A Post Disaster Public Health
Needs Assessment: Investigating
the Effects of Disaster Response
on Public Health Responders
Lisle Hites, Ph.D.
Tulane University
South Central CPHP
Hurricane Katrina Response:
How the CPHP became involved
• Informal discussions between the South
Central CPHP and State partners
• Sharing of anecdotal evidence:
– Job role versus response role concerns
– What effect is this having?
• What other needs are apparent postKatrina?
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Structured Interviews
• Job role – Response role
– How much disparity?
– Workplace safety issues?
– Psychological/emotional issues?
• Responder as victim
– Effects on job performance?
– Psychological/emotional issues?
Temporal issues in data collection:
How soon is too soon?
Data collection began in October of 2005,
just over one month after the storm.
• “It’s hard to care for others when you don’t
know how you’re going to take care of
yourself and your own family” October 14, 2005, Mississippi,
45 miles north of the coast
• “I have no patience with others who complain
but have lost so much less than I have. This
storm hit me really hard emotionally.” November 3,
2005, Mississippi, 5 miles north of the coast.
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Temporal issues in data collection:
How soon is too soon?
• Immediately after the storm, interviews
followed a consistent pattern:
– Step 1: Interviewee shows up with a cautious
“why should I take the time to talk with this
person?” attitude.
– Step 2: Bonding: “Oh, you have a story too? Tell
me yours and I’ll tell you mine”.
– Step 3: The structured interview ultimately takes
place with a free flow of information and
thoughts.
Geographic distance from the event:
How close is too close?
• Interview locations ranged from within sight of
the beach to 200 miles or more inland.
• When asked how their experience with Katrina
has effected their well being:
– “I smoke more” December 13, 2005, 200 miles from landfall
– “I am displaced, living in a FEMA trailer with my two
children. I have so much empathy for everyone
involved.” January 9, 2006, 2 miles from landfall
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Geographic distance from the
event: How close is too close?
• Correlation of perceived performance
on the job and distance from landfall
were significant up to 200 miles
inland
Emotional trauma among subjects:
PH responder-victims
• “I have headaches, I feel depressed, but I'm quick
to anger and very emotional. I sometimes have to
leave the building to go outside and cry.” November 17,
2005, 5 miles from landfall
• “I still cry every day. I'm irritable, can't sleep, have
poor concentration, extreme emotions. I wake up
about every hour at night.” January 9, 2006, 2 miles from landfall
• “It would not be normal if I did not have a good cry
every day. Also: Inability to sleep, poor
concentration, and extreme emotions.” January 9, 2006, 2
miles from landfall
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Emotional trauma among subjects:
PH responder-victims
• Across the region, psychological impacts of
the storm resulted in significant performance
losses.
• For those in directly affected areas, four
months after the storm, average perceived
effectiveness on the job was still at only 75%
(based on pre-storm 100%).
Needs Assessment Focus:
¾What needs are arising from response
roles differing from job roles?
¾Other needs highlighted by the
disaster? How are our responders
doing?
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Structured Interviews in the Field
¾Did job and response roles differ?
¾What needs arose as a result?
¾Effects of being in a dual role: victimresponder?
¾Training needs indicated?
Structured Interviews in the Field
¾ 30 items total
¾ 11 qualitative items
¾ Have you been performing duties for which you do not feel
adequately prepared? If so, please explain: ____________
¾ 7 quantitative, 11 point Likert scales
¾ How confident were you in your ability to perform your response role
during the disaster response? (0 – 10)
¾ 5 quantitative, other response
¾ What level of efficiency do you think you are currently functioning
at? (0% - 100%)
¾ 7 quantitative, demographic
¾ Age, gender, PH work history
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Differing job and response roles:
¾Results indicate job-response role
disparity is a concern among PH
responders across Mississippi and
Alabama.
¾Perceived as contributing to an increase in
on-the-job psychological stress and strain
¾Correlated with a decrease in effectiveness
on the job
Differing job and response roles:
¾Related identified training needs:
¾Cross-training: Disaster related nursing skills
for nurses.
¾Cross-training: First aid training for clerks.
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Effects of being in a dual role:
victim-responder?
¾ Related identified training needs:
¾ Psychological aspects of crisis response: Psychosocial responsibilities with victims and co-workers
¾ Working through the pain: How to remain functional at
work during a work crisis while dealing with personal
crises at home.
¾ Communicating during a crisis: How to communicate
effectively when tensions are high and co-workers are
distracted by work crises as well as personal crises.
SCCPHP’s Integration of Post
Katrina Indicated Needs
¾Content coded needs into categories
¾Categories were named to represent each
identified need and to facilitate training to
be developed
¾19 separate needs were ultimately
identified/isolated from the interviews
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Ranking by the State Partners
¾The 19 resulting needs were rank ordered
by the CPHP’s four State partners
¾Top 5 needs were ranked by each partner
State
¾Aggregate of these rankings were fed back to
the States and became the training
development priorities for the coming year.
¾The top 5 of 19 identified needs were
psychological in nature.
Future research: Where do we
go from here?
• Go back and ask again, see how temporary
the effects of trauma are. (PTSD is still
surfacing)
• Look for attrition rates in PH responders.
(MDH is seeing large turnover)
• Learn from the veterans: Self selection?
– More or less likely to respond next time
– Look for evidence of psychological hardiness
• Do you feel ready to do it again?
• Do you live in fear of having to do it again?
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For More Information Contact
Lisle Hites at [email protected]
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