Preparedness and response at long-term care facilities following Hurricane Sandy: A qualitative analysis of experiences and attitudes among staff and administrators.

BACKGROUND: In late 2012, Hurricane Sandy struck the eastern United States. Healthcare infrastructure in New York City-including long-term care facilities (LTCFs)-was affected significantly. The authors examined the impact of the storm on LTCFs 2 years after the event, using a qualitative approach consisting of a semistructured interview focused on preparedness and response. Important insights regarding preparedness and response may be lost by quantitative analysis or outcome measurement alone. During Sandy, individuals at LTCFs experienced the event in important subjective ways that, in aggregate, could lead to valuable insights about how facilities might mitigate future risks. The authors used data from a semistructured interview to generate hypotheses regarding the preparation and response of LTCFs. The interview tool was designed to help develop theories to explain why LTCF staff and administrators experienced the event in the way they did, and to use that data to inform future policy and research. METHODS: Representatives from LTCFs located in a heavily affected area of New York City were approached for participation in a semistructured interview. Interviews were digitally recorded and transcribed. Recurrent themes were coded based on time period (before, during, or after the storm) and content. A grounded theory approach was used to identify important themes related to the participants' experiences. RESULTS: A total of 21 interviews were conducted. Several overarching themes were identified, including a perception that facilities had not prepared for an event of such magnitude, of inefficient communication and logistics during evacuation, and of lack of easily identifiable or appropriate resources after the event. Access to electrical power emerged as a key identifier of recovery for most facilities. The experience had a substantial psychological impact on LTCF staff regardless of whether they evacuated or sheltered in place during the storm. CONCLUSION: Representatives from LTCFs affected by Sandy experienced the preparation, response, and recovery phases of the event with a unique perspective. Their insights offer evidence which can be used to generate testable hypothesis regarding similar events in the future, and can inform policy makers and facility administrators alike as they prepare for extreme weather events in similar settings. Results specifically suggest that LTCFs develop plans which carefully address the unique qualities of extreme weather events, including communication with local officials, evacuation and transfer needs in geographic areas with multiple facilities, and plans for the safe transfer of residents. Emergency managers at LTCFs should consider electrical power needs with the understanding that in extreme weather events, power failures can be more protracted than in other types of emergencies.

A pilot study of solar water disinfection in the wilderness setting.

OBJECTIVE: Solar disinfection of water has been shown to be an effective treatment method in the developing world, but not specifically in a wilderness or survival setting. The current study sought to evaluate the technique using materials typically available in a wilderness or backcountry environment. METHODS: Untreated surface water from a stream in rural Costa Rica was disinfected using the solar disinfection (SODIS) method, using both standard containers as well as containers and materials more readily available to a wilderness traveler. RESULTS: Posttreatment samples using polyethylene terephthalate (PET) bottles, as well as Nalgene and Platypus water containers, showed similarly decreased levels of Escherichia coli and total coliforms. CONCLUSIONS: The SODIS technique may be applicable in the wilderness setting using tools commonly available in the backcountry. In this limited trial, specific types of containers common in wilderness settings demonstrated similar performance to the standard containers. With further study, solar disinfection in appropriate conditions may be included as a viable treatment option for wilderness water disinfection.