In the wake of deadly Superstorm Sandy and a noreaster less than two weeks later, public health nurses in New York and New Jersey have been barraged by residents in need, initially treating patients, often without power, in chilly temporary shelters.
Immediate effects of the storm included more than 100 deaths, millions of residents without power and thousands left homeless. The long-term effects on public health are uncertain. But health departments are trying to get the word out about dangers such as food contamination, mold growth and other safety issues that arise when power has been out for extended periods of time.
Kathleen Henry, RN, MA, deputy commissioner, Rockland County Health Department, Pomona, N.Y., said nurses on the scene were seeing a number of cases of carbon monoxide poisoning. People without power were hooking up generators and lighting gas grills in enclosed spaces such as garages and poisoning themselves with the fumes. Colorless and odorless, carbon monoxide can kill within minutes.
Nellie Quinn, RN, BSN, director of patient services for Rockland County, said lack of power led people to patch and tape together cords to tap into a neighbors power source, which heightens the risk for electrical fires.
Some of the effects still have yet to unfold. Among the areas of concern are as follows:
Food contamination: Kathleen Percacciolo, RN, BSN, supervising public health nurse, Putnam County Department of Health, Carmel, N.Y., said she hopes local residents threw out refrigerated or frozen food after 48 hours without power, but that cant be assumed. People already struggling financially may have loaded up on food before the storm and couldnt bear to throw it out.
Floodwaters could have left bacteria on screw tops, pull-tops, cutting boards, baby bottle nipples or pacifiers. Contamination may result in severe gastrointestinal distress.
The worries are primarily for food prepared in homes. Local health departments have worked with restaurants to inspect and clear them for re-opening after the storm.
Mold: According to the Centers for Disease Control and Prevention, exposure can cause nasal stuffiness, itchy or sore eyes, wheezing or rashes. People with severe allergies may have intense reactions.
Nurses who might think of these symptoms as normal signs of a seasonal cold should consider the possibility they are a result of exposure to mold, according to Percacciolo. “You have to put the pieces together,” she said.
Items that cannot be cleaned and dried easily should be thrown out, including carpeting, furniture, appliances, photo albums, books, air conditioners, computers and filters. Musty odors, discoloration or water stains are among the signs mold growth has started.
Water contamination: Some drinking water systems and private wells were contaminated by floodwaters and may carry traces of fecal matter from sewage system overload, infectious diseases or fuel oil.
Flu shots: People who had been planning to get these shots around the time of the storm may have forgotten or made them a low priority. With some people living in crowded conditions after the storm, theres even more need to remind people to get immunized. “You dont need another illness on top of the disaster,” Percacciolo said.
Tetanus shots: Adults should make sure they have been immunized within the past 10 years and if not, they should get a tetanus shot in case they encounter tetanus bacteria, particularly during cleanup, said Lauren Barlow, RN, MS, public health nurse with the Suffolk County Department of Health Services on Long Island. The bacteria can enter through a cut or wound, which are common for people handling debris.
Animal bites: Pets and wild animals alike may have ended up far from their homes and could pose a threat to those who come in contact with them in unfamiliar surroundings, Barlow said. Rabies could become a concern in the aftermath of the storm.
Medication cycles interrupted: Medications may have been washed away or refills forgotten in the chaos. Nurse outreach will be important to help patients get back on track.
Depression/anxiety/insomnia: It will be important in future interactions with patients to ask specific questions about how they dealt with the storms, Quinn said.
Patients or their loved ones may have been displaced, lost income or possessions or been frightened, and they may need help dealing with emotions raised by their ordeals. On top of that, the holiday season also can bring on additional anxiety, stress and heightened emotions.
Nurse exhaustion: Nurses were thrown into service around the clock, dealing with abnormal ailments under challenging circumstances while also worrying about their loved ones at home. Some sent to the hardest-hit areas were particularly shaken.
“Let them vent; let them get it out,” Percacciolo said. “Let your co-workers talk about it.”
Nurses may want to advise patients, while its still fresh in their minds, to write down what they encountered in the storm — how much water, what chemicals they used to clean up, whether they had skin irritations, headaches or respiratory problems immediately after, and what they ate and drank. Those facts may be helpful down the road if medical problems arise, Percacciolo said.
A lesson in preparation
Percacciolo, who has worked in public health for 30 years, said Putnam County never has experienced this level of damage and displacement. But she knows it wont be the last weather emergency for the region.
“The time to prepare is now, not two days before the storm,” she said.
Local citizens need to have water, flashlights, a battery-powered radio, a change of clothes and medications at the ready. Oxygen-dependent patients must be aware that the tanks need electricity to operate. People taking medications need to assume pharmacies will be closed in such a disaster.
“What they teach you in public health came to life,” Percacciolo said. “You have to be prepared because no ones going to help you for at least 72 hours. This was a huge lesson.”
Marcia Frellick is a freelance writer.