No. 2, April 2006
LETTER TO THE EDITOR
Florida Disasters and Chronic Disease Conditions
Suggested citation for this article: Baggett J. Florida disasters and
chronic disease conditions [letter to the editor]. Prev Chronic Dis [serial
online] 2006 Apr [date cited].
Available from: URL: http://www.cdc.gov/pcd/issues/2006/
To the Editor:
Florida had five hurricanes during 51 days beginning on August 12, 2004.
More than 8 million residents lost power; more than 9 million people were
evacuated; 368,438 people were housed in general and special-needs shelters;
and 117 people died. There were long lines for water and gasoline, many homes
and businesses were destroyed, and familiar landmarks disappeared. Not broadly
publicized was the way people with chronic diseases were affected and how
disaster planning will change because of it.
I observed firsthand the obstacles faced by evacuees in special-needs
shelters and the impact on Florida Department of Health staff who cared for
these people. Florida citizens and leaders have now seen the toll
chronic disease takes on quality of life and its impact on disaster
The following information provides a glimpse into the needs of people with
chronic diseases during disasters and suggestions for future disaster
- Designated special-needs shelters. Florida provides special-needs
shelters to meet the needs of people with chronic diseases and
disabilities during times of disaster. Each shelter has health
professional staff, including at least one physician. Many people arriving
at the shelters during recent disasters had diabetes, heart disease,
kidney disease, cancer, chronic obstructive pulmonary disease, arthritis,
asthma, emphysema, Alzheimer’s disease, anxiety disorders, Crohn’s
disease, cystic fibrosis, depression, epilepsy, multiple sclerosis,
Parkinson’s disease, or combinations of these conditions. Most
people in these shelters needed oxygen, special diets, and medication.
Many were unable to make their way to the bathroom without help, could not
sleep lying flat, or could not breathe well without oxygen.
- Shelter beds. A number of people at our shelters were overweight
or obese. Military cots that are normally used for shelter beds were not strong
enough and sometimes broke under the excess weight. Getting people on and
off of cots was difficult because the cots were so close to the ground.
Shelter residents could not maneuver on and off the cots by themselves,
and staff members were physically stressed by helping to lift heavy people. The
cots also had sharp metal edges that caused many scrapes and bruises —
extremely dangerous to the large number of elderly people with thinning
skin, to people with diabetes for whom skin integrity is a serious
concern, and to individuals taking blood-thinning medication. At the West
Florida special-needs shelter where I was assigned to work, we found that
chaise lounges were more useful. Other areas of the state reported
successfully using reclining chairs instead of beds.
- Shelter electricity, supplies, and transportation. Designated
shelters benefit by having generators that are located in nonflood areas
and that are regularly serviced and tested to ensure that they will work when
needed. Shelters need to provide a stockpile of hand sanitizer, gloves,
brooms, buckets, disposable wipes, and disinfectant spray to help with the
immediate need for infection control. In addition, shelters should have
on-site an easy-to-locate, spare key for janitorial and supply closets. The
West Florida special-needs shelter had an on-site ambulance and a
team of law enforcement and emergency staff. The ambulance and team
provided extra security, the ability to move large people, and
transportation to the hospital.
- Diet, nutrition, and food safety. Many people in our
special-needs shelter required special diets. A heart-healthy, low-sodium,
low-fat food selection should be standard fare in shelters. Providing such
fare may best be accomplished by using prepared meals similar to the
military’s ready-to-eat meals. In addition, when people are confined, it
becomes important to observe precautions for preventing communicable
diseases, especially for people with compromised immune systems.
Disaster-relief workers would benefit from receiving sanitation,
hand-washing, and food-handling education before assignment.
- Medication. People often arrived at our shelters without vital
medications. Others depleted their prescriptions before they could return
home. Residents should continue to be encouraged to bring a list of all
prescriptions and the containers for all prescription medications or a
copy of the prescription with them to a shelter. Each state would
benefit from having a disaster prescription plan to accommodate emergency
prescribing and dispensing by shelter physicians. In addition, the state
would benefit by partnering with state, federal, or private prescription
insurance providers to identify alternatives for increasing supplies of
medications or replacement medications before or during times of disaster.
- Personal information. People in our shelters were often unable to
recall personal, medical, and insurance information. Severe stress
prevented some from recalling the names, addresses, and telephone numbers
of next of kin. Individuals should maintain a medical history and
insurance card for use in times of emergency. This information would
enable health care professionals at the shelter to assess
- Mass transportation. Many low-income and elderly people and
people with disabilities caused by chronic diseases need help in getting
out of harm’s way before disaster strikes. A mass transportation system
to move many people over a short time span is preferable. Military buses
and helicopters were used in Florida to move some staff in and out of
disaster areas. This may become the standard for moving residents away
from affected areas. Standing arrangements with nearby states to house
evacuees, with a well-defined notification and evacuation plan, is also
- Communication. All modes of communication are used to educate
people who may be affected by the storm, especially people with chronic diseases requiring
medications and other medical supplies. Materials written in many
languages and at a low literacy level are best for educating the widest
segment of the population. Florida did an excellent job of educating
residents. The state broadcasted public service announcements and
distributed written directives. Public service announcements are
available from the Florida Department of Health: http://www.doh.state.fl.us/Hurricane/ Hurricanefactsheet.html*.
- Postdisaster help. Individuals with chronic diseases, the
elderly, and low-income people need help cleaning up their homes when
they return from the shelters. Florida residents returned to debris in homes
and yards and rotting food in refrigerators and freezers. Many could not
tolerate using disinfectant products, did not have the strength or stamina
to clean, or did not have the money to hire someone to clean or
repair their home. A community-based system of home inspection to
determine habitability of homes before people with special needs return
may be considered.
The 2004 and 2005 hurricane seasons left many communities without grocery
stores, physicians’ offices, drug stores, or religious institutions. The
entire infrastructure of some communities disappeared entirely. People
returning to these communities were stunned and did not know where to turn.
Providing help to these people is critical, especially when they are elderly,
have a limited income, or have a chronic disease or disability.
Florida has developed extensive plans, formed additional partnerships, and
collected data on disaster situations that are available to help other
This information is a personal account and intended to provide insight into
the scope of chronic disease issues that must be addressed during times of
disaster. Florida has made many advances in disaster preparation and relief
and is ready to help others learn from its experiences.
This was the first time in my 28 years with the Florida Department of
Health that I participated in disaster relief at the community level. I am
extremely proud of my department and my coworkers for their kindness,
courtesy, sympathy, and helpfulness to people affected by these storms. Many
worked 24 hours each day for several days in a row and worked through the
disaster not knowing the status of their own homes or families. It truly
brought out the best in the Florida public health work force and gave the
people of Florida a sample of the importance of their public health
infrastructure. I hope the lessons learned and the opportunities for
improvement that have been identified are acted upon in every state for the
benefit of those affected by future disasters.
Bureau of Chronic Disease Prevention and Health Promotion
Florida Department of Health
4052 Bald Cypress Way, Bin A-18
Tallahassee, FL 32399-1744
Back to top
*URLs for nonfederal organizations are provided solely as a
service to our users. URLs do not constitute an endorsement of any organization
by CDC or the federal government, and none should be inferred. CDC is
not responsible for the content of Web pages found at these URLs.