Lessons from Katrina: Be prepared, know your site's post-disaster risks
Occ health nurses should help with pre-planning and recovery
The devastation left in the wake of Hurricane Katrina gives occupational health professionals cause to consider what effects natural disasters can have on worker safety and health, both when disasters strike workers' homes and jobs and when disasters are far away.
Floods, tornadoes, earthquakes, and hurricanes wreak obvious damage at the time they occur, but even after cleanup, people returning to work face residual hazards that are less obvious, yet still serious.
While rescue and recovery workers are exposed to the immediate hazards of a natural disaster, their training affords them some protection that non-emergency workers don't have. Those who are not trained in disaster work but who volunteer or people who venture into disaster recovery sites after the immediate threat is over are exposed to injury, illness, and stress that can come from not preparing for or taking precautions against what they are going to encounter.
There are a couple of ways to look at how large- and small-scale disasters can affect the occupational health professional, according to Susan Randolph, MSN, RN, COHN-S, FAAOHN, president of the Atlanta-based American Association of Occupational Health Nurses.
"You have nurses who might be responding themselves and treating people at the scene and people doing search and rescue, and getting injured while they're doing that," she says. "And then you have nurses who may have employees there, or have employees who have family or friends [caught in the disaster], and they're trying to help them with the concern and stress. Or, you may work for a company that has a location [at the disaster site], and you're wondering what you can do to help the folks at that site."
Don't neglect occ health, safety
If Hurricane Katrina has any legacy for occupational safety and health professionals, it is that even organizations that have disaster plans might not be adequately prepared, according to Bruce Lippy, PhD, CIH, CSP, director of the National Clearinghouse for Worker Safety and Health Training in Washington, DC.
And, says Tee Guidotti, MD, vice president of the American College of Occupational and Environmental Health and a George Washington University professor of environmental and occupational health, "the big lesson is don't neglect occupational health and safety when something does happen."
Anyone, from professional rescuers to everyday workers, gets into trouble when they ignore plans and protocols in the heat of a crisis, Guidotti says.
The United States has never seen destruction from a natural disaster like that caused by Katrina. That means that even the most well-thought-out disaster plans probably could not stand up to the flooding and loss of electricity, shelter, food, and portable water.
Emergency and rescue workers are trained to deal with the hazards posed by flooding, contamination, and other conditions that result from natural disasters, experts point out. It's when untrained volunteers — or people returning to their damaged homes and work sites — go in to contaminated or damaged areas that injuries and illnesses become greater concerns.
"In past hurricanes, it's the accidents from chainsaws and axes that occurred during debris cleanup that jump out at you," says Lippy. "You have volunteers and small companies [contracted to help clean up], and they're not adequately trained, and you get lots of physical injuries. That was a major issue with Hurricane Andrew [in 1992], and [Hurricane Katrina] is beyond any scope we've dealt with in the recent past."
Loose and leaking chemical tanks and underground tanks, downed electrical wires, infectious agents in the water, toxic molds, and unstable surfaces are just a few of the hazards that can be left behind after a serious storm or flood, Lippy says, and ignoring well-established occupational safety procedures in the drive to get cleanup or recovery under way can have serious consequences.
"We are urging people to try to work from a staging area and to train people before they go in" to disaster-stricken areas, Lippy continues. "There is a course, a two-day course created by [the Occupational Safety and Health Administration (OSHA) and National Institute for Environmental Health and Safety (NIEHS)] for people who are not emergency responders but who come into an area afterward."
Lippy says this training (information available at www.niehs.nih.gov) gives participants a crash course in following an incident command system, and is important for occupational health nurses who come to a work site returning to assist recovery workers and workers.
Effects just as dangerous, more subtle
While recovery after some disasters can begin immediately with few residual hazards that is not always true with many disasters. Even after the New Orleans area is drained of water and debris is cleared, the health threats left behind will last for years, some experts predict. Guidotti says the area hit by Katrina "is like one big Superfund site," and the precautions and cleanup required will be comparable to cleanup at a toxic waste site.
Michael Harbut, MD, MPH, FCCP, chief of the Center for Occupational and Environmental Medicine at the Karmanos Cancer Institute at Wayne State University and a leading expert on environmental health and toxins, says while disease and injury are obvious risks right now for recovery workers in the areas hit by Katrina, long-term effects could be just as deadly, though much more subtle.
Carcinogens, mutagens, molds, lead, and organic solvents will be present long after the risk of infectious disease is gone from the flooded areas, Harbut points out.
"The main problems will be subtle and long term, for a long period of time," he explains. "There will be carcinogens left on surfaces that people will come in contact with, so there will most likely be an increased risk of cancer in people there.
"There's not going to be some enormous epidemic of cancer. Carcinogens sneak up on you, and that's my big concern," he explains.
Additionally, it's hard to tell how much lead contamination can be left behind after a flood.
"If I were in charge of ensuring a healthy work site for people to come back to after it had been flooded, I would contract with an environmental testing company to test for residual levels of hazardous substances," he says.
Expect respiratory ailments
Following a flood, respiratory ailments take a sharp upturn, experts say. In any flooded-out area, molds become a real problem, air quality can be difficult to ensure, and improperly remediated plaster can result in airborne plaster and construction dust, exacerbating respiratory complaints.
Guidotti says flooding can cause "explosive" mold contamination as waters recede, creating serious health problems.
"The initial dangers merge into environmental concerns, including groundwater contamination, contaminated soil, overgrowth of mold, pathogens that can be stirred up in the soil or imbedded in building materials," he says. "In New Orleans, we're in for a very, very long haul."
Julie Anderson, PhD, RN, CCRC, a professor at the University of North Dakota in Grand Forks, was living in Grand Forks in 1997 when a catastrophic flood forced evacuation of the city's 60,000 residents. Flooding was followed by years of recovery, and Anderson says the city is a changed place — one with markedly increased numbers of respiratory ailments.
"What I found was that asthma increased significantly in certain populations," she says. "Some people just didn't feel comfortable returning to the city, and those who did felt their asthma was much worse, that things seemed to trigger their asthma that didn't before, and some of them had to move away."
She says occupational health nurses working in areas that are recovering from flooding should monitor respiratory complaints among workers.
Another health risk that nurses at recovering work sites should guard against is carbon monoxide (CO) poisoning, Anderson emphasizes. Following the Grand Forks flood, she and other health care providers began noticing more cases of CO poisoning, and quickly broadcast public service announcements and distributed pamphlets warning against the dangers of CO poisoning after floods.
According to the Centers for Disease Control and Prevention (CDC) in Atlanta, 33 laboratory-confirmed cases of CO poisoning were identified following the Grand Forks flood, and all involved the use of gasoline-powered pressure washers — a ubiquitous cleanup tool following a flood — being used in basements.
For that reason, the CDC now warns that CO poisoning must be considered a potential hazard after major floods. Work sites where cleanup is going on in closed spaces should be closely monitored for ventilation and buildup of CO.
Lippy says occupational health and safety workers should have learned another respiration-related lesson from the Sept. 11, 2001, terror attacks on the World Trade Center. Safety supervisors involved in recovery and cleanup did a bad job of enforcing respirator use during operation of heavy machinery, he says, and the clouds of dust from the cleanup resulted in workers who now suffer from chronic lung diseases.
Lippy urges companies to bring OSHA in whenever a disaster affects a work site, because the resources available to help in cleanup and safety are extensive. Plus, he says, during the immediate period after a disaster, OSHA "is not in enforcement mode." But once recovery and cleanup begins, OSHA will start enforcing its requirements, so getting input early on can help avoid citations later and ensure safety for workers.
Watch for signs of stress
As workers return to their homes and work after a disaster, occupational health nurses should be attuned to the toll stress and — if lives were lost — grief can take.
"You need to move into critical incident stress management," says Lippy. "There can be a lot of issues about traumatic stress."
During cleanup at the World Trade site in 2001, Lippy says he watched as heavy machine operators who were clearing the rubble "got that thousand-mile stare."
"You could see these people drifting away, and it's a real concern. Who's watching out for those people? There have been suicides from the people at the [World Trade Center] site. They saw things people shouldn't have to see, and the same thing has happened in Louisiana."
Randolph says occupational health nurses need to keep in mind that if they are victims of natural disasters, they need to make sure they take care of themselves, too. While helping the people they work with, nurses might be wondering how their own lives will regain normalcy, she points out.
Anderson, who studied the Grand Forks flood, says clinic visits for depression and drug and alcohol abuse increased significantly after the flood.
Martha Starr, MS, BCETS, a crisis management expert and faculty member at the University of Alabama at Birmingham's department of education, says health care workers, particularly those who work in rescue operations, operate "on autopilot" during the crisis, but then may be debilitated by the stress that follows.
Symptoms of stress that nurses should make workers aware of include poor concentration, anxiety, depression, irritability, chest pains, and headaches.
"These are normal reactions to an abnormal event, but if the symptoms increase to where they remain over time, they may develop post-traumatic stress," Starr explains. "Health care and emergency workers have this little gene that makes them take care of everyone else but themselves, and they need to make sure they practice what they preach in terms of getting enough rest, food, water, and in terms of talking to someone they trust about what they're going through."
One on-site occupational health nurse will be hard-pressed to monitor the emotional well-being of a plant full of people coping with the aftermath of a disaster, Starr acknowledges. The nurse can help beef up the support system by encouraging a "buddy tree" — one person calls to check on another person he or she feels close to, another friend or co-worker is keeping tabs on the first, and so on.
Following a disaster in which homes, lives, and jobs are lost, survivors' buddy trees should probably go on for several months, she says.
Anyone whose life and work has been disrupted by a natural disaster will be anxious to restore things to the way they used to be, but Starr cautions that health care providers must emphasize to people in their care that recovery from a disaster is not a short-term proposition.
"It's going to go on for months, and if they burn the candle at both ends, they will wear out," says Starr. "They need to have a goal in mind, and to take care of themselves while they work to achieve it. The occupational health nurse can help by setting a good example and saying 'this is how you survive one of these things.'"
[For more information, contact:
- Bruce Lippy, PhD, CIH, CSP, director, National Clearinghouse for Worker Safety and Health Training, 1250 Connecticut Ave., NW Suite 610, Washington, DC 20036. Phone: (202) 331-7733. E-mail: [email protected].
- Susan A. Randolph, MSN, RN, COHN-S, FAAOHN, president, American Association of Occupational Health Nurses. E-mail: [email protected].
- Julie Anderson, PhD, RN, CCRC, University of North Dakota College of Nursing, Grand Forks, ND. Phone: (701) 777-4541. E-mail: [email protected].
- Martha Starr, MS, BCETS, adjunct professor, University of Alabama at Birmingham department of education. Phone: (205) 542-3371. E-mail: [email protected].]
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