Hurricanes Harvey, Irma and Maria are long gone, but their physical and emotional impact may be felt for years to come. Images of roofs ripped off homes and people wading through waters in Puerto Rico, Florida and Texas have not ceased since Hurricane Harvey made landfall Aug. 26.
While preservation of life was the focus during the storms and soon after, when each storm passes focus turns to cleanup, assessing damage and rebuilding, all of which can take weeks, months, even years. Add to the mix the physical stressors and emotional turmoil experienced by residents of affected areas and it becomes apparent how devastating hurricanes truly are.
According to a preliminary estimate from Moody’s Analytics, the storms may have caused up to $200 billion in damage to areas, including Florida and Texas — a number comparable to the costs incurred by Hurricane Katrina in New Orleans in 2005. Damage to Puerto Rico alone as a result of Hurricane Maria’s assault is estimated to be between $45 billion and $95 billion, and the U.S. territory remains the site of a humanitarian crisis.
Heather Chung, MSN, PhD, RN, director of psychiatric services at Houston Methodist Hospital in Texas, is one of many nurses who are witnessing firsthand the hurricanes’ health effects on the thousands who have lost homes, workplaces, transportation and much more.
Chung’s team is seeing a surge in the number of patients who are experiencing the re-emergence of post-traumatic stress disorder, depression and relapse into substance use — issues they had overcome way before Harvey struck.
One veteran patient had driven to Galveston, Texas, to check on a relative’s home when he started experiencing symptoms of PTSD as he drove through the devastated neighborhood, Chung said. The man had initially suffered from PTSD after serving in the military, and was unaware that he had lapsed into a different mental state as he started forming a suicide plan. Fortunately, his brother knocked on the door before he started carrying out his plan and drove him to the hospital.
Although it may be tempting for patients to push aside medical needs like mental health treatment as they grapple with the overwhelming tasks of rebuilding their lives, neglecting these medical issues can lead to problems in the long term, said Roberta Lavin, PhD, APRN-BC, associate dean for academic programs at the University of Missouri-St. Louis.
“It’s really important for nurses to take a holistic approach and help their patients address their basic needs because this will allow them to focus on their medical needs,” Lavin said.
“Nurses may feel like social services are not their role, but we need to take the time to educate our patients about the resources that can help them find food, shelter, medication and other things critical for stability,” Lavin said.
At Houston Methodist Hospital, one of the largest influxes of patients after Hurricane Harvey was people suffering from dementia, and the family members of these patients need assistance understanding the options for these now-homeless relatives, said Alric Hawkins, MD, a psychiatrist at the hospital.
“Many of these new patients were living in their communities but not functioning very well, and after they lose their homes and familiar environments, they are unable to live independently anymore,” he said.
The mental health professionals at Houston Methodist Hospital also are starting to see increasing numbers of patients who are experiencing drug and alcohol relapse as they cope with the grief and depression triggered by the loss of homes, possessions and routines.
“We are giving these patients a brief counseling session and directing them to pursue help through longer-term counseling, psychiatry and support groups like Alcoholics Anonymous,” said Marshall Getz, PhD, an educational psychologist at the hospital.
During and after Hurricane Harvey, Kelsea Bice, BSN, RN, CEN, a nurse in the emergency room at Memorial Hermann Memorial City Medical Center in Houston, saw a number of patients who needed treatment for skin infections. One woman had been carrying her cat through the water, but the cat scratched her and created an open wound. And more patients are arriving at the hospital after construction accidents.
“People who don’t usually work with building materials are getting injured as they pull out drywall and carpet or try to demolish their own homes,” Bice said. “We’re seeing more lacerations, flare-ups of arthritis and falls.”
Texas officials are encouraging people to get tetanus booster shots because the disease enters the body through cuts. Based on CDC reports after Hurricane Katrina, evacuees and rescue workers during the recent storms may be at risk of MRSA, an antibiotic-resistant bacterium, and Vibrio pathogens, or flesh-eating bacteria.
Cases of mosquito-borne illnesses such as Zika, dengue and West Nile virus also may increase among people who were forced out of homes and buildings for days at a time during the storms. As people return to their homes, exposure to molds also can increase the risks of inflammatory reactions, asthma and allergies.
While some people recover their economic security, mental and physical health within a few months after storms like Irma and Harvey, this is not the norm, according to studies by David Abramson, PhD, MPH, a clinical associate professor at NYU College of Global Public Health.
Abramson studied the long-term impact of disasters on communities after Hurricanes Katrina and Sandy. He found recovery often takes three to five years or longer. After studying New Jersey residents whose homes were significantly damaged by Hurricane Sandy in 2012, Abramson found 27% of these people were experiencing moderate or severe mental health distress two and a half years after the storm. Fourteen percent reported signs and symptoms of PTSD more than two years after the storm.
“We’ve also been struck by how long kids can have potentially serious emotional disturbances even five years after these events,” Abramson said.
In his 2015 Sandy Child and Family Health Study, children living in homes with minor damage were more than four times as likely to feel sad or depressed as children living in homes that were not damaged. They were more than twice as likely to have difficulty sleeping.
“I think nurses can play an important role in picking up on some of these issues early,” Abramson said. Oftentimes the loss of a home can trigger these mental health issues, and asking about a patient’s housing circumstances gives them an opportunity to share about the psychological challenges they are facing, he said.
To provide mental health services for children who were suffering from longer-term effects of Hurricane Sandy, NYC Health + Hospitals/Coney Island in New York created a specialized program to identify children who needed additional psychological support. The program, which was funded by the Substance Abuse and Mental Health Services Administration, started six months after the storm and continued for two years, and children were screened in the primary care setting. Some children were having flashbacks and fears of another disaster during power outages or rain storms. Others were anxious because their parents seemed stressed and preoccupied as they faced the task of rebuilding their lives after Sandy.
“A lot of times parents didn’t know how to deal with the stress, and they didn’t communicate with their children,” said John Jannes, PhD, associate executive director for the department of behavioral health at NYC Health + Hospitals/Coney Island. “One of the most important things we did is encourage family members to talk to each other about what was going on. Children also needed to hear that Sandy was a very rare event, and a simple rain storm doesn’t mean it will happen again.”
Even though the community impact of hurricanes may linger for years, caregivers who were on the front lines of Sandy said the disaster also gave patients an opportunity to discover their own resilience. “Many employees at the hospital lost everything, but they still came to work,” said Katrina Maneri, RN, assistant nursing director for psychiatry at the hospital. “The community pulled together to support one another, and the experience brought me closer to the community.”
Freelance writer Heather Stringer contributed to the writing and research of this article.
60081: RNs Shelter Victims of Disaster
(1 contact hr)
Never in the history of the U.S. has disaster preparation and response been as vital as it is today. Disasters are frequently classified as manmade or from natural causes. In addition to the threat of manmade disasters — such as terrorist attacks — and natural disasters — such as fires, floods and earthquakes — the focus of disaster preparation has grown to include emerging infectious diseases, such as severe acute respiratory syndrome and avian influenza. This module will help nurses better understand the role of Red Cross nurses during major disasters and help nurses decide whether DHS nursing may be where they can best contribute their time and talents to help their fellow citizens.
60050: When Disasters Strike
(1 contact hr)
This module features an overview of disaster management in EDs, including the definition of the four stages of disaster management and the appropriate triage of patients. It also describes the unique considerations of disasters that involve a chemical, radiological, or biological agent. Preparation of ED personnel, such as EMTs and RNs, will enable them to respond to disasters and the patient populations affected by them more effectively.