Following the impact phase of Hurricane Andrew in Florida (August 24) and Louisiana (August 26) (Figure 1), the primary objectives of the public health response have been to address the health and medical needs of residents in the storm-damaged areas and to provide data for relief interventions and decision-making. This report presents the combined findings from rapid health needs assessment surveys conducted by state health departments with CDC assistance 3-10 days postimpact.

Population-based epidemiologic surveys were conducted in the areas of Florida and Louisiana most severely damaged by the hurricane using a method originally developed to assess vaccination coverage in developing countries (1). Detailed maps and census information of the area were used to determine the sampling frame. Using grids of the populated areas, 30 groups of homes were randomly selected. Persons from seven households in each group were interviewed using a standardizedquestionnaire that included questions on number and age of residents; descriptions of illnesses and injuries; type of shelter; water supply; and availability of food, telephones, electricity, medical care, and prescription medications. Follow-up surveys of newly selected groups were conducted to determine changes in health and medical needs and availability of services. Homestead and Florida City, Florida

On August 27, 3 days after impact of the category four (on a scale of five) hurricane, a survey of 211 households representing 1005 persons was conducted within the adjacent communities of Homestead and Florida City. This survey was repeated on September 3. With a team of 10-12 interviewers in three vehicles, the surveys were completed within 5 hours of arrival on site. No interviews were refused.

The findings of the initial survey indicated the need to restore electrical service and communications (Table 1). Sanitary facilities had been largely preserved in occupied households, and sufficient water was available to operate toilets in most households. All electrical power was supplied by portable generators, and telephone service was primarily through cellular telephone networks.

The findings of the second survey showed significant improvements in the availability of food, water, and electricity (in the form of home generators) (p less than 0.05, two-tailed test). The number of households reporting functioning toilets increased from 67% to 89%. Injuries and the need for medical services and prescription medications increased slightly; many who needed medical services were already receiving them. In both surveys, 83% of the households had access to transportation. St. Mary Parish, Louisiana

On August 29, 3 days after Hurricane Andrew (as a category three hurricane) struck Louisiana, a disaster epidemiologic assessment team of six persons in four vehicles began a survey of St. Mary Parish, the Louisiana county hardest hit by the hurricane, using the same methods as in Florida. Because of the size of the area surveyed, the 211 interviews representing 684 persons (one third in rural areas) were conducted during a 24-hour period; no interviews were refused. A second survey was conducted on September 3.

Transportation, running water, telephones, and food were available to most of the population 3 days after the hurricane, but electricity was not generally available until after the first survey (Table 2). Few households reported hurricane-related injuries, but the number of households reporting injuries (most of which were minor) increased slightly between the surveys. The percentage of households reporting they would have difficulty obtaining medical service if needed or had difficulity obtaining prescription medications decreased significantly (p less than 0.05, two-tailed test).

At the time of the second survey, all households had adequate supplies of food; however, 27% of the households were dependent on disaster-relief food or food stamps, and 32% were dependent on disaster-relief potable water.

Reported by: Dade County Public Health Unit; Univ of Miami School of Medicine; WG Hlady, MD, RS Hopkins, MD, State Epidemiologist, C Mahan, MD, State Health Officer, Florida Dept of Health and Rehabilitative Svcs. Tulane Univ School of Public Health and Tropical Medicine, New Orleans; L McFarland, DrPH, State Epidemiologist, LJ Hebert, MD, State Health Officer, Louisiana Dept of Health and Hospitals. American Red Cross Disaster Health Svcs. National Hurricane Center, National Weather Svc, National Oceanic and Atmospheric Administration, Coral Gables, Florida. Disaster Assessment and Epidemiology Section, Health Studies Br, and Surveillance and Programs Br, Div of Environmental Hazards and Health Effects; Emergency Response Coordination Group, Office of the Director, National Center for Environmental Health; Div of Field Epidemiology, Epidemiology Program Office, CDC.

Editorial Note

Editorial Note: Approximately every 5 years, a category four or five hurricane makes landfall in the United States (2). Hurricane Andrew was one of the most devastating in 25 years. As of September 14, 42 deaths in Florida and 13 deaths in Louisiana have been associated with Hurricane Andrew; more than 30,000 houses, mobile homes, and apartment buildings were destroyed, and approximately 60,000 had major damage (J. Lee, American Red Cross, personal communication, 1992). An estimated 350,000 persons were left homeless, and damages are estimated at $30 billion. Although hurricane-warning systems in the United States are well developed, the population density in hurricane-vulnerable areas has increased substantially during the past 20 years (3).

Rapid epidemiologic assessment of the affected population has been recommended as the most important initial step in guiding the emergency response (4,5). The assessments in Florida and Louisiana were the first use of this sampling technique and health-oriented questionnaire for emergency decision-making purposes following a natural disaster. In the immediate aftermath of Hurricane Andrew, communications with the affected areas were severed, roadways were blocked by debris, neighborhoods were unrecognizable, and street signs had been blown away. These conditions hampered initial relief efforts, especially because many local officials had lost their homes or were inaccessible, and outside staff unfamiliar with the area were called in to respond. No accurate information on the acute medical needs of the population was available. The rapid needs assessment surveys were conducted as soon as heavily damaged areas could be traversed.

The results of these surveys were transmitted to state health authorities within 4 hours of completion of these emergency surveys, providing rapid and accurate information to health and emergency-management authorities, and were used to set priorities for response actions in both Florida and Louisiana. For example, decisions regarding the type of health-care personnel needed in the disaster areas were based on data obtained in the assessment, and an active surveillance system for infectious disease was started following the surveys. Additional benefits of the survey included assurance to residents that their needs were being recognized; control of rumors of epidemics; dissemination of information regarding available medical-treatment and supply-distribution sites; and preventive health messages were provided by the interviewers on the importance of handwashing, water treatment, proper handling and storage of food, mosquito control, and injury prevention.

The rapid needs assessment survey allowed disaster managers and other decision-makers to obtain an objective measure of the response and the recovery process. Rapid epidemiologic assessment is essential to assure that decisions on the allocation of resources are based on the best available information.

References

1. Henderson RH, Sundaresan T. Cluster sampling to assess

immunization coverage: a review of experience with a simplified sampling method. Bull WHO 1982;60:253-60. 2. Herbert P, Taylor G, Case R. Hurricane experience levels of coastal county population -- Texas to Maine. Miami: US Department of Commerce, National Oceanographic and Atmospheric Administration, 1984; technical memorandum NWS NHC 25. 3. French JG. Hurricanes. In: Gregg MB, ed. The public health consequences of disasters, 1989. Atlanta: US Department of Health and Human Services, Public Health Service, CDC, 1989:33-7. 4. Guha-Sapir D. Rapid assessment of health needs in mass emergencies: review of current concepts and methods. World Health Stat Q 1991;44:171-81.

5. Glass RI, Noji EK. Epidemiologic surveillance following disasters. In: Halperin W, Baker EL. Public health surveillance. New York: Von Nostrand Reinhold, 1992:195-205.

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