Events of recent years have highlighted the importance of planning and preparing for the continuity of health care services in the event of any type of emergency or disaster. Following a disaster, a thorough emergency response allows health centers to shifts gears to address the longer-term health consequences of disaster as well as the many health and safety risks from cleanup and demolition, both for those who were impacted by the disaster and for the mobile cleanup crews that arrive in the weeks and months after. Providing health care services to mobile underserved populations, like agricultural workers, poses a host of challenges to service providers under the best of circumstances, including isolated rural work and home locations, group housing, substandard housing, mobility, limited English proficiency, cultural factors, transportation, documentation status, and poverty. The significance of these factors is undoubtedly magnified under emergency circumstances.
The Clinician's Role
Clinicians can serve an important role in helping patients to avoid disruption of their health care needs in an emergency by discussing safety and other prevention measures with them. In particular, those whose well-being is dependent on medications or medical equipment should be encouraged to have a personal emergency plan with important contact information and options for securing needed supplies and care.
Since emergencies are by their very nature unpredictable, the appropriate response for health centers will vary depending on the duration, scope, severity, and nature of the emergency.
Clinicians are trained to manage medical emergencies by establishing clearly defined roles and functions for the members of the health care team, using triage systems, establishing a safe and efficient care environment, reassuring patients through clear communication, and providing treatment swiftly and according to urgency and degree of need. These same principles and skills need to be utilized in emergency or disaster settings, and require planning and practice to function effectively in a time of need.
Migrant Population Emergency Care Plan
Protocols which focus on the ability to prioritize needs and to be able to function with limited human and material resources must be developed, and adequate time for training and drills must be allocated.
Critical issues for clinicians to consider in planning for the care of migrant populations in an emergency include:
- The need to establish back-up systems for energy generation, documentation, communication, and other clinical operations;
- Identification and location of high risk patients such as those with disabilities, chronic illnesses, and those who are culturally, linguistically, and geographically isolated;
- Inclusion of outreach staff and promotores in planning—they can be critical partners in preparing, educating, locating, and transporting patients in need;
- Training of staff on clinical aspects of possible emergencies relevant to the migrant population or the geographic setting such as pesticide exposure, weather-related emergencies, and disease epidemics;
- Collaboration with other service providers in planning for continuity of services and clinical supplies;
- The need to advocate for an immigrant population that may be fearful of accessing needed services in an emergency.
Recovery and Cleanup
Days, weeks, and months after a major hurricane, earthquake, or other disaster, a new set of health concerns replaces the acute ones felt during the event itself. After Hurricane Katrina in 2005, thousands of workers arrived from around the US and Latin America to begin the long process of cleanup; displaced locals also joined the efforts. Many of these workers had no experience in post-disaster cleanup and the risks to their health and safety that they were taking. Injuries and illnesses relating to standing water, mold, and bacteria -- including skin abrasions and lesions, allergic reactions, and asthma attacks -- often increase after hurricanes, as do the injuries that make the construction injury one of the most dangerous in the country, like falls from unsafe structures or ladders or heavy machinery incidents.
Heat and dust are two more major risks. Warm temperatures, high humidity, and new worksites and workers mean that safety protocol to prevent heat illnesses may be less closely followed. After 9/11, thousands of cleanup workers were exposed to dust containing numerous toxic properties including silica and asbestos, leading to short-term health problems, long-term illness, and death.
Other health problems seen during cleanup include skin abrasions, allergic reactions, tetanus, and the health issues related to the increase in contact with insects and vermin. Just a week after Hurricane Harvey hit Houston in 2017, HOPE Clinic hosted a tetanus shot booster clinic and increased its ordering of the vaccination, and of basic first aid supplies like bandages and ointments, in preparation for such concerns.
Electrocution and fires from equipment or circuits in contact with water or had contact with water; carbon monoxide poisonings from enclosed generator or other equipment use; collapsing buildings; gas leaks; damage to chemical vessels, propane tanks, and other dangerous materials -- all can cause serious and life-threatening injury after a disaster.
For immigrant workers, these risks are compounded. Fear over immigration status may cause workers to be reluctant to complain of unsafe conditions. Culturally and linguistically appropriate trainings may not exist during quickly assembled disaster cleanups -- if training exists at all. Personal Protective Equipment may or may not be available; in some instances, employers have required workers to bring their own, which can be troubling when hardware stores are out of stock for weeks on end.
The safety concerns don’t end when work ends. Transportation and housing are limited and at times unsafe. After Katrina, immigrant workers were targeted for robberies as they made their way home from work because immigrant demolition workers, many of whom don’t have bank accounts or access to banking, are often paid in cash.
Occupational Safety and Health Administration (OSHA)
- OSHA Hurricane Preparedness, Response, and Recovery (webpage) Comprehensive hurricane information including links to preparedness and response/recovery pages.
- OSHA Flood Preparedness, Response, and Recovery (webpage). Comprehensive flood information including links to preparedness and response/recovery pages.
- Keeping Workers Safe during Hurricane Cleanup and Recovery Fact Sheet in English and Spanish. This resource addresses potential hazards and protective measures that apply to cleanup workers.
- Disaster Cleanup and Recovery PPE Matrix in English and Spanish. This resource details which PPE should be utilized depending on the type of activity taking place.
- Mold Hazards during Disaster Cleanup in English and Spanish. This resource addresses mold as a health hazard, including recommended PPE and other protective measures for workers.
National Institute of Environmental Health Sciences (NIEHS)
- Safety Awareness for Responders to Hurricanes: Protecting Yourself While Helping Others in English and Spanish. This comprehensive guide to protective measures for cleanup workers covers a wide variety of potential hazards.
National Council for Occupational Safety and Health (NCOSH)
- How You Can Help: #SafeCleanUp from Hurricane Harvey (Webpage). This site includes various helpful links including information on health hazards, mold remediation, respirator use, and related policy information.
Centers for Disease Control and Prevention (CDC)
- Medical Management and Patient Advisement After a Disaster (Webpage): This page highlights important tools for clinicians as well as diagnoses to consider when caring for disaster-affected patients.
- Clean Up Safely After a Disaster Factsheet. Offers tips about potential hazards and protective strategies during disaster cleanup.
American Public Health Association (APHA)
- Keeping Food and Water Safe in an Emergency Situation (Webpage). Information on keeping food and water safe for consumption and best hygiene practices in the face of disasters.
U.S. Department of Labor (DOL)
- Blog post highlighting common hazards during hurricane cleanup as well as links to additional readings.
Barry Commoner Center for Health and the Environment
- Post Disaster Toolkit for Training Clean-up and Reconstruction Laborers. This resource offers training for community based organizations and workers in the aftermath of natural disasters. It includes educational materials as well as trainer guides and tools.
Clinician Resources for Occupational Injuries and Illnesses
- MCN’s Environmental and Occupational Health Screening Questions - Three concise and effective environmental/occupational health screening questions for the primary care provider. English/Spanish
- MassCOSH: Addressing Work-related Injuries and Illnesses: A Guide for Primary Care Providers in Massachusetts - Offers basic screening questions, common occupations and ailments associated with them, as well as recommended treatment. Also includes sample letters from clinicians to employers for restricted work.
- A Community Action Plan for Disaster Response (from the Spanish-speaking and immigrant communities of Sonoma County) - This action plan outlines recommended steps to take during a disaster that provide equal access to resources for Spanish-speaking and immigrant communities.
For additional technical assistance in planning for the clinical aspects of emergency preparedness and MCN's programs, please contact Marysel Pagán-Santana, MCN Puerto Rico Program Manager, firstname.lastname@example.org.