photo shows national guard member leading civilian throughflood waters to a waiting truck
North Carolina Army National Guardsmen (NCNG) and local emergency services assist with the evacuation efforts on Friday, Oct. 08, 2016. Heavy rains caused by Hurricane Matthew led to flooding throughout eastern North Carolina. Credit: Staff Sgt. Jonathan Shaw, 382nd Public Affairs Detachment / Flickr Creative Commons

By Catherine Clabby

When Hurricane Matthew produced record-breaking flooding in the fall of 2016, Southeastern Regional Medical Center in Lumberton lost power.

The hospital was ready with generators, and extra help soon arrived in the form of an emergency operating room dispatched by Charlotte-based Carolinas HealthCare System (now Atrium Health). The two hospitals had that cooperative plan already in place because natural hazards disrupt life in North Carolina with regularity.

Shows man in an attic window. Flood waters come to about 5 feet below the window sill, completely covering the first floor.
Jim Harrell in the window of the attic where he and his parents waited out the flooding after Hurricane Matthew. Photo courtesy: Jim Harrell

So, it may surprise no one that the state is well prepared to look after people’s health when those disasters strike.

That was confirmed by the latest National Health Security Preparedness Index. Compiled annually by the Robert Wood Johnson Foundation, the report measures 140 factors to assess how well individual states are equipped to manage health emergencies.

In other words, lots has been learned from the hurricanes, record flooding, wildfires and other destructive events in recent years, including tornadoes, which blew off a school roof, snapped trees and power poles, and demolished homes in Guilford County just last weekend.

“North Carolina overall has more experience in disaster response,” said Bill Gentry, who runs programs that provide training in community preparedness and disaster management at the Gillings School of Global Public Health at UNC-Chapel Hill. “That’s a double-edge sword. The more events you have, you get better at responding.”

The state lags behind national averages, however, when it comes providing some aspects of health surveillance, health care delivery and environmental and occupational health services, leaving room for improvement.

Report card

North Carolina scored seven overall on a 10-point scale for preparedness, pretty much matching a national 7.1 average score for states. That’s a 3 percent improvement from last year’s assessment and almost an 11 percent gain from five years ago.

Index categories tally everything from the number of chemical-threat preparedness exercises conducted within the state to the percentage of child care providers who have both evacuation and family reunification plans for disasters.

Others assess the number of pediatricians practicing per 100,000 children younger than 18 living here, as well the amount of coordination between hospitals and state health officials.

Despite the wonky-sounding language, these topics can be vital in a crisis, such as in the case of Southeastern Regional Medical Center.

One deficiency noted in this year’s report was that North Carolina had one epidemiologist per 100,000 residents statewide; other states ranged from .2 to 14.4 Per 100,000 people. Those public health professionals are important because they work to monitor, prevent and reduce health threats.

But it takes money to hire and retain staff with that type of expertise and funding for such slots is less abundant today than it was a decade ago, Gentry said.

“Those positions have gone by the wayside,” Gentry said.

Economics play a frequent role in whether communities take adequate steps to protect themselves from extreme events, Scott Curtis, assistant director of the Center for Natural Hazards Research at East Carolina University.

One spot where he sees that play out is the tension between those who want to limit construction near areas vulnerable to flooding and those eager to expand development that can produce more jobs and a wider tax base.

“There are good motives in both,” Curtis said. “But we have to  be careful with these things.”

Granular feedback

The preparedness index findings list 140 categories of health-supporting topics compiled from 64 sources. The state Department of Health and Human Services finds the measures useful, spokesman Cobey Culton said.

“North Carolina receives detailed information on the 140 measures allowing us to identify and develop strategies for improvement,” Culton said.

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But they are not 100 percent up to date. This year’s index doesn’t capture changes that are already in the works, for instance.

The report notes that North Carolina previously required that private laboratories send specimens associated with reportable food-borne diseases to the state public health laboratory but no longer does.

State health officials are considering collecting more specimens from patients who are diagnosed with those illnesses, Culton said, using culture-independent diagnostic tests, such as rapid tests or polymerase chain reaction (PCR).

And while the index notes that the state Division of Public Health is not yet accredited by the Public Health Accreditation Board, the division has applied and is submitting evidence of its compliance, Culton said.

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