts from a coastal storm can be.  When disasters like this strike, many local and state health workers are often willing to help in another jurisdiction, but they aren’t quite sure how.  

The New York City Department of Health and Mental Hygiene took on the unique challenge of serving communities located thousands of miles from our own. In late 2017 and early 2018, the agency deployed multiple teams to Puerto Rico and the U.S. Virgin Islands to support public health. This was an unprecedented mission for our agency.

We wrote the Health Security journal article to reflect on what worked and what didn’t work for our team. It is our hope that other jurisdictions can use this information to organize and execute similar missions in the future, and collectively we can continue to advance the field of public health preparedness and response.

Here is our top ten list of lessons we learned about deploying teams for emergency response:

  1. Leadership skills for your team leaders are more important than any particular subject matter expertise. 

  2. Choose these leaders first and let them help form their teams.

  3. Don't forget that every team needs support personnel for issues like planning and logistics.

  4. Trust the Emergency Management Assistance Compact (EMAC) process, and only deploy in coordination with your emergency management partners.

  5. Make sure you research the situation, continuously using local and national media resources and official situational reports. Brief your team well as you gather more information, since events will change constantly. 

  6. Adaptability and creative problem-solving are key traits for any staff you send, since the mission will change on site. 

  7. Train staff in humility and consensus building. Remember, your team is there to help the real heroes: the survivors.

  8. Team building exercises before you go improve your success rates in the field.

  9. Once the team deploys, trust them to run their mission. Stand by to help them, but don't bother them for excessive updates. 

  10. When a team returns, try to create a clear debrief process with all administrative issues and hotwashes. Make it easy on them, and give them time to adjust back to regular work. 

In order to fully understand why we felt required to take on this mission, remember that the 2017 coastal storm season was historic by almost every measure. Three major hurricanes, Harvey, Maria and Irma, made landfall from mid-August to late September just weeks apart on American soil. These storms collectively caused more than $200 billion in damages, making 2017 the most expensive storm season ever.

The storm season was also deadly. In Puerto Rico, officials estimate the death toll to be more than 2,975.

A year later, now that the lives lost and dollars spent have been tallied, the current storm season presents a moment of reckoning for policymakers at the federal, state and local level, who allocate resources for response.

In the wake of the hurricanes, New York City sent multiple teams from a broad range of agencies and disciplines to help support the response (for example, first responders to assist with search and rescue) and, later, to aid the recovery efforts – including debris removal and emergency management support for coordination centers.

But this was the first time our agency sent public health teams to support a community.

In Puerto Rico and the U.S. Virgin Islands, health care systems were devastated, and millions lost access to both emergency and routine medical care. New dangers surfaced when safe water and food were not available, resulting in sanitation issues that enabled diseases to spread and desperate families searching for basic necessities. Telecommunications failures made the most vulnerable patients difficult to find. The infrastructure damage released toxic chemicals that caused contamination.

These traumas inflicted on the wider population meant that post-storm suicide rates surged, resulting in the number of people taking their own lives rising by almost a third.

Our health department responded by dispatching mental health trainers to the island in teams. They leveraged curriculum and lessons learned from our own experiences following Superstorm Sandy, adopting it to the local context. 

The department completed multiple missions to the embattled island. Our Acting Health Commissioner, Dr. Oxiris Barbot, who is of Puerto Rican descent, described these missions as such: “Our fellow Americans in Puerto Rico needed our help as they coped with the trauma from the hurricanes. We saw the urgent need for mental health resources on the island, especially among children.”

A unique partnership between our city and Puerto Rico was formed. Last March, Mayor Bill de Blasio announced the deployment of a 12-person team of mental and behavioral health experts from the Health Department to train school staff across Puerto Rico on warning signs for their students, and how to take care of themselves in this post disaster setting, as the recovery operations dragged on for months on end. Coupled with the commitment of personnel, the Mayor’s Fund to Advance New York City provided a grant of $100,000 to the Hispanic Federation’s UNIDOS Program to increase mental health services on the island.

The Hispanic Federation’s UNIDOS Disaster Relief & Recovery Program matched the Mayor’s grant of $100,000, bringing the total new support for community health centers in Puerto Rico to $200,000.

We are grateful to have participated in an effort that marshaled resources in such a unique way. Although this storm was historic, we know the public health field should prepare to see more like it.  

Global warming means that storms like Harvey, Maria and Irma are getting stronger and more frequent. Climate change is creating storms of higher intensity, with greater wind speeds. Experts estimate that since the turn of the century, the likelihood of a storm’s rainfall reaching Hurricane Harvey levels has risen from once every 100 years to once every 16 years.

These hard truths are coupled with the fact that our country has not made the investments needed to sustain the capabilities of first responders and to further build these capabilities in preparation for future emergencies. Health preparedness funds have been slashed by 31 percent for public health and 50 percent for health care preparedness over the past decade.

Local health professionals have a special role in helping communities survive and come back from disasters. Federal response assets are powerful, but limited. The federal government is better at focusing on the immediate impacts of an incident and standing up short-term teams of responders, rather than rebuilding the underlying infrastructure or supporting long-term recovery. Local health departments are often better at understanding local needs, making them better suited to provide the sort of front line tactical assistance that survivors need.

We hope that the lessons learned from our experience can advance the field and help save lives. To read more about the teams we created, and how we designed our response, read our full account here.