Environmental health disaster management: A new approach

Abstract

The need for an integrated approach to assessing environmental health issues and priorities after a disaster has been highlighted by recent disasters in northern Queensland. In response, the Cairns Public Health Unit (CPHU), Queensland Health, initiated a project to work with local and state governments from across northern Queensland to address these issues. This approach has proved successful and resulted in the development of a response guide, an environmental health rapid assessment tool, and an evacuation centre checklist. These achievements demonstrate that an objective forum for local and state governments can be effective in solving issues requiring multi-agency solutions. The project has provided a framework that can be applied to a range of issues other than environmental health and disaster management, and may be adapted to other settings beyond northern Queensland.

Full text

37
Disaster Resilient Australia: Get Ready
I
Overview
Recent natural disasters in northern Queensland
highlight the need for an integrated approach to
assessing environmental health issues and priorities
that arise following a disaster. During recent responses
there were concerns raised that field officers did
not have access to tools that allowed for timely and
systematic assessments. This culminated in limited
information being collected for decision-makers to
determine priority areas in a timely manner and allow
public health interventions to be based on evidence.
In response, the Cairns Public Health Unit (CPHU),
Queensland Health, initiated a project to work with
local and state governments from across northern
Queensland to address these issues. This work centred
on the formation of the Far North Queensland Public
Health Disaster Management Working Group (working
group), which provided an objective forum for state
and local government disaster management and
environmental health experts.
Environmental health and disasters
The environmental health response to a disaster aims
to manage public health effects caused by the event
and improve disaster preparedness to respond to future
events (UCLA, 2006). The main elements considered in
the response include, but are not limited to:
• drinking water
• hazardous waste (e.g. asbestos)
• general waste
• sanitation
• food safety
• communicable diseases
• vector issues, and
• mass gatherings (e.g. evacuation centres).
Public health professionals, particularly Environmental
Health Officers (EHO), are in the best position to assess
the impact of disasters on populations and conduct
evaluations on responses due to their population-based
focus (Degutis, 2008). Also, the core skills of EHOs
allow the profession to effectively respond, monitor and
assess public health issues in a disaster situation.
The most effective way to protect the health of people
impacted by disasters is to ensure adequate shelter,
water, food and sanitation. A systematic approach to
the assessment and control of communicable diseases
and other public health issues is a key component of a
response, and is crucial to protect the health of affected
populations (TFQCDM/WADEM, 2002).
Regional approach
The range of environmental health issues (such as
asbestos, sewage and contaminated drinking water)
arising from recent natural disasters in northern
Queensland led the CPHU to work with local and state
governments to form the working group in mid 2011. The
working group facilitated environmental health teams
and disaster co-ordinators to work together in identifying
and managing public health risks within existing disaster
management arrangements. Further, it was anticipated
this approach would allow local governments in the
region to enhance their public health resilience and allow
core business activities to continue during a disaster
response (e.g. water treatment).
ABSTRACT
The need for an integrated approach to
assessing environmental health issues
and priorities after a disaster has been
highlighted by recent disasters in northern
Queensland. In response, the Cairns Public
Health Unit (CPHU), Queensland Health,
initiated a project to work with local and
state governments from across northern
Queensland to address these issues.
This approach has proved successful and
resulted in the development of a response
guide, an environmental health rapid
assessment tool, and an evacuation centre
checklist. These achievements demonstrate
that an objective forum for local and state
governments can be effective in solving
issues requiring multi-agency solutions.
The project has provided a framework that
can be applied to a range of issues other
than environmental health and disaster
management, and may be adapted to other
settings beyond northern Queensland.
Environmental health disaster
management: a new approach
Ben Ryan, Brad Milligan and Dr Annie Preston-Thomas (Cairns Public
Health Unit) and Geoff Wilson (Cassowary Coast Regional Council) detail the
development of a response guide and supplementary planning tools to assist in
the information-gathering stage of health emergencies in Queensland.

38
Australian Journal of Emergency Management
Volume 28, No. 1, January 2013
I Disaster Resilient Australia: Get Ready
Local governments, indigenous and non-indigenous,
and state agencies were invited to be part of the working
group. Acceptance required nomination of a contact
person from an environmental health or disaster-
related field. CPHU facilitated the working group, which
included discussions, communication and organisation of
meetings. The group consisted of representatives from a
range of local governments including Cairns, Cassowary
Coast, Cook, Pormpuraaw, Tablelands, Yarrabah,
and Weipa. There was also active participation from
Emergency Management Queensland and the Australian
Red Cross.
Integrated framework
Based on lessons from recent natural disasters and
working group discussions, an integrated framework
was identified as the preferred approach for preparing
for and responding to environmental health risks
associated with disasters. The framework includes
a response guide, an environmental health rapid
assessment tool, and an evacuation centre checklist.
These were developed as part of this project.
Response Guide
An Environmental Health Disaster Response Guide
(Figure 1) provides an overview of the processes
involved in ensuring an effective response to a disaster.
The objective is to provide a systematic approach for
gathering public health information after a disaster and
providing this to decision-makers in a timely manner.
The primary role of local and state government EHOs
is to determine the environmental health risks and
priorities from a community perspective.
Environmental health assessments would be
undertaken within 72 hours of a disaster to identify
community-wide risks and priorities. The environmental
health rapid assessment form and evacuation centre
checklist would be used to ensure consistency in
the information gathered. Ongoing assessments are
conducted using these forms or modified versions to aid
the community’s recovery and re-building efforts. This
is particularly important to ensure the effectiveness of
interventions is monitored and guide transition from
response and recovery phases of disaster management.
This type of process has been used successfully in
the United States when responding to hurricanes,
floods and ice storms (Rubin, 2005). Information
gathered from such assessments allows responders to
understand the public health issues, actual numbers
of resources needed, and the messages required for
affected residents (Rubin, 2005).
The environmental health rapid response teams are led
by a Rapid Response Coordinator (RRC). Depending on
local arrangements, the teams would be made up of
EHOs from local and state governments to increase the
pool of resources available and ensure all public health
jurisdictional responsibilities are covered. Ideally, in a
large disaster such as Cyclone Yasi, the RRC position
would be filled by a state government representative
who functions as the Operations Officer or a similar
position in an Incident Management Team within
Queensland Health. If this was the case, the role of the
RRC would be transferred to local government when
capacity permits. Alternatively, the RRC could be a local
government representative or any other appropriate
person. The key is to ensure this type of position is
agreed, identified and filled.
The RRC would deploy teams of two EHOs to
undertake assessments of public health risks in
selected communities and evacuation centres. The
term ‘community’ refers to a selected suburb, area or
town. The application of this term is at the discretion
of the RRC. A community-wide assessment may take
approximately two hours and an evacuation centre up to
an hour. A decision on the communities and evacuation
centres assessed would be made by the RRC. Before
a team is deployed, the RRC would provide a detailed
briefing of the situation and areas to be assessed.
The information gathered by EHOs in the field is
provided to the RRC. The RRC is responsible for
assessing information gathered and disseminating it to
the Local Disaster Management Group (LDMG) public
health representative and other agencies deemed
necessary. The LDMG and other agencies use the
information to develop an evidence-based response
strategy. The RRC periodically deploys teams of EHOs to
monitor the response.
For successful implementation of this guide it is
recommended that triggers in disaster management
plans be agreed and identified for appointing an RRC.
For example, when a severe cyclone, such as Larry
or Yasi (categories 4 and 5, respectively, at landfall)
is imminent an RRC is appointed and a pool of EHOs
placed on stand-by.
This guide should be consistent whether the work is
completed by local, state or federal governments. The
question of who conducts this work requires further
discussion, however, it should be dependent on the size
of the disaster and the capacity for the local
government to respond. Where disaster, such as
cyclones Larry or Yasi, overwhelms local government
resources, assistance will be required from other
agencies and all levels of government to address public
health risks.
Environmental health
rapid assessment tool
One of the key lessons learned following the response
to cyclones Larry and Yasi was the lack of evidence-
based and objective tools that allowed community-
level environmental health rapid assessments. This
resulted in insufficient information being collected and
collated to determine priority public health risks and
interventions based on evidence. The public health
Asbestos containing material littered private, public and state land
Raw sewage in swimming pool
Mixed debris
Tidal surge destroyed some houses
Damaged beachfront rock wall
Damage at Tully Heads (impacted by tidal surge) from Cyclone Yasi.
Images: Queensland Health

39
Australian Journal of Emergency Management
Volume 28, No. 1, January 2013
Disaster Resilient Australia: Get Ready
I
risks and priorities identified in this situation should
be accurate and timely. These can include inadequate
water supply, waste, food and sanitation systems, which
can have a direct, and potentially devastating, impact on
the health and livelihood of disaster-affected persons
(World Health Organization, 2004). To address this, the
working group developed an environmental health rapid
assessment tool.
The rapid assessment tool is a three-page form
divided into the key environmental health themes.
These include drinking water, sewerage, waste,
asbestos, food safety, personal hygiene, vectors and
chemical hazards. EHOs use their expertise to
complete the rapid assessment tool as soon as access
permits (as outlined in Figure 1, ideally within
72hours). This enables a systematic approach to
identifying and reporting on environment health issues
and priorities from a community perspective. As part
of the development process, Exercise Recon was held
at Tully Heads, Queensland on 9 November 2011 to
test the rapid assessment tool. Both assessment tools
were designed for use in hard-copy or in an electronic
format to ensure adaptability for unique
disastersituations.
The form concludes with a section for EHOs to prioritise
environmental health issues and priorities in-line with
FIGURE 1. Environmental Health Disaster Response Guide.

40
Australian Journal of Emergency Management
Volume 28, No. 1, January 2013
I Disaster Resilient Australia: Get Ready
the key themes. The RRC uses the priority ratings as a
guide on what actions may be required. Ultimately, any
decision made on the response strategy will be made by
the LDMG with advice from the RRC and other experts.
EHOs are not expected to conduct detailed assessments
of specific issues (e.g. determining methods for waste
disposal and food business inspections) and implement
solutions. The information gathered is provided to the
RRC. It provides a platform for a LDMG and other experts
to develop a response strategy.
Evacuation Centre Checklist
Mass gatherings, such as those at evacuation centres,
present some of the most complex management
challenges faced by governments. The influx of large
numbers of people and the infrastructure needed can
place a severe strain on public health systems and
services. This may compromise the ability to detect
developing problems and make effective responses
(World Health Organization, 2009).
Asbestos containing material littered private, public and state land
Raw sewage in swimming pool
Mixed debris
Tidal surge destroyed some houses
Damaged beachfront rock wall
Damage at Tully Heads (impacted by tidal surge) from Cyclone Yasi.
Images: Queensland Health

41
Australian Journal of Emergency Management
Volume 28, No. 1, January 2013
Disaster Resilient Australia: Get Ready
I
Pre-exercise briefing to participants
Field tests allowed participants to test the tools and make assessments
Post-exercise briefing
Field exercise, Exercise Recon, was useful to test the rapid assessment tools and get feedback from participants.
Images: Queensland Health

42
Australian Journal of Emergency Management
Volume 28, No. 1, January 2013
I Disaster Resilient Australia: Get Ready
To address this risk, the evacuation centre checklist
was developed for EHOs to use before and after an
evacuation centre is opened. The checklist provides
guidance for managers on the minimum environmental
health standards. The development of the checklist
involved a review of literature and adapting relevant
items from national and international documents.
Thisincluded the:
• Environmental Health Assessment Form for Shelters
- developed by the Centers for Disaster Control and
Prevention (United States of America)
• Sphere project – humanitarian charter and minimum
standards in humanitarian response
• Emergency Management Australia Manual 12 – Safe
and Healthy Mass Gatherings A Health, Medical and
Safety Planning Manual for Public Events, and
• consultation with the working group and the
Australian Red Cross.
The checklist is a two-page form and is segmented
into various sections including general overview, power
supply, sanitation, food and water, waste, vectors,
health (surveillance) and pets. EHOs use their expertise
to complete the form and some information is pre-
populated from the evacuation centre managers (e.g.
number of occupants). The checklist provides a process
for identifying environment health issues and priorities
at evacuation centres.
As with the rapid assessment tool, the information
gathered is provided to the RRC. It then informs the
LDMG and other experts when developing a response
strategy to environmental health issues at
evacuationcentres.
Discussion
This project demonstrated that providing an objective
forum for local and state governments can be an
effective way to solve issues requiring multi-agency
solutions. Communication between EHOs across
northern Queensland has strengthened, a response
guide was developed, a rapid assessment tool and
evacuation centre checklists have been adopted. To
complement these achievements, the development of a
database indicating baseline public health information
is required.
A current understanding of the public health status of
populations and infrastructure from an environmental
health perspective is incomplete in northern
Queensland. This would include gathering information
about areas likely to have buildings with asbestos
containing materials, the type of sewerage systems
in various suburbs, sewage overflow points, water
infrastructure including access to chemical suppliers,
waste disposal sites, emergency food and water
suppliers, etc. The development of such a baseline
database allows decision-makers to immediately
understand the public health impacts of a disaster
(Wilson, 2005).
Ongoing activities are required to sustain momentum of
the project. This would include regular meetings of the
working group and the establishment of a specialised
team of EHOs from local and state governments
in northern Queensland who can undertake rapid
assessments of communities to determine the
environmental health risks and priorities. A key element
of forming such a team is identifying co-ordinators and
ensuring access to a suitable training course.
Due to resource constraints it is going to be a challenge
to build on the achievements of this project. The risk
is that momentum is lost, and attention is only paid
to this area in the context of the next disaster. This
does not allow for the other preparations described
before an event occurs that would permit informed
decision-making and response. Funding has now
ceased, however, there are tangible benefits that can be
used to enhance disaster preparedness and response
activities. One solution may be for local governments to
formally adopt the response guide and tools developed
by including these in their public health disaster
management plans. Such an approach would ensure
EHOs across northern Queensland use similar systems
and tools which would streamline disaster response
activities and ultimately mitigate public health risks.
Conclusion
The project has enhanced the ability of local and
state government departments to address key
environmental health risks after a disaster. This
has been achieved through the development of an
environmental health response guide, environmental
health rapid assessment tool and an evacuation centre
checklist. These achievements provide a framework
for allowing the environmental health risks after a
disaster to be systematically identified and collated
for decision-makers. However, due to resource
constraints there is a risk of the achievements being
lost and the collection of baseline data and creation
of a specialised team of EHOs remaining incomplete.
To address this concern, it is recommended that local
governments formally adopt the response guide and
tools developed. This will allow priority areas to be
identified in a timely manner and ensure appropriate
interventions based on evidence, all of which is vital
for protecting livelihoods and mitigating public health
risks after a disaster.
Acknowledgements
Far North Queensland Public Health Disaster
Management Working Group. Mr Alex Skubij, Principal
Environmental Health Officer, Cairns Regional Council.
Mr Daryl Hanger, Australian Red Cross. Emergency
Management Queensland. The residents of Tully Heads
who participated in Exercise Recon.
Further information
Please contact Ben at ben_ryan@health.qld.gov.au.
Pre-exercise briefing to participants
Field tests allowed participants to test the tools and make assessments
Post-exercise briefing
Field exercise, Exercise Recon, was useful to test the rapid
assessment tools and get feedback from participants.
Images: Queensland Health

43
Australian Journal of Emergency Management
Volume 28, No. 1, January 2013
Disaster Resilient Australia: Get Ready
I
References
Degutis, L., 2008, Public health systems and public health
preparedness, Yale Centre for Public Health Preparedness,
New Haven, Connecticut.
UCLA, 2006, Hazard Risk Assessment Instrument, Centre for
Public Health and Disasters, viewed 20 June 2011, http://www.
cphd.ucla.edu/resources.html
Rubin, C., 2005, National Centre for Environmental Health,
Center for Disease Control and Prevention, USA in: Hooke,
W. & Rogers, P., 2005, Public Health Risks of Disasters –
Communication, Infrastructure and Preparedness – Workshop
Summary, National Academies Press, Washington DC, p. 40.
TFQCDM/WADEM, 2002, Health Disaster Management:
Guidelines for Evaluation and Research in the “Utstein Style”,
Chapter 3: Overview and concepts, Prehospital Disaster
Medicine, vol. 17, no. 3, pp:31–55, viewed 18 June 2011, http://
www.wadem.org/guidelines/intro.pdf
Wilson, S., 2005, National Institute of Environmental Health
Sciences, USA, in: Hooke, W. & Rogers, P., 2005, Public Health
Risks of Disasters – Communication, Infrastructure and
Preparedness – Workshop Summary, National Academies
Press, Washington DC, p. 41.
World Health Organization, 2004, Water and Disasters -
Leading Off, Health in Emergencies, No. 19.
World Health Organization, 2009, WHO Global Forum on
Mass Gatherings: Rome, Italy - October 26 - 29, 2009, World
Health Organization, Geneva.
About the authors
Ben Ryan is an Environmental Health Officer (EHO)
with Queensland Health anddoctoral candidateat
James Cook University. He has worked as an EHO
duringresponses to cyclone’s Larry and Yasi,
facilitated delivery of health services to asylum
seekers and worked in public health at all levels of
government in Australia.
Brad Milligan is Manager of Environmental Health
Services for the Cairns Public Health Unit.In this
role heoversaw and co-ordinatedenvironmental
health and public health aspects of the response
toCyclone Yasi and represented Queensland Health
on the Innisfail District Disaster Management Group.
Based on this experienceand 17 years ofwork in
environmental health at local and state government
in North Queensland he initiatedandsponsored
thisproject.
Geoff Wilson is Manager of Environmental Services
for Cassowary Coast Regional Council.During
the response to Cyclone Yasi he co-ordinated the
environmental health and waste management
aspects from a local government perspective. He is
amember ofthe Local Disaster Management Group
and has seven years local government management
experience in North Queensland. This has included
overseeing the environmental health response by
Cardwell Shire Council to CycloneLarry.Geoff used
these experiences toplay a vital role in steering a
partnership between local and state government
agencies during this project.
Dr Annie Preston-Thomas is a Public Health
Registrar in the Cairns Public Health Unit and a
Fellow of the Royal Australian College of General
Practice, with over ten years experience working in
community-controlled health services. Annie used
this experience and her research skills to assist in
developing the evacuation centre checklist, a major
component of this project.