NASA satellite image of Hurricane Irma at peak intensity, Sept. 6, over Virgin Islands

On Sunday, September 10, many of the residents of coastal towns around the state of Florida sought shelter from Hurricane Irma in shelters, and in their homes when shelters reached capacity. Hurricane Harvey relief efforts were still fresh in the minds of the public—and in fact still underway—even as Florida prepared for a projected direct hit of Hurricane Irma and Georgia and South Carolina braced for storm surges and tropical storms.

By Tuesday, the weather system had dissipated and flood waters covered the areas hit by Hurricane Irma, creating environments that present many hazards, some known and others unknown. As other parts of the Southeast feel relief, with restored electricity and Internet and cell phone service restored, some towns that didn’t fare so well are still recovering from the devastation. Recovery may be hampered as we receive news of additional severe storms developing in the Atlantic.

For Florida residents in certain areas, the storm is far from over. Those most vulnerable for health problems in this post-hurricane period include persons with chronic conditions, children, older adults, those living in poverty and those newly impoverished by the hurricane, relief workers and first responders, undocumented immigrants, and the temporary workers hired for clean-up in the aftermath.

In providing care to people after storms and flooding, nurses should be aware of the variety of hazards that are now part of the environment, including:

  • Heat stress and dehydration, worsened by electrical failures that prevent the use of fans and air-conditioning
  • Carbon monoxide poisoning from enclosed stoves and portable generators
  • Spread of insect-borne disease by increased insect habitation in the standing water
  • Bacterial and hygiene hazards from raw sewage and lack of plumbing
  • Allergen exposure (i.e., mold, dust) and decreased indoor air quality
  • Chemical hazard exposure in flood waters (i.e., herbicides and pesticides in agricultural land runoff, PCBs from power transformers, solvents, hydrogen sulfide from flooded grease traps)
  • Transportation hazards (docks inoperable, road blockage from downed trees, traffic with return of evacuees)
  • Psychological stress
  • Ergonomic and physical injury hazards from damaged buildings, debris cleanup, and downed power lines
  • Toxicant exposure from demolition and cleanup efforts (i.e., asbestos, airborne particulate matter, noxious gases)
  • Drowning from storm surges, standing water, and flash floods
  • Unknown hazards from mixtures and compounds of chemicals in the floodwaters

After a hurricane, approaches to nursing care may need to shift in order to adapt to the hazards present. Actions nurses can take to adapt care after a hurricane include:

  • Anticipate patient needs with designated “fast-tracks” areas in ambulatory care settings for nebulizer treatments, portable oxygen tank and nasal cannula/mask distribution, and IV rehydration.
  • Triage should be based upon a new set of environmental circumstances, taking into account that there may be increased levels of dehydration, heat illness, waterborne infections, respiratory distress, psychological distress, dermatitis/lesions/lacerations, poisoning, musculoskeletal injuries, and infections.
  • Have a specific plan in place for triaging and working up patients in a contained area, who may have encounter hazardous materials.
  • Be aware that decreased access to medications, medical equipment (portable oxygen, nebulizers), food and water, and care (such as dialysis) may result in exacerbations of chronic conditions (diabetes, hypertension, psychiatric disorders, heart failure, asthma, allergies), especially for children and older adults.
  • Be vigilant of symptoms of reportable diseases in patients and report any cases to the appropriate authority.
  • Assemble hygiene kits and first aid kits for distribution that include items like insect repellent, socks, toothbrush and toothpaste, trash bags, soap, and underwear.
  • Assemble medical aid kits for patients with chronic conditions, including at-home meters like blood glucose meters (with test strips) and spacers.
  • Stock bottled water and sports drinks to distribute in patient waiting areas and rehydration solutions for children.
  • Provide precautionary guidance regarding relevant hazards for patients, including the use of insect repellant, personal protective equipment (like wading gaiters) for community members participating in relief efforts, and rehydration recommendations.
  • Direct residents to seek assistance from trained local officials for the safe disposal of building debris and waste.
  • If these resources are not available, nurses need to advocate for their communities at local, state, and federal levels for support aimed at minimizing exposure to dangerous toxicants from standing debris or fumes from the unsupervised burning of waste.

Valerie Vi Thien Mac, PhD, RN, is an assistant professor and emergency nurse practitioner candidate at the Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, where Jeannie Weston, EdD, MS, RN, is a clinical professor.