public health departments and disaster management activities: an oral history of the new york city...

Public Health Departments and Public Health Departments and Disaster Management Disaster Management

Activities: Activities: An Oral History of the New An Oral History of the New

York City Department of Health York City Department of Health and Mental Hygiene (NYC and Mental Hygiene (NYC

DOHMH) and the Events of DOHMH) and the Events of 9.11.019.11.01

Nancy VanDevanter, Dr PH* and Nancy VanDevanter, Dr PH* and Perri Leviss, MPM**Perri Leviss, MPM**

*Columbia University, Mailman School of Public Health *Columbia University, Mailman School of Public Health **Consultant**Consultant

February 8, 2006February 8, 2006 2006 National Health Policy Conference Adjunct Meeting 2006 National Health Policy Conference Adjunct Meeting

– Public Health Systems Research– Public Health Systems Research Page 2

The Lasting Effect of 9.11.01 The Lasting Effect of 9.11.01 on Public Healthon Public Health

““Public Health has been challenged to Public Health has been challenged to change its normal, historical way of doing change its normal, historical way of doing business, to become more responsive to business, to become more responsive to

the kind of first responder orientation the kind of first responder orientation which often means making decisions…which often means making decisions…

very rapidly with limited data available…. very rapidly with limited data available…. Something that the field historically hasn’t Something that the field historically hasn’t

done.” done.” Public Health needs to come to the table Public Health needs to come to the table as a stakeholder in order to gain more as a stakeholder in order to gain more

attention, more support and, ultimately, attention, more support and, ultimately, more respect.more respect.



AcknowledgementsAcknowledgements

• We would like to thank the leadership and staff of We would like to thank the leadership and staff of the NYC DOHMH who generously shared their the NYC DOHMH who generously shared their experiences and assessment of the role and experiences and assessment of the role and function of the department in the World Trade function of the department in the World Trade Center (WTC)and Anthrax disasters of 2001.Center (WTC)and Anthrax disasters of 2001.

• David Rosner PhD, Professor of History, Mailman David Rosner PhD, Professor of History, Mailman School of Public Health who collaborated on the School of Public Health who collaborated on the study.study.

• Robert Wood Johnson Foundation, Columbia Robert Wood Johnson Foundation, Columbia University Office of Oral History, New York University Office of Oral History, New York Historical Society who funded the study.Historical Society who funded the study.



Chronology of EventsChronology of Events

• 9.11.01 WTC attacked9.11.01 WTC attacked• 9.12.01 DOH headquarters closed; staff relocated9.12.01 DOH headquarters closed; staff relocated• 9.12-9.22.01 DOH at WTC site; 24 hr operations9.12-9.22.01 DOH at WTC site; 24 hr operations• 9.20-9.24.01 Staff returned to DOHMH 9.20-9.24.01 Staff returned to DOHMH

headquarters headquarters • 10.4.01 Anthrax reported in Miami10.4.01 Anthrax reported in Miami• 10.8.01 Anthrax suspected at NBC10.8.01 Anthrax suspected at NBC• 10.12.01 Anthrax confirmed at NBC10.12.01 Anthrax confirmed at NBC• 10.12-11.30.01 Multiple anthrax investigations10.12-11.30.01 Multiple anthrax investigations



Methodology of Oral History Methodology of Oral History ResearchResearch

• In-depth qualitative interviews (1 ½- 2 hrs In-depth qualitative interviews (1 ½- 2 hrs in length), 3-6 months post disasterin length), 3-6 months post disaster

• Interviews transcribedInterviews transcribed

• Transcripts returned to interviewee for Transcripts returned to interviewee for permission to depositpermission to deposit

• Transcribed interviews entered into Atlas tiTranscribed interviews entered into Atlas ti

• Thematic analysis and coding of data by 2 Thematic analysis and coding of data by 2 independent coders (kappa .85)independent coders (kappa .85)



Oral History as Tool in Public Oral History as Tool in Public Health Systems ResearchHealth Systems Research

• Provide personal accounts and observations Provide personal accounts and observations of historical events by participantsof historical events by participants

• Allow researchers to document events and Allow researchers to document events and identify themes as they emerge from the identify themes as they emerge from the datadata

• Provide opportunities to examine interfaces Provide opportunities to examine interfaces between organizational and structural issuesbetween organizational and structural issues

• Allow for historical data to be gathered for Allow for historical data to be gathered for future researchfuture research



Factors that Facilitated and Factors that Facilitated and Impeded the NYC DOHMH’s Impeded the NYC DOHMH’s

Response to 9.11.01Response to 9.11.01

• Unanticipated Functions and DemandsUnanticipated Functions and Demands– Leadership role in disasterLeadership role in disaster– Environmental health activities including air Environmental health activities including air

quality and worker safetyquality and worker safety– Public relationsPublic relations– First aid/first responderFirst aid/first responder– Public health laboratoryPublic health laboratory



Factors that Facilitated and Factors that Facilitated and Impeded the NYC DOHMH’s Impeded the NYC DOHMH’s Response to 9.11.01 cont.Response to 9.11.01 cont.

• Risk FactorsRisk Factors– Physical proximity to the disaster sitePhysical proximity to the disaster site

““The one plan we didn’t have was an The one plan we didn’t have was an evacuation evacuation plan.”plan.”– Antiquated physical plant/equipmentAntiquated physical plant/equipment– Overburdened staff Overburdened staff – Lack of medical records information exchangeLack of medical records information exchange– No system for procurement, inventorying, and No system for procurement, inventorying, and

distribution of supplies/equipmentdistribution of supplies/equipment– No systems for monitoring worksite safety No systems for monitoring worksite safety

from a public health perspective (food, from a public health perspective (food, sanitation) sanitation)



Factors that Facilitated and Factors that Facilitated and Impeded the NYC DOHMH’s Impeded the NYC DOHMH’s

Response to 9.11.01Response to 9.11.01• Unique CapacitiesUnique Capacities

– Pre-9.11.01disaster experience (Y2K, West Pre-9.11.01disaster experience (Y2K, West Nile, table-top exercise training)Nile, table-top exercise training)

– Strength of infrastructure: clinics, surveillance Strength of infrastructure: clinics, surveillance systems, relationship with CDCsystems, relationship with CDC

– Leadership of Mayor Rudolph GuilianiLeadership of Mayor Rudolph Guiliani– Commitment of DOHMH workforceCommitment of DOHMH workforce– Attention to mental health issuesAttention to mental health issues



Changes in NYC DOHMH Changes in NYC DOHMH After 9.11.01After 9.11.01

• Stronger and new relationships among staff Stronger and new relationships among staff ““The other thing…that has been really The other thing…that has been really phenomenal with World Trade Center and then phenomenal with World Trade Center and then also with Anthrax, that, you know, the people in also with Anthrax, that, you know, the people in this agency have been through a war together, I this agency have been through a war together, I mean, at least people, you know, within these mean, at least people, you know, within these emergency response groups, it has forced us to emergency response groups, it has forced us to assort, you very closely work for very long hours, assort, you very closely work for very long hours, under stressful conditions, with different people under stressful conditions, with different people than we would ordinarily be dealing with. It’s than we would ordinarily be dealing with. It’s forged some indescribable bonds …”forged some indescribable bonds …”

• New collaborations w/other city agenciesNew collaborations w/other city agencies



Changes in NYC DOHMH Changes in NYC DOHMH After 9.11.01 cont.After 9.11.01 cont.

• Improved relations with communityImproved relations with community• Removed barriers between government and press Removed barriers between government and press • Culture shift – being more preparedCulture shift – being more prepared

– Protocols for staff with specific jobs in Protocols for staff with specific jobs in emergency management (EM) and staff emergency management (EM) and staff training in EM procedurestraining in EM procedures

– Balance between being prepared and running Balance between being prepared and running the everyday responsibilities of core programsthe everyday responsibilities of core programs



Lessons from NYC DOHMH’s Lessons from NYC DOHMH’s Experience in 9.11.01: Experience in 9.11.01:

Applicability to Hurricane Applicability to Hurricane KatrinaKatrina

1.1. Press – Media TrainingPress – Media Training• Telling the public Telling the public ‘what they know’‘what they know’ and ‘ and ‘what what

they do not know’they do not know’

• Ensuring a consistent voice from multiple Ensuring a consistent voice from multiple government organizationsgovernment organizations

• Importance of public officials’ credibilityImportance of public officials’ credibility




Applicability to Hurricane Applicability to Hurricane Katrina cont.Katrina cont.

““Whether it’s in terms of just getting messages Whether it’s in terms of just getting messages out on TV, having people get out and represent out on TV, having people get out and represent the health departments’ perspective on the crisis. the health departments’ perspective on the crisis. We had a lot of people who spoke at one time or We had a lot of people who spoke at one time or another or gave time to be interviewed. As a another or gave time to be interviewed. As a priority, it’s something that frequently we don’t priority, it’s something that frequently we don’t feel comfortable – we’re not media people. We feel comfortable – we’re not media people. We sort of work in our one arena and not deal with sort of work in our one arena and not deal with that but at least these times its just greatly that but at least these times its just greatly important and its something that there has to be important and its something that there has to be some focus and training on just how to do it.”some focus and training on just how to do it.”





2.2. Role of CommunityRole of Community• Routine communications between public health Routine communications between public health

departments and communitydepartments and community““I think I was so struck by the need to find out I think I was so struck by the need to find out what a community needs and wants, and to what a community needs and wants, and to make sure the work that you’re doing is based make sure the work that you’re doing is based on that—not what the government thinks on that—not what the government thinks people need, but what people say they need.” people need, but what people say they need.” “So I just feel like sort of I’ve been impressed by “So I just feel like sort of I’ve been impressed by the need to have your public health the need to have your public health interventions very much connected to the interventions very much connected to the reality of what communities need. So I think reality of what communities need. So I think that’s sort of the biggest thing.”that’s sort of the biggest thing.”





3.3. Coordinating with Government Coordinating with Government Agencies Agencies

• Coordination between local, state and federal Coordination between local, state and federal public health organizations public health organizations

• Collaborative working relationship with public Collaborative working relationship with public health and law enforcementhealth and law enforcement

• Coordination and communications among local Coordination and communications among local government agenciesgovernment agencies

• Government relationsGovernment relations

““You don’t want to exchange business cards at You don’t want to exchange business cards at the time of the emergency.”the time of the emergency.”





“…“…the level of communications among agencies the level of communications among agencies is really far less than what it needs to be to is really far less than what it needs to be to respond to these kinds of events. And I think its respond to these kinds of events. And I think its just another reflection of how that infrastructure, just another reflection of how that infrastructure, that communication structure has not really been that communication structure has not really been developed or well developed. I think it also raises developed or well developed. I think it also raises questions about thinking about public health in questions about thinking about public health in terms of the multiple agencies and disciplines terms of the multiple agencies and disciplines and expertise that are needed.”and expertise that are needed.”





4.4. Building communication systems Building communication systems and collaborations with physiciansand collaborations with physicians

• Health alert network – web-based secure Health alert network – web-based secure systemsystem

• Educating physicians and healthcare workers in Educating physicians and healthcare workers in emergency management emergency management

5.5. Planning for the impact on routine Planning for the impact on routine public health activities (e.g., death public health activities (e.g., death and birth certificates)and birth certificates)





6.6. Investing in information technology Investing in information technology security and disaster recoverysecurity and disaster recovery

• NYC DOHMH built second data centerNYC DOHMH built second data center

““When you think about it, registry data, you When you think about it, registry data, you know, some of the living, breathing documents, know, some of the living, breathing documents, bodies of information that we rely on to do our bodies of information that we rely on to do our work, are so vulnerable”work, are so vulnerable”





7.7. Creating state of the art public health Creating state of the art public health laboratorieslaboratories

• Data management – systems to track specimensData management – systems to track specimens“…“…those systems need to be in place routinely those systems need to be in place routinely and not to rely on being able to ramp up during a and not to rely on being able to ramp up during a crisis.”crisis.”

8.8. Developing health and safety Developing health and safety plans/occupational health and safetyplans/occupational health and safety

• Personal protective equipmentPersonal protective equipment• Air monitoringAir monitoring





9.9. Assuming the role of emergency Assuming the role of emergency responderresponder

• Emergency response plansEmergency response plans

• Staff cross-trainingStaff cross-training

• Inventory/distribution systems for medications Inventory/distribution systems for medications and equipmentand equipment

• Use of volunteersUse of volunteers





““In my fourteen years with the Department of In my fourteen years with the Department of Health, I’ve seen a real shift that’s been Health, I’ve seen a real shift that’s been accelerated in the last couple of years now. It accelerated in the last couple of years now. It really started with the emergency of West Nile really started with the emergency of West Nile (virus) in 1999. But traditionally, we were never, (virus) in 1999. But traditionally, we were never, in the culture, a twenty-four-by-seven agency, in the culture, a twenty-four-by-seven agency, and we are rapidly becoming a twenty-four-by-and we are rapidly becoming a twenty-four-by-seven agency. We do not necessarily have to be seven agency. We do not necessarily have to be a twenty-four-by-seven staff, but the thinking is a twenty-four-by-seven staff, but the thinking is around emergency response, and twenty-four-by-around emergency response, and twenty-four-by-seven (response).”seven (response).”





10.10.Using spatial analysisUsing spatial analysis• ER chief complaints to identify upticks in certain ER chief complaints to identify upticks in certain

symptoms citywidesymptoms citywide



Importance of Public Health Importance of Public Health Systems Research in 9.11.01 Systems Research in 9.11.01

and Hurricane Katrinaand Hurricane Katrina•9-11 studies: Population Impact 9-11 studies: Population Impact

– FEMA funded study of 9-11 residents at the FEMA funded study of 9-11 residents at the time, employee-occupants, school children, time, employee-occupants, school children, rescue workerrescue worker

– NYC DOHMH study of domestic assaults NYC DOHMH study of domestic assaults following 9.11.01following 9.11.01

– Traumatic brain injury studyTraumatic brain injury study– Worker-injury surveillance systemWorker-injury surveillance system



Disaster Related Public Disaster Related Public Health Systems Research Health Systems Research

Questions Questions • Types of questions that researchers need Types of questions that researchers need

to ask (e.g., contextual issues)to ask (e.g., contextual issues)– What basic public health systems need to be in place for What basic public health systems need to be in place for

EM?EM?– What role does a public health department play in EM?What role does a public health department play in EM?– What organizations need to participate in EM and what What organizations need to participate in EM and what

functions do each serve?functions do each serve?– How does the placement of the public health within the How does the placement of the public health within the

larger government structure affect its ability to respond larger government structure affect its ability to respond to emergencies?to emergencies?

• Distribution channels for researchDistribution channels for research• Funding sources for researchFunding sources for research

public health departments and disaster management activities: an oral history of the new york city...

Documents

public health departments

public healthpublic

public health needs

public health perspective

nyc dohmhs response

historical data

professor of history

staff relocated9