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Hurricane Katrina Relief Response Preventive Medicine Measures: Hurricane Katrina Relief Response Preventive Medicine Measures Name Command Contact Information Prepared by: U.S. Army Center for Health Promotion and Preventive Medicine (800) 222-9698/ DSN 584-4375/(410) 436-4375 http://chppm-www.apgea.army.mil/


Agenda: Agenda Purpose Background Medical Threat Stress Post Deployment Summary Conclusion


Purpose: Purpose Inform Deploying Personnel (Military and Civilian) of the Potential Health Hazards and the Individual Countermeasures Necessary to Assure Personal Safety and Health


Background: Background US Forces are mobilizing and deploying in support of hurricane relief efforts Environmental and occupational health hazards are a potential medical threat to deployed personnel Hurricane Katrina left the Louisiana and Mississippi coastlines in ruin. Up to 1 million people are without power, safe food, and safe water.


Southeastern United States: Southeastern United States Katrina caused extensive flooding and widespread devastation Health risks rise with Lack of waste disposal Contaminated food Contaminated water Inadequate water for hygiene Increased exposure to the heat


Disease Trends (1999 data)Louisiana: Disease Trends (1999 data) Louisiana Hep A rate – 4.9/100,000 which is half the national rate Hep C rate – 7.0/100,000 six times higher than the national rate Louisiana had the 10th highest number of AIDS cases in the nation 2 confirmed cases of Eastern Equine Encephalitis (EEE) in humans, 97 in horses 15 cases of Lyme Disease


Pre-Deployment: Pre-Deployment All Active Component (AC) personnel must complete a Pre-Deployment Medical Health Assessment (DD Form 2795) Reserve Component (RC) personnel activated to active duty status greater than 30 days must complete DD Form 2795. Only those RC activated for 30 days or less are exempt from completing the form.


Military Vaccine Recommendations: Military Vaccine Recommendations Tetanus-diphtheria (Td) if no booster within the past 10 years Hepatitis A Hepatitis B for those at risk with direct blood and body fluid exposures Influenza when available


Physical Environment: Physical Environment Topography Mostly flat, coastal, some areas below sea level Climate (September) High Humidity 90+° F day 70° F night Potential for additional storms


Heat Injury Prevention: Greatest threat is from heat injury Heat Cramps, Exhaustion, or Stroke COUNTERMEASURES Drink fluids continuously (hourly fluid intake should not exceed 1.5 quarts, daily fluid intake should not exceed 12 quarts) Maintain acclimatization Protect yourself from exposure to sunlight and wind Maintain good physical condition Establish work/rest schedules Wear proper clothing Participate in training Heat Injury Prevention


Slide13: H: Heat category – WBGT Index E: Exertion level (prior 3 days) A: Acclimatization T: Tables – Water/Work/Rest Units which have soldiers who do not drink because they do not have opportunities to urinate have a leadership problem. REMEMBER Water requirements are not reduced by any form of training or acclimatization.


Sunburn: Sunburn Sunburn reduces soldier readiness and increases the likelihood of skin cancer. Prevent overexposing skin and eyes to solar radiation and wind COUNTERMEASURES Use sunscreen and lip balm Use protective eyewear Limit exposure Cover nose and mouth to limit drying


Environmental Health Risk: Environmental Health Risk Drowning after being trapped in debris / flash floods Avoid contact with water near downed power lines Ensure facilities are properly inspected prior to entry Identify, report and avoid ruptured natural gas lines Ensure adequate ventilation when using any carbon monoxide producing device (preferably outdoors) Building material hazards: asbestos, lead based paint, etc Mold may proliferate in continuously wet conditions and cause adverse reactions in some individuals. Monitor and treat personnel appropriately. Personnel with asthma and allergies are at greatest risk Investigate local waste disposal methods


Physical Injury: Physical Injury Injury was a top diagnosis following Hurricane Andrew Walking over and handling debris that is covered with water can cause cuts, scrapes, bruises, sprains, etc. Remain current with tetanus vaccination – revaccinate for a dirty wound if current vaccination is over 5 years old Consider steel toe/shank footwear if available


Foot Care : Foot Care Protect your feet by: keeping feet clean and dry change socks at least every 8 hours or whenever wet and apply foot powder bring extra boots to field - alternate boots from day to day to allow boots to dry. seek medical care at the first sign of any problems


Industrial Hazards: Industrial Hazards Industrial chemicals and fuel contamination of the soil and water Benzene Hydrofluorine and Hydrofluoric acid Carbon monoxide poisoning from the burning of any fossil fuel without adequate ventilation Building material hazards: asbestos, lead based paint, etc Structural and electrical hazards Appropriate personnel protective equipment; may require respirator fit-testing


Foodborne and Waterborne Diseases: Foodborne and Waterborne Diseases Bacterial diarrhea Viral diarrhea Hepatitis A and E COUNTERMEASURES Do not consume any food, ice, water, or beverage (to include bottled water) that have not been approved by the U.S. military Assume all non-approved food, ice, and water is contaminated Staphylococcus Chemicals/Pesticides Heavy Metal Poisoning Even a one-time consumption of these foods or water may cause severe illness


PPM Against Insects: PPM Against Insects YOU NEED TO KNOW… Dry cleaning removes permethrin from the uniform DOD Insect Repellent System + + = MAXIMUM PROTECTION Permethrin On Uniform DEET On Exposed Skin Properly Worn Uniform Flooding will increase the potential for the spread and transmission of mosquito-borne diseases


Insect Repellents for Skin and Clothing: DEET lotion NSN 6840-01-284-3982 Apply a thin coat to EXPOSED skin One application lasts up to 12 hours Insect Repellents for Skin and Clothing Individual Dynamic Absorption Kit (IDA) Treatment lasts for for over 50 launderings NSN 6840-01-345-0237 NSN 6840-01-278-1336 Aerosol spray can Treatment lasts through 5-6 washes Permethrin


Water Contact Diseases: Water Contact Diseases Water-contact Diseases Standing water may persist in the New Orleans area for a month or more FHP Priorities avoid unnecessary contact with lakes, rivers, streams, and other surface water water contact in the performance of duties is expected – avoid unnecessary contact


Respiratory Diseases: Respiratory Diseases Respiratory Diseases May increase in displaced civilian camps and tent cities FHP Priorities Avoid close contact when possible Provide at least 72 square feet per person in sleeping areas / sleep head to toe Provide and emphasize hand washing/sanitizer and proper hygiene


Handling Bodies of Victims: Handling Bodies of Victims Unburied human remains not a disease threat Cadavers in the water supply rarely transmit diseases. Increased number of filth flies can increase shigellosis. Mortuary staff, and body retrieval teams risk exposure to hepatitis B virus (HBV) and HIV For personnel exposed to blood and body fluids: Use gloves when handling bodies or body fluids Use eye protection, gowns, and masks when large quantities or splashes of blood are anticipated Wash hands frequently Use body bags to reduce the risk of contamination


Universal Precautions: Universal Precautions “Universal Precautions or Standard Precautions" are the terms used to describe a prevention strategy in which all blood, potentially infectious materials, and respiratory secretions are treated as if they are, in fact, infectious, regardless of the perceived status of the source individual. In other words: Whether or not you think the blood/body fluid is infected with bloodborne pathogens, you treat it as if it is.


Prevention of Blood/Body Fluid Pathogens: Prevention of Blood/Body Fluid Pathogens Personal Protective Equipment (PPE) Gloves (Fluid-Proof) Eyes and Face Protection Body Protection Head and Foot Protection If you find yourself in a situation where you have to come in contact with blood or other body fluids and you don't have any standard personal protective equipment handy, you can improvise. Use a towel, plastic bag, or some other barrier to help avoid direct contact.


Improve Resistance to Stress 1 of 2: Improve Resistance to Stress 1 of 2 Remember the larger purpose of what you must do. You are showing care, giving hope, and preventing disease for the living. You are recovering the bodies for registrations and respectful burial. Limit exposure to the stimuli. Mask odors with disinfectants, deodorants, air-fresheners. AVOID FOCUSING on any individual victims. Have people who did NOT search the body examine any materials collected for identification of the body or intelligence. Remind yourself the body is not “the person,” just the remains.


Improve Resistance to Stress 2 of 2: Improve Resistance to Stress 2 of 2 Keep humor alive Don’t desecrate or steal from the victims Schedule frequent breaks; maintain hygiene, drink plenty of fluids, and eat good food. Have your team get together for mutual support and encouragement. Help buddies or subordinates in distress by being a good listener. Prepare yourself for what you will see and do. Don’t feel guilty about distancing yourself mentally from the suffering of individuals. Don’t be disheartened by horrible dreams, feeling tense, or intrusive memories. Participate in a critical event debriefing with trained people from your supporting unit ministry and/or behavioral health/combat stress control team.


Venomous Animals: Venomous Animals Snakes, Alligators (possibly displaced by floodwaters) Bees, wasps, hornets, and fire ants Spiders COUNTERMEASURES Avoid bees, hornets, wasps, fire ants, and spiders Assume ALL snakes are poisonous Do not attempt to handle or capture any snakes Shake out clothes, shoes, and bedding before use Wear foot protection at all times (no barefoot) Bring proper medication if allergic to bites/stings


Post-Deployment: Post-Deployment All AC and those RC personnel activated more than 30 days must: Complete Post-Deployment Medical Health Assessment (DD Form 2796) Receive post-deployment preventive medicine briefing Receive post-deployment screening, testing, and follow-up


Summary: Summary Background Physical Environment Medical Threat Stress Post Deployment


CONCLUSION: CONCLUSION "Preparation through education is less costly than learning through tragedy." - MAX MAYFIELD, DIRECTOR NATIONAL HURRICANE CENTER


Slide35: Contact Your Local Preventive Medicine Service or Medical Support Unit for Additional Information Prepared by: U.S. Army Center for Health Promotion and Preventive Medicine (800) 222-9698/ DSN 584-4375/(410) 436-4375 http://usachppm.apgea.army.mil