Lessons Only Mother Nature Could Deliver

 

 
 
 

Howard Rodenberg, MD | | Thursday, November 8, 2007


In my last piece, I mentioned the severe weather incidents we've had in Kansas as a prelude to talk about the potential health effects of climate change and global warming. Weather-related emergencies have become defining events for me during the past several years. My tenure in public health is measured less by months or years in the job, but by the events I've encountered, starting with the Florida hurricanes of 2004, extending into the nationwide public health response to Hurricanes Katrina and Rita in 2005, and working with ice storms, tornadoes and floods in Kansas this year. In retrospect, it seems like a fairly strange existence -- marking my professional life less by accomplishments and more by disasters -- but working through these events has given me a much greater appreciation of just what s involved in emergency management at different levels of responsibility.

Before we approach the professional end, I hope you'll indulge me with a few personal reflections. I shared with JEMS readers my thoughts on the Florida hurricanes during my farewell to creative writing in 2004. Without going into excruciating detail, the biggest memories I carry from being caught in the storm involve a sense of total immersion in nature, literally being surrounded by the primordial forces that rightfully scared the bejeezus out of our australopithecine ancestors wind, rain, a pervasive darkness, and an uneasy realization that there is absolutely nothing you can do about it.

The tornado in Greensburg was an experience of a totally different kind. With a hurricane, there's usually some variation of damage. Block houses hold up better than wood ones, for example, and you can pretty much predict where the worst damage is going to be based on the shoreline. That's not the case in a tornado. Damage is much more random, but when it happens, it's more or less complete. So while more than 90 percent of the town of Greensburg was literally destroyed, there were still two tall bins from the grain elevator inexplicably standing like sentinels on the north edge of town.

(For the record, this was not just a tornado. This was the largest EF 5 tornado ever on record, with a width of 1.7 miles, following a path of 22 miles, with estimated maximal wind velocities of over 200 mph. And this was only one of a series of 120 twisters across seven states on May 4 and 5.)

I flew into Greensburg on a National Guard helicopter about five days after the tornado struck ground. I had been to Greensburg twice before, and it was what you d expect from the name -- a prairie town like something out of a storybook with small neat houses, businesses and schools in older brick buildings, a drugstore with an operating soda fountain, two obligatory minor tourist attractions, and lots of trees planted years ago and lovingly nurtured over time.

When I flew over it this time, though, it could have been the inner city. If you've ever flown into an airport located in the inner core of a city (like Chicago Midway or Houston Hobby), you know that if you look down, you'll see shades of brown and gray of the city streets and the roofs of buildings. That s what it looked like over Greensburg. All the greenery was gone, the houses and lawns destroyed, with just shades of brown and gray where green should have been. What was more striking is that the agricultural fields around the town were still green, making the contrast as even more radical and out of place.

When you were on the ground in the middle of what was the town, you could piece it together, because the browns and grays were constant in any direction you looked. But from the air, things made no sense, and I experienced cognitive dissonance like I've never felt before. (I also really like the description of my colleague Ron Hammerschmidt, Director of Environment here at KDHE. To him, Greensburg looked like someone had put it in a Mixmaster and then dumped it out.")

The floods in Southeast Kansas brought a different feeling entirely. It wasn't that there was really that much to see. By the time we were allowed in to help in the hardest hit areas, the flood water had receded, and we mostly saw buildings with dirty bands that delineated the high-water mark and stands of trees that were uniformly bare of foliage below a dark brown line. What struck me more were the disparities between those who suffered most in the flood and those who did not.This is not to make light of the very real hardships experienced by everyone in the City of Coffeyville. But you could see that there were problems with the quality of housing down by the levees on the Verdegris River before any flood occurred, and you knew that the people who were now out of their homes were also least likely to be able to recover. It must have been, in a microcosm, what the Ninth Ward looked like in New Orleans. While in Greensburg, my initial impression was of sight, in Coffeyville it was of feeling.

Feelings aside for a moment, both of these incidents taught me more about emergency response than I ever learned at the EMS or county level. When emergency incidents do occur, you tend to see them only from your own perspective. I recall that when I was an EMS Medical Director in Daytona Beach, we were threatened by Hurricane Floyd. All I saw of the response was the need to make some phone calls to assess hospital capacity and to be available to assist if any questions arose about prehospital care. To be honest, while I knew it occurred, I never really even saw the operational side of the EMS preparation -- transporting the homebound to shelters, repositioning of assets, standing down responses due to weather criteria. And while working as a County Health Department Director exposed me to many other facets of emergency management ICS systems, ESF schemes, the role of environmental health, the breadth of the people involved in emergency response, the role of the media, and the critical link between personal relationships and organizational cooperation my role was still limited to those things with a direct impact upon health.

Here at the state, it's a whole different ball game. Some of the efforts we engaged in are of the expected kind. For instance, you'd anticipate that there would be a call for tetanus immunizations during the debris clean-up process (although you might be surprised by the scale of logistics of the immunization effort), and you'd probably reason that there would be expectations for assessment of local medical capacities and disease surveillance. You might also reliably predict that public health preparedness staff would also be involved in the command and coordination of the public health response.

But I had never thought about the issue of documents. Much of our lives are predicated on having the right paperwork -- birth certificates, marriage documents, citizenship papers, and the like. Without them we can't get driver's licenses, provide proof of age, or even have any proof that our parents are really our parents or our children are really our kids. You can't qualify for government benefits or even get a new Social Security card. So one of the things I learned is that providing new documentation to those who've lost their important records is an extremely high priority in disaster response. At KDHE, the Office of Vital Statistics set up field service sites to help people reclaim their identity by connecting them with our electronic databases.

Childcare and food services are other areas that generate an unexpected disaster response. Food safety staff from our food safety program not only provide advice on food safety and food disposal, but work with temporary food providers to help keep response workers healthy. Childcare staff work with community organizations to allow temporary expansion of child care capacities for displaced families.

I also learned a great deal about the process of rebuilding a community. In the hurricanes I'd experienced, while the damage was great, the community itself was essentially intact. In Greensburg, there was no community left, and there was (still is, though to a lesser degree) a real danger that no one would come back. I had always surmised that residences were the key to getting a community back on its feet. I now recognize that, after restoration of basic services, providing a place to work, shop and attend school is what really brings people back to a community. Greensburg had a small grocery store that was destroyed in the tornado, and it took a while before I understood why the restoration of the local hospital and the grocery store were among the top priorities for getting people back into town. The hospital was one of the top employers in town, and a short commute is always a good commute. And while people might have been willing to drive 50 miles to work (that s not uncommon in Western Kansas), they re not going to do it to get a gallon of milk.

The serious work aside, there were a few moments of levity in our response to this incident. My two favorite stories are from Greensburg. I had previously noted that there were two tourist sites in the community. One of them was the World's Largest Hand-Dug Well (very cool) and the other was the World's Largest Pallasite Meteorite. (Pallasite, for those of you who ve been asking, is a stony-iron amalgamation found in meteorites thought to originate close to an asteroid s core.)

During the tornado, the well pretty much stayed where it was (in the ground), but the meteorite managed to get itself blown across town, where it was reportedly found in the wreckage of a convenience store. Apparently nobody could lift the several ton chunk of metal to relocate it to a safer place. So, while the meteorite was kept under 24/7 guard, a forklift was transported in from Dodge City. The meteorite was so heavy it tipped the back wheels of the forklift off the ground. The situation was finally resolved with a railway crane, and now the meteorite sits in a protected boxcar somewhere within our nation s rail system.

I also appreciated the inadvertent amusement provided to us the Centers for Disease Control and Prevention (CDC). The CDC likes to send teams to investigate things that intrigue them, but don't usually do so unless "invited" by the respective state. They had strongly hinted to us that they wanted to send a team to Greensburg to do a house-to-house survey of residents to find out why more people didn't die (as if the 10 who tragically lost their lives just wasn't enough). We literally had a good laugh before sending our reply back to Atlanta. They could do the study if they wanted, but we already had their answer. The reasons were that this is Kansas, and we know about things like tornados, and we have storm sirens and basements, and we have people who check on their neighbors, and while all 2.7 million of us may not be rocket scientists (only 1.4 million of us are), we generally know what to do when, in the parlance of the one guy who always gets interviewed after the storm, the wind begins to "sound like a freight train." That being said, they were welcome to come do their house-to-house survey if they wanted to. All they had to do was find the doors first.

Amusement aside, I need to note that there were some real cases of heroism and fortitude, the kind that gives you hope for our species. In Greensburg, Dennis McKinney, the Minority Leader of the Kansas House, was digging neighbors out of their residences moments after he lost his own home. Mitzi Hesser, the Director of the Kiowa County Health Department, had her office up and running three days after the event in a tent on the front lawn of what used to be her house. And in Coffeyville, Mayor Virgil Horn, a veritable mountain of man, preacher by choice and Mayor by chance, had also lost his home to the flood. But he led by example, shouldering his burden with an intuitive understanding that the city needed guidance and comfort. And because of this, he walked through his own pain to reach out to the community using his presence as his pulpit. In an age where most politicians are neatly packaged, Mayor Horn was not but was so totally full of the spirit that the rest just didn t matter.


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Related Topics: Industry News, Leadership and Professionalism, Provider Wellness and Safety, Natural Disasters, Operations and Protcols

 
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