Hurricane Response and Recovery

• Follow the direction of local officials. Dangerous flooding continues; do not return home until local authorities say it is safe. 
• Avoid affected areas. Stay off the roads so that first responders/service crews can get to those who most need help.  
• Keep out of the water. Flood water can contain dangerous debris, downed power lines or hazardous materials. Do not walk, swim, wade, or drive through flood waters. 
• Power, water, and communication outages may be extensive. Services in affected areas may take time to fully restore. 
• Cash is best. A financial contribution to a recognized disaster relief organization is the most effective donation to make.  
• Be vigilant in looking for certain infectious diseases. Clinicians assessing patients affected by hurricanes should be watching for certain infectious diseases, including leptospirosis, hepatitis A, vibriosis, and influenza. 

Response activities take place during the hurricane and include actions to save lives and prevent future damage in an emergency situation. These activities could include: 

• Evacuation – When a hurricane is pending, there may be a need to evacuate your home, hospital, or office. Pediatricians should follow evacuation orders from officials and encourage families to do the same. If evacuation is required: 
  • Bring your Disaster Supply Kit and/or your portable emergency kit for the car. 
  • Communicate with your clients regarding office closure or relocation of services. 
  • Ensure you have extra cash, water, and gasoline for your car and generator. 
  • Determine a plan for pets and animals. 

• Sheltering – Taking appropriate shelter is critical in times of disaster. Sheltering is appropriate when conditions require that you seek protection in your home, place of employment, or other location. Children require a safe, secure environment during and after a disaster. 
  • Locate American Red Cross shelters. 
  • Review Standards and Indicators for Disaster Shelter Care for Children. 
  • Offer to conduct child health assessments or assist in acquiring supplies for children in shelters. 

• Vaccine Storage – If there is a loss of power, do not open freezers or refrigerators containing vaccines, except to transport vaccine to an alternative storage location. Continue to monitor the temperatures of your vaccines. After the event, do not discard vaccines. If vaccines were lost or damaged: 
  • Contact the manufacturers for their replacement/refund policies. 
  • The AAP summarized the policies and processes of vaccine manufacturers and the Centers for Disease Control and Prevention (CDC) Vaccine for Children Program related to vaccine loss due to a natural disaster in the US and Puerto Rico. 
  • See the CDC Vaccine Storage and Handling Toolkit and the CDC tip sheet on packing vaccines for transport during emergencies. 

Recovery activities take place after a hurricane and include actions to return to normal or an even safer situation following an emergency situation. These activities could include: 

• Response to a Power Outage – During a power outage, several issues may arise. In addition to vaccine storage mentioned above, depending on the time of year, extreme temperatures could impact children. Food and water safety, as well as safe generator use, will be important to consider in recovery efforts. 
  • Food and Water Safety – Take steps to prevent illness from unsafe food and water. Keep food at recommended temperatures. Do not eat or drink anything that has touched flood water. When there is doubt about a certain food item, throw it out. If you are unsure about the safety of your water, boil the water or use bottled water. The US Food and Drug Administration and the CDC offer strategies for keeping food and water safe after an emergency. 

• Returning to Affected Areas – Children should be the last to return during flood recovery or when disaster clean-up is needed. Clinical recommendations are available from the Pediatric Environmental Health Specialty Units (PEHSUs) regarding return of children to areas impacted by flooding and/or hurricanes.  
• Prevention of Infectious Diseases – Flooding can increase the transmission of many communicable diseases. Preventative measures should be taken, including enforcing the importance of hand-hygiene when running water is available. 
• Mosquito Bite Prevention – Flood waters can result in a very large population of mosquitos. Take steps to protect yourself from mosquito bites after a disaster to prevent mosquito borne diseases, including Zika, dengue, malaria, and others. Share the Mosquito Bites are Bad activity book with families. 
• Determining Special Needs – The special needs of pregnant women, new mothers, and their newborns (especially when water and/or medical care is not consistently available), is important to consider. The AAP has recommendations for infant feeding in disasters and emergencies. Emergencies or disasters are difficult for all families, but for those that include a child with special needs, this can be even more challenging. 

The AAP does not send teams to disaster-impacted areas or endorse/approve any particular means of traveling to or volunteering in disaster-impacted areas. The security and safety of members continues to be a high priority, and members are urged to educate themselves about the reality of travel details, security issues, liability insurance, living conditions, and other details regarding the provision of medical care in austere conditions. It is important that health care professionals carry copies of licenses and board certifications when traveling, as well as become knowledgeable about documentation needed when taking medicines into a foreign country. 

Below are some resources that may be of interest: 

• Health Care Volunteers and Disaster Response - First, Be Prepared 
• International Medical Corps 
• National Voluntary Organizations Active in Disasters

Clinicians can learn more about Direct Relief, an organization that provides assistance to people and communities in all 50 states and more than 80 countries. Volunteer opportunities are available through the National Voluntary Organizations Active in Disasters.