Floods are one of the most common hazards in the US and account for approximately 30% of disasters worldwide. The frequency of flooding is increasing, due in part to removing trees, climate change, building communities, and increasing habitation in flood-prone areas. Damage from floods can be major (drowning deaths, crop disruption, need for rescue missions) or minor (water damage to buildings, power outages, traffic delays).
Assuring access to safe water and primary health care services is critical, as are surveillance and early warning to detect epidemic-prone diseases known to occur in flooded areas. See Epidemics after Natural Disasters for more information. Mosquitos like to lay eggs in and around standing water. This becomes a major concern with Zika virus. Discuss with families the importance of removing standing water from items in and around their home.
Begin the Conversation with Families
Pediatricians play a central role in encouraging disaster preparedness in conversations with families, children and their communities. Begin conversations with families about preparing for situations such as floods. Start by explaining the difference between a flood watch and a flood warning. A flood watch means that conditions are right for flooding to occur in your area. A flood warning means that flooding is either happening or will happen shortly. Flash floods are the number one cause of weather-related deaths in the US, so it's important to discuss what a flash flood is and how to avoid risks as well.
The Federal Emergency Management Agency offers the following safety tips to prepare for flooding, and this is good information for pediatricians to pass on to families:
- Turn around, don't drown.
- Avoid walking or driving through flood waters. Just 6 inches of moving water can knock you down, and 2 feet of water can sweep your vehicle away.
- If there is a chance of flash flooding, move immediately to higher ground.
- If floodwaters rise around your car but the water is not moving, abandon the car and move to higher ground. Don't leave the car and enter moving water.
- Avoid camping or parking along streams, rivers, and creeks during heavy rainfall. These areas can flood quickly with little warning.
It is important to remind parents to go over this information with children of all ages, particularly those with adolescents and young adults who might be learning to drive.
Flash floods are especially hazardous and can occur without warning during heavy rains, tidal surges, or when dams or levees give way. Most deaths during flash floods are caused by drowning, usually from people wading or driving through moving water. The hazards posed by rapidly moving water are often unrecognized. A gallon of water weighs 8 pounds; hundreds of gallons of rushing water represent thousands of pounds of force. Adults and children can easily be swept off their feet or rushing water can carry a vehicle away, trapping the passengers.
Additional considerations need to be taken into account when preparing children and youth with special health care needs for disasters. The AAP HealthyChildren.org Web site offers additional strategies to help families plan ahead for disasters and prepare for flash floods.
Children are especially vulnerable to environmental hazards that may be present after floods or other natural disasters including hurricanes/storms. Children are in a critical period of development when toxic exposures can have profound negative effects, and their exploratory behavior often places them in direct contact with materials that adults would avoid. Children, and whenever possible teens, should not be involved in clean-up efforts but should return after the area is cleaned.
Clinician Recommendations Regarding Return of Children to Areas Impacted by Flooding and/or Hurricanes.
To ensure their safety and protection, children of all ages should be directly supervised during and after a disaster. Adults involved in clean-up efforts should consider how children might be impacted by the following issues:
- Habitability – Key issues include restoration of drinking water and wastewater treatment facilities, safe road conditions, removal of solid waste and debris, and replacement or renovation of flood damaged homes. Water supplies and household surfaces can also become contaminated with petroleum products (fuel oil or kerosene), household chemicals, and molds.
- Hazardous clean-up – Contamination of floodwaters poses a hazard to those participating in the cleanup. Rubber boots and gloves should be worn and open wounds and sores protected. Hands should be washed frequently, especially when handling food or food containers.
- Contamination of drinking water – Drinking water must be disinfected through boiling and/or chlorination, or an alternative clean water supply (eg, bottled water) must be identified and made accessible.
- Food contamination – Foods that may have been contaminated should be discarded. Eating utensils and inside surfaces (especially those used for food preparation), should be cleaned and disinfected.
- Schools and outdoor play areas – Before children return, these areas should be cleaned and disinfected, along with all toys, clothing, etc. Materials that cannot be readily disinfected should be discarded.
In general, children should be among the last individuals to return to areas affected by flooding or other disasters. Public health officials and pediatricians are encouraged to jointly determine and announce when the environment is safe for children to return.