Hurricane Sandy and the Community Nurse in Brooklyn

The effects of Hurricane Sandy on the Brooklyn borough of New York City were deleterious to the public health and wellbeing of its residents. The socioeconomic status of many Brooklyn residents compounded the destruction to public services that Sandy brought, but the variability of public health and community nurses aided in minimizing the impact of the hurricane. The exhibit, Documenting Sandy, in the 3rd-floor gallery of the Brooklyn Historical Society shows the effects of Hurricane Sandy throughout Brooklyn. The conditions that followed are also documented, providing an understanding of the public health challenges Brooklyn residents faced in the aftermath of the hurricane. Navigating those conditions was a challenge for public and community health nurses, but the community-based approach such nurses practice on a daily basis prepared them for such a challenge.

The first public health and community nurses were implemented within urban environments to serve the most vulnerable members of society, those exposed to the risky environment of urban slums. Since their inception, community nurses have had a population-oriented focus in which their approach to promoting health and wellness encompassed the most vulnerable members of an area, across an entire population. Their focus was also set to determine the best course for implementing preventative healthcare. By identifying ongoing or potential problems in health, lifestyle, and/or living arrangements of such vulnerable individuals, community nurses were first able to decrease health-related problems later in life that would fully debilitate the individual and create a greater burden on the public health and community nurses.

The strength of the community nurse lies in the framework that can be drawn from preventative and population-based care models. The Community Participatory Health Promotion Model, developed in 2006 to address substance abuse in rural Virginia, is such a framework that encourages collaboration between healthcare professionals and community members alike (Kulbok, Thatcher & Meszaros, 2012). The Community Participatory Health Promotion Model allows community nurses to identify the most effective preventative care techniques by providing an understanding of the demographics of a community, and connecting the community’s strengths and weaknesses to healthcare professionals or other alternative means of care provision. The use of such a model is founded on the idea that a community nurse must have “an appreciation of culture, economics, politics, and psychosocial problems as determinants of health and illness” (Kulbok et al., 2012, p. 4). It is evident, then, that public health and community nurses were best suited for responding to the acute emergencies that took place during and after Hurricane Katrina throughout the neighborhoods of Brooklyn due to their understanding of the cultural, economic, political, and psychosocial character of the individuals within those neighborhoods.

An understanding of the working conditions within most Brooklyn neighborhoods, as well as the demographic characteristics, was necessary for public health and community nurses to respond to the disaster zones created by Hurricane Sandy. This is especially true in urban areas that have high levels of poverty, inadequate educational opportunities, and medical care that is hard to access. As of 2010, the population of Brooklyn was 2.5 million, 50% of which were non-white minorities (“Brooklyn economic and employment status,” 2010). The population of Brooklyn residents over 62 in 2010 was 5.7%, while 37.5% were living in non-family households, 10.3% were unemployed, and 15% were below the poverty line (“Brooklyn economic and employment status,” 2010). In some neighborhoods, like the public housing Red Hook neighborhood, the poverty level reached upwards of 45% (Schmeltz, Gonzalez, Fuentes, Kwan, Ortega-Williams, & Cowan, 2013). Brooklyn, and especially neighborhoods like Red Hook, showed a significant level of vulnerability prior to Hurricane Sandy.

In the aftermath of the hurricane 97 people died, rolling blackouts affected parts of Brooklyn for up to 3 weeks, and billions of dollars of structural damage were strewn throughout the New York City metropolitan area (Schmeltz et al., 2013). Many people heeded the mandatory evacuation orders, but those that stayed or were told not to evacuate from nursing homes and hospitals began a several-week long process of living with no public resources. In their analysis of Hurricane Sandy and the public health response in Brooklyn, Schmeltz et al. (2013) found that the major issue throughout Brooklyn wasn’t the initial disaster response, but the inability for disaster preparedness plans to address “extensive and long-lasting power outages and subsequent lack of key services” (p. 800). The responsibility for providing heat, clean water, emergency care, and food fell on the shoulders of first responders and community nurses.

Many reasons prompted vulnerable residents of Brooklyn to remain in their homes despite mandatory evacuation notices. The warnings associated with Hurricane Irene one year earlier, followed by very minimal damage, created a false sense of security, and many residents worried they would have nowhere else to go if they were never allowed back into their former residencies. In their evidence-based commentary on the state of public health activities during and after Hurricane Katrina, Powell, Hanfling, and Gostin (2010) concluded that “both Katrina and Sandy highlighted the difficulty in attaining ‘situational awareness’ – the data and insights needed to make strategic planning and response decisions” (p. 2570). Many nursing homes, clinics, and hospitals considered evacuating but were reassured by high ranking officials to keep patients within their current situations. The major public health problems that arose in the aftermath may be attributed to this lack of evacuation prior to the storm, as many of these nursing homes and hospitals immediately saw the need to relocate during the subsequent weeks of power outages, sewage build-up, and a lack of running water.

While the disaster management plans did not effectively consider the most vulnerable residents of Brooklyn, public health workers, and community nurses utilized their population-based and preventative skill sets to identify acute problems in poor neighborhoods like Red Hook. One medical student, Matt Kraushar, responded to the hurricane by organizing a team of 60 EMT, physician, and community nurse volunteers to address problems like elderly medication care, emergency response, food provision, and ongoing checkups. By using a model of community and population-based care Kraushar’s team was able to document the immediate medical needs of over 300 residents, rescue an 80-year-old man experiencing a myocardial infarction, and respond to a woman who had run out of supplementary oxygen (Evans, 2012).

Community nurses were integral in Brooklyn’s response to Hurricane Sandy. The underlying reason they were so effective was their understanding of the demographic and socioeconomic characteristics of the communities involved. Public health and community nurses were able to document medication regimens that needed to be followed or filled for an ambiguous amount of time, provide first response emergency care, and connect residents to active support agencies. The hallmark of the successes within the Red Hook neighborhood was Kraushar and his team’s sense of community participation. Nurses were able to identify at-risk residents by referencing past visits, and doctors were able to administer emergency rations of medication while stores and pharmacies remained closed for weeks. Schmetz et al. (2013) concluded that “high social capital within the neighborhood…contributed to Red Hook’s resiliency in the weeks after Hurricane Sandy landed” (p. 804). Disaster preparedness could take a page out of the community nurse’s book and focus more on population-based considerations, as well as person-to-person interaction.

References

Brooklyn economic and employment status. (2010). American FactFinder. Retrieved from http://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_12_5YR_S2301

Evans, H. (2012, November 17). Matthew 'Medical Matt' Kraushar comes to the rescue of stranded Red Hook residents after Hurricane Sandy paralyzes Brooklyn neighborhood. New York Daily News, pp. 1-2.

Kulbok, P. A., Thatcher, E., Park, E., & Meszaros, P. S. (2012). Evolving public health nursing roles. The Online Journal of Issues in Nursing, 17(2), 1-6. Retrieved from http://www.medscape.com/viewarticle/772434_6

Powell, T., Hanfling, D., & Gostin, L. O. (2012). Emergency preparedness and public health: The lessons of Hurricane Sandy. The Journal of the American Medical Association, 308(24), 2569-2570.

Schmeltz, M. T., Gonzalez, S. K., Fuentes, L., Kwan, A., Ortega-Williams, A., & Cowan, L. P. (2013). Lessons from Hurricane Sandy: A community response in Brooklyn, New York. Journal of Urban Health, 90(5), 799-809.